The cost effectiveness of ivabradine in the treatment of chronic heart failure from the U.K. National Health Service perspective.

OBJECTIVE: Ivabradine, a specific heart rate lowering therapy, has been shown in a randomised placebo-controlled study, Systolic HF Treatment with the If Inhibitor Ivabradine Trial (SHIfT), to significantly reduce the composite end point of cardiovascular death and hospitalisation for worsening heart failure (HF) in patients with systolic HF who are in sinus rhythm and with a heart rate ≥70 bpm, when added to optimised medical therapy (HR: 0.82, 95% CI 0.75 to 0.90, p<0.0001). We assessed the cost effectiveness of ivabradine, from a UK National Health Service perspective, based on the results of SHIfT. METHODS: A Markov model estimated the cost effectiveness of ivabradine compared with standard care for two cohorts of patients with HF (heart rate ≥75 bpm in line with the EU labelled indication; and heart rate ≥70 bpm in line with the SHIfT study population). Modelled outcomes included death, hospitalisation, quality of life and New York Heart Association class. Total costs and quality adjusted life years (QALYs) for ivabradine and standard care were estimated over a lifetime horizon. RESULTS: The incremental cost per additional QALY for ivabradine plus standard care versus standard care has been estimated as £8498 for heart rate ≥75 bpm and £13 764 for heart rate ≥70 bpm. Ivabradine is expected to have a 95% chance of being cost-effective in the EU licensed population using the current National Institute for Health and Care Excellence cost effectiveness threshold of £20 000 per QALY. These results were robust in sensitivity analyses. CONCLUSIONS: This economic evaluation suggests that the use of ivabradine is likely to be cost-effective in eligible patients with HF from a UK National Health Service perspective.

The effects of reasons given for ineligibility on perceived gender discrimination and feelings of injustice.

We examine whether the reason given for a negative outcome influences the likelihood of making gender discrimination attributions. Men and women were given one of four reasons for their ineligibility to attend an event: an explicit gender reason, a reason based on an attribute correlated with gender, that same gender-related reason with explanatory information attached, or they were given no reason. Providing participants with a reason based on a gender-related attribute deflected them from making attributions to gender discrimination, indicating that discrimination attributions can easily be averted. Adding explanatory information to the gender-related reason decreased feelings of injustice, illegitimacy and anger while increasing acceptance of the outcome.

Thinking about one's gender group's privileges or disadvantages: consequences for well-being in women and men.

Thoughts about group-based privileges or disadvantages were expected to have different consequences for personal and group well-being, depending on whether the individual is a member of a high- or low-status group. To test this hypothesis, women and men were randomly assigned to consider the ways that their gender group membership has resulted in either beneficial or detrimental outcomes in their lives. For men, thinking about their gender group's privileges resulted in lower scores on the group-related well-being measures compared to women, and thinking about their group's disadvantages resulted in higher personal self-esteem scores in men compared to women. It is suggested that among high-status group members, thinking about privilege can evoke guilt and taint one's group image, whereas thinking about disadvantage can augment personal internal attributions for the positive outcomes received. Discussion focuses on the implications that the operation of two types of mechanisms--group-based emotions and the undermining or augmenting of attributions--has for the responses of high- and low-status group members when their groups are portrayed as exerting either negative or positive effects on their lives.

Self and group protection concerns influence attributions but they are not determinants of counterfactual mutation focus.

The relative impact of differential motivation and knowledge for both counterfactual mutation focus and attributional processes were examined. Functional views of counterfactual thinking predict that what feature of an event is focused on during mutation is influenced by the perceiver's motivation, and that what is mutated is then perceived as causal of the outcome. Other research, however, has indicated that mutation and attribution are based on distinct processes and that the two are not necessarily correlated. In three experiments we investigated the relationship between target mutation and blame assignment following a negative outcome. As expected, both when group that one is highly identified with and when the self is involved in a negative event, attributions were biased in favour of the self or the in-group. Mutation did not, however, show either a self- or group-serving bias. These findings support the view that mutation focus stems from a relatively automatic orientation towards features that may be differentially available to perceivers with varying degrees of knowledge about a domain, whereas the attribution of blame results from conscious processes that permit motivational influences to operate.

Influence of level of identification with a group and physiological arousal on perceived intergroup complexity.

Influence of group identification and physiological arousal on perceived intergroup complexity and intergroup evaluations were investigated. Group identification was examined because persons with differing levels of identification differ in the degree to which they possess stereotypes about groups while physiological arousal was investigated because of its known ability to limit cognitive capacity and potentially encourage the use of stereotypes. Specifically, increases in incidental arousal resulting from exercise were expected to result in increased stereotype use, reflected in differential intergroup complexity. This effect was expected only for those high in identification with the in-group, for whom stereotypes were available. The results supported the predictions. In terms of group evaluations, an in-group favouritism effect was found, although it was only exhibited by those high in identification. Arousal level did not significantly influence evaluation of groups. Thus, incidental arousal can decrease complexity, without simultaneously increasing negativity. Discussion focuses on the differences between the current method and those employed in past research.

Peripheral ingroup membership status and public negativity toward outgroups.

Peripheral membership status in a desirable ingroup was predicted to elevate outgroup derogation when Ss believed other ingroup members might learn of their responses. Less negativity toward outgroups was expected when peripheral members' responses were to remain private. Core ingroup members, in contrast, were not expected to show public-private differences in derogation of outgroups. The results of 2 experiments supported these predictions, with peripheral but not core ingroup members advocating the most coercion for the outgroup under public conditions in both laboratory-created ingroups (Experiment 1) and naturally occurring groups that had meaning for the participants (Experiment 2). Thus, outgroup derogation can serve a public presentation function that allows for enhancement of an insecure status within a desirable ingroup.