Wenyaw Chan — Page 2 | Search PubMed

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Survival among patients with dementia from a large multi-ethnic population.

Survival among patients with dementia is critical information needed for planning and assessing the overall impact of dementia. Attrition from longitudinal cohorts often limits the confidence in survival estimates. For this study, we examined survival among dementia patients from a large multi-ethnic population with excellent longitudinal follow-up. Subjects were all Baylor Alzheimer's Disease Center patients residing in the greater Houston area at the time of initial diagnosis. Vital status was available for all subjects. We estimated median survival time (Kaplan-Meier) from first symptom onset and from diagnosis, and examined the effects of baseline patient characteristics on survival. Median survival time for patients with any form of dementia was 10.5 years from onset and 5.7 years from diagnosis. Similarly, median survival time for probable Alzheimer disease patients was 11.3 years from onset and 5.7 years from diagnosis. Significant trends of decreasing survival with increasing age group (<70; 70-79, > or = 80) were evident for all dementia patients and for patients with Alzheimer disease. Our findings are consistent with previous studies and provide compelling evidence that survival from onset or diagnosis of dementia depends more on age than any other factor.

Adult↗

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Cost-effectiveness analysis of interventions to enhance mammography compliance using computer modeling (CAN*TROL).

OBJECTIVE: Tailored telephone counseling and physician-based and clinic-based interventions have been shown to be cost-effective in enhancing utilization of mammography among nonadherent women. The objective of this study was to evaluate the costs and benefits of a broad implementation of these interventions from a health payer perspective. METHODS: CAN*TROL computer modeling was employed in the cost-effectiveness analysis of interventions in a 2000 Texas female population. The estimated effects of the various interventions and their related costs derived from the literature were applied to a hypothetical scenario of a broad implementation of these interventions. RESULTS: Seven studies were identified from the literature, six of them employed tailored telephone counseling (TC), whereas two used comprehensive physician-based (PB) or clinic-based (CB) interventions. The estimated intervention cost per women was 43 dollars for TC, 71 dollars for PB, and 151 dollars for CB. CAN*TROL model showed that after 15 years of implementation, TC, PB, and CB could reduce cancer mortality by 6.5, 2.2, and 10.7%, respectively. The cumulative net costs of interventions, mammography screening, and medical care costs were lower for TC (TC vs. PB vs. CB, 1.05 million vs. 1.06 million vs. 1.60 million). Nevertheless, CB resulted in more life-years saved (TC vs. PB vs. CB, 11,413 vs. 8515 vs. 14,559). The incremental cost-effectiveness ratio was more favorable for tailored telephone counseling interventions. One-way sensitivity analysis indicated that compliance rates and intervention costs had the most significant impact on the incremental cost-effectiveness ratio. CONCLUSION: Tailored telephone counseling interventions may be the preferred first-line intervention for getting nonadherent women aged 50 to 79 years on schedule for mammography screening.

Aged↗