Analysing uncertainty around costs of innovative medical technologies: the case of fibrin sealant (QUIXIL) for total knee replacement.

This paper presents a relatively simple cost model comparing the costs of using a commercial fibrin sealant (QUIXIL) in addition to conventional haemostatic treatment vs. conventional treatment alone in total knee replacement (TKR) surgery, and demonstrates and discusses how one- and two-way sensitivity analyses can inform decisions regarding an innovative medical technology, for which there is limited evidence on economic parameters. The model synthesises data from various sources and assesses the proportion of individuals likely to need blood transfusion, the resource use after TKR and transfusion-related adverse events. Whether using fibrin sealant is cost saving strongly depends on the amount used, the achieved reduction in hospital length of stay (LOS) and price of QUIXIL. If a 10-ml dose of fibrin sealant is required to achieve the effects as described in the published trials, its use adds cost, but if 25% or more of patients are treated with a 5-ml dose, its use becomes cost saving for the NHS. The sensitivity analyses provide clear guidance regarding parameters for additional data collection; design of future trials; and product pricing in relation to its effectiveness, and are likely to be preferred over more sophisticated approaches to inform medical device decision-making, particularly at the local level.

Assessment of the value of doubled haploids as progenitors in cocoa (Theobroma cacao L.) breeding.

In order to evaluate twelve doubled haploids (DHs) of Theobroma cacao L. used as parents, a trial was set up in Côte d'Ivoire. Several traits were observed, such as yield, vigour, yield/vigour ratios, resistance to the black pod disease caused by Phytophthora, percentage of flat beans and mean weight of 100 cocoa beans. Out of the three progenies derived from crosses between two DHs, two showed severe drawbacks. A reduction of the heterogeneity within these progenies was occasionally observed for some of the traits, but failed to be consistent. When tested as female parents in combination with diploid testers, some of the DHs showea significantly higher combining value than their parents for traits such as the mean weight of 100 beans and the yield/canopy surface ratio. The results showed the potential of DHs to improve selected parents in only one cycle of selection but more crosses between two DHs need to be tested in order to evaluate potential of the resulting F(1) progenies.

Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States.

BACKGROUND: The economic impact of adding chlorhexidine gluconate (CHG)-impregnated sponge dressing to standard care (ie, chg-impregnated sponge dressing + skin preparation and transparent film dressing vs skin preparation and transparent film dressing) for the prevention of central-line infections was evaluated. METHODS: Clinical and economic data were obtained from peer-reviewed published studies to populate the decision model. The efficacy of reducing catheter-related bloodstream infection (CR-BSI) incidence with CHG-impregnated sponge dressing came from 2 recent randomized controlled trials. One-way and two-way sensitivity analyses were performed on key clinical and economic parameters. RESULTS: Based on model calculations, a hypothetical 400-bed hospital inserting 3,078 central venous catheters (CVCs) per year is expected to avoid an average of 35 CR-BSIs, 145 local infections, and 281 intensive care unit days annually with the systematic use of CHG-impregnated sponge dressing. Potential hospital net cost savings (mainly because of reduced CR-BSIs with use of the dressing) would be $895,000 annually. Results were robust across a range of values in sensitivity analyses. CONCLUSION: CHG-impregnated sponge dressing is a cost-effective CR-BSI prevention treatment option for patients requiring CVCs. The importance of these results should be considered in the context of federal government and insurance company policies that no longer permit enhanced reimbursement for CR-BSI.