Reduced costs with bisoprolol treatment for heart failure - An economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure

The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: A report from the Euro Heart Survey on Coronary Revascularisation

Objective: Self-perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS-CR) provided an opportunity to explore whether impaired health status was a predictor of 1-year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods: Data from the EHS-CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self-report measure of health status, the EuroQol Questionnaire (EQ-5D) at discharge and information on 1-year follow-up, resulting in a study population of 3786 patients. Results: The 1-year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ-5D as compared with non-survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self-care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (≤ 60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1-year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions: This analysis shows that impaired health status is associated with a 2-3-fold increased risk of all-cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice

Erprobung der Anwendbarkeit von Hochtemperatursupraleitern im Weltraum Abschlussbericht

Within the research project developments of HTS components for the 'High-Temperature-Superconductivity Space Experiments (HTSSE)' as well as additional work towards future HTS projects has been carried out. The miniaturized patch antenna in thin film technology and the compact hydrogen maser resonator as well have been tested and subsequently integrated together with the HTS components from other groups into the HTSSE-I payload. Although in 1993 the launch of the satellite failed. From results obtained in laboratory tests important conclusions with respect to manufacturing technology, film aging and radiation resistance were gained. Within HTSSE-II a demonstrator for a multifrequency multibeam feed array has been developed. A terrestrial version of this demonstrator has been delivered to the NRL where it was already tested. After the decision for the implementation of the HTSSE-II payload on the backside of the ARGOS-satellite the implementation of the antenna turned out to be no more realizable. Despite that decision the work towards a space version of the demonstrator was in consens with the NRL continued. Additionally the concept of multifrequency array systems has been further developed. Finally RF-properties of Josephson-junctions were investigated with respect to potential applications to nonlinear RF-signal-processing. (orig./MM)Im Forschungs-Vorhaben wurden Arbeiten zur Erprobung der HTSL-Technologie im Rahmen des amerikanischen 'High-Temperature-Superconductivity Space Experiments (HTSSE)' und ergaenzende Arbeiten zur Vorbereitung avisierter zukuenftiger Projekte in diesem Anwendungsfeld durchgefuehrt. Die miniaturisierte Patch-Antenne in HTSL-Duennfilmtechnologie und der kompakte Wasserstoffmaser-Resonator mit YBCO-Oberflaechen wurde vom NRL getestet und zusammen mit anderen Komponenten in das Weltraummodul HTSSE I integriert. Obwohl Ende 1993 der Weltraumstart des HTSSE-I-Moduls mit Hilfe einer Titan-Rakete misslang, fuehrten Auswertungen der bis dahin erzielten Testergebnisse zu wichtigen Erkenntnissen bezueglich der Herstellungstechnologie, der Filmalterung und der Strahlungsresistenz. Im Rahmen der HTSSE-II-Mission wurde ein Demonstrator fuer das Speisesystem einer multifrequenten Mehrfachkeulenantenne aus HTSL entwickelt. Ein terrestrischer Demonstrator fuer dieses Konzept wurde 1993 an das NRL ausgeliefert und dort getestet. Nachdem eine Entscheidung zur Implementierung der HTSSE-II-Nutzlast in den erdabgewandten Teil des ARGOS-Satelliten fiel, erwies sich eine Integration dieses Antennen-Demonstrators aus technischen und finanziellen Gruenden als nicht mehr realisierbar. Trotzdem wurden in Absprache und Kooperation mit dem NRL die Arbeiten an diesem Demonstrator fortgesetzt und insbesondere eine weltraumtaugliche Version realisiert. Ergaenzend wurden Arbeiten zur Fortentwicklung der Konzeption von multifrequenten Antennen-Arrays und Arbeiten zur Verwendung verschiedener Josephson-Element-Strukturen fuer die nichtlineare Hochfrequenzsignalverarbeitung durchgefuehrt. (orig./MM)Available from TIB Hannover: F97B79+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany); Deutsche Agentur fuer Raumfahrtangelegenheiten (DARA) GmbH, Bonn (Germany)DEGerman