Estimating the cost-effectiveness of fluticasone propionate for treating chronic obstructive pulmonary disease in the presence of missing data

Objectives: To explore the cost-effectiveness of fluticasone propionate (FP) for the treatment of chronic obstructive pulmonary disease (COPD), we estimated costs and qualityadjusted life-years (QALYs) over 3 years, based on an economic appraisal of a previously reported clinical trial (Inhaled Steroids in Obstructive Lung Disease in Europe [ISOLDE]). Methods: Seven hundred forty-two patients enrolled in the ISOLDE trial who received either FP or placebo had data available on health-care costs and quality of life over the period of the study. The SF-36-based utility scores for quality of life were used to calculate QALYs. A combined imputation and bootstrapping procedure was employed to handle missing data and to estimate statistical uncertainty in the estimated cumulative costs and QALYs over the study period. The imputation approach was based on propensity scoring and nesting this approach within the bootstrap ensured that multiple imputations were performed such that statistical estimates included imputation uncertainty. Results: Complete data were available on mortality within the follow-up period of the study and a nonsignificant trend toward improved survival of 0.06 (95% confidence interval [CI] –0.01 to 0.15) life-years was observed. In an analysis based on a propensity scoring approach to missing data we estimated the incremental costs of FP versus placebo to be £1021 (95% CI £619–1338) with an additional effect of 0.11 QALYs (CI 0.04–0.20). Cost-effectiveness estimates for the within-trial period of £17,700 per life-year gained (£6900 to ∞) and £9500 per QALY gained (CI £4300–26,500) were generated that include uncertainty due to the imputation process. An alternative imputation approach did not materially affect these estimates. Conclusions: Previous analyses of the ISOLDE study showed significant improvement on disease-specific health status measures and a trend toward a survival advantage for treatment with FP. This analysis shows that joint considerations of quality of life and survival result in a substantial increase in QALYs favoring treatment with FP. Based on these data, the inhaled corticosteroid FP appears costeffective for the treatment of COPD. Confirmation or refutation of this result may be achieved once the Towards a Revolution in COPD Health (TORCH) study reports, a large randomized controlled trial powered to detect mortality changes associated with the use of FP alone, or in combination with salmeterol, which is also collecting resource use and utility data suitable for estimating cost-effectiveness

Paleoseismic and Slip-Rate Observations along the Honey Lake Fault Zone, Northeastern California, USA

The Honey Lake fault is a major strike-slip fault in northeastern California that accommodates northwest-directed right-lateral shear in the northern Walker Lane. We reexamine the fault’s paleoseismic history and slip rate by evaluating a natural stream bank exposure of the fault and offset terrace riser. Structural and stratigraphic relations within the modern stream cut, radiocarbon ages, and a detailed topographic survey of the offset terrace riser are used to estimate a Holocene fault slip rate of 1.7–0.6 mm/yr or more. We also interpret the occurrence of at least four surface-rupturing earthquakes during the last 7025 calendar years before present (B.P.). Three of the surface-rupturing earthquakes occurred prior to 4670 calendar years B.P. and have interevent times that range between 730 and 990 yr. The stratigraphic record is limited after ~4670 calendar years B.P., and records evidence for at least one more subsequent surface-rupturing earthquake

Harnessing Intellectual Resources in a Collaborative Context to Create Value

The value of electronic collaboration has arisen as successful organisations recognize that they need to convert their intellectual resources into customized services. The shift from personal computing to interpersonal or collaborative computing has given rise to ways of working that may bring about better and more effective use of intellectual resources. Current efforts in managing knowledge have concentrated on producing; sharing and storing knowledge while business problems require the combined use of these intellectual resources to enable organisations to provide innovative and customized services. In this chapter the collaborative context is developed using a model for electronic collaboration through the use of which organisations may mobilse collaborative technologies and intellectual resources towards achieving joint effect.electronic collaboration;value creation;collaborative computing;knowledge management and intellectual resources

Creating excitonic entanglement in quantum dots through the optical Stark effect

We show that two initially non-resonant quantum dots may be brought into resonance by the application of a single detuned laser. This allows for control of the inter-dot interactions and the generation of highly entangled excitonic states on the picosecond timescale. Along with arbitrary single qubit manipulations, this system would be sufficient for the demonstration of a prototype excitonic quantum computer.Comment: 4 pages, 3 figures; published version, figure 3 improved, corrections to RWA derive

The BATSE Gamma-Ray Burst Spectral Catalog. I. High Time Resolution Spectroscopy of Bright Bursts using High Energy Resolution Data

This is the first in a series of gamma-ray burst spectroscopy catalogs from the Burst And Transient Source Experiment (BATSE) on the Compton Gamma Ray Observatory, each covering a different aspect of burst phenomenology. In this paper, we present time-sequences of spectral fit parameters for 156 bursts selected for either their high peak flux or fluence. All bursts have at least eight spectra in excess of 45 sigma above background and span burst durations from 1.66 to 278 s. Individual spectral accumulations are typically 128 ms long at the peak of the brightest events, but can be as short as 16 ms, depending on the type of data selected. We have used mostly high energy resolution data from the Large Area Detectors, covering an energy range of typically 28 - 1800 keV. The spectral model chosen is from a small empirically-determined set of functions, such as the well-known `GRB' function, that best fits the time-averaged burst spectra. Thus, there are generally three spectral shape parameters available for each of the 5500 total spectra: a low-energy power-law index, a characteristic break energy and possibly a high-energy power-law index. We present the distributions of the observed sets of these parameters and comment on their implications. The complete set of data that accompanies this paper is necessarily large, and thus is archived electronically at: http://www.journals.uchicago.edu/ApJ/journal/.Comment: Accepted for publication: ApJS, 125. 38 pages, 9 figures; supplementary electronic archive to be published by ApJ; available from lead author upon reques

Time Dependent Clustering Analysis of the Second BATSE Gamma-Ray Burst Catalog

A time dependent two-point correlation-function analysis of the BATSE 2B catalog finds no evidence of burst repetition. As part of this analysis, we discuss the effects of sky exposure on the observability of burst repetition and present the equation describing the signature of burst repetition in the data. For a model of all burst repetition from a source occurring in less than five days we derive upper limits on the number of bursts in the catalog from repeaters and model-dependent upper limits on the fraction of burst sources that produce multiple outbursts.Comment: To appear in the Astrophysical Journal Letters, uuencoded compressed PostScript, 11 pages with 4 embedded figure