Treating miscarriages: a randomised study of cost-effectiveness in medical or surgical choice.

OBJECTIVE: The aim was to carry out a cost effectiveness analysis (CEA) of medical and surgical treatment of miscarriage using quantitative and qualitative indicators. DESIGN: A prospective study where the data of the clinical course of the treatment and the patients; experiences (pain and satisfaction) were collected from a previous randomised study. SETTING: Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland. POPULATION: Ninety-eight eligible women with a diagnosed miscarriage. METHODS: The incremental cost-effectiveness ratio (ICER) was calculated by using institutional prices (provider's aspect) of the medical care and the number of patients who experienced pain, dissatisfaction or unsuccessful treatment while treated for the miscarriage. MAIN OUTCOME MEASURES: Primary (uncomplicated treatment) and secondary (complications and other unplanned events) costs of the treatments. RESULTS: Primary costs of the surgical treatment were higher, but the more frequent unplanned events and complications in the medical group brought the costs to the same level. In the medical group, based on the ICER, 12 patients more experienced pain, 7 patients more were dissatisfied with the treatment and 5 patients more had unsuccessful treatment compared with surgically treated patients. In theory, these negative outcomes could have been avoided by investing euro1688 more in the surgical treatment. CONCLUSIONS: Medical treatment of miscarriage was not more cost-effective, when the adverse events were considered. As neither of these two methods was economically superior, the treatment choice should be made on an individual basis by respecting the patient's choice.

Cost-effectiveness analysis of nimodipine treatment after aneurysmal subarachnoid hemorrhage and surgery.

OBJECTIVE: To assess the cost-effectiveness ratio of nimodipine administration after aneurysmal subarachnoid hemorrhage (SAH) and surgery. METHODS: One hundred twenty-seven patients of both sexes who had a ruptured aneurysm (verified using angiography), who presented with Hunt and Hess Grades I to III on admission, who underwent an operation within the first week after SAH, and who had participated in a randomized prospective clinical trial of nimodipine medication were enrolled in the study. The efficiency (cost-effectiveness) of nimodipine treatment was evaluated by incremental cost-effectiveness analysis. The cost-effectiveness ratio was evaluated for two groups: patients treated with nimodipine and patients given placebo. The cost was estimated as direct hospitalization costs, and the patient outcome was measured as life years gained. RESULTS: The incremental cost-effectiveness ratio for nimodipine treatment was $223 per life year gained on the basis of 1996 monetary values and contemporary management of SAH. Patients in the nimodipine group had an average of 3.46 years longer life expectancy (incremental effectiveness) than those in the placebo group. There was a significant difference in 3-month follow-up mortality and a slight difference in sickness pensions during the 10 years after SAH. Nimodipine treatment was associated with a significant decrease in mortality. There were no statistically significant differences between the treatment groups in the length of hospital stay. There were no statistically significant differences between the treatment groups in sickness pensions. CONCLUSION: Nimodipine is cost-effective. Therefore, its use in the management of patients with SAH seems economically justified because it increases patient life years at very low incremental cost.

Long-term follow-up of conservatively treated chronic tennis elbow patients. A prospective and retrospective analysis.

This study aimed to assess the long-term outcome of progressive exercise and local pulsed ultrasound in the treatment of 30 chronic tennis elbow patients (2 men, 18 women, mean age 42.3 years). The patients were originally randomised into 1) four-step progressive exercise (EX, n = 16) and 2) local pulsed ultrasound (US, n = 14) treatment groups. Before the beginning of the treatment, the groups were similar in terms of pain scores, sick-leave days and duration of symptoms. The patients underwent an 8-week treatment intervention. Long-term follow-up evaluation of the patients was performed 1) prospectively using a pain questionnaire on VAS and pain drawings classified into 5 categories, and 2) retrospectively with a postal questionnaire (which was sent to the patients to fill in. Sick-leave days, medical and physiotherapy visits, operations, early retirements and job relocations were inquired in the postal questionnaire. The diagnosis-related sick-leave days of the patients were collected from the Database of the Social Insurance Institution of Finland and the number of operations from the local hospital register. Twenty-three patients (12 in the EX group and 11 in the US group) responded. The mean follow-up time was 36 months. After the treatment the patients in the EX group needed significantly less physiotherapy (p = 0.02), fewer medical consultations (p = 0.005) and other treatments and had fewer sick-leave days (p = 0.005) than before the treatment intervention. The patients in the US group had after the treatment intervention more 17 medical visits (ns), 291 sick-leave days (ns) and less 95 physiotherapy visits (ns) than before the treatment. Eight patients (67%) in the EX group and 5 (45%) in the US group still held their previous job, while two patients in the US group, but none in the EX group were absent from work because of the tennis elbow syndrome. The patients in the EX group reported significantly lower pain scores on VAS than those in the US group. The mean pain drawing category was 1.5 in the EX group and 2.7 in the US group (p = 0.008). All the pain scores and pain drawing categories in the EX group had changed to be significantly better than in the US group, where only pain under strain had significantly improved. Because of resistant symptoms, 5 patients were operated in the US group and one in the EX group. Neither spontaneous healing, nor self-limiting of the disorder were noted during the follow-up period. The progressive exercise evaluated in this study showed beneficial long-term effects compared to ultrasound treatment in terms of pain alleviation and working ability, and the functional overall condition of the exercise patients was also better. Exercise may be able to prevent chronicity and should hence be tried and recommended.

Cochlear implant patients and quality of life.

During the last two decades, cochlear implants have been available for profoundly hearing-impaired patients who do not benefit from conventional hearing aids. The quality of life of these implantees has not been extensively studied, and has not been studied at all in Finland. To assess their quality of life, the Nottingham Health Profile questionnaire was sent to all adult implanted patients in Finland. Implantees tended to have more favourable average pain, emotional reaction and mobility indexes in each age group studied than the average population. Social-isolation seemed to be more common in the youngest and oldest age groups of implantees. Apparently, implantees are physically healthier than the average population. However, a bias caused by the strict selection of implant candidates cannot be excluded.

Cochllear implants and GSM phone.

Use of a telephone and GSM phones, in particular, was assessed by means of a postal interview sent to all adult Finnish implantees. The response rate was very high (87%). Fifty-one of the 61 respondents used a telephone and 27/61 also used a mobile phone, usually a digital phone. Two GSM phone models from Nokia (3110 and 6110) were tested with three different cochlear implant systems used by nine patients. Definite differences between the processors were found. Nucleus Spectra (two implantees) could not be used with any of the GSM phones under any test condition. Nucleus SPrint was incompatible with both GSM phone models in a poor field, while GSM phone model 6110 could be used in a good field. The Med-El Combi 40+ processor was compatible with both GSM models tested under any condition.