Diana J. Kaniecki

Cost of treating an episode of variceal bleeding in a VA setting

OBJECTIVES:The specific aims of this study were to develop a demographic description of a sample of patients presenting with bleeding esophageal varices and determine the direct health care costs of variceal bleeding.METHODS:This was a retrospective evaluation of patients who underwent esophagogastroduodenoscopy at the Portland VA Medical Center between January 1993 and May 1997. Data sources included both electronic databases and patient medical charts. The primary unit of analysis was an episode of care, defined as an index bleed plus 6 months of follow-up or death, whichever came first.RESULTS:The total inpatient direct cost was

Comparative cost-effectiveness analysis of quinidine, procainamide and mexiletine

1,566,904 and outpatient direct cost was

Medical Resource Use and Costs of Congestive Heart Failure after Carvedilol Use

104,611, for a total of

Economic analysis in clinical trials : Practical considerations

1,671,515 for 100 bleeding episodes in 79 patients. Episodes of care for patients receiving ≤2 units of packed red blood cells were approximately a third as costly as those receiving >2 units of packed red blood cells (n = 17,

Considerations in Measuring Resource use in Clinical Trials

6,470 and n = 83,

Pharmacoeconomic Considerations in Antiarrhythmic Therapy

17,553). The difference in costs was statistically significant (p < 0.05), and primarily attributable to hospital bed costs.CONCLUSIONS:There is a substantial financial burden associated with this illness, primarily attributable to inpatient costs. In addition to severity of bleeding, Childs class, endoscopic findings, and the timing of pharmacological therapy seem to influence the overall cost of managing esophageal varices.

Use of a Decision-Analytic Model to Support the Use of a New Oral US Contrast Agent in Patients with Abdominal Pain

Quinidine and procainamide have the potential for major organ toxicity, whereas mexiletine has been reported to have little risk of organ toxicity, serious proarrhythmia or congestive heart failure, but a relatively high incidence of nuisance side effects. In light of the potential adverse effects of all antiarrhythmic agents as highlighted by the Cardiac Arrhythmia Suppression Trial, the relative cost-effectiveness of these 3 agents was assessed. Based on a review of greater than 1,000 published reports, studies included in the analysis examined greater than or equal to 1 of these agents in adults, with adequate efficacy or safety data, or both. The majority of studies assessed patients with symptomatic or malignant arrhythmias, or both. Data were analyzed using a decision analysis/cost-effectiveness model. Probabilities were averaged using techniques of meta-analysis. Costs were obtained from a university medical center cost-accounting system and from expected follow-up visits to university clinics. Thirty-seven separate side effects were included in the analysis. In terms of overall cost, 12 months of mexiletine would engender

Integrating worldwide marketing needs and clinical research.

875, quinidine

The effect of atopic dermatitis on total burden of illness and quality of life on adults and children in a large managed care organization.

1,239 and procainamide

Comparative Cost-effectiveness Analysis of Theophylline and Ipratropium Bromide in Chronic Obstructive Pulmonary Disease: A Three-center Study

1,911 of expenses. Mexiletine dominates the older agents in terms of cost per successful drug response, a result that holds over a wide range of efficacy and safety data. Analyses demonstrated no increase in all-cause mortality for quinidine and mexiletine over placebo, but a trend toward higher mortality with procainamide. The results suggest that mexiletine is a cost-saving alternative therapy for ventricular arrhythmias when adverse reactions are considered in addition to pharmaceutical costs and treatment efficacy.