499 research outputs found

    Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment

    Get PDF
    Introduction: Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women. Methods: Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorptiometry (DXA), and alendronate treatment for individuals with osteoporosis; with a comparator of "no screening" and treatment only after fracture occurrence. We evaluated annual alendronate costs of 20through20 through 800; outcome measures included fractures; nursing home admission; medication adverse events; death; costs; quality-adjusted life-years (QALYs); and incremental cost-effectiveness ratios (ICERs) in 2010 U.S. dollars per QALY gained. A lifetime time horizon was used, and direct costs were included. Base-case and sensitivity analyses were performed. Results: Base-case analysis results showed that at annual alendronate costs of 200orless,osteoporosisscreeningfollowedbytreatmentwascostsaving,resultinginlowertotalcoststhannoscreeningaswellasmoreQALYs(10.6additionalqualityadjustedlifedays).Whenassumingalendronatecostsof200 or less, osteoporosis screening followed by treatment was cost-saving, resulting in lower total costs than no screening as well as more QALYs (10.6 additional quality-adjusted life-days). When assuming alendronate costs of 400 through 800,screeningandtreatmentresultedingreaterlifetimecoststhannoscreeningbutwashighlycosteffective,withICERsrangingfrom800, screening and treatment resulted in greater lifetime costs than no screening but was highly cost-effective, with ICERs ranging from 714 per QALY gained through 13,902perQALYgained.Probabilisticsensitivityanalysesrevealedthatthecosteffectivenessofosteoporosisscreeningfollowedbyalendronatetreatmentwasrobusttojointinputparameterestimatevariationatawillingnesstopaythresholdof13,902 per QALY gained. Probabilistic sensitivity analyses revealed that the cost-effectiveness of osteoporosis screening followed by alendronate treatment was robust to joint input parameter estimate variation at a willingness-to-pay threshold of 50,000/QALY at all alendronate costs evaluated. Conclusions: Osteoporosis screening followed by alendronate treatment is effective and highly cost-effective for postmenopausal women across a range of alendronate costs, and may be cost-saving at annual alendronate costs of $200 or less. © 2012 Nayak et al

    Sexual harassment and abuse in sport: The research context

    Get PDF
    This special issue of the Journal of Sexual Aggression draws on the contributions to a Symposium on ‘Sexual Harassment in Sport – Challenges for Sport Psychology in the New Millennium’, held at the Xth Congress of the International Society for Sport Psychology, Skiathos, Greece from May 28th to June 2nd 2001. The symposium, which was organised by the authors of this editorial, was intended to move forward the international research agenda on sexual harassment and abuse in sport and to examine professional practice issues for sport psychologists. It was clear from the attendance of over 60 delegates at that symposium that international interest in this subject is growing. Further evidence of this came from the attendance of 26 members states – from Azerbaijan to Sweden - at a Council of Europe seminar on The Protection of Children, Young People and Women in Sport, held in Helsinki in September 2001

    Feminist phenomenology and the woman in the running body

    Get PDF
    Modern phenomenology, with its roots in Husserlian philosophy, has been taken up and utilised in a myriad of ways within different disciplines, but until recently has remained relatively under-used within sports studies. A corpus of sociological-phenomenological work is now beginning to develop in this domain, alongside a longer standing literature in feminist phenomenology. These specific social-phenomenological forms explore the situatedness of lived-body experience within a particular social structure. After providing a brief overview of key strands of phenomenology, this article considers some of the ways in which sociological, and particularly feminist phenomenology, might be used to analyse female sporting embodiment. For illustrative purposes, data from an autophenomenographic project on female distance running are also included, in order briefly to demonstrate the application of phenomenology within sociology, as both theoretical framework and methodological approach

    Simulation modeling for stratified breast cancer screening : a systematic review of cost and quality of life assumptions

    Get PDF
    BACKGROUND: The economic evaluation of stratified breast cancer screening gains momentum, but produces also very diverse results. Systematic reviews so far focused on modeling techniques and epidemiologic assumptions. However, cost and utility parameters received only little attention. This systematic review assesses simulation models for stratified breast cancer screening based on their cost and utility parameters in each phase of breast cancer screening and care. METHODS: A literature review was conducted to compare economic evaluations with simulation models of personalized breast cancer screening. Study quality was assessed using reporting guidelines. Cost and utility inputs were extracted, standardized and structured using a care delivery framework. Studies were then clustered according to their study aim and parameters were compared within the clusters. RESULTS: Eighteen studies were identified within three study clusters. Reporting quality was very diverse in all three clusters. Only two studies in cluster 1, four studies in cluster 2 and one study in cluster 3 scored high in the quality appraisal. In addition to the quality appraisal, this review assessed if the simulation models were consistent in integrating all relevant phases of care, if utility parameters were consistent and methodological sound and if cost were compatible and consistent in the actual parameters used for screening, diagnostic work up and treatment. Of 18 studies, only three studies did not show signs of potential bias. CONCLUSION: This systematic review shows that a closer look into the cost and utility parameter can help to identify potential bias. Future simulation models should focus on integrating all relevant phases of care, using methodologically sound utility parameters and avoiding inconsistent cost parameters

    Omori-like decay of postseismic velocities following continental earthquakes

    Get PDF
    Various mechanisms have been proposed to explain the transient, enhanced surface deformation rates following earthquakes. Unfortunately, these different mechanisms can produce very similar surface deformation patterns leading to difficulty in distinguishing between them. Here, we return to the observations themselves and compile near-field postseismic velocity measurements following moderate to large continental earthquakes. We find that these velocities have a remarkably consistent pattern, with velocity inversely proportional to time since the earthquake. This suggests that postseismic velocities show an Omori-like decay and that postseismic displacements increase logarithmically over time. These observations are inconsistent with simple, linear Maxwell or Burgers body viscoelastic relaxation mechanisms but are consistent with rate-and-state frictional afterslip models and power-law shear zone models. The results imply that postseismic surface deformation measurements are primarily the result of fault zone processes, and therefore, that the inference of lower crustal viscosities from near-field postseismic deformation requires care
    corecore