Cost-effectiveness of percutaneous coronary intervention with cobalt-chromium everolimus eluting stents versus bare metal stents: Results from a patient level meta-analysis of randomized trials.

BACKGROUND: Second-generation drug eluting stents (DES) may reduce costs and improve clinical outcomes compared to first-generation DES with improved cost-effectiveness when compared to bare metal stents (BMS). We aimed to conduct an economic evaluation of a cobalt-chromium everolimus eluting stent (Co-Cr EES) compared with BMS in percutaneous coronary intervention (PCI). OBJECTIVE: To conduct a cost-effectiveness analysis (CEA) of a cobalt-chromium everolimus eluting stent (Co-Cr EES) versus BMS in PCI. METHODS: A Markov state transition model with a 2-year time horizon was applied from a US Medicare setting with patients undergoing PCI with Co-Cr EES or BMS. Baseline characteristics, treatment effects, and safety measures were taken from a patient level meta-analysis of 5 RCTs (n = 4,896). The base-case analysis evaluated stent-related outcomes; a secondary analysis considered the broader set of outcomes reported in the meta-analysis. RESULTS: The base-case and secondary analyses reported an additional 0.018 and 0.013 quality-adjusted life years (QALYs) and cost savings of $236 and $288, respectively with Co-Cr EES versus BMS. Results were robust to sensitivity analyses and were most sensitive to the price of clopidogrel. In the probabilistic sensitivity analysis, Co-Cr EES was associated with a greater than 99% chance of being cost saving or cost effective (at a cost per QALY threshold of $50,000) versus BMS. CONCLUSIONS: Using data from a recent patient level meta-analysis and contemporary cost data, this analysis found that PCI with Co-Cr EES is more effective and less costly than PCI with BMS. © 2016 The Authors. Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

Removable cast chrome cobalt retainers for extended or indefinite period clinical use.

Patients are frequently being asked to wear orthodontic retainers for as long as they want their teeth to remain in the post-treatment position. Fixed retainers, which are placed on the lingual surface of anterior teeth only, have the advantage of minimal compliance issues but are not without their problems related to wire fracture, adhesive failure and potential gingival or periodontal disease. Plastic retainers, although associated with relatively good aesthetics and compliance, have limitations related to their physical and mechanical properties. This paper describes a chrome cobalt metal retainer that could be used as a long-term retainer with few drawbacks. The properties of chrome cobalt are described and the clinical procedure is outlined.

Cast metal bases as an economical alternative for the severely resorbed mandible.

Resorption of the alveolar ridge is a common problem in edentulous patients and can compromise the stability and function of dentures. Resorption and its consequences can be minimized when strategically placed implants are used; however, this option is financially out of reach for many patients. The article discusses a more cost-effective alternative (metalbased dentures) for patients with ridge resorption. In certain environments, like a dental school, where patients are looking for solutions to their dental problems at a reasonable price, cast metal bases can be a feasible economical alternative for edentulous patients. Both cases presented here demonstrated a significant improvement in stability, phonation, and mastication.

Effect of re-using nickel-chromium alloy on its ultimate tensile strength, yield strength and modulus of elasticity.

In order to bring down the cost of the castings used in fixed partial denture prosthesis, a study was conducted by reusing the nickel chromium alloy without adding any new material. We studied the effect on the ultimate tensile strength, yield strength and modulus of elasticity after reusing the nickel-chromium alloys. Results showed degenerative changes in the properties evaluated after recasting. These changes were statistically significant, suggesting that it can not be reused.

Soldering and remelting influence on fatigue strength of cobalt-chromium alloys.

STATEMENT OF PROBLEM: For laboratory production, it would be economically advisable to reuse excess cobalt-chromium alloys in manufacturing partial denture frameworks. Furthermore, discrepancies in fit, modifications, repairs, and also economic factors could lead to soldering procedure on the metal framework. PURPOSE: This study evaluated the influence of soldering and remelting procedures on the fatigue strength of Steldent, Dentorium, and Biosil cobalt-chromium alloys, as new alloys and in a mixture of new and previously casted alloy and when submitted or not submitted to conventional soldering procedure. MATERIAL AND METHODS: The soldering procedure was conducted in rod specimens 1.7 mm in diameter made with new, or with a mixture of new and reused alloy (n = 10 per group). The results were compared with those of intact rods. The fatigue strength was carried out with a cyclic testing machine simulating the insertion and the removal of partial dentures. After failure, the fracture surface was examined with a scanning electron microscope. RESULTS: The soldered specimens revealed 1119 loading cycles before fracture. These means differed statistically from those of intact alloys, which disclosed 2733 cycles before failure (p < 0.05). Statistical analysis indicated that the soldering procedure reduced fatigue strength of all new alloys or those in a mixture of new and previously casted alloys. It was also found that the soldering procedure may cause premature failure of a removable partial denture. Photomicrographs from fracture surfaces revealed the presence of inclusions and voids. Conversely, there were no significant differences between new and reused specimens, soldered or not (p > 0.05), which suggested that it may be possible to reuse excess cobalt-chromium alloys without compromising the fatigue strength of the framework.