The cost-effectiveness of losartan versus captopril in patients with symptomatic heart failure.

The Losartan Heart Failure ELITE Study recently found that in patients with symptomatic heart failure and a left ventricular ejection fraction of /=65 years with symptomatic heart failure. Data on health care resource utilization were collected as part of the trial. We conducted a cost-effectiveness analysis to estimate the lifetime benefits of treatment and the associated costs. We observed no differences between treatments in the number of hospitalizations, hospital days, and emergency room visits per patient over the trial period. We estimated the total cost of losartan to be USD 54 (95% CI: USD -1,717, USD 1,755) less per patient than captopril over this time frame. We also estimated that over the projected remaining lifetime of the study population, losartan compared to captopril would increase survival by 0.20 years (undiscounted) at an average cost of USD 769 (discounted) more per patient. This cost increase translated into a cost-effectiveness ratio of USD 4,047 per year of life gained for losartan relative to captopril. In patients with symptomatic heart failure, losartan compared to captopril increased survival with better tolerability at a cost well within the range accepted as cost-effective.     

Reconstruction of an Active Integron Recombination Site after Integration of a Gene Cassette at a Secondary Site

As the site of insertion of the aadB gene cassette on pRAY, from a clinical isolate of Acinetobacter, is almost identical to the preferred site on integrons, the composite 59-base element (59-BE) associated with this cassette is potentially recombinationally active. By using a conduction assay to quantitate site activity, the 59-BE was recognized by integrase with high frequency, indicating that the composite site is recombinationally active.     

Self-Criticism and Dependency in Depressed Patients Treated with Cognitive Therapy or Pharmacotherapy

The current study aimed to assess the role of self-criticism and dependency in response to cognitive therapy (CT) or pharmacotherapy (PT). It was hypothesized that (a) self-criticism would moderate treatment outcome to CT and PT, and (b) the degree of change in self-criticism and the relationship of this change to treatment response would be greater for patients treated with CT than for patients treated with PT. A sample of outpatients with unipolar major depression received either CT (n = 51) or PT (n = 58). Neither pretreatment self-criticism and dependency scores nor self-criticism and dependency change scores were found to predict response to PT. Treatment response to CT, however, was associated with pretreatment self-criticism scores and pre- and post-self-criticism change scores. Although highly self-critical patients were more likely to have a poor response to CT, the degree to which self-criticism was successfully reduced in treatment was shown to be the best predictor of treatment response to CT.