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

Tiptoeing between restoration and invasion: seed rain into natural gaps within a highly invaded relic forest in the Azores

The last remains of native laurel forest in the Azores are highly threatened by the spread of invasive plants. Because landslides are very frequent in these islands, conservation of native laurel forest requires knowledge of the patterns of bird-dispersed seed rain into forest gaps. We monitored 78 seed traps over 1 year to investigate (1) the role of perches in attracting avian dispersers into gaps, (2) temporal patterns in the dispersal of exotic and native seeds, (3) how seed rain affects vegetation establishment in gaps at different distances from the native forest and (4) whether the caloric content of fruits could explain the number of seeds dispersed. Perches were highly effective in concentrating avian seed dispersal. While some native fruits are produced all year-round, most exotic plants set fruits during the main peak of the native fruit production (August–November). Most seeds recovered from the traps were native, and native seed rain inside the native forest was higher than in gaps. However, deposition of exotic seeds was not affected by distance from native forest. Seed dispersal frequencies monitored by seed traps and by faecal analysis were correlated with each other, but not with fruit caloric content, suggesting that other factors are more important that the nutritional value in predicting avian fruit choice. Forest restoration activities should take into consideration that seed dispersal decreases sharply beyond 100 m from native forest and the attractive potential of perches to direct natural seed dispersal into forest gaps

Past and present trophic position and decadal changes in diet of Yellow-legged Gull in the Azores Archipelago, NE Atlantic

This study evaluates the trophic position of adult Yellow-legged Gulls Larus michahellis atlantis resident in the Azores archipelago in the past (1921–1928) and in the present (2009–2010), and analyses the decadal variation in the diet of breeding birds from the 1990s to the 2000s for three main colonies (Topo Islet, Baixo Islet and Mistério da Prainha). Using mixing models, we compared stable isotope signatures of nitrogen and carbon in adult breast feathers between birds from 1921 to 1928 (held in museum collections) and 2009 to 2010, jointly with both isotopic signatures of their main prey groups (fish, goose barnacles (Lepas anatifera), seabirds, mammals and refuse). The diet of breeding birds was analysed using pellets collected in 1989, 1995, 1996, 2004, 2009 and 2010. Stable isotopes analysis (SIA) results were in accordance with the results provided from the analysis of pellets, showing a relatively recent and significant change in the diet of adult gulls. In particular, SIA revealed a significant decrease in the trophic position of Yellow-legged Gulls in the Azores, over the last 89 years in response to the decrease in the consumption of seabirds and fish and, an increase in the consumption of marine invertebrates (goose barnacles) and refuse. The analysis of pellets confirmed the significant decrease in the fish ingested, whereas the ingestion of lower trophic level prey (i.e. goose barnacles, mammals and refuse) increased. Both methods reflect the feeding plasticity and opportunistic foraging behavior of this species, and are in accordance with patterns described for continental Europe.We acknowledge the support given by Fundação para a Ciência e Tecnologia, Portugal, to Patricia Pedro (SFRH/BD/ 40095/2007)