Budget impact of adding ivabradine to standard of care in patients with chronic systolic heart failure in the United States

BACKGROUND: Heart failure (HF) costs $21 billion annually in direct health care costs, 80 OBJECTIVE: To estimate the budget impact of ivabradine from a U.S. commercial payer perspective. METHODS: A budget impact model estimated the per-member-per month (PMPM) impact of introducing ivabradine to existing formularies by comparing a reference scenario (SoC) and a new drug scenario (ivabradine + SoC) in hypothetical 1 million-member commercial and Medicare Advantage plans. In both scenarios, U.S. claims data were used for the reference cumulative annual rates of hospitalizations (HF, non-HF cardiovascular [CV], and non-CV), and hospitalization rates were adjusted using SHIFT data. The model controlled for mortality risk using SHIFT and U.S. life table data, and hospitalization costs were obtained from U.S. claims data: HF-related =$37,507; non-HF CV = $28,951; and non-CV =$17,904. The annualized wholesale acquisition cost of ivabradine was $4,500, with baseline use for this new drug at 2 RESULTS: Based on the approved U.S. indication, approximately 2,000 commercially insured patients from a 1 million-member commercial plan were eligible to receive ivabradine. Ivabradine resulted in a PMPM cost savings of$0.01 and $0.04 in years 1 and 3 of the core model, respectively. After including the acquisition price for ivabradine, the model showed a decrease in total costs in the commercial ($991,256 and $474,499, respectively) and Medicare populations ($13,849,262 and $4,280,291, respectively) in year 1. This decrease was driven by ivabradine’s reduction in hospitalization rates. For the core model, the estimated pharmacy-only PMPM in year 1 was$0.01 for the commercial population and $0.24 for the Medicare Advantage population. CONCLUSIONS: Adding ivabradine to SoC led to lower average annual treatment costs. The negative PMPM budget impact indicates that ivabradine is an affordable option for U.S. payers

Antimatter and Matter Production in Heavy Ion Collisions at CERN (The NEWMASS Experiment NA52)

Besides the dedicated search for strangelets NA52 measures light (anti)particle and (anti)nuclei production over a wide range of rapidity. Compared to previous runs the statistics has been increased in the 1998 run by more than one order of magnitude for negatively charged objects at different spectrometer rigidities. Together with previous data taking at a rigidity of -20 GeV/c we obtained 10^6 antiprotons 10^3 antideuterons and two antihelium3 without centrality requirements. We measured nuclei and antinuclei (p,d,antiprotons, antideuterons) near midrapidity covering an impact parameter range of b=2-12 fm. Our results strongly indicate that nuclei and antinuclei are mainly produced via the coalescence mechanism. However the centrality dependence of the antibaryon to baryon ratios show that antibaryons are diminished due to annihilation and breakup reactions in the hadron dense environment. The volume of the particle source extracted from coalescence models agrees with results from pion interferometry for an expanding source. The chemical and thermal freeze-out of nuclei and antinuclei appear to coincide with each other and with the thermal freeze-out of hadrons.Comment: 12 pages, 8 figures, to appear in the proceedings of the conference on 'Fundamental Issues in Elementary Matter' Bad Honnef, Germany, Sept. 25-29, 200

role of limbic system in the control of hamster growth

Rostral septal lesions accelerate somatic growth in adult hamsters. This study tested the hypothesis that this effect results from damage to fibers of passage by observing the effects of transections of septohippocampal and septohypothalamic connections on growth. We attempted to identify these fibers further by (a) measuring spectrofluorometrically changes in the monoamine concentrations in hippocampus, cerebral cortex, corpus striatum, and diencephalon, (b) staining the degenerating axons after septal lesions and the two cuts, and (c) examining the correspondence between such damage and the acceleration of growth. Both knife cuts accelerated somatic growth and were associated (as well as septal lesions) with significant depletions of serotonin (-27 to -57%) and norepinephrine (-27 to -60%) in the hippocampus, with less consistent depletions of these monoamines in the cerebral cortex, and with no changes in regional dopamine content. All three procedures were associated with degeneration in the hippocampal formation and its fiber systems. Thus, fibers interconnecting hippocampus and brainstem, and passing through septum, exert tonic suppression over somatic growth in adult hamsters.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23616/1/0000579.pd

Stability of strangelet at finite temperature

Using the quark mass density- and temperature dependent model, we have studied the thermodynamical properties and the stability of strangelet at finite temperature. The temperature, charge and strangeness dependences on the stability of strangelet are investigated. We find that the stable strangelets are only occured in the high strangeness and high negative charge region.Comment: 12 pages, 14 figure

Multibaryons in the collective coordinate approach to the SU(3) Skyrme model

We obtain the rotational spectrum of strange multibaryon states by performing the SU(3) collective coordinate quantization of the static multi-Skyrmions. These background configurations are given in terms of rational maps, which are very good approximations and share the same symmetries as the exact solutions. Thus, the allowed quantum numbers in the spectra and the structure of the collective Hamiltonians we obtain are also valid in the exact case. We find that the predicted spectra are in overall agreement with those corresponding to the alternative bound state soliton model.Comment: 16 pages, 1 figur

Cold Strangelets Formation with Finite Size Effects in High Energy Heavy-Ion Collisions

We have studied the phase diagram and evolution of a strangelet in equilibrium with a finite hadronic gas. Significant finite size modifications of the phase diagram are found and their parameter dependences are studied. With the inclusion of finite size effects we have also been able to obtain the detailed properties of the cold strangelet emerging in the final stage of the isentropic expansion of a finite strange fireball in high energy heavy-ion collisions.Comment: 19 pages(RevTex), 11 Postscript figures; To appear in Phys. Rev.

Financial impact of ivabradine on reducing heart failure penalties under the Hospital Readmission Reduction Program

Objective: The introduction of the Hospital Readmission Reduction Program (HRRP) has led to renewed interest in developing strategies to reduce 30 day readmissions among patients with heart failure (HF). In this study, a model was developed to investigate whether the addition of ivabradine to a standard-of-care (SoC) treatment regimen for patients with HF would reduce HRRP penalties incurred by a hypothetical hospital with excess 30 day readmissions. Research design: A model using a Monte Carlo simulation framework was developed. Model inputs included national hospital characteristics, hospital-specific characteristics, and the ivabradine treatment effect as quantified by a post hoc analysis of the Systolic Heart failure treatment with the If inhibitor ivabradine Trial (SHIFT). Results: The model computed an 83% reduction in HF readmission penalty payments in a hypothetical hospital with a readmission rate of 22.95% (excess readmission ratio = 1.056 over the national average readmission rate of 21.73%), translating into net savings of $44,016. A sensitivity analysis indicated that the readmission penalty is affected by the specific characteristics of the hospital, including the readmission rate, size of the ivabradine-eligible population, and ivabradine utilization. Conclusions: The results of this study indicate that the addition of ivabradine to an SoC treatment regimen for patients with HF may lead to a reduction in the penalties incurred by hospitals under the HRRP. This highlights the role ivabradine can play as part of a wider effort to optimize the care of patients with HF

The synergistic response of primary production in grasslands to combined nitrogen and phosphorus addition is caused by increased nutrient uptake and retention

Background and aims A synergistic response of aboveground plant biomass production to combined nitrogen (N) and phosphorus (P) addition has been observed in many ecosystems, but the underlying mechanisms and their relative importance are not well known. We aimed at evaluating several mechanisms that could potentially cause the synergistic growth response, such as changes in plant biomass allocation, increased N and P uptake by plants, and enhanced ecosystem nutrient retention. Methods We studied five grasslands located in Europe and the USA that are subjected to an element addition experiment composed of four treatments: control (no element addition), N addition, P addition, combined NP addition. Results Combined NP addition increased the total plant N stocks by 1.47 times compared to the N treatment, while total plant P stocks were 1.62 times higher in NP than in single P addition. Further, higher N uptake by plants in response to combined NP addition was associated with reduced N losses from the soil (evaluated based on soil δ15N) compared to N addition alone, indicating a higher ecosystem N retention. In contrast, the synergistic growth response was not associated with significant changes in plant resource allocation. Conclusions Our results demonstrate that the commonly observed synergistic effect of NP addition on aboveground biomass production in grasslands is caused by enhanced N uptake compared to single N addition, and increased P uptake compared to single P addition, which is associated with a higher N and P retention in the ecosystem

ϕ\phi Meson Production in In-In Collisions and the ϕ\phi Puzzle

The NA60 experiment measured dimuon production in In-In collisions at 158 AGeV. This paper presents a high statistics measurement of $\phi\to\mu\mu$ with the specific objective to provide insight on the $\phi$ puzzle, i.e. the difference in the inverse $T$ slopes and absolute yields measured by NA49 and NA50 in the kaon and lepton channel, respectively. Transverse momentum distributions were studied as a function of centrality. The slope parameter $T$ shows a rapid increase with centrality, followed by a saturation. Variations of $T$ with the fit range of the order of 15 MeV were observed, possibly as a consequence of radial flow. The $\phi$ meson yield normalized to the number of participants increases with centrality and is consistently higher than the yield measured by the NA49 experiment at any centrality.Comment: 4 Pages, 2 Figures. Proceedings of the 20$^{th}$ International Conference on Ultra-Relativistic Nucleus Nucleus Collision