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- Johannesson, Magnus, et al.
(författare)
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The cost effectiveness of lipid lowering in Swedish primary health care
- 1996
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Ingår i: Journal of internal medicine. - : Blackwell Science Ltd. - 1365-2796 .- 0954-6820. ; 240:1, s. 23-29
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate the cost‐effectiveness of two types of advice (usual and intensive) to lower cardiovascular risk, with or without pharmacological medication aimed at lowering cholesterol levels. Design. Prospective, randomized, controlled clinical study of 18 months' duration. Setting. Thirty‐two primary health care centres in Sweden. Subjects. A total of 384 males, aged 30–59 years, with at least one cardiovascular risk factor in addition to moderate primary hyperlipidaemia; of these, 355 completed the 18‐month follow‐up. Interventions. Intensive advice consisted of group sessions led by a health care professional; the usual level of advice was given at follow‐up visits. The pharmacological intervention consisted of pravastatin. The goal was to achieve a 15% reduction in cholesterol. Main outcome measures. Cost per life‐year gained based on the change in serum cholesterol and the net intervention cost of the four treatment options. Results. The usual level of advice and intensive advice in combination with pharmacological treatment achieved no incremental effects and were not considered in the cost‐effectiveness analysis. The cost per life‐year gained of pharmacological treatment compared with intensive advice decreased. The cost per life‐year gained of pharmacological treatment compared with no treatment was about $61 000, if no adverse consequences on noncardiovascular mortality were assumed. Conclusions. According to the results of the CELL trial, intensive advice is not a cost‐effective strategy compared with lipid‐lowering drug treatment. However, it is also doubtful whether drug treatment as primary prevention is cost‐effective compared with no treatment in the studied patient population.
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| 3. |
- Katz, Jacob, et al.
(författare)
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Interpretation of change scores in ordinal clinical scales and health status measures: The whole may not equal the sum of the parts
- 1996
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Ingår i: Journal of clinical epidemiology. - : Elsevier Inc. - 1878-5921 .- 0895-4356. ; 49:7, s. 711-717
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to analyze the problem of interpreting change scores of ordinal health status measures for clinical research or practice. Methods used included exploration of the generation of change scores in the physical ability scale of the SF-36, one of the most widely used generic health status instruments. Resulting data are presented as the ranking of items according to baseline score; a percentage of patients with severe difficulty and Rasch analysis provided the same rank order of item difficulty. On the interval scale provided by the Rasch model a concentration of items reflecting moderate difficulty occurred. This “inflates” numerical gains for patients with moderate disability compared to patients with very severe or minor physical disability. Calibration of change scores using patient perception of the level of change in function showed important variation of numerical gains with baseline. We conclude that numerically equal gains may differ in their meaning depending on baseline health status. It is recommended that distribution of baseline health status measures and distribution of responders by baseline status be reported in evaluative studies.
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| 5. |
- Stucki, G, et al.
(författare)
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Use of Misoprostol in the Elderly : Is the Expense Justified?
- 1996
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Ingår i: Drugs & aging. - : Springer Science and Business Media LLC. - 1179-1969 .- 1170-229X. ; 8:2, s. 84-88
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Tidskriftsartikel (refereegranskat)abstract
- Misoprostol is a prostaglandin E1 analogue which reduces both gastric ulcerations and clinically important bleeding in patients taking nonsteroidal antiinflammatory drugs (NSAIDs). Economic evaluations of prophylactic use of misoprostol with NSAIDs differ in their conclusions mainly because of different assumptions regarding the absolute risk reduction of symptomatic ulcers. Assuming a conservative estimate of the absolute risk reduction based on new effectiveness data, all studies would have concluded that misoprostol prophylaxis results in net costs in the general population of NSAID users. However, in the elderly with a clearly increased risk of gastrointestinal (GI) lesions and ulcer complications, and an increased hospitalisation rate, misoprostol may be cost saving. Also, in the elderly the gain in quality of life seems to offset the uncertain reduction in quality of life due to the adverse effects of misoprostol. However, the suggestion that misoprostol prophylaxis in the elderly is cost effective or cost saving needs to be confirmed in further studies.
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| 6. |
- Tomson, Y, et al.
(författare)
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The costs and effects of two different lipid intervention programmes in primary health care
- 1995
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Ingår i: Journal of internal medicine. - : Blackwell Science. - 1365-2796 .- 0954-6820. ; 237:1, s. 13-17
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To compare the costs and effects of two different intervention strategies for the nonpharmacological treatment of hypercholesterolaemia. Design. Randomized, controlled trial. Subjects were randomly allocated to one of two intervention models and followed up for 1 year. Setting. Vårby Health Centre, a primary care practice located in a suburb of Stockholm. Subjects. Subjects with a total serum cholesterol in the range 7.0–7.8 mmol L−1 and no signs of ischaemic heart disease or diabetes mellitus, randomized to a low‐intensity (n = 35) or medium‐intensity (n = 41) intervention. Intervention. Two strategies were used, one labelled medium‐intensity strategy which followed national current guidelines for nonpharmacological treatment of hypercholesterolaemia, the other was a low‐intensity strategy. Main outcome measures. Total serum cholesterol and intervention costs. Results. Both intervention strategies resulted in small (mean 3.5%) decreases in total cholesterol with no significant difference between the groups. The cost per subject in the low‐intensity group was SEK 753 and in the medium‐intensity group SEK 3614. Conclusions. Because the effect of the two intervention programmes did not differ, the low‐intensity programme is to be preferred from a cost‐effectiveness point of view. If only one‐third of the population in Stockholm county with cholesterol levels ≥ 6.5 mmol L−1 are discovered by the primary health care system, and follow the treatment advice, the net savings in the low‐intensity model compared to the current guidelines here presented as the moderate‐intensity model, would be SEK 93 million.
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