Evaluation of the "Know Your Health" program for type 2 diabetes mellitus and hypertension in a large employer group.

OBJECTIVE: To evaluate the effect of an educational intervention program on clinical outcomes and on compliance with medical therapy in patients with type 2 diabetes mellitus (DM), hypertension, or both. STUDY DESIGN: Six-month randomized unblinded study. METHODS: Three hundred fifty-two patients were screened, and 347 were randomized to the intervention group (education through the Know Your Health [KYH] program [n = 174]) or to the control group (usual care [n = 173]). Evaluation of the effectiveness of the KYH program was based on the cohort of patients who were not at goal at baseline (124 in the intervention group and 115 in the control group). The primary research interests were to assess patient acceptance of the KYH materials and to compare the clinical outcomes of the intervention group with those of the control group. RESULTS: After 6 months, significantly more patients in the intervention group than in the control group were at goal (44.2% vs 29.2%, P = .046). Among patients with hypertension, reductions in the mean diastolic blood pressure were significantly greater in the intervention group compared with the control group at month 6 (-6.7 vs -3.6 mm Hg, P = .04). The groups did not differ significantly on other primary end points (percentage of patients with DM who were at goal, change from baseline glycosylated hemoglobin level, and change in Morisky score). CONCLUSIONS: Participation in the KYH educational program during a 6-month period improved clinical outcomes in patients with type 2 DM or hypertension. The KYH materials were well received and were considered informative and easily comprehensible by patients who completed the program.

An economic evaluation of donepezil in mild to moderate Alzheimer's disease: results of a 1-year, double-blind, randomized trial.

The costs and consequences of donepezil versus placebo treatment in patients with mild to moderate Alzheimer's disease (AD) were evaluated as part of a 1-year prospective, double-blind, randomized, multinational clinical trial. Patients received either donepezil (n = 142; 5 mg/day for 28 days followed by 10 mg/day according to the clinician's judgement) or placebo (n = 144). Unit costs were assessed in 1999 Swedish kronas (SEK) and converted to US dollars (USD). Donepezil-treated patients gained functional benefits relative to placebo on the Progressive Deterioration Scale (p = 0.042) and Instrumental Activities of Daily Living scale (p = 0.025) at week 52. Caregivers of donepezil-treated patients spent an average of 400 h less annually providing care than caregivers of placebo-treated patients. Mean annual healthcare costs were SEK 137,752 (USD 16,438) per patient for the donepezil group and SEK 135,314 (USD 16,147) in the placebo group. With the average annual cost of donepezil at SEK 10,723 (USD 1,280) per patient, the SEK 2,438 (USD 291) cost difference represented a 77% cost offset. When caregiver time and healthcare costs were included, mean annual costs were SEK 209,244 (USD 24,969) per patient in the donepezil group and SEK 218,434 (USD 26,066) in the placebo group, a total saving associated with donepezil treatment of SEK 9,190 (USD 1,097) per patient [95% CI of SEK -43,959 (USD -5,246), SEK 25,581 (USD 3,053); p = 0.6]. The positive effects on the efficacy outcome measures combined with no additional costs from a societal perspective indicate that donepezil is a cost-effective treatment, representing an improved strategy for the management of patients with AD.