Biomedical subjects

R E Richner

Publications and source records attributed to R E Richner.

5 recordsLinked to original sources

PubMed1999

Cost effectiveness of carvedilol for heart failure.

In this study, we examine the cost effectiveness of carvedilol for the treatment of chronic heart failure (CHF). We use a Markov model to project life expectancy and lifetime medical care costs for a hypothetical cohort of patients with CHF who were assumed alternatively to receive carvedilol plus conventional therapy (digoxin, diuretics, and angiotensin-converting enzyme inhibitors) or conventional therapy alone. Patients on carvedilol were assumed to experience a reduced risk of death and hospitalization for CHF, which is consistent with findings from the US Carvedilol Heart Failure Trials Program. The benefits of carvedilol were projected under 2 alternative scenarios. In the first ("limited benefits"), benefits were conservatively assumed to persist for 6 months, the average duration of follow-up in these clinical trials, and then end abruptly. In the other ("extended benefits"), they were arbitrarily assumed to persist for 6 months and then decline gradually over time, vanishing by the end of 3 years. We estimated our model using data from the US Carvedilol Heart Failure Trials Program and other sources. For patients receiving conventional therapy alone, estimated life expectancy was 6.67 years; corresponding figures for those also receiving carvedilol were 6.98 and 7.62 years under the limited and extended benefits scenarios, respectively. Expected lifetime costs of CHF-related care were estimated to be $28,756 for conventional therapy, and $36,420 and $38,867 for carvedilol (limited and extended benefits, respectively). Cost per life-year saved for carvedilol was $29,477 and $12,799 under limited and extended benefits assumptions, respectively. The cost effectiveness of carvedilol for CHF compares favorably to that of other generally accepted medical interventions, even under conservative assumptions regarding the duration of therapeutic benefit.

Adrenergic beta-Antagonists↗

PubMed1995

Cost-effectiveness of enoxaparin vs low-dose warfarin in the prevention of deep-vein thrombosis after total hip replacement surgery.

BACKGROUND: Enoxaparin sodium, a low-molecular-weight heparin, was recently approved for use in the United States to prevent deep-vein thrombosis after total hip replacement surgery. Its cost-effectiveness relative to prophylaxis with low-dose warfarin sodium is unknown. METHODS: A decision-analytic model was developed to compare two strategies of prophylaxis for deep-vein thrombosis with a strategy of not using prophylaxis in a hypothetical cohort of 10,000 patients undergoing total hip replacement surgery. For each of these strategies, we estimated the expected number of cases of confirmed deep-vein thrombosis or pulmonary embolism, the expected number of thromboembolic deaths, and the expected costs of venous thromboembolic care, including prophylaxis, diagnosis, and treatment. Data were drawn primarily from the published literature. RESULTS: Compared with no prophylaxis, the use of low-dose warfarin would be expected to reduce the number of cases of confirmed deep-vein thrombosis from about 1000 (per 10,000 patients) to 420 and the number of thromboembolic deaths from about 250 to 110. Expected costs of care related to deep-vein thrombosis also would be reduced from approximately $530 to $330 per patient. Prophylaxis with enoxaparin would be expected to reduce further the number of cases of confirmed deep-vein thrombosis and the number of thromboembolic deaths (to 250 and 70, respectively) but increase costs of care by approximately $50 per patient. The cost-effectiveness of enoxaparin (relative to low-dose warfarin) is estimated to be approximately $12,000 per death averted. CONCLUSION: Although enoxaparin is more costly than low-dose warfarin, its cost-effectiveness in total hip replacement compares favorably with that of other generally accepted medical interventions.

Cost-Benefit Analysis↗

PubMed1990

Transfusion therapy: associated risks and alternative approaches.

Transfusion therapy has been the mainstay for treating the anemia of end-stage renal disease (ESRD). Recently, several factors, including the awareness of associated risks, especially the transmission of blood-borne diseases and the transient treatment effect with regard to reversal of anemic symptoms, have caused a reassessment of transfusion therapy. Recombinant human erythropoietin (epoetin) has emerged as the alternative treatment, capable of sustained reversal of anemia without the associated risks of transfusions. The result of epoetin therapy has been marked improvement in the quality of life of ESRD patients. However, the advent of this therapy has also changed the nurse's role in caring for ESRD patients, as new medical management issues are identified and supportive care is tailored to the individual patient.

Anemia↗

PubMedDate not supplied

Cost-effectiveness results from the US Carvedilol Heart Failure Trials Program.

OBJECTIVE: To evaluate the cost-effectiveness of carvedilol, a beta-blocker that is approved for use in the US for the treatment of heart failure, based on data from Phase III clinical trials. METHODS: We conducted an economic evaluation alongside the US Carvedilol Heart Failure Trials Program, which consisted of four concurrent, randomized, double-blind, placebo-controlled clinical trials; the mean duration of follow-up across these four trials was 6.5 months (the program was terminated prematurely based on a finding of a 65% mortality benefit). Using data from these trials, we examined the cost-effectiveness of carvedilol in terms of the estimated cost per death averted among patients randomized to such therapy versus those receiving placebo. Attention was focused on the cost of carvediol therapy plus the cost of cardiovascular-related inpatient care. Costs of care were estimated by combining infomation on healthcare utilization from the clinical trials with secondary sources of cost data. RESULTS: Patients randomized to receive carvedilol had lower mean +/- SD estimated costs of cardiovascular-related inpatient care over 6.5 months compared with those receiving placebo ($1912 +/- $7595 vs. $4463 +/- $20,565, respectively). As mortality alsowas lower among carvedilol patients, the estimated cost per death averted was negative. The probability that carvedilol would both increase survival and decrease costs of cardiovascular-related care over a 6.5-month period was estimated to be 0.98. CONCLUSIONS: Data from the US Carvedilol Heart Failure Trials Program indicate that carvedilol reduces mortality in patients with heart failure; our study suggests that it also may be cost-saving over a period of approximately six months.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Effect of long-term epoetin beta therapy on the quality of life of hemodialysis patients.

Differences in quality of life were observed using two separate patient populations with end-stage renal disease who were on maintenance hemodialysis. The first population (91 patients) received epoetin beta (Marogen Sterile Powder, Chugai-Upjohn, Inc., Chicago, Ill.) for an average of 18 months. The second population (96 patients) did not receive this therapy. The measured quality of life parameters included a number of global and psychological well-being measurements and the Sickness Impact Profile (SIP), as well as energy, activity levels, appetite, work, and sexual function. When adjusted for covariates (health status and demographics), 16 of 26 parameters were significantly higher (p less than .05) in patients receiving epoetin beta. All mean scores for global measurements were significantly higher. Significantly higher scores were also obtained for total SIP and total psychosocial subscale, as well as for sleep, home management, recreation, emotional behavior, social interaction, ability to work, and energy. While not statistically significant, all of the remaining measurements were higher for epoetin beta than for untreated patients.

Adult↗