Economic analysis of two structured treatment and teaching programs on asthma.

The aims of the present study were as follows: 1) to evaluate the medical outcomes of two treatment and educational asthma programs 2) to determine by cost-analysis both cost and economic outcome of the programs 3) to perform a cost-benefit analysis (determining the net cost-benefit) and a cost-effectiveness analysis (determining the cost per unit of effect and the incremental cost-effectiveness ratio) from the perspective of health program policy makers (HPP; indirect costs, i.e., loss of productivity, excluded) and of society as a whole (SaW, all costs included). Patients were randomly assigned to a complete (CP; n = 32) or reduced (RP; n = 33) program: the RP group received a reduced education (self-reading of an educational booklet on asthma), while the CP group attended an "asthma school", consisting of six lessons based on the same booklet and including educational videotapes. Both programs included peak-flow monitoring and treatment according to international guidelines, and follow-up. The outcome variables (asthma attacks, urgent medical examinations, admission days, working days lost) did not differ significantly between CP and RP. Morbidity savings were $1894.70 (CP) and $1697.80 (RP) according to SaW, and $1349.50 and $1301.80, respectively, according to HPP. The net cost-benefit was $1181.50 for CP and $1028.00 for RP, and the cost-benefit ratio per dollar spent was 1:2.6 for CP and 1:2.5 for RP, according to SaW. One day of admission prevented had a cost of $110.20 (CP) and $94.10 (RP). CP gave slightly better results and was slightly more cost-effective than RP in improving patients' welfare. It cannot be excluded that the retrospective analysis used to determine baseline costs might have inflated differences for both groups. Sensitivity analysis was slightly in favor of RP when the outcome variables were tested at their upper and lower 95% CI.

Preliminary study to antituberculosis chemotherapy in a region of sub-Saharian Africa: annual risk of tuberculosis infection calculation and tuberculin survey.

A tuberculin survey was performed in Arua District (577,799 inhabitants, recent return of refugees from Zaire and Sudan) in 1987 prior to the implementation of antituberculosis Chemotherapy and Control Programme. 50 clusters (schools) of 30 pupils each were selected in the 7 Counties by Sistematic Random Sampling. 1110 students 10 year old without BCG vaccination scar were injected with 5 IU of PPD; 1016 of them (more than 6% of the estimated district population of 10 year of age) came back after 72 hours for reading. 125 of them were positives (more than 10 mm of induration). The Infection Rate detected was 1.23% +/- 0.19. Considering the infection rates found by the Ugandan National Surveys done in 1950 (2.6%) and in 1970 (2.3%), and the slight slope of the curve calculated on those values we have underestimated the real Infection Rate in the district. To avoid this bias we suggest to include schools in sampling (it is simple and cost-effective) only if the Student's population is likely to be representative of the general population.

Effects of ubidecarenone in an exercise training program for patients with chronic obstructive pulmonary diseases.

A study was undertaken to determine the usefulness of ubidecarenone in pulmonary rehabilitation in exercise training programs in the management of chronic obstructive pulmonary disease (COPD). The subjects were 20 patients with COPD who had been participating in an exercise training program for at least four weeks. The patients were randomly assigned either to receive 50 mg of oral ubidecarenone daily or to enter a control group during the program. Oxygen consumption, expired volume, and heart rate were measured during exercise tests before and after training. Maximum oxygen consumption increased 13% in the ubidecarenone-treated patients and 7% in the controls, and maximum expired volume increased 10% in each group. The increases were significant in the ubidecarenone group but not in the controls. Heart rate increased 2% in both groups. It is concluded that ubidecarenone deserves further evaluation in exercise training programs for patients with COPD.