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

Theory of weak hypernuclear decay

The weak nomesonic decay ofΛ-hypernuclei is studied in the context of a one-meson-exchange model. Predictions are made for the decay rate, thep/nstimulation ratio and the asymmetry in polarized hypernuclear decay

Micropillar compression studies on a bulk metallic glass in different structural states

Uniaxial compression experiments on 0.3, 1 and 3 mu m diameter micropillars of a Zr-based bulk metallic glass in as-cast, shot-peened and structurally relaxed conditions were conducted. Shear band formation and stable propagation is observed to be the plastic deformation mode in all cases, with no detectable difference in yield strength according to either size or condition. The limitations of uniaxial compression tests in assessing the influence of various material conditions on plasticity, when it is inhomogeneous in nature, are illustrated

Nitrogen fixation and transfer in grassclover leys under organic and conventional cropping systems

Background and aim Symbiotic dinitrogen (N2) fixation is the most important external N source in organic systems. Our objective was to compare symbiotic N2 fixation of clover grown in organically and conventionally cropped grass-clover leys, while taking into account nutrient supply gradients. Methods We studied leys of a 30-year-old field experiment over 2 years in order to compare organic and conventional systems at two fertilization levels. Using 15N natural abundance methods, we determined the proportion of N derived from the atmosphere (PNdfa), the amount of Ndfa (ANdfa), and the transfer of clover N to grasses for both red clover (Trifolium pratense L.) and white clover (Trifolium repens L.). Results In all treatments and both years, PNdfa was high (83 to 91 %), indicating that the N2 fixation process is not constrained, even not in the strongly nutrient deficient non-fertilized control treatment. Annual ANdfa in harvested clover biomass ranged from 6 to 16 gN m−2. At typical fertilizer input levels, lower sward yield in organic than those in conventional treatments had no effect on ANdfa because of organic treatments had greater clover proportions. In two-year-old leys, on average, 51 % of N taken up by grasses was transferred from clover. Conclusion Both, organically and conventionally cropped grass-clover leys profited from symbiotic N2 fixation, with high PNdfa, and important transfer of clover N to grasses, provided sufficient potassiumand phosphorus-availability to sustain clover biomass production