Cost-effectiveness analysis of organ transplantation.
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Biomedical subjects
Publications and source records attributed to E Jonsson.
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In a study involving three centers, 105 patients with duodenal ulcer proven by endoscopy were randomly assigned to treatment with either the H+, K+, ATPase inhibitor omeprazole (20 mg or 40 mg taken as a single morning dose), or ranitidine (150 mg morning and night). It was a double-blind study using a double-dummy technique. Clinical assessment and laboratory investigations were carried out at 2, 4, and 8 weeks; endoscopy was done at 2 weeks, and if not healed, at 4 and 8 weeks. The patients in the three treatment groups were well matched. Significantly more patients treated with omeprazole healed compared with ranitidine at 2 weeks (p = 0.007) and at 4 weeks (p = 0.007), but there was no statistically significant difference between the two omeprazole groups. Pain was of similar severity at the start in all groups, but patients treated with omeprazole had fewer days with pain (median values being omeprazole 20 mg: 2 days; omeprazole 40 mg: 1 day; ranitidine: 7 days). The difference between the combined omeprazole groups and ranitidine was significant (p less than 0.02). There was also a tendency towards less severe daytime pain on omeprazole during the first week. The difference was statistically significant between omeprazole (40 mg) and ranitidine for days 2-7 (p less than 0.01). No change in laboratory screen attributable to drug treatment occurred. After healing, 79 patients entered a 6-month follow-up study with endoscopy at 3 and 6 months or whenever symptoms occurred. After 6 months relapses occurred in 14/24, 19/23, and 15/25 after 20 mg omeprazole, 40 mg omeprazole, and ranitidine, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
In an open clinical trial, 16 hospital outpatients with endoscopically proven duodenal ulcer were given 30 mg omeprazole once daily for four weeks. After two weeks' treatment 14 of the 16 patients had healed and after four weeks all patients were healed. Reduction of pain was rapid and occurred during the first part of the trial. No serious adverse events or clinically significant deviations from normal laboratory values were reported. Serum gastrin levels significantly increased during treatment but returned to normal levels after the treatment was discontinued.
A Hypertension Care Program, developed in cooperation between physicians and nurses in both primary care and at the hospitals in the area, was implemented in the Skaraborg County, Sweden in 1977. The Program, which provided for the establishment of hypertensive clinics at outpatient units and referral to medical clinics, was clearly aimed towards giving nurses increased responsibility for hypertensive care. The Skaraborg Program has been evaluated from several important perspectives. A terminal population study showed better blood pressure control among the hypertensive patients within the program area than within the control area. The economic evaluation indicates that hypertensive care according to the Program is somewhat less resource demanding than conventional hypertensive care. Since the medical effects of hypertensive care were improved without increased demand for resources, the structured Care Program was more cost-effective than conventional care.
Thirty-one patients (34 joints) with pain due to carpometacarpal joint derangement were reviewed 1/2 to 12 years after a trapezium replacement arthroplasty using a Swanson silicone prosthesis. At review, 25 hands were free from pain, and nine had some pain on exertion. Mobility and strength were generally well restored. The radiographic examination revealed 12 prosthesis-fractures, three dislocations, and five cases of incongruity. However, all patients were satisfied with the results of the operation.
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Planning in the United States is based on an institution's perceived need, whereas in many other countries it is based on population need. These unique approaches to planning have led to widely differing distributions of facilities and services. Planning by the U.S. method leads to a more generous provision of services than does population-based planning. In both planning systems, the planning process appears of paramount importance, while the fundamental questions of effectiveness outcome and impact of medical care services are usually ignored. Even population-based planning either cannot or will not deal with the conflict between professional desire for highly developed technology on the one hand and treatment effectiveness on the other. Nevertheless, population-based planning has at least the virtue of providing a less expensive yet more efficient system. Physicians and the public appear able to adjust to the quite different resource provisions of the two planning systems; both the abundant U.S. supply and the restricted supply in Sweden are perceived as adequate.
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Coronary care unit usage has expanded rapidly in all high income countries with little attention to effectivity or cost. A study of six randomly chosen Swedish units showed that larger units in teaching hospitals had significantly lower age-adjusted mortality rates, higher proportions of myocardial infarction patients, and greater productivity and efficiency. Comparisons with a study from the United States showed better results in the Swedish hospital units according to all variables measured. Although proof of effectiveness of CCU's is lacking, their continued use is assured. A less than optimal solution is a rational distribution of units based upon epidemiologically determined need, while stressing good organization and efficiency.
Today, managers are being asked to analyze and justify the costs for new and expensive equipment. In the case of the CAT Scanner, however, there has been little "hard" information available. To fill the gap, the authors present the findings of several Swedish studies that compare the uses and the costs of the CAT Scanner with other diagnostic techniques.
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