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Biomedical subjects

Sanjay Sharma

Publications and source records attributed to Sanjay Sharma.

At least 109 records · Page 6Linked to original sources
PubMed2002

Incremental cost-effectiveness of initial cataract surgery.

PURPOSE: The purpose of this study was to perform a reference case, cost-utility analysis of initial cataract surgery using the current literature on cataract outcomes and complications. DESIGN: Computer-based econometric modeling. METHODS: Visual acuity data of patients treated and observed over a 4-month postoperative period was obtained from the US National Cataract Patient Outcomes Research Team (PORT). The results from this prospective study were combined with other studies that investigated the complication rates of cataract surgery to complete the cohort of patients and outcomes. These synthesized data were incorporated with time-tradeoff utility values, decision analysis, and econometric modeling to account for the time value of money. MAIN OUTCOME MEASURES: The number of quality-adjusted life-years (QALYs) gained was calculated for the study group undergoing cataract extraction in the first eye when the vision was the same in both eyes. This was divided into the cost of the procedure to find the year 2000 nominal US dollars spent per quality-adjusted life-year ($/QALY) gained. RESULTS: Initial cataract surgery, compared with observation, resulted in a mean gain of 1.776 QALYs per patient treated. A 3% annual discount rate was used to account for the benefit over time, yielding 1.25 QALYs gained. The mean cost of treatment (also discounted at a 3% annual rate) of each patient totaled 2525 US dollars. The cost divided by the discounted benefit resulted in $2020/QALY gained for this procedure. CONCLUSIONS: Initial cataract surgery seems to be highly cost-effective compared with procedures across multiple medical specialties. This information, incorporating patient preferences into evidenced-based medicine, will play an increasingly important role in the evaluation of health care in the future.

Aged↗
PubMed2002

A cost-utility analysis of therapy for amblyopia.

OBJECTIVE: Evaluation of the incremental cost-effectiveness of therapy for amblyopia. DESIGN: Cost-utility reference-case analysis. METHODS: A cost-utility analysis was performed from a third-party insurer perspective by using decision analysis, evidence-based data from the literature, and patient preference-based time trade-off utility values. DATABASE: Patient-derived time trade-off ocular utility values and the American Academy of Ophthalmology Preferred Practice Pattern guidelines for the treatment of amblyopia. INTERVENTION: Treatment of childhood amblyopia using medical and surgical therapies per the American Academy of Ophthalmology Preferred Practice Pattern. MAIN OUTCOME MEASURE: Dollars (year 2001 nominal U.S. dollars) expended per quality-adjusted life-year ($/QALY) gained. RESULTS: Treatment for amblyopia resulted in a $/QALY gained of $2281 with a discount rate of 3% for costs and outcomes. Sensitivity analysis, varying costs and utility values by 10%, resulted in a $/QALY gained range from $2053 to $2509. CONCLUSIONS: When compared with other interventions in health care, therapy for amblyopia seems to be highly cost-effective. This information is increasingly important for health care policy makers.

Amblyopia↗
PubMed2002

Sudden death in young athletes: HCM or ARVC?

Sudden non-traumatic death in young athletes is due to underlying congenital/inherited cardiac diseases in over 80% of cases. The two commonest conditions leading to sudden cardiac death in athletes below the age of 25 years are hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Hypertrophic cardiomyopathy is caused by mutations in genes, which code for sarcomeric contractile proteins. It can present with symptoms such as palpitation, presyncope or syncope. In a small number of cases, sudden death is the first clinical manifestation of the condition. It is well established that HCM accounts for over half of all cases sudden cardiac death in young individuals below 25 years of age. The management of HCM broadly encompasses symptom control, familial evaluation and the prevention of sudden death. Arrhythmogenic right ventricular cardiomyopathy, similarly, is a genetic disorder of the heart muscle and leads to symptoms such as palpitation and syncope and more rarely sudden death. The diagnosis of ARVC is most likely underestimated due to the lack of a single diagnostic test and subtle morphological changes in some cases. The diagnosis is based on clinical and family history and non-invasive investigations. The physiological adaptations seen in some athletes, as a response to physical training, may resemble phenotypically mild forms HCM and ARVC. Therefore, a diagnostic algorithm enabling this differentiation would be of importance especially bearing in mind the consequences of a misdiagnosis.

Adolescent↗
PubMed2002

Radiopaque shadow in the lumbar region on plain X-ray abdomen: diagnostic dilemma.

A 28-year-old man presented with right flank pain. Radiological investigations suggested the diagnosis of a calcified mass in the retroperitoneum below the right kidney. Laparoscopic exploration using the retroperitoneoscopic approach was performed. However, it was not possible to locate the lesion and an open exploration was done. During exploration a large fecolith was found trapped in a diverticulum of the cecum.

Adult↗
PubMed2002

Incremental cost-effectiveness of laser therapy for visual loss secondary to branch retinal vein occlusion.

PURPOSE: To ascertain the incremental cost-effectiveness of therapeutic interventions for improving visual loss associated with branch retinal vein occlusion. METHODS: A cost-utility analysis incorporating data from the Branch Vein Occlusion Study Group was performed using patient-based preferences obtained from time tradeoff utility analysis, decision analysis with Markov modeling, and economic modeling with future value analysis. The cost-effectiveness results are expressed in dollars/QALY (dollars expended per quality-adjusted life-year) gained. This unique model takes into account the visual acuity in the better seeing eye and the recurrent risk for visual loss in the contralateral eye. RESULTS: Laser therapy for macular edema secondary to branch retinal vein occlusion was associated with an incremental dollars/QALY gained of 6118 dollars (in year 2000 U.S. dollars). Two-way sensitivity analysis, varying the discount rate and the proportion of patients developing a vascular occlusion in the contralateral eye, revealed a range of dollars/QALY gained from 3370 dollars to 19,299 dollars. CONCLUSIONS: Laser therapy appears to be a cost-effective intervention for improving visual loss associated with macular edema secondary to branch retinal vein occlusion. Variants of the methodology employed to calculate the incremental cost-effectiveness of this intervention can be widely applied across all specialties in medicine.

Aged↗
PubMed2002

Versatility of the sural fasciocutaneous flap in the coverage of lower extremity wounds.

The distally based sural nerve flap is an excellent option for covering defects of the lower third of the leg. It allows rapid, reliable coverage of defects extending as far distally as the forefoot. The flap can be elevated under a tourniquet in relatively bloodless fashion without sacrificing a major vessel to the foot. Its use is described in a variety of defects in 11 patients, ranging in age from 3 to 64 years. The flap was used bilaterally in one case and in cross-leg fashion in another. All defects were covered with no major complications, and none of the patients required a blood transfusion. One flap experienced a small amount of distal marginal necrosis, which was excised and closed primarily. The technical aspects of flap elevation are emphasized.

Adolescent↗
PubMed2002

Quality of life and systemic comorbidities in patients with ophthalmic disease.

AIM: To ascertain the effect of serious systemic comorbidities upon the quality of life of patients with ophthalmic diseases. METHODS: Time tradeoff utility values were obtained in consecutive ophthalmic patients who presented with ocular disease. Multivariate analysis was undertaken to evaluate whether the systemic comorbidities of diabetes mellitus, heart disease, cancer, cerebrovascular accident, and/or renal failure requiring dialysis influenced ocular utility values. RESULTS: Among the 390 patients with ocular diseases studied, 250 had the systemic comorbidities of diabetes mellitus, heart disease, cancer, stroke, and/or renal failure requiring dialysis, while 140 lacked these comorbidities. There was no statistically significant difference (p = 0.091) between the comorbidity and no comorbidity groups in self assessed quality of life as measured by ocular utility values after taking into account potentially confounding variables. CONCLUSIONS: In patients with ocular disease, ocular utility values related to the visual loss do not appear to be affected by the presence of select, concomitant, serious systemic diseases. Thus, visual loss seems to cause a similar diminution in self assessed quality of life in those who do and do not have serious associated systemic comorbidities. This information has important implications for the calculation of cost effective analyses.

Adult↗
PubMed2002

Chemosensitization of solid tumors by modulation of resistance mechanisms.

The number of drugs available for chemotherapy is growing exponentially, and this trend looks set to continue. Chemosensitization strategies use the administration of one drug or agent to render cancer cells more susceptible to a second agent. Modulation of resistance mechanisms due to xenobiotic membrane pumps such as the multidrug resistant proteins, MDR1/P-glycoprotein or MRP is feasible and a number of new agents have been produced to inhibit drug efflux resulting from expression of these molecules. However, tumor cells may express or upregulate more than one such molecule at one time, and this approach is unlikely to benefit every patient. Detoxification mechanisms mediated by glutathione conjugation or metallothionein are also responsible for resistance--the former has been linked to MRP-mediated resistance. Again, modulation is possible but may increase the toxicity of drugs to normal tissues and an increased therapeutic index is not guaranteed. Tumors exposed to DNA damaging agents often upregulate DNA repair mechanisms and this contributes to resistance. Different pathways perform the repair of different forms of DNA damage, and it is difficult to inhibit all of these. Nevertheless, inhibition of DNA repair can re-sensitize tumors to chemotherapy and is increasingly exploited. One of the most successful and widely used approaches is to combine gemcitabine with an alkylating or platinating agent. While gemcitabine may inhibit DNA polymerases directly, this cytidine analog is also likely to be incorporated by DNA repair leading to activity against non-cycling cells, which form the majority of the neoplastic cell population in most solid tumors. Oncologists should take account of potential resistance mechanisms when treating patients: it is often feasible to design combinations with old or new drugs which exploit these apparent weaknesses to the patient's advantage.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2002

Chemosensitization of solid tumor cells by alteration of their susceptibility to apoptosis.

Chemosensitization strategies use the administration of one drug or agent to render cancer cells more susceptible to a second agent. Usually this involves enhanced drug metabolism, improvement of drug uptake or blockage of resistance mechanisms. Alteration of the susceptibility of cancer cells to apoptosis, the process of individual cell death by which many chemotherapeutic drugs act, shows particular promise for therapy in the future, and is the focus of this review. The dependence of cancer cells on non-neoplastic cells to form solid tumors allows anti-angiogenic therapy to be used in conjunction with chemotherapy to increase the therapeutic index. Chemosensitization strategies are set to become increasingly important in cancer therapy, allowing rational design of synergistic drug combinations at an earlier stage in drug development.

Apoptosis↗
PubMed2002

Patient, community and clinician perceptions of the quality of life associated with diabetes mellitus.

BACKGROUND: A study was undertaken to assess the quality of life of patients with type 1 and type 2 diabetes mellitus and to ascertain whether clinicians and non-diabetic respondents from the general public have similar views of the impact of diabetes upon health-related quality of life. MATERIAL/METHODS: Time tradeoff utility values were generated from a standardized time-tradeoff questionnaire. Three hundred and fifty-two individuals with type 1 or type 2 diabetes mellitus, 157 non-diabetic participants from the general public (community), and 61 health care clinicians participated in the study. RESULTS: The mean utility score for diabetic patients was 0.889 and the median utility score was 1.000. The mean utility score for clinicians was 0.861, with a median value of 0.894, while the respective mean and median scores for the general public were 0.919 and 0.953. There was a significant difference between the distribution of the means of scores of clinicians and patients as well as between clinicians and the general public. There was no significant difference between the utility scores of patients and the general public. Within the group of diabetic patients, there was no significant difference in utility scores between type 1 and type 2 diabetics. CONCLUSIONS: Clinicians tended to overemphasize the impact that diabetes mellitus has on health related quality of life, while the non-diabetic publics' utility values are more closely correlated with those of diabetics themselves. We conclude that there is a significant difference in how clinicians, diabetics and the general public perceive the effect diabetes has upon quality of life.

Adult↗
PubMedDate not supplied

Health care economic analyses and value-based medicine.

Health care economic analyses are becoming increasingly important in the evaluation of health care interventions, including many within ophthalmology. Encompassed with the realm of health care economic studies are cost-benefit analysis, cost-effectiveness analysis, cost-minimization analysis, and cost-utility analysis. Cost-utility analysis is the most sophisticated form of economic analysis and typically incorporates utility values. Utility values measure the preference for a health state and range from 0.0 (death) to 1.0 (perfect health). When the change in utility measures conferred by a health care intervention is multiplied by the duration of the benefit, the number of quality-adjusted life-years (QALYs) gained from the intervention is ascertained. This methodology incorporates both the improvement in quality of life and/or length of life, or the value, occurring as a result of the intervention. This improvement in value can then be amalgamated with discounted costs to yield expenditures per quality-adjusted life-year ($/QALY) gained. $/QALY gained is a measure that allows a comparison of the patient-perceived value of virtually all health care interventions for the dollars expended. A review of the literature on health care economic analyses, with particular emphasis on cost-utility analysis, is included in the present review. It is anticipated that cost-utility analysis will play a major role in health care within the coming decade.

Cost of Illness↗
PubMedDate not supplied

Impact of visual impairment on use of caregiving by individuals with age-related macular degeneration.

BACKGROUND: To assess the patient-reported use of caregiving among individuals with age-related macular degeneration (AMD) and evaluate the impact of visual impairment level on this use. METHODS: A survey including the AMD Health and Impact Questionnaire and the Daily Living Tasks Dependent on Vision Questionnaire (DLTV) was mailed to members of the Macular Degeneration Partnership. The study was approved by an institutional review board, and respondents provided consent before participating. Responses were analyzed by estimated visual acuity determined by scores from the DLTV. Deidentified data were analyzed using SAS Version 8.2 (SAS Institute, Cary, NC). RESULTS: Of 803 respondents, 56% were male, and the mean age was 73 years. Use of paid and unpaid help significantly increased as visual acuity decreased. Using a national average for caregiver time, annual costs for caregiving ranged from 225 to 47,086 US dollar depending on visual acuity. CONCLUSION: There are substantial differences in caregiver support with increased AMD severity. Delaying progression of AMD could result in considerable cost savings.

Aged↗
PubMedDate not supplied

Cytokines and chemokines are expressed at different levels in small and large murine colon-26 tumors following intratumoral injections of CpG ODN.

Direct tumor injections of (CpG ODN) into murine colon tumor 26 (CT-26) tumors can induce a potent antitumor response. Tumor size at the beginning of treatment determines the final therapeutic outcome, with smaller tumors responding favorably to CpG ODN therapy whereas large tumors do not. CpG ODN injections in small tumors resulted in tumor necrosis and extensive inflammatory cell infiltration, with average survival that is significantly higher (48.1 +/- 34 days) when compared to control ODN-treated mice (16.1 +/- 3.5 days). Cytokines and chemokines are expressed at different levels in small and large CT-26 tumors following intratumoral injections of CpG ODN. We observed that granulocyte-macrophage colony-stimulating factor and interleukin (IL) 6 are the major cytokines that were overexpressed in CpG ODN-treated small tumors but not in large tumors. Similarly, several chemokines (CXCL1, CCL2, and CCL3) were also significantly higher in CpG ODN-treated small tumors compared to control ODN-treated tumors.

Adjuvants, Immunologic↗