Biomedical subjects

U Persson

Publications and source records attributed to U Persson.

114 records · Page 7Linked to original sources

PubMedDate not supplied

Ultrasonographic screening for abdominal aortic aneurysm: analysis of surgical decisions for cost-effectiveness.

A mathematic model is created to determine the economic cost per year of anticipated prolongation of life that would result from a program of abdominal ultrasonographic (US) screening for abdominal aortic aneurysm. The protocol involves US screening at age 60, 67, and 74 years with additional annual follow-up US and examination if an aneurysm of less than 40 mm is detected. Larger aneurysms are assumed to be sent for early elective resection. The benefits and risks for a subset of men with symptoms of intermittent claudication (IC) as an additional risk factor of atherosclerosis is calculated for comparison. Many of the factors on which these calculated costs and benefits are based are approximations and inferences. These include operative mortality for elective and emergent cases, charges for each such condition, cost of US, and anticipated survival following successful aneurysmectomy both with and without concomitant IC. Sensitivity analysis is performed to show how variations in the major parameters alter the outcome of the calculated cost per year of anticipated extension of life.

Aged↗

PubMedDate not supplied

The economic impact of poultry-borne salmonellosis: how much should be spent on prophylaxis?

Foodborne salmonellosis constitutes a major health problem in many countries. Moreover, the costs associated with salmonellosis could be considerable. There are thus strong arguments for preventive efforts. Ambitious, often government-sponsored, programmes aimed at preventing and controlling salmonellosis in for instance, poultry production represent one alternative to lower salmonellosis-related illness and economic costs. On the other hand, such comprehensive programmes are rather resource-demanding. From the economic point of view the key problem is to find the optimal level for prophylactic measures. The purpose of this study is to compare two different approaches to preventing poultry-borne salmonellosis among humans. We identify and compare the economic costs of illness due to poultry-borne salmonellosis and the costs of salmonella control in England and Wales and Sweden, respectively. An alternative option is then introduced: the concept of competitive exclusion (CE). Our results show that the cost of illness constitutes the major part of the total cost in England and Wales, whereas in Sweden, the control cost amounts to 95% of the total cost. By using the CE concept, the cost of illness due to poultry-borne salmonellosis in England and Wales could be reduced by at least GB pound 12.6 million. These advantages apply to individuals, producers, and to society, and we thus conclude that the CE concept is a very cost-effective way of using scarce resources.

Animals↗

PubMedDate not supplied

A 1-year cost-effectiveness model for the treatment of chronic schizophrenia with acute exacerbations in Belgium.

OBJECTIVE: A 1-year semi-Markov model was constructed to simulate the cost-effectiveness of atypical and typical antipsychotic treatments for schizophrenia. METHODS: The core model comprised nine 6-week cycles and includes events such as survival, response, adverse events, and compliance. The nature, duration, intensity, and timing of adverse events were incorporated. Compliance was modeled as a function of health state, time, and adverse events. Three first-line treatments were considered (risperidone, olanzapine, and haloperidol oral) and the transition probabilities of switching between five different therapies (haloperidol oral, haloperidol depot, risperidone, olanzapine and clozapine) were included. Effectiveness was modeled based on a modified method of TWiST (time without symptoms and toxicity). The direct costs of utilization of medical resources are taken into account, including five different patient care settings, consultations, neuroleptic medication, laboratory tests, and treatment of side-effects. RESULTS: This paper reports the methodology used to construct the model and the results obtained when it was applied to the treatment of patients with schizophrenia in the Belgian health care system. CONCLUSIONS: Over the study period, risperidone and olanzapine were more cost-effective than haloperidol and of the two major atypical drugs, risperidone was the more cost-effective.

Journal Article↗

PubMedDate not supplied

The cost-effectiveness of treating diabetic lower extremity ulcers with becaplermin (Regranex): a core model with an application using Swedish cost data.

OBJECTIVES: The objective of this study was to develop a model capable of assessing the cost-effectiveness in Sweden of treating diabetic neuropathic lower extremity ulcers with becaplermin gel (Regranex) plus good wound care (GWC) relative to treating them with GWC alone. METHODS: A Markov simulation model was developed that includes six health states: Uninfected Ulcer, Infected Ulcer, Gangrene, Healed Ulcer, Healed Ulcer-History of Amputation, and Deceased. To predict clinical outcomes, information was taken from a specially designed prospective 9-month follow-up study of 183 neuropathic patients in the US treated with GWC. Cost of treatment data were taken primarily from a study of a cohort of 314 patients in Sweden. The efficacy of becaplermin was assumed equal to that achieved in a pooled analysis of four randomized clinical trials. A model application provides expected clinical outcomes for a cohort of patients. Annual treatment costs per patient were estimated using treatment practice and unit prices from Sweden. RESULTS: Due to a higher rate of healing and a shorter average healing time, treatment with becaplermin gel was predicted to increase the average number of months spent in the healed state over the first year following development of an ulcer by 24% relative to GWC alone. In addition, the corresponding number of amputations was 9% lower for the becaplermin-treated cohort. The average expected cost of $12,078 US for an individual treated with GWC alone declines to $11,708 US for one treated with becaplermin, in spite of $1262 becaplermin costs. Expenses related to topical treatment and inpatient care account for 83% of the resources conserved. CONCLUSIONS: Our results suggest that in Sweden treatment with becaplermin in conjunction with GWC consumes fewer resources and generates better outcomes than treatment with GWC alone for diabetic neuropathic ulcers. In light of the high and increasing incidence of such ulcers, the potential savings in costs and suffering may be important. Results are difficult to extrapolate internationally because they are strongly related to country-specific treatment practices and price levels.

Aged↗

PubMedDate not supplied

Scintigraphic evaluation of traumatic splenic lesions in children.

Ninety-eight children with recent blunt abdominal trauma which initially evoked clinical suspicion of splenic injury were examined with colloid scintigraphy of the spleen and the liver using multiple imaging views and with abdominal survey. Nineteen children were, in addition, examined with tomographic scintigraphy. The clinical findings and the course of the disorder were reanalyzed. Scintigraphy indicated splenic injury in 56 children and hepatic injury in another 5 children. The left lateral and the left oblique were the optimum imaging views for detecting splenic ruptures. Tomographic scintigraphy did not improve the diagnostic yield. Abdominal survey failed to indicate almost every second case of splenic rupture and provided no additional information of significance. The clinical review agreed with the scintigraphic diagnosis of splenic lesions but, in addition, it suggested possible splenic lesions in another 10 children with normal scintigraphy. This discrepancy cannot be explained as surgery was not employed; the occurrence of splenic lesions too small to become detectable at scintigraphy or to provoke clinically evident symptoms may be supposed.

Abdominal Injuries↗

PubMedDate not supplied

Lymphocyte activation by Con A.

Con A can activate cytotoxic effector cells, helper cells and suppressor cells. In all cases Con A activates polyclonally and thus the entire T cell repertoir can be revealed by Con A activation. Nylon purified T cells cannot be activated by Con A. however, in the presence of helper cells, such as adherent cells, or in the presence of serum from several species, Con A activates purified T cells. The serum factors that are responsible for Con A activation of purified T cells are present in the albumin fraction. It is suggested that Ia molecules may be responsible for the ability of Con A to activate purified T cells and a general hypothesis for T cell activation is outlined.

Albumins↗