How to deal with cost differences at baseline

BACKGROUND: To our knowledge, adjustment for baseline imbalances in costs has never been performed in trial-based cost-effectiveness analyses. METHODS: We used data from a clinical trial performed in the Netherlands comparing two outpatient psychotherapies: schema-focused therapy (SFT) versus transference-focused psychotherapy (TFP). Costs were assessed with a cost interview. Outcome was the proportion of recovered patients measured with the Borderline Personality Disorder Severity Index (BPDSI-IV). We used three methods to adjust the costs for baseline differences: (i) mean difference adjustment, calculating total costs after baseline by adjusting the difference between groups with the difference of the mean baseline costs; (ii) delta adjustment, calculating the individual differences between patient baseline and the subsequent measurements (concerning incremental costs, this is the same as mean difference adjustment); and (iii) regression-based adjustment, adjusting total costs with a regression model, with total costs as the dependent variable and baseline costs as the independent variable. RESULTS: Mean baseline costs were 3339 euros for SFT and 4238 euros for TFP, a mean difference of 899 euros. Total unadjusted follow-up costs were 30822 euros for SFT and 36812 euros for TFP. The fraction of recovered patients was 45% for SFT and 24% for TFP. Cost-effectiveness acceptability curves show that mean difference and delta adjustments are different from the regression-based methods. CONCLUSIONS: Although the routine starting point of an analysis should always be an unadjusted analysis of the cost effectiveness, a baseline difference between treatment groups should be adjusted for. This should be done by reported patient characteristics or, when these are not sufficiently present, by baseline costs as a substitute. This adjustment should be carried out most preferably with a regression-based method

How to Deal with Cost Differences at Baseline

Background To our knowledge, adjustment for baseline imbalances in costs has never been performed in trial-based cost-effectiveness analyses. Abstract: Methods We used data from a clinical trial performed in the Netherlands comparing two outpatient psychotherapies: schema-focused therapy (SFT) versus transference-focused psychotherapy (TFP). Costs were assessed with a cost interview. Outcome was the proportion of recovered patients measured with the Borderline Personality Disorder Severity Index (BPDSI-IV). We used three methods to adjust the costs for baseline differences: (i) mean difference adjustment, calculating total costs after baseline by adjusting the difference between groups with the difference of the mean baseline costs; (ii) delta adjustment, calculating the individual differences between patient baseline and the subsequent measurements (concerning incremental costs, this is the same as mean difference adjustment); and (iii) regression-based adjustment, adjusting total costs with a regression model, with total costs as the dependent variable and baseline costs as the independent variable. Abstract: Results Mean baseline costs were €3339 for SFT and €4238 for TFP, a mean difference of €899. Total unadjusted follow-up costs were €30 822 for SFT and €36 812 for TFP. The fraction of recovered patients was 45% for SFT and 24% for TFP. Cost-effectiveness acceptability curves show that mean difference and delta adjustments are different from the regression-based methods. Abstract: Conclusions Although the routine starting point of an analysis should always be an unadjusted analysis of the cost effectiveness, a baseline difference between treatment groups should be adjusted for. This should be done by reported patient characteristics or, when these are not sufficiently present, by baseline costs as a substitute. This adjustment should be carried out most preferably with a regression-based method.

Valores de referência e influência da idade no eritrograma de fêmeas bovinas da raça Aquitânica Reference values and age effect on the erythrogram of bovine females of the Aquitanian breed

Determinaram-se os valores de referência e estudou-se a influência da idade sobre o eritrograma em fêmeas bovinas da raça Aquitânica. Amostras de sangue de 80 fêmeas bovinas, acima de 12 meses de idade, e não reagentes ao antígeno do vírus da leucose dos bovinos, foram colhidas utilizando-se EDTA como anticoagulante para realização das seguintes provas: contagem global das hemácias, determinação do volume globular, concentração de hemoglobina, cálculo dos índices hematimétricos absolutos - volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM) e concentração de hemoglobina corpuscular média (CHCM). A idade exerceu influência significativa (P<0,05) sobre a maioria dos parâmetros hematológicos estudados, com diminuição da quantidade de hemácias e aumento do volume globular, quantidade de hemoglobina, VCM e HCM. Os valores foram: hemácias 6,68&plusmn;0,58&times;10(6)/mm³, volume globular 41,2&plusmn;4,5%, hemoglobina 12,8&plusmn;1,31g/dl, VCM 61,83&plusmn;6,54fl, HCM 19,28&plusmn;2,25pg, CHCM 31,4&plusmn;2,3%.<br>The reference values and the influence of the age factor on the erytrogram in bovine females of the Aquitanian breed were evaluated. Blood samples of 80 healthy females, all tested negative for bovine leucose virus, were utilized for the analysis. Erythrocyte counts, determination of the packed cell volume, concentration of hemoglobin, calculation of hematimetric absolute rates of mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) were evaluated. Significant influence (P<0.05) of age was observed for most of the hematological characteristics, with decreased of the number of erythrocytes and increase of packed cell volume, quantity of hemoglobin, MCV, MCH. The reference values were: erythrocytes counting 6.68&plusmn;0.58&times;10(6)/mm³, packed cell volume 41.2&plusmn;4.5%, hemoglobin 12.8&plusmn;1.31g/dl, VCM 61.83&plusmn;6.54fl, HCM 19.28&plusmn;2.25pg, CHCM 31.4&plusmn;2.3%

Eritrograma de bezerras sadias, da raça Holandesa, no primeiro mês de vida

Com a finalidade de estabelecer valores de referência e de avaliar a influência do fator etário sobre o eritrograma de bezerras sadias, da raça Holandesa, utilizaram-se amostras de sangue de 300 animais, distribuídos por 15 grupos experimentais, de acordo com a idade, no primeiro mês de vida. As variações dos valores médios obtidos para os componentes do eritrograma foram as seguintes: número de hemácias (x10(6)/mm³) = 6,68-7,60, volume globular (%) = 29,80-33,35, taxa de hemoglobina (g/dl) = 9,00-10,43, volume corpuscular médio (fl) = 38,93 47,68, hemoglobina corpuscular média (pg) = 11,75-14,69, concentração de hemoglobina corpuscular média (%) = 29,53-31,63% e número de reticulócitos (x10³/mm³) = 0,00-11,86. A influência do fator etário provou-se significativa para o volume corpuscular médio, hemoglobina corpuscular média e número de reticulócitos

Estudo retrospectivo de 66 casos de urolitíase obstrutiva em ovinos

Objetivou-se realizar um estudo retrospectivo dos principais achados epidemiológicos, clínicos, patológicos e laboratoriais de ovinos acometidos por urolitíase obstrutiva, atendidos na Clínica de Bovinos, Campus Garanhuns/ UFRPE. Para isso, foram analisadas 66 fichas clínicas de ovinos, todos machos não castrados, com idade entre dois meses e cinco anos. A maioria dos casos (79,63%) ocorreu na época chuvosa. A maioria dos animais (87,88%) era criada intensivamente e todos eram alimentados com concentrados. Os sinais clínicos mais importantes foram as manifestações de dor, congestão de mucosas, hipertermia e aumento da tensão abdominal associados a obstrução do trato urinário. Metade dos animais apresentou obstrução total da uretra. Destes, 69,70% morreram, enquanto nos casos de obstrução parcial, 30,30% morreram. Nos exames laboratoriais verificou-se neutrofilia e desvio à esquerda regenerativo, hiperfibrinogenemia e azotemia. Na urinálise constatou-se hematúria em 89,29% dos casos e pH ácido em 46,43%. Na sedimentoscopia predominaram hemácias, leucócitos, células de descamação do epitélio uretral e cristais de urato amorfo. Os achados necroscópicos renais mais frequentes foram pielonefrite (61,54% dos casos) e hidronefrose (50%). Nos ureteres foram visualizados ureterite e hidroureter. Na bexiga foi mais evidente a cistite hemorrágica difusa (50%) e a presença de urólitos (57,69%). Na uretra observaram-se urólitos (61,54%) e uretrite hemorrágica difusa (57,69%). Quanto à composição dos urólitos predominaram os compostos por oxalato de cálcio hidratado. Conclui-se que no Agreste de Pernambuco a urolitiase é uma doença importante de ovinos, com alta letalidade, estando associada à alimentação rica em concentrados e sal mineral