treated was 2,575 for fondaparinux and 2,688 for enoxaparin. Over 65% of total costs were attributed to the invasive treatment (PCI and revascularization). Drug costs (in-hospital therapies) accounted for 10% (fondaparinux) and 12% (enoxaparin) of total costs. The estimated rates of cardiovascular events were 7.3% and 9.0% for fondaparinux and enoxaparin, respectively. Results kept unchanged on days 30 and 180 post-NSTE-ACS. Sensitivity analysis confirmed base-case results. CONCLUSIONS: Fondaparinux was dominant over enoxaparin (lower costs, better long-term benefits). The budget impact after 5 years of anticoagulant substitution (at 20% constant adoption rate per year) could reach 90 million BRL in savings for the Brazilian MoH and healthcare system. OBJECTIVES:The objective of this analysis was to estimate the cost effectiveness of commonly used antiarrhythmic agents for the treatment of supraventricular tachycardia (SVT) and intraoperative/ postoperative tachycardia and hypertension. METHODS: A decision tree model was built to examine the cost effectiveness of esmolol, metoprolol, diltiazem and amiodarone for the treatment of SVT and intraoperative and postoperative tachycardia and hypertension from a hospital perspective. The default pharmacy costs in the model were based on publicly available wholesale acquisition costs (WAC). Literature based values were used for the rates and medical costs of adverse cardiac events including myocardial infarction, stroke, hypotension, bradycardia, and ischemia. The primary efficacy parameter, rate of successful heart rate control, was based on literature values. The outcome was the cost per successful heart rate control with incremental cost effectiveness ratios (ICERs) calculated. No discounting was applied due to the short time frame of the analysis. For the probabilistic sensitivity analysis, a Monte Carlo simulation consisting of 1,000 simulations was conducted to test the joint uncertainty of all modeling parameters simultaneously. RESULTS: The total cost of therapy was $1,250.82, $2,630.19, $2,280.21, and $1,555.14 for esmolol, metoprolol, diltiazem and amiodarone, respectively. The rate of successful heart rate control was 90% (esmolol), 64% (metoprolol), 90% (diltiazem) and 74% (amiodarone). The cost per successful heart rate control was $1,389.80 (esmolol), $4,109.67 (metoprolol), $2,533.57 (diltiazem), and $2,101.54 (amiodarone). The ICER of esmolol dominated metoprolol, diltiazem and amiodarone. In the probabilistic sensitivity analysis, esmolol was the most cost-effective antiarrhythmic in 99.6% of simulations. One-way sensitivity analyses showed the model was most sensitive to the cost of hypotension and bradycardia. CONCLUSIONS: In this model, esmolol was the least costly and most effective antiarrhythmic. Esmolol is cost-effective in comparison with metoprolol, diltiazem and amiodarone for the treatment of SVT and intraoperative/ postoperative tachycardia and hypertension.
months of AICC infused prophylaxis (PX) with 6 months of on-demand (OD) therapy, separated by a 3-month washout period during which patients used on-demand therapy. HRQoL was summarized in two continuous variables: Physical Component Score (PCS-36) and Mental Component Score . The difference between two study periods for 6-month change from baseline in PCS-/MCS-36 are compared using Wilcoxon signed-rank test to measure the difference between two groups regardless of the sequence of medications. To investigate the effect of random sequence in the change of HRQoL, the difference between two study periods for 6-month change from baseline in PCS-/MCS-36 is compared by random sequence using Wilcoxon-Mann-Whitney U test with exact statement. RESULTS: Twenty-six patients completed both study periods. 17 of them were Ͼ14 years old and thus completed QoL questionnaires and are included in this analysis. The difference between PX and OD in 6-month change from baseline was 2.83 for PCS-36 (pϭ0.378) and 1.29 for MCS-36 (pϭ0.890), favored PX on both measures. Regardless of random sequence of medication, HRQoL showed a moderate improvement with PX. When comparing the difference of 6-month change by treatment sequence, patients who initiated with PX then switched to OD had a greater improvement compared to the opposite sequence (PX-ϾOD: 6.59, OD-ϾPX: 0.19 for PCS-36 (pϭ0.475); PX¡OD: 2.66, OD¡PX: 0.33 for MCS-36 (pϭ0.601)). CONCLUSIONS: A cross-over effect, albeit statistically non-significant, was observed when the difference of 6-month change was compared by treatment sequence. Patients who started with more favorable medication tended to show a greater improvement, whereas patients in opposite sequence showed a slight improvement.
OBJECTIVES:A daily assessment of the speed of action and effectiveness of treatment of a combination of paracetamol and codeine in patients suffering from intense pain, which has progressed since less than 7 days. METHODS: A multicentre longitudinal observational prospective study carried out in metropolitan France using data collected by general practitioners who agreed to participate. RESULTS: A total of 574 patients treated by a paracetamol-codeine combination (600mg/50mg and 400mg/20mg) were included. The severity of pain measured at inclusion using a visual numeric scale was 7Ϯ1.28. The severity of pain measured after half a day of treatment was 5.61Ϯ1.87 and 5.28 Ϯ 1.86 at the end of the first 24 hours of treatment. A significant improvement in pain was observed from the first half-day (pϽ0.001). The severity of pain on the 2nd, 4th and 7th evenings was respectively 4.08Ϯ1.85; 2.76Ϯ1.76 and 1.79 Ϯ1.69 On D1, 69.7% declared treatment to be effective, 61.04% were satisfied with their treatment and 79.26% did not observe any side effects to the treatment. On D7, 96.15% (D3, 91.3% ) declared treatment to be effective, 87.10% were satisfied with their treatment and 88.96% did not observe any side effects to the treatment. 8 out of 10 patients did not complain about side effects related to the treatment. CONCLUSIONS: A reduction in pain within the first 12 hours showed the pertinence of treatment using a paracetamol-codeine combination. This pertinence was confirmed by two-thirds patients who declared the treatment to be effective from the 1st day, and 91% of them declared this on the 3rd day OBJECTIVES: To assess epidemiology of anemia cased by chronic renal failure in patients on dialysis and patient's quality of life. METHODS: Health survey of patients in dialysis departments of 23 regions. About 1400 questionnaires were distributed in May -June 2010. The form contained following questions: personal information (name, age, patients' education and employment), medical data (di-
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