OBJECTIVE: To evaluate the cost-effectiveness of carvedilol, a beta-blocker that is approved for use in the US for the treatment of heart failure, based on data from Phase III clinical trials. METHODS: We conducted an economic evaluation alongside the US Carvedilol Heart Failure Trials Program, which consisted of four concurrent, randomized, double-blind, placebo-controlled clinical trials; the mean duration of follow-up across these four trials was 6.5 months (the program was terminated prematurely based on a finding of a 65% mortality benefit). Using data from these trials, we examined the cost-effectiveness of carvedilol in terms of the estimated cost per death averted among patients randomized to such therapy versus those receiving placebo. Attention was focused on the cost of carvediol therapy plus the cost of cardiovascular-related inpatient care. Costs of care were estimated by combining infomation on healthcare utilization from the clinical trials with secondary sources of cost data. RESULTS: Patients randomized to receive carvedilol had lower mean +/- SD estimated costs of cardiovascular-related inpatient care over 6.5 months compared with those receiving placebo ($1912 +/- $7595 vs. $4463 +/- $20,565, respectively). As mortality alsowas lower among carvedilol patients, the estimated cost per death averted was negative. The probability that carvedilol would both increase survival and decrease costs of cardiovascular-related care over a 6.5-month period was estimated to be 0.98. CONCLUSIONS: Data from the US Carvedilol Heart Failure Trials Program indicate that carvedilol reduces mortality in patients with heart failure; our study suggests that it also may be cost-saving over a period of approximately six months.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Estimated economic costs of obesity to U.S. business.

OBJECTIVE: To estimate the economic costs of obesity to U.S. business. METHODS: Standard epidemiologic methods for risk attribution and techniques for ascertaining cost of illness were used to estimate obesity-attributable expenditures on selected employee benefits, including health, life, and disability insurance and paid sick leave by private-sector firms in the U.S. in 1994. Data were obtained from a variety of secondary sources, including the National Health Interview Survey, reports from the Bureau of Labor Statistics and other federal agencies, and the published literature. Attention was focused on employees between the ages of 25 and 64 years who were classified according to body mass index (BMI) as "nonobese" (BMI < 25 kg/m2), "mildly obese" (BMI = 25-28.9 kg/m2), or "moderately to severely obese" (BMI > or = 29 kg/m2). RESULTS: The cost of obesity to U.S. business in 1994 was estimated to total $12.7 billion, including $2.6 billion as a result of mild obesity and $10.1 billion due to moderate to severe obesity. Health insurance expenditures constituted $7.7 billion of the total amount, representing 43% of all spending by U.S. business on coronary heart disease, hypertension, type 2 diabetes, hypercholesterolemia, stroke, gallbladder disease, osteoarthritis of the knee, and endometrial cancer. Obesity-attributable business expenditures on paid sick leave, life insurance, and disability insurance amounted to $2.4 billion, $1.8 billion, and $800 million, respectively. CONCLUSIONS: The health-related economic cost of obesity to U.S. business is substantial, representing approximately 5% of total medical care costs. Further research is needed to determine the cost-effectiveness of worksite weight management programs and of other efforts to reduce the prevalence of obesity in the U.S. workforce.

Adult↗

PubMedDate not supplied

Maternal smoking during pregnancy and expenditures on neonatal health care.

Cigarette smoking during pregnancy substantially increases the risk of low-weight birth, and infants born to smokers weigh less, on average, than those born to nonsmokers. Low birth weight is an important predictor of neonatal morbidity and death, and the intensity of neonatal care is significantly higher for low-birth-weight infants. In this study, we estimate expenditures on neonatal care based on the relation between maternal smoking during pregnancy and the incidence of low-weight births. Our results indicate that maternal smoking during pregnancy was responsible for 35,816 low-weight births in the U.S. in 1983, or about 14.5% of all low-weight births. We also estimate that 14,977, or 6.6%, of all admissions to neonatal intensive care units were a result of maternal smoking and that these admissions cost approximately $272 million, representing 8.5% of total national expenditures on neonatal intensive care services. We estimate that the average cost of neonatal care was $288 higher for infants born to smokers than for those born to nonsmokers.

Birth Weight↗

PubMedDate not supplied

Plasminogen activator in vaginal smears during the menstrual cycle.

A cytologic staining technique in which the reaction produces an insoluble colored precipitate at the site of trypsin-like proteolysis was applied to human vaginal smears, taken daily over six menstrual cycles. The day of urinary LH surge for each cycle was determined. The enzyme action, namely hydrolysis by plasminogen activator, is confined mainly to intermediate squamous cells. The number of cells stained by the enzyme method reaches a maximum three days prior to the LH surge, whereas the maximum in karyopyknosis occurs close to or at the day of LH surge. The enzyme staining method can thus be used when anticipation of ovulation by about 4 days is needed. No immediate fixation is required prior to the enzyme staining.

Adult↗