25 research outputs found
Dabigatran for the Treatment and Secondary Prevention of Venous Thromboembolism; A Cost-Effectiveness Analysis for the Netherlands
Background Dabigatran was proven to have similar effect on the prevention of recurrence of venous thromboembolism (VTE) and a lower risk of bleeding compared to vitamin K antagonists (VKA). The aim of this study is to assess the cost-effectiveness (CE) of dabigatran for the treatment and secondary prevention in patients with VTE compared to VKAs in the Dutch setting. Methods Previously published Markov model was modified and updated to assess the CE of dabigatran and VKAs for the treatment and secondary prevention in patients with VTE from a societal perspective in the base-case analysis. The model was populated with efficacy and safety data from major dabigatran trials (i.e. RE-COVER, RECOVER II, RE-MEDY and RESONATE), Dutch specific costs, and utilities derived from dabigatran trials or other published literature. Univariate, probabilistic sensitivity and a number of scenario analyses evaluating various decision-analytic settings (e.g. the perspective of analysis, use of anticoagulants only for treatment or only for secondary prevention, or comparison to no treatment) were tested on the incremental cost-effectiveness ratio (ICER). Results In the base-case scenario, patients on dabigatran gained an additional 0.034 quality adjusted life year (QALY) while saving epsilon 1,598. Results of univariate sensitivity analysis were quite robust. The probability that dabigatran is cost-effective at a willingness-to-pay threshold of epsilon 20,000/ QALY was 98.1%. From the perspective of healthcare provider, extended anticoagulation with dabigatran compared to VKAs was estimated at epsilon 2,158 per QALY gained. The ICER for anticoagulation versus no treatment in patients with equipoise risk of recurrent VTE was estimated at epsilon 33,379 per QALY gained. Other scenarios showed dabigatran was cost-saving. Conclusion From a societal perspective, dabigatran is likely to be a cost-effective or even cost-saving strategy for treatment and secondary prevention of VTE compared to VKAs in the Netherlands
COPD depicted - patients drawing their lungs
Ad A Kaptein,1 Jitske Tiemensma,2 Elizabeth Broadbent,3 Guus M Asijee,4,5 Maarten Voorhaar4,5 1Medical Psychology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands; 2Psychological Sciences, University of California, Merced, CA, USA; 3Psychology Department, Auckland University Medical School, Auckland, New Zealand; 4CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; 5Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany Background: Given the increasing importance of patient-reported outcomes (PRO) in quality medical care, we examined the value and feasibility of an innovative method for assessing patients’ illness perceptions, represented in drawings made by patients with COPD of their lungs. Aim: The aim of our study was: to study patients’ representation of COPD as reflected in their drawings of their lungs; and to examine scores on a validated measure that assesses illness perceptions (ie, Brief Illness Perception Questionnaire [B-IPQ]). Patients and methods: One hundred outpatients with COPD, mean age 70 years, selected from a pharmacy database, participated and 98 filled out the B-IPQ. Eighty-seven patients completed the drawing task. Results: The illness perceptions as reflected in the responses to the B-IPQ scales represented a quite optimistic view of COPD and its consequences. The drawings of the lungs reflected a considerable discordance between patients’ representations and medically accepted representations of lungs of a person with COPD. Conclusion: Assessing illness perceptions in clinical care and research about COPD offers opportunities to identify goals for patient education and self-management. Inviting patients to draw their illness is an innovative and promising approach to assessing PRO. Keywords: COPD, drawings, illness perceptions, PRO, quality of life, self-managemen
A TASMAN Expedition: Development of a Questionnaire to Assess Specific Self-Management Abilities
Introduction: Self-management (SM) is a core component of well-being and perceived
health for patients with chronic obstructive pulmonary disease (COPD). Most theories on SM
share that self-efficacy, illness-perception and coping are determinants of SM behavior.
Optimal support to improve SM should be tailored to the individual patient’s level of these
determinants as SM abilities vary between patients. To tailor SM support, it is therefore
necessary to assess the scores on these determinants. Unfortunately, no such instrument
exists for clinical use. Therefore, the first goal of this study was to verify presumed
correlations between SM and the determinants thereof. The second goal was to develop an
instrument to assess the SM abilities.
Methods: In this cross-sectional, observational study, COPD patients completed the General
Self-Efficacy Scale (GSES), Brief Illness Perception Questionnaire (B-IPQ) and the Utrech
Synthesis of well-defined glycopolymers in various architectures and their interactions with DC-SIGN
Validation of the Dutch version of the primary care resources and support for self-management tool:A tool to assess the quality of self-management support
INTRODUCTION: Enhancing the self-management activities of patients improves the quality of care and is an integrated element of current healthcare provision. However, self-management support (SMS) is not yet common in healthcare. The Primary Care Resources and Support for Self-Management (PCRS) is a tool for healthcare professionals to assess the quality of SMS. In this study, we assessed the validity and reliability of the Dutch version of the PCRS. METHOD: The validation of the PCRS was performed in Dutch healthcare centres. Correlations between the PCRS scores and the Assessment of Chronic Illness Care (ACIC) and Clinician Support for Patient Activation Measure (CS-PAM) scores were calculated to assess the convergent and discriminant validity. A confirmatory factor analysis (CFA) was performed to test the factor structure. Lastly, the internal consistency and face validity were assessed. RESULTS: The convergent and discriminant validity were good, with respective correlations of 0.730 (p 0.050) between the PCRS and the ACIC SMS subscale and the PCRS and the CS-PAM. Although 49% of the variance of the PCRS was explained by one factor, the CFA could not confirm a fit between a one-factor model and the data. The reliability was excellent (Cronbach's α = 0.921). CONCLUSION: The PCRS showed good validity and excellent internal consistency. However, the evidence for its validity was inconclusive. We therefore suggest rephrasing specific items
Adsorption behaviour of sulfur containing polymers to gold surfaces using QCM-D
We investigate the influences that functional group, polymer molecular weight and polymer molecular architecture have on the adsorption behaviour of some sulfur containing oligo(ethylene glycol) polymers to gold. QCM-D and XPS was used in this investigation revealing that disulfide functional groups bind with more mass deposited than dithio, trithio or thiols. This was observed with small di(ethylene glycol) polymers and with higher mass polymers. The effect of the sulfo-groups was not as apparent with higher mass polymers. Longer PEG pendent chains resulted in lower binding overall on the gold surface in comparison to shorter DEG chains caused by shielding of sulfur by the longer pendent chains. Thiols undergo two steps during the adsorption process while all other sulfur species adsorb in one step. XPS revealed the dissociation of disulfide bonds when binding to gold. These findings are important when forming stable polymer films on gold efficiently, with uses in applications from bio-fouling to polymer-lipid bilayers
Controlled Alternate Layer-by-Layer Assembly of Lectins and Glycopolymers Using QCM-D
Layer-by-layer (LBL) assembly of concanavalin A (Con
A), peanut
agglutinin (PNA) plant lectins, and well-defined synthetic glycopolymers
via their biological affinities have been prepared using a quartz
crystal microbalance with dissipation monitoring (QCM-D). We demonstrate
the use of mannose/galactose glycopolymers as lectin binders due to
their selective binding to Con A/PNA, respectively. A detailed analysis
of the adsorption processes and the adsorbed layer are provided and
tuning the composition of multilayers using a series of well-defined
glycopolymers differing only in the pendant sugar ratio is discussed