The cost-effectiveness of ivermectin vs. albendazole in the presumptive treatment of strongyloidiasis in immigrants to the United States

The presumptive treatment of parasitosis among immigrants with albendazole has been shown to save both money and lives, primarily via a reduction in the burden of Strongyloides stercoralis. Ivermectin is more effective than albendazole, but is also more expensive. This coupled with confusion surrounding the cost-effectiveness of guiding therapy based on eosinophil counts has led to disparate practices. We used the newly arrived year 2000 immigrant population as a hypothetical cohort in a decision analysis model to examine the cost-effectiveness of various interventions to reduce parasitosis among immigrants. When the prevalence of S. stercoralis is greater than 2%, the incremental cost-effectiveness ratios of all presumptive treatment strategies were similar. Ivermectin is associated with an incremental cost-effectiveness ratio of $1700 per QALY gained for treatment with 12 mg ivermectin relative to 5 days of albendazole when the prevalence is 10%. Any presumptive treatment strategy is cost-effective when compared with most common medical interventions

Survival on Renal Replacement Therapy: Data from the EDTA Registry

Extensive survival data are presented from the EDTA Registry's files for patients who started renal replacement therapy in 1970-1974 compared to 1980-1984. The contribution of the different treatment modalities (haemodialysis, continuous peritoneal dialysis, and transplantation) to the survival of patients according to geographical region is also shown. Survival on renal replacement therapy, irrespective of treatment modality and of primary renal disease, was best in the 10-14-year-old patients, with 58% at 10 years and 52% at 15 years, and decreased with rising age to 28% at 10 years and 16% at 15 years in patients aged 45-54 when they commenced therapy in 1970-1974. When comparing the 0-4-year-old with the 10-14-year-old cohort of the paediatric patients, 5-year survival rates for patients starting renal replacement therapy in the early eighties declined from 85% to 70% with decreasing age. Treatment policy, as reflected by the proportion of patients on different modes of therapy, varied markedly between European regions but affected survival to a small extent only. The large population with diabetic nephropathy incurred annual mortality rates 2-3 times greater than those observed in patients with ‘standard' primary renal diseases. Haemodialysis and continuous peritoneal dialysis, although not comparable because of important differences in selection policy, yielded similar survival rates. Patient and graft survival rates have improved markedly when comparing patients starting renal replacement therapy in the early seventies with the eighties; particularly for cadaveric transplantation. Patient survival after second grafting was similar to that after first grafting, with 83% at 5 years after second cadaveric grafting in the 15-44-year-old cohort, vs 85% after first cadaver transplantation in 1980-1984. Second cadaveric graft survival was superior to average first-graft survival for those recipients whose first graft had been functioning for more than 1 year. However, second-graft survival in rapid rejectors of a first graft as well as third cadaveric graft survival were curtailed by the large number of early losses, with only 52% of third grafts functioning at 1 year. For living related donor transplantation, parents were mostly used in children whilst identical siblings predominated in adults older than 45. In the early eighties, patient survival was 92% at 5 years for recipients younger than 15, 87% for the 15-45 year old cohort and 72% for those aged 45 or older. From the overall survival rates on renal replacement therapy obtained at 5 years in the early eighties, it appears safe to predict that at least 65% of young adults and 25% of patients aged 55-64 will be surviving at 10 years after starting therap

Demography of Dialysis and Transplantation in Europe, 1984: Report from the European Dialysis and Transplant Association Registry

The demography of treatment of children by renal replacement therapy in Europe is presented based on returns of individual patient questionnaires to the EDTA Registry up until the close of 1984. Patient questionnaires for 1984 were completed by all centres which defined themselves as special paediatric units. A total of 4983 patients have been reported to the Registry up until 31 December 1984 as having commenced renal replacement therapy under the age of 15. Of these, 1570 were known to be alive on a defined form of treatment at the end of 1984 and still under the age of 15. The numbers of these patients kept alive by different forms of treatment in individual countries are presented. The stock of patients aged under 15 at the end of 1984 exceeded 30 per million child population in Belgium, France, Iceland and Luxembourg. The highest age specific acceptance rates for children onto renal replacement therapy during 1984 were noted in those aged between 10 and 14 at first treatment. Age specific acceptance rates for children varied greatly between individual countries, and 18 countries reported no new patients under the age of 5 during 1984. Transplant activity in paediatric patients during 1984 has been analysed and results on regrafting presented. Proportional distribution of primary renal diseases amongst children commencing therapy in 1984 is shown according to age at start of treatment. Haemolytic uraemic syndrome was reported as the cause of end-stage renal failure in 12.0% of children commencing treatment under the age of 5, and 12.3% of children between 5 and 9. Finally, information on cause of death in paediatric patients dying during 1984 is presented, and shows cardiovascular disease was the leading cause of mortalit

EDTA Registry Centre Survey, 1985: Report from the European Dialysis and Transplant Association Registry*

This paper summarises the information given on the 1985 EDTA Registry centre questionnaire which was returned by 82% of 1959 known dialysis and transplant units in 33 European countries. Trends in the use of different forms of renal replacement therapy are discussed, and attention drawn to the discrepancy between the EDTA centre and individual patient questionnaires as a source of demographic information on dialysis and transplantation. The results of special questions on dialyser re-use, dialysis equipment, AIDS, and hepatitis are presented, and information obtained from the special paediatric section of the centre questionnaire is also give

Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy

Background. Elderly patients with end-stage renal disease and severe extra-renal comorbidity have a poor prognosis on renal replacement therapy (RRT) and may opt to be managed conservatively (CM). Information on the survival of patients on this mode of therapy is limited

Active collaboration with primary care providers increases specialist referral in chronic renal disease

BACKGROUND: Late referral to specialist nephrological care is associated with increased morbidity, mortality, and cost. Consequently, nephrologists' associations recommend early referral. The recommendations' effectiveness remains questionable: 22–51% of referrals need renal replacement therapy (RRT) within 3–4 months. This may be due to these recommendations addressing the specialist, rather than the primary care providers (PCP). The potential of specialist intervention aiming at slowing progression of chronic renal failure was introduced individually to some 250 local PCPs, and referral strategies were discussed. To overcome the PCPs' most often expressed fears, every referred patient was asked to report back to his PCP immediately after the initial specialist examination, and new medications were prescribed directly, and thus allotted to the nephrologist's budget. METHODS: In retrospective analysis, the stage of renal disease in patients referred within three months before the introductory round (group A, n = 18), was compared to referrals two years later (group B, n = 50). RESULTS: Relative number of patients remained stable (28%) for mild/ moderate chronic kidney disease (MMCKD), while there was a noticeable shift from patients referred severe chronic kidney disease (SCKD) (group A: 44%, group B: 20%) to patients referred in moderate chronic kidney disease (MCKD) (group A: 28%, group B: 52%). CONCLUSION: Individually addressing PCPs' ignorance and concerns noticeably decreased late referral. This stresses the importance of enhancing the PCPs' problem awareness and knowledge of available resources in order to ensure timely specialist referral