una estrategia dominante debido a que mostró una mayor mejoría en un IT que refleja efectividad y seguridad, a un menor costo de tratamiento. PRS10 CoSto -efeCtividad de la CombinaCion de gliCoPiRRonio/indaCateRol vS. SalmeteRol/ flutiCaSona (CombinaCion de doSiS fija -Cdf) en el manejo de loS PaCienteS Con enfeRmedad PulmonaR obStRuCtiva CRoniCa (ePoC) en Colombia (SuR améRiCa)
2009. Subjects had to be continuously enrolled and be Ͼϭ 18 years of age. Cases had to have at least one incident claim with a primary diagnosis of acute liver necrosis, hepatitis, hepatic coma, hepatorenal syndrome, or coagulopathy. 3:1 controls matched on age, gender, and geographic region were randomly chosen. Acetaminophen maximum and average daily doses were calculated in a range of acute periods (7, 20, and 30 days) and in the chronic one year prior period. Conditional logistic regression was used to estimate the risk of acetaminophen exposure adjusted for comorbidities, other hepatotoxic drugs, and health system factors. RESULTS: There were 1350 cases and 4050 controls with a mean age of 47.29 years and 53.85% were male. 116 (8.59%) cases and 144 (3.56%) controls were exposed to acetaminophen in the 30-day prior period with mean maximum daily doses of 3234.32 and 3021.40 mgs. Hepatotoxicity was associated with any acute acetaminophen exposure that decreased with longer look back periods; 7 days (ORϭ2.23, pϽ0.001), 30 days (ORϭ1.84, pϽ0.001). Cumulative dose in the year prior was not associated with hepatotoxicity (ORϭ1.05, pϭ0.889). Acute maximum daily doses Ͼ4gms/day were associated with greater risks of hepatotoxicity (ORϭ2.45, pϽ0.001). CONCLUSIONS: Acute exposure to prescription acquired acetaminophen is associated with increased risk of hepatotoxicity, however use over longer chronic periods was not. Further research is necessary before the safety of chronic acetaminophen can be established.
vaccine prevents 408 469 cases of precancerous cervical lesions. Due to HPV vaccination the incidence of CC is reduced by1858 cases, which corresponds to 31 588 years of life saved in the vaccinated cohort. The cost of an additional life-year saved is 10,166 € (405,535 rubles), and the cost of averted CIN case is 786 € (31,360 rubles). CONCLUSIONS: Vaccination with Human Papillomavirus recombinant vaccine seems a cost-effective option in Russia.OBJECTIVES: Pertussis incidence has been increasing in adolescents and adults in the last two decades with transmission to vulnerable young infants. This epidemiological changing has raised interest in the cost-effectiveness of booster vaccination (extra administration of a vaccine after an earlier dose). A critical review of economic evaluations of pertussis booster vaccination was performed in order to develop recommendations for future studies. This review illustrates specific challenges encountered in economic evaluations of vaccination programmes.
METHODS:The literature search covered cost-effectiveness studies of pertussis booster vaccination, published until November 2010, worldwide. We extracted information on model structures, input data and results. RESULTS: We identified 13 publications (9 distinct models) referring to cost-effectiveness of pertussis booster vaccination. The most frequently studied strategies were adolescent booster vaccination (9/13), cocooning strategy, i.e. vaccination of mothers and family member(s) of newborn infants (6/13), one-time adult pertussis booster vaccination (6/ 13), and decennial vaccination of adults with pertussis containing boosters (4/13). All studies found that booster vaccination was a cost-effective or cost-saving strategy compared to no booster vaccination. However, conclusions differed concerning the exact age groups to vaccinate and frequency of vaccination. Results were strongly affected by assumptions regarding unreported cases and uncertainty around incidence. Four models ignored herd immunity (HI) effects, 3 assumed incidence reduction attributable to HI, and 2 were transmission dynamic models predicting HI effects. Several studies considered incidence at steady state, although it was not reached before 80 years for some strategies. Methods used to compare multiple strategies were often inappropriate. CONCLUSIONS: Reviewed studies showed that pertussis booster vaccination is cost-effective or dominant vs. no booster vaccination, but did not identify any optimal vaccination schedule. Results are variable due to uncertainty surrounding disease incidence and extent of HI. Future economic evaluations should explore a wider range of strategies, according to local context.
OBJECTIVES:Streptococcus pneumoniae is a leading cause of life-threatening pneumococcal diseases (PDs). In Germany, PPV23 has been recommended in the elderly (aged 60 and over) since 1998. In 2006, the pneumococcal conjugate vaccine (PCV) was introduced in children. The US experience showed that PCV vaccination of children led, ten years after its intr...
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