It has been shown that the difference between consumption and production during life years gained should be included as a cost in cost-effectiveness analysis. In this study the authors estimate the impact of including these future costs on the cost-effectiveness of the treatment of hypertension in Sweden. The cost per quality-adjusted life year (QALY) gained changes little among young men and women due to the addition of future costs, but increases by about $14,000 for middle-aged men and women and about $27,000 for older men and women. When future costs are not included, the cost per QALY gained is generally lowest among older men and women, but when future costs are included, the cost per QALY gained is generally lowest among middle-aged men and women. The authors conclude that the total resource consequences of changes in mortality should be routinely considered in cost-effectiveness analyses.

Adult↗

PubMedDate not supplied

Hemorrhoids: associated pathologic conditions in a family practice population.

BACKGROUND: Hemorrhoidal disease is an affliction that in referral populations coexists with other significant anorectal diseases. Published texts recommend aggressive procedures to diagnose associated pathologic conditions and as an aid for planning the extirpation of these diseases. Procrastination in management is said to be characteristic of both patient and primary care physician. The purpose of this study was to ascertain whether patients with hemorrhoids in the general population are truly at high risk for significant anorectal disease. METHODS: Charts of 173 patients with hemorrhoids from a nonselected population were reviewed for treatment management, associated anorectal disease, and sequelae. RESULTS: A small subpopulation of persons aged more than 55 years was identified who may be at higher risk for colon polyps. Anoscopy, barium enema, fecal occult blood testing, and complete blood counts had very low yields. These findings differ significantly from data collected on highly selected populations that suggest hemorrhoids rarely exist alone. CONCLUSIONS: It appears that family physicians have not been cavalier in their attitudes toward and management of this common ailment. Clinical investigation of hemorrhoids should be initiated based on clinical impression from evaluating symptoms and signs combined with age-specific screening recommendations.

Adult↗