PubMed · 16136869
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G D Crotty. 2001. A call for help.. https://pubmed.ncbi.nlm.nih.gov/16136869/
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The advent of prospective reimbursement in hospitals has forced hospital administrators, pharmacy directors, and pharmacy and therapeutic committees to carefully compare the cost and benefits of similar drugs. Accomplishing this task is difficult. This paper reviews the literature on drug-drug cost effectiveness procedures and outlines a methodology that might be used to contrast and compare two drugs with similar therapeutic outcomes. The data to conduct this analysis can be obtained from published articles on clinical studies and company sources and entered into a microcomputer electronic spreadsheet. The study discusses the implications and use of cost effectiveness analysis to evaluate drugs by hospital formulary committees.
BACKGROUND: The purpose of this study was to determine the sensitivity, specificity, and positive and negative predictive values of a newly developed paper urease test (PUT) for ultra-rapid detection of helicobacter pylori (HP) in gastric mucosa. MATERIAL/METHODS: 100 patients (43 men) with a mean age of 57+/-6.8 years participated. Patients presenting for upper endoscopy with no recent exposure to HP-altering drugs were enrolled. Gastric biopsy specimens were tested by the PUT and histology methods, and then the patients underwent [13C] urea breath tests (UBT). HP was considered positive when either UBT or histology demonstrated it, and negative if HP was not detected in either UBT or histology. The PUT was reported at 15 minutes. RESULTS: 87 of 100 patients tested positive for HP. The PUT correctly identified 74 of 87 HP-positive and 13 of 13 HP-negative patients, yielding sensitivity, specificity, and positive and negative predictive values of 87%, 100%, 100% and 53.5%, respectively, in this population. CONCLUSIONS: Rapidly available and reliable results from the PUT can facilitate clinical decision prior to patient discharge from the endoscopy suite. We recommend PUT for screening of HP in endoscopy candidates, due to high specificity, rapid reaction, simplicity and low cost. A positive result shows a definite diagnosis, although a negative result needs further diagnostic methods.
BACKGROUND: Inherited hemoglobin disorders are an important problem in many developing countries including Thailand. Of the several inherited hemoglobin disorders, hemoglobin E (HbE) (beta 26, GAG-AAG, Glu-Lys) is the most common hemoglobinopathy in Thailand. Presently, screening to identify carriers of hemoglobin disorders among pregnant subjects is an interesting topic in antenatal care in Thailand. Of late, many trials have been conducted to identify the right screening methods for the detection of hemoglobin disorders among Thai pregnant women. The common screening methods include red blood cell (RBC) index determination, application of mathematical model and hemoglobin electrophoresis. METHODS: Here, the author presents an evaluation of the cost utility of those tests in medical practice in Thailand. The cost/utility of hemoglobin electrophoresis is the highest followed by RBC index determination, application of mathematical model and DCIP test. RESULTS: Here, it can be shown that the cost per accurate diagnosis for DCIP is the least expensive. CONCLUSION: It is interesting to note that DCIP also posed high sensitivity in the screening for HbE disorder. Therefore, this test is the best method for screening the population, particularly pregnant women, to identify carriers of hemoglobin disorders. It should be recommended as part of antenatal care in Thailand as well as its neighbouring countries which have a similar high rate of HbE disorder.