RESUMO
Objective : To examine the cost-effectiveness of interferon αcon-1 [consensus interferon (CIFN)] for chronic hepatitis C patients with genotype lb and high-titer. <BR>Design : Cost-effectiveness analysis.<BR>Methods : Data from a randomized clinical trial comparing the efficacy of CIFN to interferon-αn 1 (IFN-αn 1) for chronic hepatitis C patients were applied to a cohort simulation by Markov model to project lifelong clinical and economic outcomes from the payer's perspective. Natural history model and decision analytical model were built based on published literature and actual healthcare reimbursement data.<BR>Results : From the randomized trial, sustained response proportion and biochemical response proportion were 16.7%and 18.2%for patients receiving CIFN, compared with 3.3%and 18.0%for IFN-αn 1, respectively. The simulation model showed that CIFN should prolong life expectancy by 0.4 year at negative incremental costs, compared to IFN-αn 1 strategy. Compared to no IFN strategy, CIFN should prolong life expectancy by 1.2year at an incremental cost-effectiveness ratio of ¥1, 320, 000 per life year gained. The results were robust, with CIFN remaining cost-effective in sensitivity analysis compared to IFN-αn 1 and no IFN treatment.<BR>Conclusion : For chronic hepatitis C patients with genotype 1b and high-titer, CIFN should prolong life and be cost effective in comparison with IFN-αn 1 and no IFN treatment.
RESUMO
Because first-yearresi dents don't have adequate skills to handle the minor surgical problems that they will immediately begin to surface in the emergency room or other place, we advocate that teaching surgical techniques of office minor surgery to medical students should be encouraged.<BR>We designed a practical exercise session as one of the bed side teaching program at Kawasaki Medical School to help medical students learn some basic surgical techniques of office minor surgery.<BR>Fresh frozen pig's feet were used following the examples of medical training in America.<BR>Eighty percent of all students acknowledged in the questionnaire that this exercise seems to be very useful for their medical training.