Vwy Lee

Cost of Type 2 Diabetes mellitus in Hong Kong Chinese.

OBJECTIVE Hong Kong (HK) is a special administrative region of China as well as being a metropolitan city. In HK, like in many developed countries, Diabetes mellitus, with over 97% of diabetic patients having Type 2 Diabetes mellitus (Type 2 DM), is a growing public health problem but the local financial burden has never been investigated. The primary objectives of this study were to evaluate from the social perspective the costs of Type 2 DM, to identify the major cost drivers, and the proportion of the burden shared by the government, patient and the society. The study was carried out in a group of Hong Kong Chinese patients attending a government hospital. The economic impact of Type 2 DM on local and governmental healthcare expenditure was also examined. METHODS A retrospective cohort observational study was conducted in Type 2 DM patients attending the Diabetes Mellitus Outpatient Clinic at a public hospital in the period January 2004 to May 2004, in which 204 patients were randomly selected and invited to join this study. A total of 147 patients were subsequently enrolled giving an inclusion rate of 72%. RESULTS Annual total cost of Type 2 DM in a patient was US

Short-term efficacy of combination methotrexate and infliximab in patients with ankylosing spondylitis: a clinical and magnetic resonance imaging correlation

1,725 +/- 2,044 (HK

Effects of rosuvastatin on subclinical atherosclerosis and arterial stiffness in rheumatoid arthritis: a randomized controlled pilot trial

13,457 +/- 15,943) with direct costs accounting for > 87.9%. The government was the major payer with over 78.4% of the total costs. Annual total direct medical costs per patient were US

Vertebral body corner oedema vs gadolinium enhancement as biomarkers of active spinal inflammation in ankylosing spondylitis

1,492 +/- 1,716 (HK

PIN17 COST-EFFECTIVENESS OF PNEUMOCOCCAL VACCINATION (PCV) FOR INFANTS WITH THE 7-VALENT PNEUMOCOCCAL CONJUGATE VACCINE IN HONG KONG

11,638 +/- 13,386) of which the government paid 90.6%. Direct medical costs increased markedly if complications were present. In patients with microvascular or macrovascular complications only, the costs increased 1.1-fold compared to those for patients without complications. If both microvascular and macrovascular complications were present in the same patient, the costs were 1.3-fold higher than in patients without complications. CONCLUSION Costs of Type 2 DM have a significant impact on the local healthcare budget. It contributed in 2004 up to 3.9% of the total HK healthcare expenditure and 6.4% of the HK Hospital Authoritys (public sector) expenditures on health.

Costs and quality of life of patients with ankylosing spondylitis in Hong Kong

OBJECTIVE To examine the short-term efficacy and safety of MTX in combination with infliximab compared with infliximab and placebo in the treatment of AS using MRI to monitor its effect. METHOD Thirty-eight subjects with active AS were randomized to receive MTX (MTX group) or placebo (placebo group) for 22 weeks. Both groups received infliximab for three infusions of 5 mg/kg at week 16, 18 and 22 and were followed up until week 30. MRI changes in the spine were assessed before and after infusion. RESULTS The Assessments in Ankylosing Spondylitis (ASAS) 20 response at week 16 was 5.4% in the MTX group vs 15.8% in the placebo group (P = 0.17). In the MTX group, 5.4, 31.6, 52.6 and 63.2% of patients vs 15.8, 21.1, 57.9 and 68.4% patients in the placebo group achieved ASAS20 at week 16, 18, 22, 30, respectively. There were no significant differences between the two groups at any time points. Likewise, the secondary outcome showed no significant differences between the two groups. MRI changes in 31 subjects showed an overall improvement of 36.4% but the changes were not significant between the two groups. CONCLUSIONS Combination MTX with infliximab is as safe and as effective as infliximab monotherapy in the treatment of AS with a significant improvement in ASAS20 and in the different core sets in assessment. MRI improvements were also seen. However, there was no additional clinical or MRI improvement with the addition of MTX to infliximab in AS.

Combined antibiotic/corticosteroid cream in the empirical treatment of moderate to severe eczema: friend or foe?

Objective: To ascertain the effect of rosuvastatin on carotid atherosclerosis and arterial stiffness in patients with rheumatoid arthritis (RA). Methods: Fifty RA patients were randomized in a double-blind placebo-controlled trial to receive 10 mg rosuvastatin (n = 24) or placebo (n = 26). Patients were followed prospectively every 3 months for 12 months. Intima–media thickness (IMT), augmentation index (AIx), and subendocardial viability ratio (SEVR) were measured at baseline, 6 and 12 months. Results: Rosuvastatin resulted in statistically significant reductions of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), and urate levels vs. placebo. However, rosuvastatin had no significant effect on changes in inflammatory markers, including C-reactive protein (CRP) levels [from 2.9 (1.4–11.0) to 3.1 (0.9–13.3) mg/L in the rosuvastatin group compared with from 5.8 (2.6–14.2) to 4.4 (1.2–12.3) mg/L in the placebo group]. Nonetheless, a significant improvement in the Disease Activity Score (DAS) and a reduction in fibrinogen level was observed at 6 and 12 months compared with baseline in the rosuvastatin group. The treatment group exhibited a significant increase in SEVR (from 157 ± 28% to 163 ± 33% in the rosuvastatin group compared with from 143 ± 18% to 143 ± 26% in the placebo group, p = 0.023), but no significant effect was observed in the changes in IMT and AIx. Conclusion: Our data suggest that rosuvastatin has a modest anti-inflammatory effect in RA patients with low disease activity in terms of reduction in DAS and fibrinogen level. Rosuvastastin may also improve subendocardial perfusion and lower the urate level.

PCV27 Cost-Effectiveness of Left Atrial Appendage Occlusion Device for Stroke Prevention in Atrial Fibrillation

OBJECTIVE To investigate the relative performance of T(2) weighted short tau inversion-recovery (STIR) and fat-suppressed T(1) weighted gadolinium contrast-enhanced sequences in depicting active inflammatory lesions in ankylosing spondylitis (AS). METHODS Whole-spine MRI was performed on 32 patients with AS, who participated in a clinical trial of infliximab treatment, by STIR and contrast-enhanced sequences at baseline and after 30 weeks. The AS spine MRI-activity (ASspiMRI-a) scoring method was used. The images from these two imaging techniques were evaluated separately by two independent readers. RESULTS For the pre-treatment lesion status, the intraclass correlation coefficients comparing STIR readings and contrast-enhanced readings were 0.69±0.23 for Reader 1 and 0.65±0.21 for Reader 2. At baseline, the mean ASspiMRI-a score was 15.4% and 17.7% higher for contrast-enhanced images than for STIR images for Reader 1 and Reader 2, respectively. After infliximab treatment, Reader 1 rated an ASspiMRI-a score reduction of 50.8±33.6% and 25.3±35.3% for STIR images and contrast-enhanced images, respectively, whereas Reader 2 rated an ASspiMRI-a score reduction of 42.4±50.4% and 32.9±35.6% for STIR images and contrast-enhanced images, respectively. CONCLUSION While both contrast-enhanced and STIR sequences showed sensitivity to change over a short period of time after infliximab treatment, these two sequences may reflect different disease mechanisms.

PMD45 Variation in Health Related Quality of Life Improvement After Percutaneous Coronary Intervention

dence from clinical studies concerning the relative effectiveness of Fluad® and non-adjuvanted vaccines in the over 65 population. Evidence concerning the impact of Fluad® on hospitalisation was taken from an observational study, other resource use parameters and costs from the literature. The analysis was performed from the payer perspective (direct medical costs). RESULTS: Based on the increased protective efficacy of Fluad® compared to non-adjuvanted vaccines, we estimated a reduction in cases of between 11.8% and 23.8% depending on the influenza strain circulating in the community. Using these estimates, for an attack rate of Influenza-like Illness of 5% and a discount rate of 3%, the incremental cost per life year gained (CLYG) ranged from €3103 to €23,894. In situations where there is antigenic drift (which occurs every 2–5 years), all vaccines are less effective. However, the efficacy of Fluad® falls by only 2%, whereas that of non-adjuvanted vaccines falls by 22%. With antigenic drift, the cost-effectiveness of Fluad® compared to non-adjuvanted vaccines is enhanced due to the better protective effect, and depending on the circulating strain, ranged from being cost saving to an incremental CLYG of €5709. CONCLUSION: Compared to nonadjuvanted vaccines, Fluad® is cost-effective. Since the estimated cost per life year gained is within acceptable thresholds, Fluad® should be used as the vaccine of choice in older people. * Fluad® is registered under the trade name Gripguard® in France.