Cost-effectiveness of counseling and pedometer use to increase physical activity in the Netherlands: a modeling study

Background

Counseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes. We investigated the cost-effectiveness of this intervention targeted at one million insufficiently active adults who visit their general practitioner in the Netherlands.

Methods

We used the RIVM chronic disease model to estimate the long-term effects of increased physical activity on the future health care costs and quality adjusted life years (QALY) gained, from a health care perspective.

Results

The intervention resulted in almost 6000 people shifting to more favorable physical-activity levels, and in 5100 life years and 6100 QALYs gained, at an additional total cost of EUR 67.6 million. The incremental cost-effectiveness ratio (ICER) was EUR 13,200 per life year gained and EUR 11,100 per QALY gained. The intervention has a probability of 0.66 to be cost-effective if a QALY gained is valued at the Dutch informal threshold for cost-effectiveness of preventive intervention of EUR 20,000. A sensitivity analysis showed substantial uncertainty of ICER values.

Conclusion

Counseling in combination with pedometer use aiming to increase physical activity may be a cost-effective intervention. However, the intervention only yields relatively small health benefits in the Netherlands.     

Self-limiting extravasation in the unused urinary bladder

Patients being evaluated as potential renal transplant recipients routinely undergo voiding cystourethrography. Eight patients were encountered in whom extraperitoneal extravasation was noted from the region of the ureterovesical junction during voiding (seven patients) or during filling (one patient). Extravasation was bilateral in six patients and unilateral in two. The patients neither experienced symptoms related to the extravasation, required treatment, nor had sequelae. Five of the eight patients have subsequently received renal transplants and their bladders were observed to be normal at surgery. Cystoscopy was also performed in two of these five patients and was unremarkable. After transplantation, these patients' bladders functioned normally and gave rise to no symptoms.     

Effect of antidepressant and narcoleptic drugs on N-isopropyl p-iodoamphetamine biodistribution in animals

N-isopropyl p-iodoamphetamine (IMP) demonstrates a high affinity for lung and brain during the first pass following intravenous injection. Its high brain affinity has been used to advantage for cerebral perfusion imaging, but the effects of drugs on IMP distribution could affect its utility. In this study, we determined the effects of the tricyclic antidepressant imipramine and the MAO inhibitors deprenyl and phenelzine on the biodistribution of IMP. We first determined the effect of loading dose and anesthesia on the biodistribution of IMP. In rats, biodistribution was not dependent on loading dose between 0.1 and 1.1 mg/kg. Anesthesia with thiopental and chloral hydrate depressed lung and brain IMP uptake. In rats, preloading doses of imipramine depressed lung uptake but did not result in increased brain IMP uptake; postloading doses of imipramine did not release IMP from the lung. In rabbits, simultaneous or postloading doses of imipramine resulted in release of IMP from the lung with an increase in brain activity. Both mixed A and B MAO inhibitors (phenelzine) and B selective MAO inhibitors (deprenyl) did not affect IMP distribution in rats. Based on the action of imipramine on IMP uptake and clearance in the lung, we postulate that IMP uptake and metabolism within the lung is related to the mixed function oxidase (MFO) system. As the lung is rich in the MFO system in humans, we would also predict from this study that IMP distribution in patients under antidepressant therapy would not be affected by either tricyclic or MAO inhibitor agents apart from the effect of these drugs on cerebral perfusion.     

Phosphonate-modified GdDTPA complexes. II. Evaluation in a rat myocardial infarct model

The localization of 1-hydroxy-3-aminopropane-1,1-diphosphonate-modified GdDTPA (GdDTPA-HPDP) and 4-amino-butane-1,1-diphosphonate-modified GdDTPA (GdDTPA-BDP) in (1) normal and (2) infarcted rat hearts has been measured. The phosphonate-modified agents are preferentially retained in infarcted myocardium. The ratio of GdDTPA-HPDP accumulated in whole infarcted heart to that detected in normal heart is 15 at 2 hours after injecting a dose of 50 to 100 mumol/kg; the ratio is 2 for GdDTPA. At these doses, significant changes are detected in the tissue relaxation rates. An average relaxivity of 11.2 (mmol-sec)-1 is calculated for the agent in the infarcted whole heart. GdDTPA-BDP, in comparison, displayed prolonged blood retention. The result is a low diseased-to-normal heart ratio (approximately 2) at 2 hours, making this agent less attractive as a contrast agent.     

The production and evaluation of contrast-carrying liposomes made with an automatic high-pressure system

An automatic, high-pressure system (Microfluidizer) has been found useful for producing contrast-carrying liposomes on an industrial scale. The goal of this investigation was to determine the feasibility of using this new microemulsification process to manufacture contrast-carrying microemulsified liposomes (MELs). Seven contrast media (three ionic, four nonionic) were encapsulated into the MELs. Light and electron microscopy, light scattering, radioisotope, and CT scan techniques were used to characterize these MELs, and the contrast entrapments among the studied media were compared. The contrast-carrying MELs had good properties for imaging normal reticuloendothelial tissues, selectively. They had a narrow size range (0.1-3.0 micron), a single bilayer wall, high liver and spleen upake, and low leakage rates. The nonionic media were significantly more effectively entrapped in the MELs than the ionic media (P less than .05). The iodine-to-lipid weight ratio was about 1:16 for ionic media and 1:4 for nonionic media. Physical properties of the contrast media such as osmotic pressure and charge appeared to affect contrast entrapment. It was concluded that the microemulsification process is a useful system for producing contrast-carrying liposomes continuously, on a large scale and in a reproducible manner.     

Comorbidity,limitations in activities and pain in patients with osteoarthritis of the hip or knee

Background  

This study aims to contribute to the knowledge of the influence of comorbidity in OA. The objectives of the study were (i) to describe the prevalence of comorbidity and (ii) to describe the relationship between comorbidity (morbidity count, severity and the presence of specific diseases) and limitations in activities and pain in elderly patients with knee or hip OA using a comprehensive inventory of comorbidity.     

The Treatment of Septicemia in Pacemaker Patients

The authors analyzed the data of seven patients who had undergone open heart surgery because of pacemaker endocarditis in the past 4 years. Repeated surgical interventions on the pacemaker system were found to be the most common predisposing factors. Staphylococcus aureus and Staphylococcus epidermidis were the most common causative organisms. Two-dimensional echocardiography was important in the diagnosis of cases with atypical clinical picture and negative blood cultures. We concluded that: (1) any pacemaker patient with fever should be considered to have a pacemaker endocarditis; (2) all of these patients should be examined by two-dimenensional echocardiography; and (3) the total removal of the infected hardware seems to be the only way to achieve complete recovery.