Cost effectiveness of concurrent chemoradiation in comparison with radiation alone in locally advanced cervical cancer.

INTRODUCTION: Concurrent chemoradiation has been advocated to be more effective than radiation alone in the treatment of cervical cancer. However, it certainly has more side effects. Hence, it is worthwhile to investigate the cost-effectiveness (CE) of concurrent chemoradiation in comparison with radiation alone in locally advanced cervical cancer. MATERIAL AND METHOD: The treatment of cervical cancer was modeled using the decision tree where the treatment option would be either concurrent chemoradiation or radiation alone. Patients receiving each treatment had different risks of tumor recurrence. Costs in this analysis were separated into four major categories: costs for treatment of cervical cancer, costs for treatment of major side effects, costs for follow up cancer patients, and costs for diagnosis including supportive care of recurrent cervical cancer Charges were used for the costs of chemotherapy, radiotherapy, drugs, and accessories. Unit cost was used for the costs of laboratory investigations, in-patient and out-patient services. Costs incurred after the first year were discounted at an annual rate of 5%. The benefit was measured as months of life survived. The present study evaluated the patients to 5 years after complete treatment. RESULTS: The CE ratio in the concurrent chemoradiation group was 2,855 and 1,835 Baht/month survived if the chemotherapy was given as in-patient and out-patient respectively. The CE ratio in the radiation group equaled 2,366 Baht/month survived. For the sensitivity analysis, in the situation that chemoradiation was not much better than radiation alone in terms that the recurrent rate from chemoradiation group was not more than 20% lower than the radiation group, radiation therapy alone would be more cost effective even if chemotherapy was given as an out-patient basis. CONCLUSION: Radiation alone was more cost effective than chemoradiation in the treatment of cervical cancer. Nevertheless, if chemotherapy was administered on an out-patient basis, chemoradiation will be more cost effective only if the recurrent rate from the chemoradiation group was more than 20% lower than the radiation group.

A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy.

OBJECTIVE: To compare the efficacy of ginger to vitamin B6 in the treatment of nausea and vomiting of pregnancy. STUDY DESIGN: A randomized double-blind controlled trial. SETTING: The Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital. SUBJECTS: Women with nausea and vomiting of pregnancy at or before 16 weeks of gestation, who attended the antenatal care clinic. The subjects requested anti-emetics, had no medical complications, non-hospitalized and were able to attend a one week follow-up visit. From November, 1999 to November 2000, 138 women participated and gave consent for the study. METHOD: The subjects were randomly allocated into two groups to take either 500 mg of ginger orally or an identical 10 mg of vitamin B6 one capsule three times daily for three days. Subjects graded the severity of their nausea using visual analogue scales before treatment and recorded the number of vomiting episodes in the previous 24 hours and again during three consecutive days of treatment. MAIN OUTCOME MEASURES: The change of nausea scores and the number of vomiting episodes during three days of treatment. RESULTS: The 64 subjects in each group remained in the study. The demographic data were comparable in both groups. The ginger and vitamin B6 significantly reduced the nausea scores from 5.0 (SD, 1.99) to 3.6 (SD, 2.48) and 5.3 (SD, 2.08) to 3.3 (SD, 2.07) respectively, with p < 0.001. The mean score change after treatment with ginger was 1.4 (2.21), less than with vitamin B6, which was 2.0 (2.19) but with no statistically significant difference (95% CI -1.4 to 0.2, p = 0.136). The ginger and vitamin B6 also significantly reduced the number of vomiting episodes from 1.9 (2.06) to 1.2 (1.75) and 1.7 (1.81) to 1.2 (1.50) respectively, with p < 0.01. The mean number change after treatment with ginger was 0.7 (2.18), more than with vitamin B6, which was 0.5 (1.44) but with no statistically significant difference, (p = 0.498). There were some minor side effects in both groups such as sedation (26.6% vs 32.8%, p = 0.439), and heartburn (9.4% vs 6.3%, p = 0.510), a non-significant difference. CONCLUSION: The nausea score and the number of vomiting episodes were significantly reduced following ginger and vitamin B6 therapy. Comparing the efficacy, there was no significant difference between ginger and vitamin B6 for the treatment of nausea and vomiting during pregnancy.