Economic analysis of conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer.

We performed an economic analysis of data from 180 women in a clinical trial of conventional-dose chemotherapy vs high-dose chemotherapy plus stem-cell transplantation for metastatic breast cancer responding to first-line chemotherapy. Data on resource use, including hospitalizations, medical procedures, medications, and diagnostic tests, were abstracted from subjects' clinical trial records. Resources were valued using the Medicare Fee Schedule for inpatient costs at one academic medical center and average wholesale prices for medications. Monthly costs were calculated and stratified by treatment group and clinical phase. Mean follow-up was 690 days in the transplantation group and 758 days in the conventional-dose chemotherapy group. Subjects in the transplantation group were hospitalized for more days (28.6 vs 17.8, P=0.0041) and incurred higher costs (US dollars 84055 vs US dollars 28169) than subjects receiving conventional-dose chemotherapy, with a mean difference of US dollars 55886 (95% CI, US dollars 47298-US dollars 63666). Sensitivity analyses resulted in cost differences between the treatment groups from US dollars 36528 to US dollars 75531. High-dose chemotherapy plus stem-cell transplantation resulted in substantial additional morbidity and costs at no improvement in survival. Neither the survival results nor the economic findings support the use of this procedure outside of the clinical trial setting.

In knowing our students ourselves.

This article describes the relationship between a middle school student teacher and one of her students with learning handicaps. Through a series of interviews and observations for 1 school year, the teacher learned about the needs of this student and also developed insights into teaching, particularly related to students with learning disabilities. Jimmy was a sixth grader with a first-grade reading level. He revealed his tricks and methods for getting out of reading to the teacher, who was amazed that he made it so far without reading. The teacher's feelings changed from hopeless at first to hopeful and proud by the end of the year. During the interviews, Jimmy described how he would get very nervous when he was asked to read, and quickly start trouble to disrupt the class and be sent to the principal's office. He would often fake sickness and be sent to the nurse, just to get out of reading. This interview process not only enlightened the teacher about her student, but also created a vehicle for her to form a working relationship with her student. This relationship was essential to Jimmy's beginning to read.