Luciana Frighetto

Cost-Utility Analysis of Tissue Plasminogen Activator Therapy for Acute Ischaemic Stroke A Canadian Healthcare Perspective

AbstractBackground: There are over 40 000 ischaemic strokes annually in Canada, which result in significant morbidity, mortality and burden to the healthcare system. A recent, large clinical trial has evaluated tissue plasminogen activator (t-PA) intravenously for the treatment of acute ischaemic stroke with promising outcomes but with an increased risk of symptomatic intracranial haemorrhage. Objective: To compare clinical and economic outcomes of intravenous t-PA therapy (0.9 mg/kg, to a maximum of 90mg, initiated within 3 hours of stroke onset) versus no t-PA for acute ischaemic stroke based on the outcomes achieved in the National Institute of Neurological Disorders and Stroke (NINDS) trial. Design: A Markov model depicting the natural lifetime course after an initial acute ischaemic stroke. On the basis of this model, a simulated trial compared no t-PA with t-PA. Patients: A hypothetical cohort of 1000 patients with acute ischaemic stroke. Study perspective: Canadian healthcare system. Outcome measures: Total acute stroke and post-stroke treatment costs and cumulative quality-adjusted life-years (QALYs). Results: For a hypothetical cohort of 1000 patients, the estimated lifetime stroke costs were 103 100 000 Canadian dollars (

Cost Analysis of an Adult Outpatient Parenteral Antibiotic Therapy (OPAT) Programme A Canadian Teaching Hospital and Ministry of Health Perspective

Can) [1999 values) in the t-PA arm (

Cost-effectiveness of prophylactic dolasétron or droperidolvs rescue therapy in the prevention of PONV in ambulatory gynecologic surgery

Can103 100 per patient) compared with

Intravenous-to-Oral Stepdown Program: Four Years of Experience in a Large Teaching Hospital

Can106 900 000 in the no t-PA arm (

An assessment of quality of sleep and the use of drugs with sedating properties in hospitalized adult patients

Can106 900 per patient), yielding a lifetime cost difference of

Quality-of-Life Assessment in an Outpatient Parenteral Antibiotic Program

Can3 800 000 in favour of t-PA versus no t-PA (

Willingness to pay to assess patient preferences for therapy in a Canadian setting

Can3800 per patient). In the hypothetical cohort, t-PA treatment resulted in 13 130 QALYs versus 9670 QALYs with no t-PA treatment. This translated into a net benefit of 3460 additional QALYs per 1000 patients (3.46 QALYs per patient). No treatment, outcome or economic variables influenced the model outcome. Conclusion: From the standpoint of cost effectiveness, treatment of acute ischaemic stroke with intravenous t-PA is an economically attractive strategy.

Cost-Effectiveness Analysis of Enoxaparin versus Unfractionated Heparin for Acute Coronary Syndromes: A Canadian Hospital Perspective

AbstractBackground: Outpatient parenteral antibiotic therapy (OPAT) programmes have become prevalent over the past 2 decades. From the US perspective, these programmes have been shown to reduce healthcare costs. No comprehensive analysis has been published from the Canadian perspective. Objective: To describe a Canadian OPAT programme for the 3-year period since its inception and to conduct a treatment cost analysis. Design and methods: Demographics and resource utilisation data (health professional labour, laboratory and diagnostic tests, antimicrobials, delivery, home nursing care, catheters and catheter placement) were prospectively collected for enrollees in the OPAT programme over the evaluation period. Avoided hospital resource utilisation was estimated via retrospective chart review by the investigators. Costs were retrospectively assigned to each resource and total cost avoidance by the OPAT programme was determined from each perspective. Perspective: A teaching hospital and a provincial Ministry of Health (MOH). Main outcome measures and results: 140 treatment courses were initiated for 117 adult patients (mean age 54 years) who were enrolled into the programme. Mean pre-OPAT length of hospital stay was 12 days, and mean OPAT duration was 22.5 days. Bone/joint (39%), skin and soft tissue (16%), cardiac (13%) and respiratory tract (12%) infections were the most common infections managed. The most commonly used antimicrobials were vancomycin (29%), cloxacillin ± gentamicin (22%) and ceftriaxone ± gentamicin (11%). 85%of enrollees successfully completed their planned antimicrobial treatment regimens. Premature discontinuation of antimicrobial therapy for various reasons occurred in the remaining 15% of courses. The mean cost per treatment course of OPAT was 1910 Canadian dollars (

Piperacillin/tazobactam versus imipenem: a double-blind, randomized formulary feasibility study at a major teaching hospital.

Can) from the hospital perspective and

A New Ciprofloxacin Stepdown Program in the Treatment of High‐Risk Febrile Neutropenia: A Clinical and Economic Analysis

Can6326 from the MOH perspective. Assuming that patients would have otherwise completed their antimicrobial therapy in hospital, the mean cost per treatment course was estimated to be