Cost-effectiveness of two endovascular treatment strategies vs intravenous thrombolysis.

OBJECTIVE: To assess the cost-effectiveness of endovascular treatment against intravenous thrombolysis (IVT) when varying assumptions concerning its effectiveness. METHODS: We developed a health economic model including a hypothetical population consisting of patients with ischemic stroke, admitted within 4.5 h from onset, without contraindications for IVT or intra-arterial treatment (IAT). A decision tree and life table were used to assess 6-month and lifetime costs (in Euros) and effects in quality-adjusted life years treatment with IVT alone, IAT alone, and IVT followed by IAT if the patient did not respond to treatment. Several analyses were performed to explore the impact of considerable uncertainty concerning the clinical effectiveness of endovascular treatment. RESULTS: Probabilistic sensitivity analysis demonstrated a 54% probability of positive incremental lifetime effectiveness of IVT-IAT vs IVT alone. Sensitivity analyses showed significant variation in outcomes and cost-effectiveness of the included treatment strategies at different model assumptions. CONCLUSIONS: Acceptable cost-effectiveness of IVT-IAT compared to IVT will only be possible if recanalization rates are sufficiently high (>50%), treatment costs of IVT-IAT do not increase, and complication rates remain similar to those reported in the few randomized studies published to date. Large randomized studies are needed to reduce the uncertainty concerning the effects of endovascular treatment.

Patient and physician preferences for oral pharmacotherapy for overactive bladder: two discrete choice experiments.

OBJECTIVE: We examined patient and treating physician (general practitioners, urologists, and [uro]gynecologists) preferences for oral pharmacotherapy (antimuscarinics and beta-3 adrenoceptor agonists) for overactive bladder to gain a deeper understanding of which attributes drive their treatment decision-making and to quantify to what extent. RESEARCH DESIGN AND METHODS: Two separate discrete choice experiments were developed and validated using the input of patients and physicians. The patient experiment contained the following attributes: micturition frequency, incontinence, nocturia, urgency, dry mouth, constipation, increased heart rate, and increased blood pressure. The physician experiment contained two additional attributes: coping and atrial fibrillation. Both were fielded in five European countries. To allow for preference heterogeneity, utility functions were estimated using a mixed multinomial logit model. RESULTS: A total of 442 patient and 318 physician responses were analyzed. Patients ranked the attributes based on their largest potential impact on treatment value as follows: incontinence, nocturia, risk of an increased heart rate, urgency, frequency, risk of increased blood pressure, risk of constipation, and risk of dry mouth; and physicians as follows: incontinence, urgency, nocturia, frequency, risk of dry mouth, coping, risk of increased heart rate, risk of increased blood pressure, risk of atrial fibrillation, and risk of constipation. CONCLUSION AND LIMITATIONS: In their valuations, physicians put more emphasis on increasing benefits, whereas patients put more emphasis on limiting risks of side effects. Another contrast that emerged was that patients' valuations of side effects were found to be fairly insensitive to the presented risk levels (with the exception of risk of dry mouth), whereas physicians' evaluated all side effects in a risk-level dependent manner. The obtained utility functions can be used to predict whether, to what extent, and for which reasons patients and physicians would choose one oral pharmacotherapy over another, as well as to advance shared decision-making.

Studies on the descendancy of four populations of Koekelaere pines: Pinus nigra Arnold, subsp. laricio (Poiret) Maire, cv. Koekelaere. II. Heritability as a function of parental age.

The variations of heritability as a function of parental age are studied in Koekelaere pines [Pinus nigra Arnold, laricio (Poiret) Maire, cv. Koekelaere]. The age of the parental trees varies between 26 and 101 years. 16 different traits are analysed. It is shown that heritability does not vary as a function of parental age. These results are discussed in relation with the problems of ageing in trees and of the theories of ageing.

A regression model for the rate of success of in vitro fertilization.

The treatment of infertility by in vitro fertilization involves several aspects of human reproductive physiology. Since failures are still numerous and since improved techniques are becoming increasingly available, it is important to develop a model where the components of success are identified, allowing estimation of the occurrence of these components of success in the infertile population. The model of Speirs reduces these components to two: uterine receptivity and embryo viability. The probabilities of uterine receptivity and embryo viability were estimated here in a retrospective study of patients in a Belgian hospital sample. For comparison, Australian and U.S. data were used. It was shown that the estimate of uterine receptivity for the Belgian sample is located between the estimates for Australian and U.S. samples. In view of the psychological problem of repeated unsuccessful attempts at in vitro fertilization in some patients, it is important to be able to single out some prognostic factors that would allow more precise estimation of the probability for success in each case. A regression method was developed for that purpose. Only the effect of age, in the Belgian sample, was found to influence uterine receptivity significantly.

In-vitro fertilization: how many attempts before success?

Repeated attempts increase the overall rate of success of sterility therapy by in-vitro fertilization. The present study, using data collected between 1983 and 1987 in a Belgian hospital, attempts to investigate the expected number of treatment cycles before success is achieved. The answer requires some knowledge about the degree of independence between success probability and treatment duration. Using mathematical models of implantation, it can be shown that success probability actually decreases during treatment. A method for updating individual probabilities is suggested; it could be used as a prognostic estimation for women undergoing this kind of therapy.