ABSTRACT
OBJECTIVE: To estimate the cost per ischaemic event (death, nonfatal myocardial infarction, subsequent revascularisation procedure) avoided at 6 months in high risk patients undergoing coronary revascularisation treated with abciximab during routine medical care. DESIGN: Retrospective, matched cohort design. SETTING: University teaching hospital. PATIENTS: 62 abciximab-treated patients and 62 patients not treated with abciximab with high risk coronary lesions were matched according to gender, hyperlipidaemia, diabetes mellitus and stenting. MAIN OUTCOME MEASURES: Using a third-party payer's perspective, an incremental cost-effectiveness ratio (ICER) was computed as the cost per ischaemic event avoided over 6 months. Fieller's theorem was used to estimate confidence sets and confidence ellipses were generated to visually represent the variability in the data. RESULTS: At 6 months, abciximab-treated patients experienced an approximately 40% lower rate of ischaemic events (16.1 vs 27.4%; p = 0.128). The point estimate of the ICER was $US21,789 per ischaemic event avoided. Fieller's theorem resulted in a 95% confidence set consisting of 2 half-lines (-infinity to -$US115,461) and ($US391 to +infinity), reflecting the finding that the ICER denominator was not significantly different from zero at the p = 0.05 level. CONCLUSIONS: In high risk patients treated during routine care, the effectiveness of abciximab was consistent with efficacy rates from clinical trials. However, abciximab-treated patients remained approximately $US2400 more costly at 6 months.
Subject(s)
Antibodies, Monoclonal/economics , Anticoagulants/economics , Coronary Disease/economics , Immunoglobulin Fab Fragments/economics , Abciximab , Antibodies, Monoclonal/therapeutic use , Anticoagulants/therapeutic use , Cohort Studies , Coronary Disease/drug therapy , Coronary Disease/surgery , Cost-Benefit Analysis , Drug Costs , Female , Follow-Up Studies , Hospital Costs , Humans , Immunoglobulin Fab Fragments/therapeutic use , Male , Middle Aged , Myocardial Infarction/economics , Myocardial Infarction/prevention & control , Myocardial Ischemia/economics , Myocardial Ischemia/prevention & control , Myocardial Revascularization/economics , Platelet Aggregation Inhibitors/economics , Platelet Aggregation Inhibitors/therapeutic use , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Randomized Controlled Trials as Topic , Retrospective Studies , Treatment OutcomeABSTRACT
Studies of estrogen effects on growth hormone (GH) and its pulsatile release in postmenopausal women have typically utilized estrogen replacement therapy (ERT) of relatively short duration (days to weeks). The purpose of this study was to compare GH measures from healthy postmenopausal women who were on oral ERT for 3 years or more (n = 24; mean ERT duration = 16.1 years) with women not on ERT (NERT; n = 40). Blood samples were drawn remotely every 20 min for 24 h and then analyzed for mean 24-h GH, mean GH during sleep, and mean 24-h insulin-like growth factor-I (IGF-I). GH peak analyses were also performed. Mean 24-h GH and GH during sleep were significantly higher and IGF-I was significantly lower in ERT women compared with NERT women. In addition, use of long-term ERT was associated with more GH peaks relative to women not on ERT, but no change in GH peak amplitude or area. GH was not related to age in either group. GH was strongly and negatively correlated with measures of adiposity in NERT women but not in ERT women. In conclusion, long-term oral ERT is associated with increased circulating GH and decreased IGF-I levels, even after many years of treatment.