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

Facteurs limitants de la croissance initiale d'une plantation de Merisier (Prunus avium L.) sur rendzine brunifiée

International audienc

Comparaison de trois types de matériel pour l'application d'herbicides en conditions forestières

An experiment was conducted on a five-year-old Douglas plantation to determine the cause of accidental damage due to selective herbicides observed on young forest plants. Three application equipments are combined to four herbicides. No phytotoxicity was observed with a mechanical sprayer boom with slot nozzles (400 l/ha of aqueous mixture) or with Girojet centrifugal nozzles (40l/ha). Mechanical spraying with a " barrel " (airbone jet sprayer with rotating barrel) (300 l/ha) leads to damage observed on the side of the plants that has been exposed to the spraying. The intensity of the damage is correlated to the distance between the barrel and the plant. The damage is non-existent with fosamine ammonium (4800 g/ha), not frequent with glyphosate (1080 g/ha) and triclopyr + 2,4-D (additive effect). These results indicate the risks involved with the use of the barrel in selective treatment, the security of the sprayer boom equipped with slot nozzles, the additional interest of the girojet which enables to reduce the amounts of water used. / Une expérimentation est réalisée sur une plantation de Douglas âgée de cinq ans pour analyser la cause des dommages accidentels observés sur les jeunes plants forestiers avec des herbicides sélectifs. Trois matériels d'application sont combinés avec quatre herbicides. Aucune phytotoxicité n'est observée avec un pulvérisateur mécanique à rampe muni de buses à fente (400l/ha de bouillie aqueuse) ou muni de buses centrifuges Girojet (40l/ha). La pulvérisation mécanique avec un "canon" (pulvérisateur à jet aéroporté surélevé, à canon oscillant) (300 l/ha) entraîne des dégâts qui apparaissent préférentiellement sur la face des plants exposés à la pulvérisation, et dont l'intensité est corrélée à la distance entre le canon et le plant. Ces dégats sont nuls avec fosamine ammonium (4800 g/ha), peu fréquents avec glyphosate (1080 g/ha) et triclopyr + 2,4-D (520 + 465 g/ha), très fréquents avec le mélange fosamine + triclopyr + 2,4-D (effet synergique). Ces résultats montrent les risques d'emploi du "canon" en traitement sélectif ; la sûreté de la rampe équipée de buses à fente ; l'intérêt supplémentaire du girojet qui permet de réduire les quantités d'eau

Efficacité d'un paillage de papier journal sur la croissance initiale du merisier (Prunus avium L.)

International audienc

High-Current, High-Coulomb Testing of Ignitrons

Center for Electromechanic

Testing the 60 MJ Pulsed Homopolar Power Supply at the University of Texas, Center for Electromechanics

The Center for Electromechanics at the University of Texas at Austin (CEM-UT) has successfully designed, built, and tested homopolar generators (HPGs) since 1972. These machines exhibit high energy storage densities and are capable of converting stored inertial energy to electrical energy at extremely high power levels. This feature makes them well suited for a wide range of applications including thermonuclear fusion, resistance welding, pulse sintering, and electromagnetic launchers. In December 1988, CEM-UT along with Parker Kinetic Designs, Inc. (PKD) completed acceptance testing of the latest in this technology: the Balcones 60 MJ pulsed homopolar generator power supply (BHPG). This power supply is presently capable of producing 9 MA at 100 V. This paper describes the BHPG systems and operating characteristics. Data is presented from commissioning short circuit tests for the six generator system, including single and multiple generator tests, as well as system performance levels during railgun solid armature tests.Center for Electromechanic