Renée J. Goldberg Arnold

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

A retrospective randomized study of asthma control in the US: Results of the CHARIOT study

1,566,904 and outpatient direct cost was

Time for Cooperation in Health Economics among the Modelling Community

104,611, for a total of

Comparative cost-effectiveness analysis of quinidine, procainamide and mexiletine

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,

Cost containment strategies in the United States : Role of cost-effectiveness research

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.

Cost-Effectiveness of Antihypertensive Agents in Patients With Reduced Left Ventricular Function

ABSTRACT Background: The third version of the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report (EPR-3): Guidelines on the Diagnosis and Management of Asthma emphasizes the need to use asthma control rather than patient severity to base adjustments to treatment and ultimately improve patient outcomes. The objectives of the current study were to assess control of patients with moderate-to-severe asthma, examine the natural history of the disease, practice patterns and resource utilization in specialty community practices according to recently reviewed NAEPP guidelines. Research design and methods: This analysis represents a retrospective, multicenter, randomized study of 1009 patient charts in sixty United States allergy and pulmonary medicine community practices. The proportion of patients with controlled and uncontrolled asthma over 12 months, prevalence and characteristics of atopy, past asthma history, pulmonary function, medications and treatment patterns, patient and clinical practice characteristics were analyzed. Main outcome measures: The primary outcome of interest was asthma control. Results: A total of 365 male and 644 female patients with moderate-to-severe persistent asthma (mean 43.2 ± 17.1 years) were enrolled. 81.9% of patients were uncontrolled according to recent NAEPP guidelines. Importantly, a greater percentage of patients with moderate asthma vs. severe persistent asthma were uncontrolled (p < 0.0114). Atopy was detected in 92% of patients. Patients with early onset of asthma were associated with control (p < 0.0433). Atopic symptoms, such as allergic rhinitis (p < 0.0130) and rhinosinusitis (p < 0.0476), were associated with uncontrolled asthma. Uncontrolled patients were also associated with more medications (a mean of 4.05 ± 1.87 medications) than were controlled patients (a mean of 3.40 ± 1.37 medications (p < 0.0001), although the temporal relationship of this association was not recorded. Limitations may have included patient and/or study site selection bias and difficulty in the process of operationalizing the definitions of control and disease severity. Since the current study only examined patients from specialty practices, the results may not be generalizable to the overall asthma population. Conclusions: Greater than 80% of asthma patients from specialty practices were uncontrolled with regard to asthma symptoms. Atopic symptoms, such as allergic rhinitis and rhinosinusitis, in addition to a greater number of medications, were associated with uncontrolled asthma. Moreover, patients designated as having asthma of moderate severity were associated with being uncontrolled more than were those with severe asthma (p < 0.0114), which suggests that the former population may not have received adequate assessment of impairment or risk, with subsequent changes in treatment for control of symptoms.

Pharmacoeconomic Considerations in Antiarrhythmic Therapy

1 Master of Public Health Program, Mount Sinai School of Medicine, Department of Preventive Medicine, New York, New York, USA 2 Arnold Consultancy and Technology LLC, New York, New York, USA 3 Arnold and Marie Schwartz College of Pharmacy, Brooklyn, New York, USA 4 Collaborations in Chemistry, Jenkintown, Pennsylvania, USA 5 Collaborative Drug Discovery, Burlingame, California, USA 6 Department of Pharmaceutical Sciences, University of Maryland, Baltimore, Maryland, USA 7 Department of Pharmacology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA

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