Pharmacogenetic information in Swiss drug labels - a systematic analysis.

Implementation of pharmacogenetics (PGx) and individualization of drug therapy is supposed to obviate adverse drug reactions or therapy failure. Health care professionals (HCPs) use drug labels (DLs) as reliable information about drugs. We analyzed the Swiss DLs to give an overview on the currently available PGx instructions. We screened 4306 DLs applying natural language processing focusing on drug metabolism (pharmacokinetics) and we assigned PGx levels following the classification system of PharmGKB. From 5979 hits, 2564 were classified as PGx-relevant affecting 167 substances. 55% (n = 93) were classified as "actionable PGx". Frequently, PGx information appeared in the pharmacokinetics section and in DLs of the anatomic group "nervous system". Unstandardized wording, appearance of PGx information in different sections and unclear instructions challenge HCPs to identify and interpret PGx information and translate it into practice. HCPs need harmonization and standardization of PGx information in DLs to personalize drug therapies and tailor pharmaceutical care.

Trends in incidence and medical resource utilisation in patients with chronic lymphocytic leukaemia: insights from the UK Clinical Practice Research Datalink (CPRD).

Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in European adults. We aimed to evaluate time trends in CLL incidence and medical resource utilisation of CLL patients in the UK. We conducted a retrospective, observational cohort analysis using the UK Clinical Practice Research Datalink (CPRD) comprising mainly primary care data. We included adult patients with newly diagnosed CLL between January 2000 and June 2012. Descriptive and trend analyses of CLL incidence and medical resource utilisation were performed. A total of 2576 patients with CLL met the eligibility criteria. At diagnosis, the majority of patients (71.7 %) were above 65 years of age. The European age-standardised CLL incidence rate in the CPRD was 6.2/100,000 (95 % confidence interval [CI] 6.0, 6.5/100,000) person-years. There was no statistically significant increase over time. The CLL patients had on average 74.6 general practitioner visits during a median follow-up of 3.3 years. Between 2000 and 2012, the average number of recorded hospitalisations and referrals per year corrected for duration of follow-up significantly (p < 0.001) increased by 8.1 % (95 % CI 6.8 %, 9.3 %) and 16.4 % (95 % CI 15.4 %, 17.3 %), respectively. Referrals and hospitalisations in the second year compared to the first year following the CLL diagnosis significantly decreased. CLL incidence rates in the CPRD were stable over the period from 2000 to 2012. Medical resource utilisation in UK primary care was well documented, but further research is needed to describe secondary and tertiary care medical resource utilisation e.g. chemotherapy administration, which is inadequately captured in the CPRD.

Impact of genetic variability and treatment-related factors on outcome in early breast cancer patients receiving (neo-) adjuvant chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide, and docetaxel.

To assess the impact of patient-related factors, including genetic variability in genes involved in the metabolism of chemotherapeutic agents, on breast cancer-specific survival (BCSS) and recurrence-free interval (RFI). We selected early breast cancer patients treated between 2000 and 2010 with 4-6 cycles of (neo-)adjuvant 5-fluorouracil, epirubicin, and cyclophosphamide (FEC) or 3 cycles FEC followed by 3 cycles docetaxel. Tumor stage/subtype; febrile neutropenia and patient-related factors such as selected single nucleotide polymorphisms and baseline laboratory parameters were evaluated. Multivariable Cox regression was performed. Of 991 patients with a mean follow-up of 5.2 years, 152 (15.3 %) patients relapsed and 63 (6.4 %) patients died. Advanced stage and more aggressive subtype were associated with poorer BCSS and RFI in multivariable analysis (p < 0.0001). Associations with worse BCSS in multivariable analysis were: homozygous carriers of the rs1057910 variant C-allele in CYP2C9 (hazard ratio [HR] 30.4; 95 % confidence interval [CI] 6.1-151.5; p < 0.001) and higher white blood cell count (WBC) (HR 1.2; 95 % CI 1.0-1.3; p = 0.014). The GT genotype of the ABCB1 variant rs2032582 was associated with better BCSS (HR 0.5; 95 % CI 0.3-0.9, p = 0.021). Following associations with worse RFI were observed: higher WBC (HR 1.1; 95 % CI 1.0-1.2; p = 0.026), homozygous carriers of the rs1057910 variant C-allele in CYP2C9 (HR 10.9; 95 % CI 2.5-47.9; p = 0.002), CT genotype of the CYBA variant rs4673 (HR 1.8; 95 % CI 1.2-2.7; p = 0.006), and G-allele homozygosity for the UGT2B7 variant rs3924194 (HR 3.4; 95 % CI 1.2-9.7, p = 0.023). Patient-related factors including genetic variability and baseline white blood cell count, impacted on outcome in early breast cancer.

Personalized cancer medicine and the future of pathology.

In February 2011, a group of pathologists from different departments in Europe met in Zurich, Switzerland, to discuss opportunities and challenges for pathology in the era of personalized medicine. The major topics of the meeting were assessment of the role of pathology in personalized medicine, its future profile among other biomedical disciplines with an interest in personalized medicine as well as the evolution of companion diagnostics. The relevance of novel technologies for genome analysis in clinical practice was discussed. The participants recognize that there should be more initiatives taken by the pathology community in companion diagnostics and in the emerging field of next-generation sequencing and whole genome analysis. The common view of the participants was that the pathology community has to be mobilized for stronger engagement in the future of personalized medicine. Pathologists should be aware of the challenges and the analytical opportunities of the new technologies. Challenges of clinical trial design as well as insurance and reimbursement questions were addressed. The pathology community has the responsibility to lead medical colleagues into embracing this new area of genomic medicine. Without this effort, the discipline of pathology risks losing its key position in molecular tissue diagnostics.

Potential health economic impact of intravenous iron supplementation to erythropoiesis-stimulating agent treatment in patients with cancer- or chemotherapy-induced anemia.

BACKGROUND: Intravenous (i.v.) iron supplementation significantly improves the response to erythropoiesis-stimulating agent (ESA)-based therapies in patients with cancer- or chemotherapy-induced anemia. The economic implications of adding i.v. iron to ESA treatment are less well investigated. Published randomized controlled trials do not provide sufficient data for a comprehensive cost-effectiveness analysis. METHODS: Preliminary cost calculations from the Swiss health care system perspective based on a meta-analysis and published results of eight randomized controlled trials without correction for decreased ESA need provide a conservative cost-effectiveness estimate. RESULTS: The additional total cost of i.v. iron supplementation ranged from EUR 417 to EUR 901 per patient depending on the evaluated iron-carbohydrate complex. Considering a 24% absolute increase in the proportion of ESA responders, the incremental cost-effectiveness ratios per additional responder are EUR 1,704-3,686. In routine practice, better values may be achieved due to ESA dose savings. CONCLUSION: Supplementation of ESAs with i.v. iron appears to be an economically viable treatment option in anemic cancer patients. Additional research on ESA dose savings and cost-effectiveness is required.

Trastuzumab beyond progression: a cost-utility analysis.

BACKGROUND: The continuation of trastuzumab beyond progression in combination with capecitabine as secondary chemotherapy for HER2-positive metastatic breast cancer (MBC) prolongs progression-free survival without a substantial increase in toxicity. PATIENTS AND METHODS: A Markov cohort simulation was used to follow the clinical course of typical patients with MBC. Information on response rates and major adverse effects was derived, and transition probabilities were estimated, based on the results of the Breast International Group 03-05 clinical trial. Direct costs were assessed from the perspective of the Swiss health care system. RESULTS: The addition of trastuzumab to capecitabine is estimated to cost on average an additional of €33,980 and to yield a gain of 0.35 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio of €98,329/QALYs gained. Probabilistic sensitivity analysis showed that the willingness-to-pay threshold of €60,000/QALY was reached in 12% of cases. CONCLUSION: The addition of trastuzumab to capecitabine in MBC patients is more expensive than what is typically regarded as cost-effective but falls within the value ranges found for established regimens in the treatment of MBC.

Cost-effectiveness of antihypertensive treatment in patients 80 years of age or older in Switzerland: an analysis of the HYVET study from a Swiss perspective.

This analysis shows the economic benefit of antihypertensive treatment in patients 80 years of age or older from the perspective of the Swiss healthcare system. The cost-effectiveness analysis of antihypertensive treatment in the elderly was carried out applying the results of the Hypertension in the Very Elderly Trial study to the Swiss healthcare system. The analysis shows that hypertension treatment provides, compared with placebo, an additional life expectancy of 0.0457 years per patient, over a follow-up period of 2 years. The medication cost was covered by the reduction of costs related to the treatment of strokes, myocardial infarctions and heart failure: the total cost per patient in the active group resulted in a dominant strategy of savings compared with the placebo group. Sensitivity analysis yielded a stable estimate after varying the costs of medication, stroke, myocardial infarction, heart failure and life expectancy, confirming the robustness of these results. Moreover, considering that antihypertensive treatment also positively affects the incidence of dementia, those net benefits might even be underestimated.

Disparities in influenza vaccination coverage rates by target group in five European countries: trends over seven consecutive seasons.

BACKGROUND: The primary objective of this study was to measure influenza vaccination coverage rates in the general population, including children, and in high-risk groups of five European countries during the season 2007/2008. An additional aim was to analyze coverage trends over seven consecutive seasons and to gain an understanding of the primary drivers and barriers to immunization. METHODS: Community-based telephone and mail surveys have been conducted in the UK, Germany, Italy, France, and Spain, yearly, since 2001/2002. Approximately 2,000 individuals per country and season were interviewed who were considered to be representative of the adult population aged 14 years and older. Data on the vaccination status of children were obtained by proxy interviews. The questionnaire used was essentially the same for all seven seasons. Five target groups were identified for the study: (1) persons aged > or = 65 years; (2) elderly suffering from a chronic illness; (3) patients suffering from a chronic illness; (4) persons working in the health care sector; (5) children. RESULTS: In the season 2007/2008, vaccination coverage rates in the general population remained stable in Germany. Compared to the coverage rates of the previous season, increases of 3.7%, 2.0%, and 1.8% were observed for the UK, Spain, and France, respectively, while a decrease of -1.5% was observed for Italy. Across all five countries, vaccination rates in the predefined target groups decreased to some extent (elderly) or increased slightly (chronically ill and health care workers). Vaccination rates among children varied strongly between countries and ranged from 6.1% in UK to 19.3% in Germany. The most powerful motivation for getting vaccinated in all countries was advice from a family doctor (58.6%) and the perception of influenza as a serious illness (51.9%). The major reasons why individuals did not become vaccinated were (1) the feeling of not being likely to catch influenza (39.5%) and (2) never having considered the option of being vaccinated (35.8%). CONCLUSIONS: The change in general influenza vaccination coverage in the 2007/2008 season compared to the previous season was small, but decreases were seen in some target groups. The underlying motivations for and against vaccination did not substantially change. An effort to activate those driving forces that would encourage vaccination as well as dealing with barriers that tend to prevent it may help enhance coverage rates in Europe in the future.

Trends in influenza vaccination coverage rates in the United Kingdom over six seasons from 2001-2 to 2006-7.

In order to understand motivations and barriers to vaccination, and to identify people's intentions to get vaccinated for season 2007-8, influenza vaccination coverage was assessed in the United Kingdom (UK) from 2001 to 2007. Between 2001 and 2007 representative household surveys were performed by telephone interview with 12,143 individuals aged 16 or older. The overall influenza vaccination coverage rate dropped non-significantly from 25.9% in 2005-6 to 25.0% in 2006-7 (p=0.510). In the elderly (>/=65 years) the rate decreased from 78.1% to 65.3% (p=0.001), and the odds ratio of being vaccinated compared to those not belonging to any of the risk groups targeted by vaccination decreased from 36.6 to 19.9. Healthcare workers and chronically ill persons had odds ratios of 2.0 and 15.5, respectively. The most important reason for getting vaccinated was a recommendation by the family doctor or nurse, and this was also perceived as the major encouraging factor for vaccination. No recommendation from the family doctor was the main reason for not getting vaccinated. A total of 38.4% of the respondents intended to get immunised against influenza in 2007-8. From 2001 to 2006 a slightly increasing trend (p for trend across seasons <0.0001) in vaccination coverage was observed in the UK, but in 2006-7 the rates returned to the level of 2004-5. Less media attention to the threat of avian influenza after 2005 may have contributed to the recent decrease of vaccination rates.

[Evolution of influenza vaccination coverage in France from 2001 to 2006]. / Evolution du taux de couverture vaccinale contre la grippe en France : de 2001 à 2006.

INTRODUCTION: The increased risk of a new influenza pandemic has raised awareness of the need for high influenza vaccination rates. OBJECTIVES: This study aims at assessing trends in influenza vaccination coverage from 2001 to 2006 in France, at understanding the drivers and barriers, and to identify vaccination intentions for 2006/2007. METHODS: We conducted a mail-based household survey on 9,835 persons representative of the population from age 15. Essentially, the same questionnaire was used in all seasons. RESULTS: The influenza vaccination coverage rate slightly increased, reaching 24.2% in 2005/2006 (70.1% in patients over 65). In the last two seasons the fact that the vaccination was provided for free was the most frequent reason for getting vaccinated. Older age, considering influenza as a serious disease and recommendations from the family doctor or nurse were also important drivers for vaccination. Only 2% of those vaccinated in 2005/2006 indicated the threat of avian influenza as a reason. The reasons for non-vaccination among persons never vaccinated before were feeling too young for vaccination, never having considered vaccination before and absence of recommendation by the family doctor. Among those who were previously vaccinated but not in the current season, the reasons for not being vaccinated were not finding vaccination necessary, forgetfulness and having influenza-like illness despite vaccination. CONCLUSION: Stable vaccination rates were observed from 2001 to 2006. France is well on its way to reach the international vaccination goal set by the WHO (75% in the elderly population), but continuously effort is needed for others.

Cost-effectiveness of trastuzumab in the adjuvant treatment of early breast cancer: a model-based analysis of the HERA and FinHer trial.

BACKGROUND: Routine adjuvant administration of trastuzumab (T) has been implemented in most centers, but its economic impact has not yet been well examined. METHODS: A Markov model was constructed based on clinical data of the Herceptin Adjuvant (HERA) and the Finland Herceptin (FinHer) trials. Costs from the perspective of a Swiss health care provider were calculated based on resource use. RESULTS: On the basis of HERA data, our model yielded an overall survival rate of 71.8% for the T group versus 62.8% for the control group [risk ratio (RR) = 0.87) after 10 years and 62.9% versus 52.7% (RR = 0.84) after 15 years. Cost-effectiveness resulted in 40505 Euros (EUR) per life years gained (LYG) after 10 years and 19673 EUR per LYG after 15 years. For the FinHer regimen, overall survival after 10 and 15 years resulted in 81.8% versus 66.1% (RR = 0.81) and 73.6% versus 57.0% (RR = 0.77). Costs of 8497 EUR per patient could be saved after 10 years and 9256 EUR after 15 years compared with the control group. CONCLUSION: In a long-term perspective, adjuvant T based on the HERA regimen can be considered cost-effective. The regimen used in the FinHer trial is even cost saving, but estimations are based on a single small trial.

Influenza vaccination coverage rates in 5 European countries: a population-based cross-sectional analysis of the seasons 02/03, 03/04 and 04/05.

INTRODUCTION: Influenza continues to be a considerable health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups OBJECTIVES: The objective of this survey was to assess and compare the level of influenza vaccination coverage during three consecutive influenza seasons (02/03, 03/04, 04/05) in the five European countries United Kingdom, France, Italy, Germany and Spain, understand the driving forces and barriers to vaccination now and 3 years ago and determine vaccination intentions for the following winter. METHODS: We conducted a random-sampling, telephone-based household survey among non-institutionalized individuals representative of the population aged 14 and over. The surveys used the same questionnaire for all three seasons. The data were subsequently pooled. Four target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field; (3) persons suffering from chronic illness and (4) a group composed of persons aged 65 and over or working in the medical field or suffering from a chronic illness. RESULTS: The overall sample consisted of 28,021 people. The influenza vaccination coverage rate increased from 21.0% in season 02/03 to 23.6% in season 03/04 and then to 23.7% in season 04/05. The differences between the seasons are statistically significant (p = 0.01). The highest rate over all countries and seasons had Germany in season 04/05 with 26.5%, Spain had in season 02/03 with 19.3% the lowest rate totally. The coverage rate in the target group composed of person's aged 65 and over or working in the medical field or suffering from a chronic illness was 49.7% in season 02-04 and 50.0% in season 04/05. The driving forces and barriers to vaccination did not change over the years. The most frequent reasons for being vaccinated given by vaccines were: influenza, considered to be a serious illness which people wanted to avoid, having received advise from the family doctor or nurse to be vaccinated and not wanting to infect family and friends. Reasons for not being vaccinated mentioned by people who have never been vaccinated were: not expecting to catch influenza, not having considered vaccination before and not having received a recommendation from the family doctor to be vaccinated. Options encouraging influenza vaccination are: recommendation by the family doctor or nurse, more available information on the vaccine regarding efficacy and tolerance and more information available about the disease. The adjusted odds ratio of receiving influenza vaccine varied between 2.5 in Germany and 6.3 in the United Kingdom in any risk group. CONCLUSION: The vaccination coverage rate increased from the first season (21.0%) to the third season (23.7%) by 2.6%. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.

Developments in influenza vaccination coverage in Italy over five seasons (2001-2006).

This study aims at assessing trends in influenza vaccination coverage from 2001 to 2006 in Italy, at understanding the drivers and barriers to vaccination, and to identify vaccination intentions for season 2006/07. We conducted telephone-based household surveys representative of the population from age 14. Total sample size was 10,026 persons. The influenza vaccination coverage rate in Italy increased over the years, reaching 24.1% in season 2005/06. In the elderly (> 65), the vaccination rate reached 63.4% in 2005/06. The increase between seasons 2004/05 and 2005/06 was statistically significant. A recommendation for the doctor/nurse, considering influenza as a serious illness, older age and not being in very good health were the most frequent reasons for getting vaccinated. Four percent of those vaccinated in 2005/06 indicated the threat of avian flu as a reason. For the winter 2006/07, 30% of the population intended to get vaccinated, indicating the potential to increase vaccination coverage next year. The threat of avian influenza may have contributed to a substantial recent increase in season 2005/06 as compared to the year before. Despite of this positive evolution, major effort is still needed to reach WHO objectives for 2010 (75% vaccination coverage rate in the elderly population).

Pharmacoeconomics of anticoagulation therapy for stroke prevention in atrial fibrillation: a review.

INTRODUCTION: Atrial fibrillation (AF) increases the risk of ischemic stroke 5-fold and may not only be responsible for as many as 15% of all strokes that occur but also for larger and more disabling strokes than those attributable to other causes which increase the associated costs of care. Anticoagulation with warfarin in the target INR of 2.5 is a major clinical challenge in real-life practice, given that the complex relationship between warfarin dosage and response is readily altered by a variety of factors such as concurrent medications, illnesses, genetic influences, and dietary/lifestyle changes. Consequently, INR values are out of the target range approximately half of the time in real-life studies compared to clinical trial setting. Current anticoagulation therapies are less likely to be cost-effective in routine clinical practice and need improvement. The aim of this review is to discuss the pharmacoeconomic consequences of this management strategy by analysing the optimal treatment option within specific age and risk groups, confirming current guidelines for a health economic perspective and considering the economic impact on health care policy. METHODS: An electronic search of the Medline/PubMed database from 1966 to 2005 was performed to identify articles dealing with all pharmacoeconomic aspects of stroke prevention in atrial fibrillation. The following search terms were used: 'atrial fibrillation', 'stroke', 'cost', 'warfarin'. RESULTS: Treatment with warfarin is cost-effective (versus aspirin or no therapy) in patients with AF at moderate-to-high risk of stroke. The cost-effectiveness of anticoagulation therapy is driven by the achieved risk reduction rather than the potential benefits estimated from clinical trials. Failure to maintain optimal anticoagulation places patients at risk of complications, the management of which is a significant cost driver. CONCLUSION: Improvement could be achieved by optimising physicians and patient's knowledge driven through prevention campaigns by health care policy.

[Coverage rates of influenza vaccination in France: a population-based cross-sectional analysis of seasons 2001-2002 and 2002-2003]. / Taux de couverture vaccinale contre la grippe en France: analyse démographique transversale des saisons 2001-2002 et 2002-2003.

INTRODUCTION: Influenza is a serious health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. OBJECTIVES: The authors had for aim to assess influenza vaccination coverage during two seasons in France, to understand the incentives and barriers to vaccination and to determine vaccination intentions for the following winter. METHODS: A random-sampling, mail-based household survey was made among non-institutionalised individuals aged 15 and over. The surveys for 2001-2002 and 2002-2003 used the same questionnaire and were subsequently pooled. Three target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field and (3) persons aged 65 and over or working in the medical field. RESULTS: Influenza vaccination coverage in France decreased from 23.0% in 2001-2002 to 22.4% in 2002-2003. Most frequent reasons for being vaccinated were advice from the family doctor (50.8%), influenza considered as a serious illness (45.3%) and free vaccine (44.1%). Reasons for not being vaccinated mentioned by people who had never been vaccinated were young age (27.0%), not considering vaccination (18.9%), and not expecting to catch influenza (13.9%). CONCLUSION: Vaccination coverage decreased during the 2002-2003 season in comparison to the 2001-2002 season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.

[Coverage rates of influenza vaccine in Italy during the 2002/3 and 2003/04 seasons: a cross-sectional study]. / La copertura da vaccino influenzale in Italia: indagine trasversale sulla popolazione Italiana nelle stagioni vaccinali 2002/3 e 2003/4.

The objective of this survey was to assess the level of influenza vaccination coverage in the season 2002/ 2003 compared with the season 2003/2004 in Italy, to understand the drivers and barriers to vaccination and to determine the intention for vaccination for the following winter. We conducted a random-sampling, telephone-based household survey among non-institutionalised individuals representative of the population aged 14 years and above. The surveys for 2002/2003 and 2003/2004 used the same questionnaire and were subsequently pooled. Four target groups were determined for analysis: (1) persons aged 65 years and above; (2) people working in the medical field; (3) persons suffering from a chronic illness and (4) all other groups. The overall sample consisted of 4010 people. The influenza vaccination coverage rate in Italy increased from 19.6% in season 2002/2003 to 22.2% in season 2003/2004. The most frequent reasons mentioned by vaccinees to get vaccinated were advice received from the family doctor or nurse (48.9%), influenza being considered a serious illness which people did not want to contract (38.5%) and not wanting to pass the influenza bug to family and friends (29.2%). Reasons mentioned by never vaccinated people for not getting vaccinated were the fact that people did not consider it before (34.9%), the opinion that one was not very likely to catch influenza (32.2%) and influenza not being a serious illness (23.4%). Options encouraging an influenza vaccination are a recommendation by the family doctor or nurse (58.4%), more available information on the vaccine regarding efficacy and tolerance (34.4%) and more available information on the disease (24.3%). We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself in order to enable them to actively inform their patients on these topics accordingly.

[On the prognosis of hip fractures. Assessment of mortality after hip fractures by analyzing overlapping segments of longitudinal data]. / Zur Prognose der Schenkelhalsfraktur. Beurteilung der Mortalität nach Schenkelhalsfraktur durch sektorübergreifende Datenzusammenführung.

BACKGROUND: Data on the treatment of hip fractures in acute care settings have been collected in a report card system for quality assurance in Germany since the beginning of the 1990s. However, there are no data on the long-term outcome and long-term quality of care. MATERIAL AND METHOD: In a retrospective study, data on 1393 patients from 1999 were collected from different sources: from the department of quality assurance at the medical association of Westfalia-Lippe, the Statutory Health Insurance Funds (AOK), and the Medical Review Board of the Statutory Health Insurance Funds (Medizinischer Dienst der Krankenkasse, MDK). Statistical analyses were performed by the Center for Clinical Studies of the University of Düsseldorf. RESULTS: Uni- and multivariate analyses reveal the following prognostic parameters for survival after hip fracture: sex, age, nursing care dependency, living in a nursing home, risk stratification according to ASA, and postoperative complications. Timing of the operation had no affect on survival. CONCLUSIONS: Prognostic factors for the outcome after hip fracture can only be obtained by analyzing data from the hospital stay and the post-hospital setting as well. Chances of survival can be significantly improved by rehabilitative care.

[Cost-effectiveness of atorvastatin for the prevention of coronary disease. An analysis of the ASCOT study]. / Kosteneffektivität von Atorvastatin zur Prävention der koronaren Herzkrankheit. Eine Analyse der ASCOT Studie.

BACKGROUND: Increasing health service expenditure, on the one hand, and the politically declared objective of stability of statutory contributions and restriction of public funds, on the other hand, have been central points in the political and social discussion for several years. PATIENTS AND METHODS: Cost-effectiveness of Atorvastatin in primary prevention was analysed by applying the results of the Anglo Scandinavian Cardiac Outcomes Trial (ASCOT study) to the German health system. Costs and effectiveness were subject to an extensive sensitivity analysis. RESULTS: The cost-effectiveness of Atorvastatin treatment in Germany is approximately 10,102 Euro (95% CI: 9109; 12,881) per life-year gained. Taking 2004 price reductions into consideration, these values are reduced to 7311 Euro [95% CI: 5197; 10,091) per life-year gained. The robustness of this result was substantiated through extensive sensitivity analyses. CONCLUSION: The administration of the lipid lowering compound Atorvastatin in hypertensive patients with additional coronary heart disease risk factors in Germany is cost-effective.

Comparison of resource utilization and long-term quality-of-life outcomes between laparoscopic and conventional colorectal surgery.

BACKGROUND: The outcomes of laparosopic and conventional colorectal surgery, with special reference to costs of treatment and patients' quality of life, were compared. METHODS: A partly retrospective cohort study was designed to assess the use of resources, and a follow-up interview was undertaken to evaluate patients' quality of life after both to define laparoscopic (LAP) and conventional (CON) surgery. RESULTS: The length of hospital stay was significantly lower in the LAP group (median, 11 days; interquartile range [IQR], 9-15) than in the CON group (median, 16 days; IQR, 13-23; p < 0.0001), which is reflected in lower costs of hospitalization calculated for the three most frequent surgical interventions. Statistically significant improvements were noted between the median scores in the domains of physical functioning (LAP 85 vs CON 68; p < 0.05) and vitality (LAP 85 vs CON 69; p < 0.05). CONCLUSION: Laparoscopy is a promising alternative for the treatment of patients with colorectal diseases, offering lower costs and a better quality of life in the long term.