scholarly journals Changes in Risk in Medium Business Plating and Paint Manufacturing Plants following the Revision of the Korean Chemical Accident Prevention System

2021 ◽  
Vol 18 (22) ◽  
pp. 11982
Author(s):  
Hyo Eun Lee ◽  
Min-Gyu Kim ◽  
Seok J. Yoon ◽  
Da-An Huh ◽  
Kyong-Whan Moon
Keyword(s):  
High Risk ◽  
Risk Analysis ◽  
Local Governments ◽  
Safety Management ◽  
Risk Groups ◽  
Manufacturing Plants ◽  
Hazardous Chemical ◽  
Chemical Accident ◽  
Medium Risk ◽  
Changes In Risk

Chemical accidents can occur anywhere. The need for chemical management in Korea was realized following the 2012 Gumi hydrofluoric acid accident in 2012. The Chemicals Control Act was enacted in 2015. This system evaluates the risks (high, medium, low) and consequent safety management at all plants that handle hazardous chemical substances. However, the system was criticized as excessive when most plants were designated high-risk without considering their size. Thus, laboratories and hospitals handling very small quantities were subject to regulation. Accordingly, in 2021 Korea revised the system to include off-site consequence analyses and a Korean-style risk analysis. Plants handling very small quantities, such as laboratories and hospitals, were exempt from regulation. In this study, changes in risk were examined for four medium-sized plating and paint manufacturing plants. Under the previous system, all four factories were judged as high-risk groups. In particular, the paint manufacturing plant A, which has an underground storage tank, received a medium risk like the plating plant C, although the possibility of a chemical accident was lower than that of other plants. However, in the changed system, all plants were changed to the low-risk group. In the Korean-style risk analysis, it is possible to see at a glance what is lacking in the plants, such as cooperation between local residents and local governments and the construction of safety facilities according to the type of accident scenario. The revised system is a reasonable regulation for medium business plants.

scholarly journals Changes in Risk in Medium Business Plants Following Revision of the Korean Chemical Accident Prevention System, Focusing on Plating and Paint Manufacturing Industries

2021 ◽  
Author(s):  
Hyo Eun Lee ◽  
Min-Gyu Kim ◽  
Seok J. Yoon ◽  
Da-An Huh ◽  
Kyong Whan Moon
Keyword(s):  
High Risk ◽  
Risk Analysis ◽  
Local Governments ◽  
Safety Management ◽  
Medium Size ◽  
Manufacturing Companies ◽  
Chemical Management ◽  
Hazardous Chemical ◽  
Chemical Accident ◽  
Local Residents

: Chemical accidents can occur anywhere. The need for chemical management in Korea was realized following the 2012 Gumi hydrofluoric acid accident in 2012. The Chemicals Control Act was enacted in 2015. This system evaluates the risks (high, medium, low) and consequent safety management at all plants that handle hazardous chemical substances. However, the system was criticized as excessive when most plants were designated high-risk without considering their size. Thus, laboratories and hospitals handling very small quantities were subject to regulation. Accordingly, in 2021 Korea revised the system to include off-site consequence analyses and a Korean-style risk analysis. Plants handling very small quantities, such as laboratories and hospitals, were exempt from regulation. In this study, plating and paint manufacturing companies, which were classified as high-risk in the previous system, even though they were medium-size business plants, were re-evaluated as low-risk plants. In the Korean-style risk analysis, it is possible to see at a glance what is lacking in the plants, such as cooperation between local residents and local governments and the construction of safety facilities according to the type of accident scenario. The revised system is a reasonable regulation for medium business plants.

scholarly journals RISK ANALYSIS OF COCONUT PRODUCT MARKETING

2018 ◽  
Vol 6 (5) ◽  
pp. 138-148
Author(s):  
Ine Fausayana ◽  
Weka Gusmiarty Abdullah ◽  
La Ode Dawid
Keyword(s):  
High Risk ◽  
Risk Analysis ◽  
Risk Identification ◽  
Low Risk ◽  
Coconut Shell ◽  
Market Regulation ◽  
Shell Waste ◽  
Medium Risk ◽  
Product Marketing ◽  
Coconut Product

The aim of this study was to analysis the risks of coconut products marketing in Kendari City. The results of this study described risk identification in three stage of marketing of coconut product, namely (a) Five risks identified at the stage of storaging; broken coconut fruit, unsold product, fire market, theft of coconut fruits, and market regulation; (b) Three risks identified at the stage of processing; broken coconut, coconut shell waste, and damage to processing facilities; and (c) Four risks identified at the stage of selling; unsold product, non-strategic selling locations, substitute goods, and competitors. Overall, the risk on coconut products marketing was mapped at low risk. High risk was more prevalent in the stage of processing, which was caused by the risk of coconut shell waste. While medium risk was more prevalent in the stage of storaging.

scholarly journals P0357VALIDATION OF THE ANCA RENAL RISK SCORE IN A LONDON COHORT: POTENTIAL IMPACT OF TREATMENT ON PREDICTION OUTCOME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
PEK GHE TAN ◽  
Jennifer O'Brien ◽  
Megan Griffith ◽  
Marie Condon ◽  
Tom Cairns ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Renal Outcome ◽  
Combination Regimen ◽  
Renal Survival ◽  
Medium Risk ◽  
Risk Patients ◽  
Potential Impact

Abstract Background and Aims A renal risk score was recently developed to predict the risk of progression to end stage kidney disease (ESKD) in patients with ANCA-associated glomerulonephritis (ANCA-GN). The score defines three risk groups, each with distinct renal survival at 36 months: 68% of high-risk patients reaching ESKD, compared to 26% and 0% in the medium- and low-risk groups, respectively. The majority of patients (101/115) used to define the risk score were treated with IV cyclophosphamide and steroids. At our centre, we employ a combined low-dose IV cyclophosphamide, rituximab and oral corticosteroid induction regimen, with or without plasma exchange (PEX) depending on disease severity, for ANCA-GN. A recent cohort study suggested this combination regimen may lead to better renal survival. We thus hypothesized that choice of remission-induction treatment may affect prediction accuracy of the risk tool. We retrospectively test the validity of the ANCA renal risk score in patients with ANCA-GN treated at our centre. Method All patients with newly diagnosed, biopsy-proven ANCA-GN from 2006-19 were identified from local renal histopathology database. Patients with relapsing ANCA-GN, EGPA, other coexisting GN, or missing data on induction therapy or eventual renal outcome were excluded. ANCA-negative pauci-immune GN was included. Baseline demographics, ANCA serology, initial therapy and parameters in the ANCA risk score (including % normal glomeruli, % tubular atrophy and interstitial fibrosis (TAIF), and estimated glomerular filtration rate were collected. All patients were stratified using the risk tool and Kaplan Meier survival analysis was applied to examine the ESKD prediction. Subgroup analysis was then performed for patients who received the combination regimen of cyclophosphamide and rituximab. Results 178 patients with a median follow up of 44 month were included in the analysis. The median age was 62 years and 82 patients (46%) were female. 94(53%) were MPO-ANCA positive, 66(37%) PR3-ANCA positive, 15 (8%) ANCA-negative, and 3 (2%) were double PR3/MPO-ANCA positive. 148 (83%) patients received the combination regimen, and 45 had concurrent PEX. Total of 37 (21%) patients reached ESKD. 29 (78%) of these, developed ESKD within 36 months of initial diagnosis. Using the risk score, 64(36%), 76(43%) and 38(21%) patients were deemed low-, medium- and high-risk, respectively. Very distinct poor renal survival at 36 months was seen in high-risk group (55% reaching ESKD, p<0.01), but was less apparent between low- (95%) and medium-risk (90%)(p=0.052) (Figure1); In the subgroup of patients treated with combination regimen without concurrent PEX, the high-risk subgroup continues to demonstrate poor renal survival at 36 months (60% ESKD), but renal survival between low- and medium-risk group were comparable (0 and 2% respectively, p=0.57) (Figure 2). Conclusion In our cohort, the ANCA Renal Risk Score reliably predicted rapid ESKD progression at 36-month in high-risk patients, but was less accurate for distinguishing patients with low-and medium-risk. The subgroup analysis suggested combined cyclophosphamide and rituximab therapy may have modified long-term renal outcome especially in the medium-risk cohort, influencing the accuracy of the prediction tool. Large multi-centre cohorts are required to further evaluate the potential impact of treatment on predicting outcome.

scholarly journals Pentraxin-3 Levels Relate to the Wells Score and Prognosis in Patients with Acute Pulmonary Embolism

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Haotian Yang ◽  
Jun Zhang ◽  
Ying Huan ◽  
Yawei Xu ◽  
Rong Guo
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Acute Pulmonary Embolism ◽  
Risk Groups ◽  
Low Risk ◽  
Recurrent Pulmonary Embolism ◽  
Medium Risk ◽  
Wells Score ◽  
The Difference

Objective. To investigate the value of the PTX-3 test in evaluating the prognosis of acute pulmonary embolism (APE). Method. 117 APE patients were selected and divided into two groups according to plasma PTX-3 levels, including the group in which PTX−3≥3.0 ng/mL (n=42) and the group in which PTX−3<3.0 ng/mL (n=75). Patients were stratified into high-risk, medium-risk, and low-risk groups according to the Wells scores, and the PTX-3 levels were compared among the groups. Patients had been followed-up as well. Results. According to the Wells scores, 11 patients were classified as high-risk (9.4%) and 68 were medium-risk (58.1%), while 38 were low-risk (32.5%). The PTX-3 levels in different risk groups were statistically different (all P<0.05). During the follow-up period, 6 deaths occurred in the group with elevated PTX-3 (≥3.0 ng/mL), while 2 deaths occurred in the group with nonelevated PTX-3 (<3.0 ng/mL). The difference between the two groups was statistically significant (P<0.01). 13 patients were hospitalized due to recurrent pulmonary embolism, of which 12 were in the group with elevated PTX-3 (≥3.0 ng/mL), while 1 patient was in the group with nonelevated PTX-3 (<3.0 ng/mL). The difference was statistically significant (P<0.01). Conclusion. The plasma PTX-3 level in APE patients is correlated with PE risk stratification. There is a significant correlation between PTX-3 levels and PE-related cardiac deaths, as well as the prognosis of recurrent PE. PTX-3 can be used as a clinical indicator of PE prognosis.

High Prevalence of Relapse in Australian Children with Ph-like Acute Lymphoblastic Leukemia Despite Risk Adapted Treatment

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1419-1419 ◽  
Author(s):  
Susan L Heatley ◽  
Teresa Sadras ◽  
Eva Nievergall ◽  
Chung Hoow Kok ◽  
Phuong Dang ◽  
...  
Keyword(s):  
High Risk ◽  
Research Funding ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
Risk Groups ◽  
High Risk Group ◽  
Event Free Survival ◽  
Free Survival ◽  
Kaplan Meier ◽  
Medium Risk

Abstract Introduction: While remission rates for childhood acute lymphoblastic leukemia (ALL) now exceed 80%, relapsed ALL remains the leading cause of non-traumatic death in children. Recently, a high-risk group of B-progenitor ALL patients has been identified. Such cases exhibit a gene expression profile similar to that of BCR-ABL1 positive (Ph+) ALL but are BCR-ABL1 negative, and also experience poor treatment outcomes. This subset, termed Ph-like ALL, is characterised by a range of genetic alterations that activate cytokine receptor and kinase signalling, allowing potential targeting by available tyrosine kinase inhibitors (TKI). The frequency of Ph-like ALL in the Australian community and the prognosis in the setting of the first MRD (minimal residual disease) intervention trial by the Australian and New Zealand Children's Haematology/Oncology Group (ANZCHOG ALL8) is unknown. Method: We retrospectively screened 250 unselected samples that were available from children diagnosed with B-ALL, for Ph-like ALL. The children, aged between 1 and 18 years, were enrolled on the ANZCHOG ALL8 trial and recruited from 2002-2011. The criteria for stratification to the high-risk group, based upon Berlin-Frankfurt-Munster (BFM) protocols, were BCR-ABL1 or MLL t(4;11) translocation; poor prednisolone response at day 8; failure to achieve remission by day 33 or high MRD (>5 x10-4) at day 79. MRD was measured by RQ-PCR for patient-specific immunoglobulin and T-cell receptor rearrangements. All patients received a standard BFM four drug induction chemotherapy regimen including a prednisolone pre-phase and intrathecal methotrexate. High-risk patients received a further three novel intensive blocks of chemotherapy followed by transplant in most cases. Patients were screened for Ph-like ALL using a custom Taqman Low Density Array (TLDA) based upon previous reports. Fusions were then confirmed by RT-PCR for 30 known fusions, Sanger sequencing, mRNA sequencing and/or FISH. Results: Ten percent (25/250) of children in this cohort were identified as having Ph-like ALL, with most fusions converging on kinase activating pathways (Table 1). Three Ph-like ALL patients were considered high-risk, the remaining 22 (88%) were medium risk. Five children with Ph-like ALL, that did not have a fusion identified by RT-PCR, are currently under further investigation. Furthermore, 15 of the 20 (75%) of rearrangements involved CRLF2 with 10 (66%) of these children relapsing. Strikingly, 56% (14/25) of children in the ALL8 cohort who were identified as Ph-like subsequently relapsed compared to 16% (36/225) who were not, with significantly worse event free survival (p<0.0001) (Figure 1). Conclusion: Here we demonstrate a significantly higher frequency of relapse amongst Australian children with Ph-like ALL compared to non Ph-like disease despite a MRD-adjusted intensification regimen. In this cohort, these children should be classified as high-risk due to high treatment failure rates with standard/medium risk regimens. Importantly, rapid identification of these patients may guide future intervention with targeted therapies, such as TKI, matched to the causative genetic lesion in this high-risk group. Figure 1. Fusions identified in Ph-like ALL from ANZCHOG ALL8 cohort. Figure 1. Fusions identified in Ph-like ALL from ANZCHOG ALL8 cohort. Figure 2. Kaplan-Meier estimates of event free survival for patients with Ph-like ALL and non Ph-like ALL (all risk groups). Figure 2. Kaplan-Meier estimates of event free survival for patients with Ph-like ALL and non Ph-like ALL (all risk groups). Disclosures Hughes: ARIAD: Honoraria, Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; Novartis: Honoraria, Research Funding. Mullighan:Incyte: Consultancy, Honoraria; Cancer Science Institute: Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Speakers Bureau; Loxo Oncology: Research Funding. White:Novartis: Honoraria, Research Funding; BMS: Honoraria, Research Funding.

Initial Experience with Determination of hTERC and MYCC Amplification in Cervical Intraepithelial Neoplasia and Cervical Carcinoma in the Czech Republic

2012 ◽  
Vol 08 (02) ◽  
pp. 92 ◽  
Author(s):  
Lucie Moukova ◽  
Vladimira Vranova ◽  
Iva Slamova ◽  
Miroslava Kissova ◽  
Petr Kuglik ◽  
...  
Keyword(s):  
High Risk ◽  
Cervical Intraepithelial Neoplasia ◽  
Chromosomal Abnormalities ◽  
Intraepithelial Neoplasia ◽  
Risk Groups ◽  
Hpv Infection ◽  
High Risk Group ◽  
Medium Risk ◽  
Risk Of Progression ◽  
Human Telomerase

Tumours are frequently characterised by series of cytogenetic abnormalities. Amplifications of the human telomerase gene hTERC (3q26) and myelocytomatosis-C proto-oncogeneMYCC(8q24) have been associated with cervical intraepithelial neoplasia (CIN) and carcinoma of the uterine cervix. The results of genetic analysis allow to select patients at high risk of progression from CIN to carcinoma. Our group conducted a study in which the chromosomal abnormalities found in the cytology specimens of 26 patients with either cervical cancer or CIN were analysed using the recently developed triple-colour human papillomavirus-fluorescencein situhybridisation (HPV-FISH) assay. HPV infection was proven in 22 (85 %) patients. Amplification ofMYCCandhTERCwas found in 11 (42 %) and 16 (62 %) patients, respectively. Based on these results, the patients were divided into high-risk, medium-risk and low-risk groups. The study confirmed that the HPV-FISH assay can be used as an effective diagnostic procedure to identify patients carrying high-risk HPV infection and chromosomal aberrations associated with the development of malignancy. Patients in the high-risk group would require more frequent folllow-up and aggressive therapy.

scholarly journals 4508 Contextual Predictors of Hospitalization and Quality of Life Among Patients on Hemodialysis

2020 ◽  
Vol 4 (s1) ◽  
pp. 83-83
Author(s):  
Kathryn Taylor ◽  
Deidra Crews ◽  
Patricia Davidson
Keyword(s):  
Quality Of Life ◽  
Substance Use ◽  
High Risk ◽  
Food Insecurity ◽  
Socioeconomic Position ◽  
Risk Groups ◽  
Housing Instability ◽  
Hospitalization Rates ◽  
Medium Risk

OBJECTIVES/GOALS: People engaging in high-risk substance use or experiencing food insecurity or housing instability are at increased risk to develop end-stage kidney disease. This study will examine associations between these risk factors, patient indicators of socioeconomic position, and hospitalization rates and quality of life after initiation of hemodialysis. METHODS/STUDY POPULATION: The proposed study will leverage a prospective cohort design. We will enroll a convenience sample of 330 participants from the same large dialysis organization. Participants will complete measures of socioeconomic position (age, gender, race, ethnicity, education, income, occupation and community poverty); substance use; food insecurity; housing instability; and quality of life at baseline. We will follow participants for 6 months and extract hospitalization counts from the dialysis facility medical record. RESULTS/ANTICIPATED RESULTS: We will generate risk scores (low, medium, high) from measures of substance use, food insecurity and housing instability. We will conduct multiple logistic regression to generate odds ratios comparing risk group membership by indicators of socioeconomic position. We anticipate that low or medium-risk groups will differ from high risk groups by indicators of socioeconomic position. We will conduct Poisson regression to generate incidence rate ratios for 6-month hospitalization rates comparing low or medium-risk and high-risk groups. Lastly, we will conduct multiple linear regression to generate beta coefficients for changes in quality of life scores comparing low or medium-risk and high-risk groups. We anticipate that high-risk groups will have higher hospitalization rates and lower quality of life scores. DISCUSSION/SIGNIFICANCE OF IMPACT: As the prevalence of end-stage kidney disease continues to increase, there is a need for tertiary prevention interventions that reduce costly inpatient utilization and improve health-related quality of life. The proposed study will lay groundwork for the development of interventions to improve patient outcomes and reduce Medicare spending.

scholarly journals Investigation and Analysis of a Hazardous Chemical Accident in the Process Industry: Triggers, Roots, and Lessons Learned

Processes ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 477
Author(s):  
Jianhao Wang ◽  
Gui Fu ◽  
Mingwei Yan
Keyword(s):  
Vinyl Chloride ◽  
Chemical Industry ◽  
Safety Management ◽  
Safety Evaluation ◽  
Lessons Learned ◽  
Design Stage ◽  
Practical Procedure ◽  
Chemical Company ◽  
Hazardous Chemical ◽  
Chemical Accident

This paper performs an in-depth investigation and analysis on a catastrophic hazardous chemical accident involving domino effects in China based on an emerging accident causation model—the 24Model. The triggers and roots of the incident from the individual and organizational levels have been identified and several useful lessons have been summarized to avoid similar mistakes. This accident began with a leak of vinyl chloride caused by the failure of the gas holder’s bell housing and the operators’ mishandling. Leaked vinyl chloride was ignited by a high-temperature device in the process of diffusion and the fire quickly spread to the illegally parked vehicles. Several organizations were involved in this accident, and the chemical company should bear the main responsibility for it, and shall establish and implement an effective safety management system in its organizational structure and staffing, facilities management, hazards identification, emergency disposal, etc., to improve safety performance in a systematic way. Enterprises in the chemical industry park shall enhance the communication to clarify major hazard installations in their domains, and conduct regular safety evaluation for the plant as the external environment changed. Government agencies shall plan the layout of the chemical industry park scientifically and ensure safety starts with the design stage. The case study provides a practical procedure for accident investigation and analysis, and thus, preventive measures can be made according to the various causations at different levels.

Impact of Stratification of Comorbidities on Nutrition Indices and Survival in Patients on Continuous Ambulatory Peritoneal Dialysis

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 153-157 ◽  
Author(s):  
Narayan Prasad ◽  
Amit Gupta ◽  
Archana Sinha ◽  
Anurag Singh ◽  
Raj Kumar Sharma ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
High Risk ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Low Risk ◽  
Comorbid Illness ◽  
Medium Risk ◽  
Risk Patients

Background Case-mix comorbidities and malnutrition influence outcome in continuous ambulatory peritoneal dialysis (CAPD) patients. In the present study, we analyzed the influence of stratified comorbidities on nutrition indices and survival in CAPD patients. Patients and Methods We categorized 373 CAPD patients (197 with and 176 without diabetes) into three risk groups: low—age under 70 years and no comorbid illness; medium—age 70 – 80 years, or any age with 1 comorbid illness, or age under 70 years with diabetes; high—age over 80 years, or any age with 2 comorbid illnesses. We then compared nutrition indices and malnutrition by subjective global assessment (SGA) between the three groups. Survival was compared using Kaplan–Meier survival analysis. Results Mean daily calorie and protein intakes in the low-risk group (21 ± 6.7 Kcal/kg, 0.85 ± 0.28 g/kg) were significantly higher than in the medium- (17.6 ± 5.2 Kcal/kg, 0.79 ± 0.25 g/kg) and high-risk (17.5 ± 6.1 Kcal/kg, 0.78 ± 0.26 g/kg) groups ( p = 0.001 and p = 0.04 respectively). Relative risk (RR) of malnutrition was less in the low-risk group (103/147, 70.06%) than in the medium-risk group [135/162, 83.3%; RR: 2.0; 95% confidence interval (CI): 2.1 to 3.4; p = 0.01] or the high-risk group (54/64, 84.4%; RR: 2.3; 95% CI: 2.1 to 4.9; p = 0.03). Mean survivals of patients in the low-, medium-, and high-risk groups were 51 patient–months (95% CI: 45.6 to 56.4 patient–months), 43.3 patient–months (95% CI: 37.8 to 48.7 patient–months), and 29.7 patient–months (95% CI: 23 to 36.4 patient–months) respectively (log-rank: 35.9 patient–months; p = 0.001). The 1-, 2-, 3-, 4-, and 5-year patient survivals in the low-, medium-, and high-risk groups were 96%, 87%, 79%, 65%, and 56%; 89%, 67%, 54%, 43%, and 34%; and 76%, 48%, 31%, 30%, and 30% respectively. Conclusions Intake of calories and protein was significantly lower in the medium-risk and high-risk groups than in the low-risk group. Survival was significantly better in low-risk patients than in medium- and high-risk patients.

scholarly journals Cost effectiveness of ramipril treatment for cardiovascular risk reduction

Heart ◽  
2001 ◽  
Vol 85 (5) ◽  
pp. 539-543
Author(s):  
I S Malik ◽  
V K Bhatia ◽  
J S Kooner
Keyword(s):  
Cardiovascular Risk ◽  
Cost Effectiveness ◽  
High Risk ◽  
Risk Reduction ◽  
Risk Groups ◽  
Cardiovascular Risk Reduction ◽  
Medium Risk ◽  
The Uk ◽  
Annual Mortality ◽  
Lifetime Treatment

OBJECTIVETo assess the cost effectiveness of ramipril treatment in patients at low, medium, and high risk of cardiovascular death.DESIGNPopulation based cost effectiveness analysis from the perspective of the health care provider in the UK. Effectiveness was modelled using data from the HOPE (heart outcome prevention evaluation) trial. The life table method was used to predict mortality in a medium risk cohort, as in the HOPE trial (2.44% annual mortality), and in low and high risk groups (1% and 4.5% annual mortality, respectively).SETTINGUK population using 1998 government actuary department data.MAIN OUTCOME MEASURECost per life year gained at five years and lifetime treatment with ramipril.RESULTSCost effectiveness was £36 600, £13 600, and £4000 per life year gained at five years and £5300, £1900, and £100 per life year gained at 20 years (lifetime treatment) in low, medium, and high risk groups, respectively. Cost effectiveness at 20 years remained well below that of haemodialysis (£25 000 per life year gained) over a range of potential drug costs and savings. Treatment of the HOPE population would cost the UK National Health Service (NHS) an additional £360 million but would prevent 12 000 deaths per annum.CONCLUSIONSRamipril is cost effective treatment for cardiovascular risk reduction in patients at medium, high, and low pretreatment risk, with a cost effectiveness comparable with the use of statins. Implementation of ramipril treatment in a medium risk population would result in a major reduction in cardiovascular deaths but would increase annual NHS spending by £360 million.

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