[Analysis of cost effectiveness of photodynamic therapy with Foscan (Foscan-PDT) in comparison with palliative chemotherapy in patients with advanced head-neck tumors in Germany]. / Eine Kosten-Effektivitäts-Analyse der photodynamischen Therapie mit Foscan (Foscan-PDT) im Vergleich zu einer palliativen Chemotherapie bei Patienten mit fortgeschrittenen Kopf-Halstumoren in Deutschland.

BACKGROUND: The purpose of this manuscript is to give a cost-effectiveness analysis of the photodynamic therapy by means of Foscan (Foscan-PDT) in Germany. The basis for this paper is provided by a study performed in Great Britain which analyses the costs of Foscan-PDT compared to the costs of palliative chemotherapy and to the option of no treatment in patients with advanced head and neck cancer. METHOD: In order to calculate the cost-effectiveness, an already published model developed on the base of English data was fed with German cost-data. For consideration of the different characteristics of cost-parameters as well as to minimize the over- or underestimation of the costs, sensitivity analyses were performed. RESULTS: The Foscan-PDT revealed the highest health-related effectiveness compared to all other above-mentioned options -- 129 additional days of life in comparison to no treatment or 48 days in comparison to four cycles of palliative chemotherapy. The costs per therapy of Foscan-PDT ( 8,761 euros) were lower than those of four cycles of palliative chemotherapy (11,600 euros). CONCLUSION: Foscan-PDT is a cost-effective treatment option for patients suffering from advanced head and neck cancer. For patients who up to now had only very limited treatment possibilities at their disposition, Foscan-PDT offers a chance for reduction of the tumor, remission, and a prolonged expectancy of life.

The cost-effectiveness of Foscan mediated photodynamic therapy (Foscan-PDT) compared with extensive palliative surgery and palliative chemotherapy for patients with advanced head and neck cancer in the UK.

This study aimed to analyse the cost-effectiveness of Foscan mediated photodynamic therapy (Foscan-PDT) compared with palliative chemotherapy, extensive palliative surgery or 'no treatment' for patients with advanced head and neck cancer in the UK. A computerised cost-effectiveness model was constructed using published effectiveness data and unit costs for each of the treatment arms. Where possible, published resource use data were also used. In the absence of such information, expert opinion informed data input. Robust sensitivity analyses were performed to negate the effect of potential over or underestimation of the costs used for any of the interventions. The primary outcome was incremental cost/life year saved (cost/LYS); the secondary outcomes were incremental cost/overall tumour response and incremental cost/remission. Foscan-PDT was associated with the greatest health gains of all three interventions yielding 129 extra days of life compared with no treatment and extensive palliative surgery and 48 extra days of life compared with four cycles of palliative chemotherapy. The unit cost of Foscan-PDT ( pound 5741) was found to be lower than the unit cost for four cycles of palliative chemotherapy ( pound 9924) and extensive palliative surgery ( pound 16912). Foscan-PDT continued to have a lower unit cost than palliative chemotherapy until the number of chemotherapy cycles was reduced to two or fewer. Reducing the number of cycles would be likely to reduce the health gains associated with chemotherapy. However, even with assumed maintenance of chemotherapy efficacy, Foscan-PDT remained cost-effective versus two or fewer chemotherapy cycles. Compared with three or more cycles of palliative chemotherapy and extensive palliative surgery, Foscan-PDT dominated with a lower unit cost and greater health gains. Compared with giving no treatment, Foscan-PDT was a cost-effective treatment option at pound 14206/LYS. Sensitivity analysis showed that Foscan-PDT remained cost-effective when the costs used for the comparators were decreased and/or the costs used for Foscan-PDT were increased. Foscan-PDT is a clinically and cost-effective treatment option for patients with advanced head and neck cancer compared to palliative chemotherapy, extensive palliative surgery or 'no treatment'. Furthermore, Foscan-PDT offers patients, with traditionally very limited treatment options, a unique chance of tumour response, remission and increased life expectancy.

Antihypertensive efficacy of moxonidine in primary care: a 'real-life' study.

Both clinical trials and everyday experience indicate that most hypertensive patients will need two or more drugs to reach target blood pressures. The current framework for the selection of drugs for combination therapy is based mainly on their interaction with the renin-angiotensin system. However, this approach would not fully exploit the range of drugs now available. This study, based on current primary care practice, confirms that the centrally acting drug moxonidine has efficacy as an add-on agent comparable to that of other drugs such as beta-blockers and ACE inhibitors and that it can effectively be combined with these agents. It also shows that moxonidine is as well tolerated as the other drugs and much better than older centrally acting agents such as clonidine and methyldopa. The study reinforces the view that moxonidine can be considered as an effective and well-tolerated drug for use in combination with any other class of antihypertensives.

Improvement of asthma control with a breath-actuated pressurised metred dose inhaler (BAI): a prescribing claims study of 5556 patients using a traditional pressurised metred dose inhaler (MDI) or a breath-actuated device.

A relationship has been reported between sub-optimal inhaler technique and control of asthma symptoms. Randomised controlled trials and systematic reviews may fail to accurately represent this relationship, by excluding patients who are unable to correctly use the reviewed devices. Breath actuated inhalers (BAIs) are reported to be easier to use than metered dose inhalers (MDIs). This study uses a large primary care medical record database (DIN-LINK) to examine the 'real-life' clinical effectiveness of a BAI vs. traditional MDIs. A comparison is made between the quantity of asthma-related medication (beta2 agonist, oral steroids and antibiotics) and healthcare resource use required by children (0-12 years) and adults (13+ years) using either the BAI or an MDI over a 12-month period. Out of 5556 new asthma patients who met the inclusion criteria, 306 used a BAI and 5250 used a traditional MDI. Children and adults using the BAI received fewer prescriptions for all three medication types than those using a traditional MDI (children: beta2 agonists -18% P=0.036, oral steroids -88% P<0.05, antibiotics -68% P<0.05 and adults: beta2 agonists -10.9% P=0.179, oral steroids -51.2% P<0.05, antibiotics -19.5% P=0.276). All prescription results reached statistical significance, with the exception of beta2 agonist and antibiotic prescription numbers for adult patients. Children and adults using the BAI required less GP consultations for asthma (children -30.3%, P<0.05 and adults -22.9%, P<0.05) and less GP consultations for respiratory infections than those using a traditional MDI (children -35.2%, P=0.001 and adults -10.4%, P=0.236). Adults using the BAI required less outpatient appointments than adults using an MDI (-43.7%, P=0.166). All non-prescription resource results reached statistical significance with the exception of GP consultations for respiratory infections and outpatient visits in the adult group. In conclusion, children and adults using the BAI appear to have better asthma control than children and adults using an MDI as evidenced by fewer relief medication prescriptions and less healthcare resource use.

Critical care in the emergency department: a time-based study.

OBJECTIVES: Emergency departments serve many functions in the current U.S. healthcare system, including initial management of patients with critical illnesses and primary care for a growing proportion of the population. Overcrowding of emergency departments is a growing problem. Delays in admitting patients to inpatient units have been reported as a contributing factor to overcrowding. To date, the effect of the critically ill patients on the emergency department has not been fully described. It was the purpose of this study to examine the incidence of critical illness in the emergency department and its total burden as reflected in emergency department length of stay. DESIGN: Prospective, cohort study in 17,900 emergency department patients. SETTING: Single, not-for-profit teaching hospital. PATIENTS: All patients admitted to the emergency department during the period of April 1, 1991 to March 31, 1992. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Date and time of arrival in the emergency department and time of discharge, death, or admission to an inpatient unit were recorded. Patients admitted to intensive care units/special care units from the emergency department were defined as critically ill. All other patients were classified as noncritically ill. Emergency department length of stay was calculated as the time from arrival in the emergency department until discharge, death, or admission to an inpatient unit. Differences in length of stay were determined using Kruskal-Wallis analysis by ranks. The study population totaled 17,900 patients: 8.5% (n = 1,527) critically ill patients, 61.1% (n = 10,930) discharged patients, and 30.4% (n = 5,443) noncritically ill admitted patients. Mean emergency department length of stay for the critically ill patients was 145.3 +/- 89.6 mins (maximum length of stay, 655 mins), and for the noncritically ill patients, mean stay was 153.1 +/- 91.9 mins (maximum length of stay, 781 mins) (p < .0003). During the study period, 154 patient-days of emergency department critical care were provided. CONCLUSIONS: Critically ill patients constitute an important proportion of emergency department practice and may remain in the emergency department for significant periods of time. Solutions to emergency department overcrowding may include alternatives for continuing management of critically ill patients. Given the realities of emergency department practice, emergency medicine practitioners should receive training in the continuing management of critically ill patients.