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Biomedical subjects

J A Schofield

Publications and source records attributed to J A Schofield.

6 recordsLinked to original sources
PubMed2000

The cost-effectiveness and cost-utility of high-dose palliative radiotherapy for advanced non-small-cell lung cancer.

PURPOSE: To compute cost-effectiveness/cost-utility (CE/CU) ratios, from the treatment clinic and societal perspectives, for high-dose palliative radiotherapy treatment (RT) for advanced non-small-cell lung cancer (NSCLC) against best supportive care (BSC) as comparator, and thereby demonstrate a method for computing CE/CU ratios when randomized clinical trial (RCT) data cannot be generated. METHODS AND MATERIALS: Unit cost estimates based on an earlier reported 1989-90 analysis of treatment costs at the Vancouver Island Cancer Centre, Victoria, British Columbia, Canada, are updated to 1997-1998 and then used to compute the incremental cost of an average dose of high-dose palliative RT. The incremental number of life days and quality-adjusted life days (QALDs) attributable to treatment are from earlier reported regression analyses of the survival and quality-of-life data from patients who enrolled prospectively in a lung cancer management cost-effectiveness study at the clinic over a 2-year period from 1990 to 1992. RESULTS: The baseline CE and CU ratios are $9245 Cdn per life year (LY) and $12,836 per quality-adjusted life year (QALY), respectively, from the clinic perspective; and $12,253/LY and $17,012/QALY, respectively, from the societal perspective. Multivariate sensitivity analysis for the CE ratio produces a range of $5513-28,270/LY from the clinic perspective, and $7307-37,465/LY from the societal perspective. Similar calculations for the CU ratio produce a range of $7205-37, 134/QALY from the clinic perspective, and $9550-49,213/QALY from the societal perspective. CONCLUSION: The cost effectiveness and cost utility of high-dose palliative RT for advanced NSCLC compares favorably with the cost effectiveness of other forms of treatment for NSCLC, of treatments of other forms of cancer, and of many other commonly used medical interventions; and lies within the US $50, 000/QALY benchmark often cited for cost-effective care.

British Columbia↗
PubMed1994

Localisation of a pulmonary autoantigen in cryptogenic fibrosing alveolitis.

BACKGROUND--Cryptogenic fibrosing alveolitis (CFA) is believed to have an immunological pathogenesis with a persisting inflammatory reaction to an as yet unidentified pulmonary antigen(s). A high frequency of IgG autoantibodies has previously been found in the plasma of patients with CFA to an extractable 70-90 kDa lung antigen by Western blotting. Preliminary immunohistochemical studies with patient IgG had indicated that the target protein(s) might be associated with alveolar epithelial lining cells which have previously been suggested as the site of immunological attack in CFA. METHODS--In order to confirm this finding immunohistochemical analysis and Western blotting were performed on a human type II alveolar cell line (A549) using CFA patient plasma. In order to study further the distribution of the antigen, antibodies were raised in a rabbit to the partially purified 70-90 kDa CFA lung protein. RESULTS--The results showed that the human CFA autoantibody recognised a 70-90 kDa protein with a cytoplasmic distribution present in the A549 cells, confirming previous observations. The immune rabbit IgG recognised a protein of similar molecular weight by Western blotting of protein derived from lung biopsy samples of patients with CFA and A549 cells. In addition it immunoprecipitated protein(s) of this molecular weight from lung biopsy protein extracts from patients with CFA. The precipitated protein(s) were found to cross-react with the autoantibody found in the plasma of patients with CFA. Immunohistochemical analysis with immunised rabbit antibody revealed positive staining of type I and II alveolar epithelial lining cells in CFA. A similar pattern of epithelial staining was also observed with the rabbit IgG on biopsy specimens of lung from patients with sarcoidosis and control lung tissue, although this was more focal and less intense. No positive staining was seen on sections from a number of non-pulmonary tissues (colon, liver, kidney, tonsil, lymph node, skin, cervix). Cytoplasmic staining of the A549 cell line was also detected. CONCLUSIONS--The 70-90 kDa protein recognised by autoantibodies in patients with CFA is associated with pulmonary epithelial lining cells. The immune rabbit IgG produced appears to recognise antigen by Western blotting and immunohistochemical staining of lung tissue in a similar pattern to the patient autoantibodies. Immunohistochemical data obtained with this antibody suggest that the putative autoantigen against which patients with CFA mount a humoral immune response may be endogenous and specific to the lung.

Aged↗
PubMed1994

Comparative costs of lung cancer management.

A method is outlined for comparative costing of different protocols of lung cancer management in a free-standing clinic. The costs of chemotherapy and radiation therapy are evaluated according to alternative regimens of treatment. The costs of new patient assessment, patient follow-up, and ancillary care (social work and nutrition assistance) are also included. Except for the cost of routine blood tests during chemotherapy and radiotherapy planning computerized tomography (CT) scans, costs incurred outside the clinic are excluded. The method is illustrated by application to out-patient treatment of lung cancer at the Victoria Clinic of the British Columbia Cancer Agency in Victoria, British Columbia, Canada, using data for the 1989-90 fiscal year of the Clinic. The method may be adapted for use in other disease and institutional settings.

Health Care Costs↗
PubMedDate not supplied

Quantifying uncertainty: calculating interval estimates using quality control results.

EPA's Great Lakes National Program Office (GLNPO) is leading one of the most extensive studies of a lake ecosystem ever undertaken. The Lake Michigan Mass Balance Study (LMMB Study) is a coordinated effort among state, federal, and academic scientists to monitor tributary and atmospheric pollutant loads, develop source inventories of toxic substances, and evaluate the fate and effects of these pollutants in Lake Michigan. A key objective of the LMMB Study is to construct a mass balance model for several important contaminants in the environment: PCBs, atrazine, mercury, and trans-nonachlor. The mathematical mass balance models will provide a state-of-the-art tool for evaluating management scenarios and options for control of toxics in Lake Michigan. At the outset of the LMMB Study, managers recognized that the data gathered and the model developed from the study would be used extensively by data users responsible for making environmental, economic, and policy decisions. Environmental measurements are never true values and always contain some level of uncertainty. Decision makers, therefore, must recognize and be sufficiently comfortable with the uncertainty associated with data on which their decisions are based. The quality of data gathered in the LMMB was defined, controlled, and assessed through a variety of quality assurance (QA) activities, including QA program planning, development of QA project plans, implementation of a QA workgroup, training, data verification, and implementation of a standardized data reporting format. As part of this QA program, GLNPO has been developing quantitative assessments that define data quality at the data set level. GLNPO also is developing approaches to derive estimated concentration ranges (interval estimates) for specific field sample results (single study results) based on uncertainty. The interval estimates must be used with consideration to their derivation and the types of variability that are and are not included in the interval.

Confidence Intervals↗