J. Hay

Comparative effectiveness of statin plus fibrate combination therapy and statin monotherapy in patients with type 2 diabetes: use of propensity-score and instrumental variable methods to adjust for treatment-selection bias

Type 2 diabetes is associated with increased cardiovascular risk. The comparative effectiveness of statin plus fibrate combination therapy and statin monotherapy in reducing risk of cardiovascular disease in real‐world settings is unknown.

Measuring the impact of patient counseling in the outpatient pharmacy setting : the research design of the Kaiser permanente/USC patient consultation study

This article describes the research method used to measure the impact of three alternative models of patient counseling in the outpatient pharmacy setting. The study was conducted in pharmacies operated by the Southern California region Kaiser Permanente Medical Care Program. Both random assignment and large-scale geographic area research designs were used. The presentation of the research design includes discussions of data collection and patient sampling methods; the measurement of patient outcomes, including measures of health care costs and utilization, patient functional status, and quality of life. Demographic data are presented for the study population, including an analysis of potential biased selection of patients electing to participate in random assignment. Data are also presented documenting potential selection bias across geographically determined treatment groups in the geographic area design arm. Finally, the article presents the analysis plan for the study and discusses study limitations.

Cost-benefit analysis of in-hospital influenza vaccination of postpartum women.

OBJECTIVE: To estimate the potential economic benefits associated with hospital-based postpartum influenza vaccination. METHODS: We constructed a decision analysis model to estimate the potential cost benefit of this strategy from both a societal perspective and a third-party perspective. We included a hypothetical cohort of 1.47 million U.S. postpartum women, assuming an influenza season beginning September 1 and ending April 30. Probabilities and costs were derived from published literature, Centers for Disease Control and Prevention data, and expert recommendations. We used one-way and two-way sensitivity analyses. All cost estimates were inflated to year 2010 U.S. dollars and discounted at a 3% annual discount rate. RESULTS: From the societal perceptive, the expected costs per vaccinated and unvaccinated mother were

Efficacy of Bypassing Agents in Patients With Hemophilia and Inhibitors: A Systematic Review and Meta-Analysis

328.45 and

Cost-benefit analysis of hospital based postpartum vaccination with combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap).

341.02 respectively, resulting in an expected net benefit of

Bypass therapy assay testing as a strategy to reduce costs for treatment of haemophilia patients with inhibitors

12.57 per vaccinated mother. The overall savings in the cohort were predicted to range from

Behavioral Economics Interventions to Improve Outpatient Antibiotic Prescribing for Acute Respiratory Infections: a Cost-Effectiveness Analysis

3.69 to

Effects of Ambulatory-Care Pharmacist Consultation on Mortality and Hospitalization

14.75 million, depending on the vaccination coverage rate. This strategy would be cost-beneficial, holding all other variables to the base case, if the annual maternal influenza attack rate is more than 2.8%, influenza vaccine efficacy is more than 47%, or if vaccine acquisition and administration cost per dose are less than

Cost-Effectiveness Analysis of Abiraterone and Sipuleucel-T in Asymptomatic Metastatic Castration-Resistant Prostate Cancer

32.78. The strategy would not generate net savings from the third-party perspective. Sensitivity analyses were robust, but disease incidence and vaccine efficacy were important drivers. CONCLUSION: Our model suggests that postpartum influenza vaccination is a cost-beneficial approach for prevention of maternal and infantile influenza from a societal perspective. LEVEL OF EVIDENCE: III

Rolling Out Oral Pre-Exposure Prophylaxis (Prep) Is a Cost-Effective Hiv Prevention Strategy Among the los Angeles County (Lac) Men Who Have Sex With Men (Msm)

BACKGROUND Activated prothrombin complex concentrate (aPCC) and recombinant Factor VIIa (rFVIIa) are 2 bypassing agents commonly used for treating acute bleeds in hemophiliac patients with inhibitors. A wide range of efficacy rates for aPCC and rFVIIa have been reported in a number of single-armed and randomized controlled comparative studies. OBJECTIVE The aims of this study were to compare the clinical efficacy of aPCC and rFVIIa using a classic meta-analytic approach and to explore the role of study characteristics as covariates in a meta-analysis of previously published clinical studies in hemophiliac patients with antibodies to the missing Factor VIII or IX. METHODS A systematic search was conducted to identify studies on the efficacy of aPCC and rFVIIa 90 and 270 μg/kg for treating joint bleeds. The efficacy rates with aPCC and rFVIIa were pooled separately, assuming fixed or random effects. Subgroup analyses were conducted to pool the efficacy rates for bleeds evaluated at 8-12, 18-27, and 36-72 hours after the start of the initial infusion. Meta-regression was used to investigate the association between pooled efficacy rates and study characteristics. RESULTS Although only 2 studies directly compared the efficacy of aPCC and rFVIIa, data from ~2392 joint bleeding episodes from 19 studies were included. The pooled efficacy rates were 80.8% with aPCC and 68.4% with rFVIIa (90 μg/kg, 72.0%; 270 μg/kg, 55.7%). The pooled efficacy rates with aPCC at 8-12, 18-27, and 36-72 hours were 49.2%, 70.2%, and 90.9%, respectively. The corresponding pooled rates with rFVIIa 90 μg/kg were 66.6%, 70.7%, and 77.7%. No significant differences were found between the pooled efficacy rates with aPCC and rFVIIa overall or at any of the time points evaluated. Positive associations were found between reported efficacy and duration of follow-up and the number of bleeds evaluated. CONCLUSIONS Given the paucity of high-quality studies, the findings from the present review and meta-analysis suggest no conclusive evidence that aPCC or rFVIIa is significantly more efficacious than the other in the treatment of joint bleeding episodes in hemophiliac patients with inhibitors.