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K. Malmivaara R. Kivisaari J. Hernesniemi J. Siironen 《European journal of neurology》2011,18(4):656-662
Background and purpose: Decompressive craniectomy (DC) is used regularly in traumatic brain injury (TBI). There are, however, no cost‐effectiveness studies of the procedure. Methods: We evaluated the outcomes and treatment costs of all decompressive craniectomies performed between the 2000 and 2006 in a single institution to lower intractable intracranial pressure after TBI. The health‐related quality of life was evaluated on the Euroqol (EQ‐5D) questionnaire and on the visual‐analogue scale (VAS), and cost of a quality‐adjusted life year (QALY) was calculated. Results: In this study of 54 patients, the median follow‐up time was 5.6 years. Overall mortality rate was 41%. Of the 22 non‐survivors, 73% died within 30 days. For 32 survivors, the median EQ‐5D index value was 0.85, which is equal to the normal population. The median VAS value was 73, whilst normal population’s value is 80. Of the survivors, 81% (26/32) were able to live at home and 31% (10/32) returned to work. The cost of neurosurgical treatment for one QALY was 2400€. Estimation for all medical costs, including rehabilitation and anticipated future costs, resulted cost of a QALY 17 900 €. Conclusion Mortality after severe TBI leading to DC was high, but amongst the survivors, the health‐related quality of life was equal to normal population. Most survivors were able to live at home and were almost as satisfied with their health as in general people are. Cost of neurosurgical treatment was low, and also including all evaluated costs, cost of a QALY gained was acceptable. 相似文献
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Judith Dams MSc Uwe Siebert MD MPH MSc ScD Bernhard Bornschein MD MPH Jens Volkmann MD Günther Deuschl MD Wolfgang H. Oertel MD Richard Dodel MD MPH Jens‐Peter Reese PhD MPH 《Movement disorders》2013,28(6):763-771
In addition to medical treatment, deep brain stimulation has become an alternative therapeutic option in advanced Parkinson's disease. High initial costs of surgery have to be weighted against long‐term gains in health‐related quality of life. The objective of this study was to assess the cost‐effectiveness of deep brain stimulation compared with long‐term medical treatment. We performed a cost‐utility analysis using a lifetime Markov model for Parkinson's disease. Health utilities were evaluated using the EQ‐5D generic health status measure. Data on effectiveness and adverse events were obtained from clinical studies, published reports, or meta‐analyses. Costs were assessed from the German health care provider perspective. Both were discounted at 3% per year. Key assumptions affecting costs and health status were investigated using one‐way and two‐way sensitivity analyses. The lifetime incremental cost‐utility ratio for deep brain stimulation was €6700 per quality‐adjusted life year (QALY) and €9800 and €2500 per United Parkinson's Disease Rating Scale part II (motor experiences of daily living) and part III (motor examination) score point gained, respectively. Deep brain stimulation costs were mainly driven by the cost of surgery and of battery exchange. Health status was improved and motor complications were reduced by DBS. Sensitivity analysis revealed that battery life time was the most influential parameter, with the incremental cost‐utility ratio ranging from €20,000 per QALY to deep brain stimulation dominating medical treatment. Deep brain stimulation can be considered cost‐effective, offering a value‐for‐money profile comparable to other well accepted health care technologies. Our data support adopting and reimbursing deep brain stimulation within the German health care system. © 2013 Movement Disorder Society 相似文献
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Cost‐Effectiveness Modeling of Repetitive Transcranial Magnetic Stimulation Compared to Electroconvulsive Therapy for Treatment‐Resistant Depression in Singapore 下载免费PDF全文
Ying Jiao Zhao PhD Ai Leng Khoo PhD Monica Teng MHSc Boon Peng Lim B Yee Ming Mok MMed Grad Dip 《Neuromodulation》2018,21(4):376-382
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Cost‐effectiveness of neurostimulation in Parkinson's disease with early motor complications 下载免费PDF全文
Judith Dams PhD Monika Balzer‐Geldsetzer PhD Uwe Siebert MD MPH MSc ScD Günther Deuschl MD W.M. Michael Schuepbach MD Paul Krack MD PhD Lars Timmermann MD PhD Alfons Schnitzler MD PhD Jens‐Peter Reese PhD MPH Richard Dodel MD MPH for the EARLYSTIM‐investigators 《Movement disorders》2016,31(8):1183-1191
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Cost‐effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO‐AD trial) 下载免费PDF全文
Martin Knapp Derek King Renée Romeo Jessica Adams Ashley Baldwin Clive Ballard Sube Banerjee Robert Barber Peter Bentham Richard G Brown Alistair Burns Tom Dening David Findlay Clive Holmes Tony Johnson Cornelius Katona James Lindesay Ajay Macharouthu Ian McKeith Rupert McShane John T O'Brien Patrick P J Phillips Bart Sheehan Robert Howard 《International journal of geriatric psychiatry》2017,32(12):1205-1216
Objective
Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild‐to‐moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. We examined whether continuing donepezil, or commencing memantine, is cost‐effective for community‐dwelling, moderate‐to‐severe Alzheimer's disease patients.Methods
Cost‐effectiveness analysis was based on a 52‐week, multicentre, double‐blind, placebo‐controlled, factorial clinical trial. A total of 295 community‐dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine.Results
Continuing donepezil for 52 weeks was more cost‐effective than discontinuation, considering cognition, activities of daily living and health‐related quality of life. Starting memantine was more cost‐effective than donepezil discontinuation. Donepezil–memantine combined is not more cost‐effective than donepezil alone.Conclusions
Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. 相似文献15.
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K. Malmivaara J.
hman R. Kivisaari J. Hernesniemi J. Siironen 《European journal of neurology》2011,18(3):402-409
Background: Decompressive craniectomy is used regularly in traumatic brain injury (TBI) and malignant middle cerebral artery infarction. Its benefits for other causes of non‐traumatic brain swelling, if any, are unclear, especially after a devastating primary event. Methods: We evaluated the outcomes as well as treatment costs of all emergency decompressive craniectomies performed between the 2000 and 2006 in a single institution to lower intractable intracranial pressure, excluding the standard indications TBI and malignant middle cerebral infarction. The health‐related quality of life (HRQoL) was evaluated on the Euroqol (EQ‐5D) scale, and cost of a quality‐adjusted life year (QALY) calculated. Results: The overall 3‐year mortality rate was 62% for subarachnoid haemorrhage (SAH, 29 patients) and 31% for other neurological emergencies (13 patients). Patients with SAH were on average 13 years older than the other indications mean. Of the non‐survivors, 45% died within a month and 95% within 1 year. Median EQ‐5D index values were poor (0.15 for SAH and 0.62 for the other emergencies, versus 0.85 for the normal population), but of the survivors, 73% and 89% were able to live at home. The cost of neurosurgical treatment for one QALY was 11 000 € for SAH and 2000 € for other emergencies. Conclusion: Mortality after non‐traumatic neurological emergencies leading to decompressive craniectomy was high, and the HRQoL index of the survivors was poor. Most survivors were, however, able to live at home, and the cost of neurosurgical treatment for a QALY gained was acceptable. 相似文献
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Cost‐effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM‐E randomised controlled trial 下载免费PDF全文
Francesco D'Amico Amritpal Rehill Martin Knapp David Lowery Arlinda Cerga‐Pashoja Mark Griffin Steve Iliffe James Warner 《International journal of geriatric psychiatry》2016,31(6):656-665
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