scholarly journals Mo1668 Mucosal Healing is a Cost-Effective Endpoint With Biologic Therapy in Crohns Disease - Results From a Decision Analysis

2012 ◽  
Vol 142 (5) ◽  
pp. S-654 ◽  
Author(s):  
Ashwin N. Ananthakrishnan ◽  
Joshua R. Korzenik ◽  
Chin Hur
Keyword(s):  
Decision Analysis ◽  
Biologic Therapy ◽  
Cost Effective ◽  
Mucosal Healing ◽  
Crohns Disease

scholarly journals Treatment options in moderate and severe depression: decision analysis supporting a clinical guideline

2006 ◽  
Vol 189 (6) ◽  
pp. 494-501 ◽  
Author(s):  
Judit Simon ◽  
Stephen Pilling ◽  
Rachel Burbeck ◽  
David Goldberg
Keyword(s):  
Combination Therapy ◽  
Decision Analysis ◽  
Secondary Care ◽  
Treatment Options ◽  
Severe Depression ◽  
Cost Effective ◽  
Current Evidence ◽  
Resource Utilisation ◽  
Moderate Depression ◽  
The Cost

BackgroundTreatment options for depression include antidepressants, psychological therapy and a combination of the two.AimsTo develop cost-effective clinical guidelines.MethodSystematic literature reviews were used to identify clinical, utility and cost data. A decision analysis was then conducted to compare the benefits and costs of antidepressants with combination therapy for moderate and severe depression in secondary care in the UK.ResultsOver the 15-month analysis period, combination therapy resulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse compared with antidepressants. The cost per additional successfully treated patient was £4056 (95% CI 1400–18 300); the cost per quality-adjusted life year gained was £5777 (95% CI 1900–33 800) for severe depression and £14 540 (95% CI 4800–79 400) for moderate depression.ConclusionsCombination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation.

Percutaneous Stenting of Incidental Unilateral Renal Artery Stenosis: Decision Analysis of Costs and Benefits

2003 ◽  
Vol 10 (3) ◽  
pp. 546-556 ◽  
Author(s):  
David A. Axelrod ◽  
A. Mark Fendrick ◽  
Ruth C. Carlos ◽  
Robert J. Lederman ◽  
James B. Froehlich ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Decision Analysis ◽  
Renal Artery ◽  
Incremental Cost ◽  
Renal Artery Stenosis ◽  
Cost Effective ◽  
Artery Stenosis ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Refractory Hypertension

Purpose: To determine the incremental cost-effectiveness of prophylactic percutaneous transluminal angioplasty with stent placement (PTA-S) in patients with incidentally discovered, asymptomatic renal artery stenosis (RAS) compared to delaying PTA-S until patients develop refractory hypertension or renal insufficiency (therapeutic PTA-S). Methods: The Markov decision analysis model was used to determine the incremental cost per quality adjusted life year (QALY) saved for prophylactic PTA-S as compared to therapeutic PTA-S in a hypothetical cohort of patients with 50% unilateral atherosclerotic RAS followed from age 61 to death. Results: Prophylactic PTA-S compared to therapeutic PTA-S results in more QALYs/patient (10.9 versus 10.3) at higher lifetime costs ($23,664 versus $16,558). The incremental cost effectiveness of prophylactic PTA-S was estimated to be $12,466/QALY. Prophylactic stenting was not cost effective (>$50,000/QALY) if the modeled incidence of stent restenosis exceeded 15%/year and the incidence of progression in the contralateral renal artery was <2% of arteries/year. Conclusions: PTA-S of incidental, asymptomatic unilateral RAS may improve patients' quality of life at an acceptable incremental cost. However, this technology should be used hesitantly until a randomized comparison confirms its effectiveness.

Clinical Decision Analysis as a Means of Technology Assessment: The Effectiveness of Intraoperative Cholangiography

1992 ◽  
Vol 8 (1) ◽  
pp. 185-197 ◽  
Author(s):  
Thomas E. Scott ◽  
Itzhak Jacoby
Keyword(s):  
Decision Analysis ◽  
Mortality Risk ◽  
Technology Assessment ◽  
Common Duct ◽  
Cost Effective ◽  
Clinical Decision ◽  
Intraoperative Cholangiography ◽  
Lower Mortality ◽  
Effective Option ◽  
Lower Mortality Risk

AbstractThree strategies for timely detection of common duct stones are examined by decision analysis: the use of intraoperative cholangiography (IOC) in ALL, NONE, or in SOME of the cases that are selected by the estimated probability of a common duct stone. Selective use of IOC is the most cost-effective option and offers a slightly lower mortality risk.

‘Evidence-based’, ‘Cost-Effective’ and ‘Preference-Driven’ Medicine: Decision Analysis Based Medical Decision Making is the Pre-Requisite

1996 ◽  
Vol 1 (2) ◽  
pp. 104-113 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Decision Making ◽  
Decision Analysis ◽  
Evidence Based Medicine ◽  
Medical Decision Making ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Medical Decision ◽  
Evidence Based ◽  
Meta Analyses ◽  
Based Medicine

Three broad movements are seeking to change the world of medicine. The proponents of ‘evidence-based medicine’ are mainly concerned with ensuring that strategies of proven clinical effectiveness are adopted. Health economists are mainly concerned to establish that ‘cost-effectiveness’ and not ‘clinical effectiveness’ is the criterion used in determining option selection. A variety of patient support and public interest groups, including many health economists, are mainly concerned with ensuring that patient and public preferences drive clinical and policy decisions. This paper argues that decision analysis based medical decision making (DABMDM) constitutes the pre-requisite for the widespread introduction of the main principles embodied in evidence-based medicine, cost-effective medicine and preference-driven medicine; that, in the light of current modes of practice, seeking to promote these principles without a prior or simultaneous move to DABMDM is equivalent to asking the cart to move without the horse; and that in fact DABMDM subsumes and enjoins the valuable aspects of all three. Particular attention is paid to differentiating between DABMDM and EBM, by way of analysis of various expositions of EBM and examination of two recent empirical studies. EBM, as so far expounded, reflects a problem-solving attitude that results in a heavy concentration on RCTs and meta-analyses, rather than a broad decision making focus that concentrates on meeting all the requirements of a good clinical decision. The latter include: Ensuring that inferences from RCTs and meta-analyses to individual patients (or patient groups) are made explicitly; paying equally serious attention to evidence on values and costs as to clinical evidence; and accepting the inadequacy of ‘taking into account and bearing in mind’ as a way of integrating the multiple and distinct elements of a decision.

Decision Analysis: A Tool for Infection Control

1988 ◽  
Vol 9 (2) ◽  
pp. 88-91 ◽  
Author(s):  
Mary D. Nettleman
Keyword(s):  
Health Care ◽  
Infection Control ◽  
Decision Analysis ◽  
Diagnostic Tests ◽  
Protective Clothing ◽  
New Products ◽  
Cost Effective ◽  
New Product ◽  
Financial Resources ◽  
Active Research

Financial resources for health care have been restricted. Constraints demand that physicians and administrators get the most for their money, yet the myriad of diagnostic tests and antibiotics available today can easily boggle the minds of those who must choose among them. This situation is particularly true of infection control where active research continually produces new products. Each hospital must choose among disinfectants, detergents, antibiotics, protective clothing, immunizations, dressing supplies, respiratory therapies, and many other products. At every point, questions arise. Is a new product worth the extra money? Alternatively, is a less expensive product really more cost-effective? How many additional infections must be prevented before a product “pays” for itself?

scholarly journals P005 Regulators of the guanylate cyclase pathway are potential novel markers of mucosal healing in IBD

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S131-S132
Author(s):  
L E Jeffery ◽  
U N Shivaji ◽  
D Zardo ◽  
A Acharjee ◽  
O M Nardone ◽  
...  
Keyword(s):  
Guanylate Cyclase ◽  
Biologic Therapy ◽  
Statistical Significance ◽  
Mucosal Healing ◽  
Endoscopic Examination ◽  
Response To Therapy ◽  
Response To Treatment ◽  
University Hospitals ◽  
Therapy Assessment ◽  
The Difference

Abstract Background Intestinal guanylate cyclase C (GC-C) present in epithelial cells has been shown to have a role in gut homeostasis. The downstream effects of activation of GC-C are due to production of cyclic-GMP. GC-C is encoded by the gene GUCY2C, mutations in which are implicated in Familial Diarrhoea Syndrome and noted as risk factors for Crohn’s disease. GUCY2C and its activator, GUCA2A have been shown to be downregulated in IBD. We hypothesised that regulation of this pathway might be important in remission and response to therapy. Methods Forty-four patients with IBD and 7 patients with polyps (controls) at University Hospitals Birmingham, UK were recruited under ethical consent. Relevant demographic and clinical data were extracted from the hospital EMR. All patients had disease activity recorded on endoscopic examination of mucosa and intestinal biopsies collected for analysis. Mucosal healing was defined as MES = 0 (UC) and SES-CD &lt;6 (CD). Of 44 patients, 14 had matched baseline and 12-week post-biologic therapy assessment and had tissues collected. Intestinal biopsies were analysed by 3’RNA-sequencing using the Illumina Nextseq sequencer. FASTQ files were generated through BaseSpace and reads de-multiplexed, trimmed, aligned, and quantified using the GeneGlobe (Qiagen) workflow. Expression was compared between groups using either Wilcoxon tests or Kruskal–Wallis with Dunn post-hoc analysis as appropriate. Results Expression of Guanylate cyclase activators GUCA2A and GUCA2B in patients who showed mucosal healing was equivalent to controls, but GUCA2A was down-regulated in those with active disease (non-healing) (p = 0.006). The same pattern was observed for transcriptional regulators of GUCY2C, including HNF4A (p = 0.0248) and CDX2 (0.0062). Correspondingly, GUCY2C was reduced in non-healing mucosa, although the difference was not significant (Figure 1). In patients who responded to biologic therapy, both GUCA2A (p = 0.0234) and GUCA2B (p = 0.0117) were increased at follow-up but no change was observed for those who did not respond. Change in GUCY2C expression did not reach statistical significance in either group, although an increase was observed for a large proportion of responders. Conclusion Our findings suggest that regulation of the Guanylate Cyclase pathway may be involved in the restoration of a stable mucosa in IBD and that expression of its regulators may be used to indicate response to treatment.

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