title: [Advantages of video assisted thoracic surgery in the treatment of spontaneous pneumothorax]. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. Once daily ceftriaxone plus amikacin vs. three times daily ceftazidime plus amikacin for treatment of febrile neutropenic children with cancer. Writing Committee for the International Collaboration on Antimicrobial Treatment of Febrile Neutropenia in Children. Clinical and Economic Impact of Diabetes Mellitus on Percutaneous and Surgical Treatment of Multivessel Coronary Disease Patients: Insights From the Arterial Revascularization Therapy Study (ARTS) Trial A pharmacoeconomic comparison of UFT and 5-FU chemotherapy for colorectal cancer in South America. Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II Investigators. Primary Angioplasty in Myocardial Infarction. Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease (ERACI): in-hospital results and 1-year follow-up. ERACI Group. Cost-effectiveness analysis of treatment of E. histolytica/E. dispar cyst carriers. A model educational program for people with type 2 diabetes: a cooperative Latin American implementation study (PEDNID-LA). Economic impact of providing workplace influenza vaccination. A model and case study application at a Brazilian pharma-chemical company. Economic analysis of a pragmatic randomised trial of home visits by a nurse to elderly people with hypertension in Mexico. Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings [Prospective, randomized, comparative study of the efficacy, safety and cost of cefuroxime versus cephradine in acute pyelonephritis during pregnancy]. [Cost-effectiveness analysis of ceftriaxone and cefotaxime in the treatment of community-acquired pneumonia]. Recombinant human granulocyte-macrophage colony-stimulating factor reverses neutropenia and reduces secondary infections in visceral leishmaniasis. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care Prospective randomized clinical trial comparing high-dose ifosfamide + GM-CSF vs high-dose cyclophosphamide + GM-CSF for blood progenitor cell mobilization Will the use of low-molecular-weight heparin (enoxaparin) in patients with acute coronary syndrome save costs in Canada? Cost-benefit and efficacy of aprotinin compared with epsilon-aminocaproic acid in patients having repeated cardiac operations: a randomized, blinded clinical trial. Routine ureteral stenting after ureteroscopy for ureteral lithiasis: is it really necessary? Outpatient haemorrhoidectomy under local anaesthesia. Reduction in hospitalization costs, morbidity, disability, and mortality in patients with aids treated with protease inhibitors. Helicobacter pylori and gastric cancer: what are the benefits of screening only for the CagA phenotype of H. pylori? Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II) Three-year follow-up of the Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease (ERACI). Randomized Comparison of Primary Stenting and Provisional Balloon Angioplasty Guided by Flow Velocity Measurement The Cost-Effectiveness of Losartan versus Captopril in Patients with Symptomatic Heart Failure Optimal coronary balloon angioplasty with provisional stenting versus primary stent (OCBAS): immediate and long-term follow-up results. Pharmacoeconomic evaluation of Simulect prophylaxis in renal transplant recipients. [Use of manual vacuum aspiration in reducing cost and duration of hospitalization due to incomplete abortion in an urban area of northeastern Brazil].
abstract: Spontaneous pneumothorax ( SP ) is a disabling condition mostly affecting young , thin and otherwise healthy males . It is usually caused by ruptured pleural blebs . The first treatment is the insertion of a chest tube ( ICT ) but in a great number of patients there is recurrence of the disease . We believe that the video assisted thoracoscopy ( VATS ) is the best treatment possible because it allows us to treat the ruptured bleb radically avoiding any recurrence . In order to prove it , 40 patients admitted in a five-year period , with a SP , were r and omly assigned to be treated by ICT or VATS . The ICT patients were in the hospital a mean time of 7.5 ( 4 to 15 ) days and the VATS patients , 5.3 ( 2 to 7 ) days ( P < .05 ) . ICT patients required analgesic drugs during 76.8 + /- 31 hours and VATS patients 38.4 + /- 13 hours ( p < .05 ) . From the ICT group , 8 ( 53 % ) patients had recurrence of the disease and 6 ( 40 % ) had a prolonged air leak , while none of the patients of the VATS group had any complication ( < .001 ) . Cost of ICT and VATS  were $ 850 and $ 1730 , respectively . According to these results , VATS should be the treatment of choice in SP patients . It treats the cause of the disease . It also reduces the hospitalization time , the use of analgesic drugs post surgery , decreases recurrence of the disease and the cost of the treatment . Moreover , the patients were back to work in less than 10 days BACKGROUND The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease . METHODS A total of 1205 patients were r and omly assigned to undergo stent implantation or bypass surgery when a cardiac surgeon and an interventional cardiologist agreed that the same extent of revascularization could be achieved by either technique . The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events at one year . The costs of hospital re sources used were also determined . RESULTS At one year , there was no significant difference between the two groups in terms of the rates of death , stroke , or myocardial infa rct ion . Among patients who survived without a stroke or a myocardial infa rct ion , 16.8 percent of those in the stenting group underwent a second revascularization , as compared with 3.5 percent of those in the surgery group . The rate of event-free survival at one year was 73.8 percent among the patients who received stents and 87.8 percent among those who underwent bypass surgery ( P<0.001 by the log-rank test ) . The costs for the initial procedure were $ 4,212 less for patients assigned to stenting than for those assigned to bypass surgery , but this difference was reduced during follow-up because of the increased need for repeated revascularization ; after one year , the net difference in favor of stenting was estimated to be $ 2,973 per patient . CONCLUSION As measured one year after the procedure , coronary stenting for multivessel disease is less expensive than bypass surgery and offers the same degree of protection against death , stroke , and myocardial infa rct ion . However , stenting is associated with a greater need for repeated revascularization BACKGROUND The combination of ceftazidime plus aminoglycoside is widely used for the treatment of febrile neutropenic patients but requires multiple daily administration . Because the frequency of Pseudomonas aeruginosa is low in many centers , there is a rationale to test other antibiotic regimens that provide appropriate antibacterial coverage with the advantage of reduced dosing frequency , such as once daily ceftriaxone plus amikacin . METHODS Febrile neutropenic children with leukemia , lymphoma or solid tumors after chemotherapy were included in an open , prospect i ve , r and omized , multinational study comparing once daily ceftriaxone plus amikacin vs. 8-hourly ceftazidime and amikacin . The response to antimicrobial therapy was defined as complete response , improvement or failure . Assessment of adverse events was supplemented by specific definitions of nephrotoxicity , ototoxicity , hepatotoxicity and hypokalemia . Costs were estimated from published values of acquisition costs , delivery costs and hospitalization costs . RESULTS Efficacy was evaluable in 364 of 468 episodes in 265 children .  Response rates in ceftriaxone and amikacin vs. ceftazidime and amikacin-treated episodes were 119 of 181 ( 66 % ) vs. 121 of 183 ( 66 % ) , 7 of 181 ( 4 % ) vs. 9 of 183 ( 5 % ) and 55 of 181 ( 30 % ) vs. 53 of 181 ( 29 % ) for complete response , improvement and failure , respectively . Safety profiles were similar with both treatment regimens . The acquisition and administration costs were lower for the ceftriaxone and amikacin regimen . CONCLUSIONS A once daily regimen of ceftriaxone and amikacin is as safe and clinical ly effective as that of three times daily ceftazidime and amikacin for the treatment of febrile neutropenic children with cancer and is more cost-effective . The once daily regimen of ceftriaxone and amikacin is suitable for outpatient treatment Background —Our aims were to compare coronary artery bypass grafting ( CABG ) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study ( ARTS ) trial and to determine the costs of these 2 treatment strategies . Methods and Results — Patients ( n=1205 ) were r and omly assigned to stent implantation  ( n=600 ; diabetic , 112 ) or CABG ( n=605 ; diabetic , 96 ) . Costs per patient were calculated as the product of each patient ’s use of re sources and the corresponding unit costs . Baseline characteristics were similar between the groups . At 1 year , diabetic patients treated with stenting had the lowest event-free survival rate ( 63.4 % ) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG ( 84.4 % , P < 0.001 ) and nondiabetic patients treated with stents ( 76.2 % , P = 0.04 ) . Conversely , diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG ( 84.4 % and 88.4 % ) . The total 1-year costs for stenting and CABG in diabetic patients were $ 12 855 and $ 16 585 ( P < 0.001 ) and in the nondiabetic groups , $ 10 164 for stenting and $ 13 082 for surgery . Conclusions —Multivessel diabetic patients treated with stenting  had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting . The strategy of stenting was less costly than CABG , however , regardless of diabetic status The escalating role played by managed care organizations in the health-care system is reflected in the increased dem and for cost-effectiveness analyses ( CEAs ) to assess the balance between economic impact and clinical efficacy . For example , the high incidence and costs associated with colorectal cancer in Latin America calls for a comprehensive economic evaluation to ensure appropriate allocation of limited health-care funds . In addition , the current call for a " societal " perspective of such analyses indicates the need for increased consideration of the concerns of both patient and health-care provider . The introduction of oral tegafur and uracil ( UFT ) provided the opportunity to evaluate the pharmacoeconomic advantage of the new agent compared with the st and ard fluorouracil ( 5-FU ) . Results of this study indicated an economic advantage for oral UFT vs a 5-FU-based regimen in the treatment of colorectal cancer in Brazil and Argentina . It was further noted that the mild toxicity profile of UFT reduced both the number of clinic visits and the need for venipuncture procedures . Noting that oral UFT may have a positive impact on quality of life in addition to its estimated economic benefit , it was concluded that prospect i ve economic research and quality -of-life evaluations are needed to fully assess the pharmacoeconomic impact of oral UFT OBJECTIVES The second Primary Angioplasty in Myocardial Infa rct ion ( PAMI-II ) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty ( PTCA ) , with subsequent discharge from the hospital 3 days later , is safe and cost-effective in low risk patients . BACKGROUND In low risk patients with myocardial infa rct ion ( MI ) , few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay . METHODS Patients with acute MI underwent emergency catheterization with primary PTCA  when appropriate . Low risk patients ( age < 70 years , left ventricular ejection fraction > 45 % , one- or two-vessel disease , successful PTCA , no persistent arrhythmias ) were r and omized to receive accelerated care ( admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing [ n = 237 ] or traditional care [ n = 234 ] ) . RESULTS Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier ( 4.2+/-2.3 vs. 7.1+/-4.7 days , p = 0.0001 ) and had lower hospital costs ( $ 9,658+/-5,287 vs. $ 11,604+/-6,125 p = 0.002 ) than the patients who received traditional care . At 6 months , accelerated and traditional care groups had a similar rate of mortality ( 0.8 % vs. 0.4 % , p = 1.00 ) , unstable ischemia ( 10.1 % vs. 12.0 % , p = 0.52 ) , reinfa rct ion ( 0.8 % vs. 0.4 % , p = 1.00 ) , stroke ( 0.4 % vs. 2.6 % , p = 0.07 ) , congestive heart failure ( 4.6 % vs. 4.3 % , p = 0.85 ) or their combined occurrence ( 15.2 % vs. 17.5 % , p = 0.49 ) . The study was design ed to detect a 10 % difference in event rates ; at 6 months , only a 2.3 % difference was measured between groups , indicating an actual power of 0.19 . CONCLUSIONS Early identification of low risk patients with MI allowed safe omission of the intensive care phase and noninvasive testing , and a day 3 hospital discharge strategy , result ing in substantial cost savings OBJECTIVES This study was design ed to compare freedom from combined cardiac events ( death , angina , myocardial infa rct ion ) at 1- , 3- and 5-year follow-up in patients with multivessel disease r and omized to either percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery .  BACKGROUND Percutaneous transluminal coronary angioplasty has been an effective approach in patients with coronary artery disease , but its role in patients with multivessel coronary artery disease is still controversial . METHODS One-hundred twenty-seven patients with multivessel disease and lesions suitable for either form of therapy were r and omized to either coronary artery bypass grafting ( n = 64 ) or coronary angioplasty ( n = 63 ) . In this study we report the immediate results and freedom from combined cardiac events at 1-year follow-up . RESULTS Demographic , clinical and angiographic characteristics were similar in both groups . There were no differences in in-hospital deaths , frequency of periprocedure myocardial infa rct ion or need for emergency revascularization procedures between the two groups . At 1-year follow-up , there were no differences in mortality or in the incidence of myocardial infa rct ion between the groups . However , patients treated with coronary artery bypass grafting were more frequently free of angina , re interventions and combined cardiac events than were patients treated with coronary angioplasty ( 83.5 % vs. 63.7 % , p < 0.005 ) . In-hospital cost and cumulative cost at 1-year follow-up were greater for the coronary artery bypass grafting than for the coronary angioplasty group . CONCLUSIONS No significant differences were found in major in-hospital complications between patients treated with coronary artery bypass grafting or coronary angioplasty . Although at 1-year follow-up there were no differences in survival and freedom from myocardial infa rct ion , patients in the coronary artery bypass grafting group were more frequently free from angina , re interventions and combined events than were patients in the coronary angioplasty group Study sample 263 cyst carriers were identified from a sample population of 12,000 ( 2.1 % ) . From these , two groups each totalling 100 , were assigned to either a treatment ( receiving metronidazole ) or control ( receiving placebo ) group . Power calculations ( no details provided ) determined a minimum sample size of 79 . A loss rate of 20 % was estimated by the authors and this determined the two sample size totals , explaining the loss of 63 cyst carriers from the final sample population OBJECTIVE To implement an educational program in 10 Latin American countries and to evaluate its effect on the clinical , biochemical , and therapeutic aspects as well as the economic cost of diabetes . RESEARCH DESIGN AND METHODS Educators from each participating country were previously trained to implement the educational model .  The patient population included 446 individuals with type 2 diabetes ; all patients were < 65 years of age , did not require insulin for metabolic control , did not have severe complications of diabetes or life-limiting illnesses , and had not previously participated in diabetes education courses .  Clinical and therapeutic data and the cost of their pharmacological treatment were collected 6 months before participation in the educational program ( -6 months ) , on entry into the program ( time 0 ) , and at 4 , 8 , and 12 months after initiation of the program . RESULTS All parameters measured had improved significantly ( P < 0.001 ) by 1 year : fasting blood glucose ( mean + /- SD ) 10.6 + /- 3.5 vs. 8.7 + /- 3.0 mmol/l ; HbA(1c ) 9.0 + /- 2.0 vs. 7.8 + /- 1.6 % ; body weight 84.6 + /- 14.7 vs. 81.2 + /- 15.2 kg ; systolic blood pressure 149.6 + /- 33.6 vs. 142.9 + /- 18.8 mmHg ; total cholesterol 6.1 + /- 1.1 vs. 5.4 + /- 1.0 mmol/l ; and triglycerides 2.7 + /- 1.8 vs. 2.1 + /- 1.2 mmol/l . At 12 months , the decrease in pharmacotherapy required for control of diabetes , hypertension , and hyperlipidemia represented a 62 % decrease in the annual cost of treatment ( $ 107,939.99 vs. $ 41,106.30 [ U.S. ] ) . After deducting the additional cost of glucosuria monitoring ( $ 30,604 ) , there was still a 34 % annual savings . CONCLUSIONS The beneficial results of this educational model , implemented in 10 Latin American countries , reinforce the value of patient education as an essential part of diabetes care . They also suggest that an educational approach promoting healthy lifestyle habits and patient empowerment is an effective strategy with the potential to decrease the development of complications related to diabetes as well as the socioeconomic costs of the disease OBJECTIVE To develop and apply a model to assess the economic value of a  workplace influenza programme  from the perspective of the employer . DESIGN The model calculated the avoided costs of influenza , including treatment costs , lost productivity , lost worker added value and the cost of replacing workers . Subtracted from this benefit were the costs associated with a  vaccination programme , including administrative costs , the time to give the vaccine , and lost productivity due to adverse reactions . The framework of the model can be applied to any company to estimate the cost-benefit of an influenza immunisation programme . SETTING The model developed was applied to 4030 workers in the core divisions of a Brazilian pharma-chemical company . RESULTS The model determined a net benefit of $ US121,441 [ 129,335 Brazilian reals ( $ Brz ) ] , or $ US35.45 ( $ Brz37.75 ) per vaccinated employee ( 1997 values ) . The cost-benefit ratio was 1:2.47 . The calculations were subjected to a battery of 1-way and 2-way sensitivity analyses that determined that net benefit would be retained as long as the vaccine cost remained below $ US45.40 ( $ Brz48.40 ) or the vaccine was at least 32.5 % effective . Other alterations would retain a net benefit as well , including several combinations of incidence rate and vaccine effectiveness . CONCLUSIONS The analysis suggests that providing an influenza vaccination programme can incur a substantial net benefit for an employer , although the size of the benefit will depend upon who normally absorbs the costs of treating influenza and compensating workers for lost work time due to illness , as well as the type of company in which the immunisation programme is applied OBJECTIVE To analyse the costs and the effectiveness of an intervention of home visits made by nurses to elderly people versus usual care given by the family medicine units . MATERIAL AND METHODS A sample of 4,777 subjects aged 60 years and over covered by the Mexican Institute of Social Security ( Instituto Mexicano del Seguro Social , IMSS ) were screened . Those with a systolic and /or diastolic blood pressure level higher or equal than 160/90 mm Hg were r and omly allocated to the intervention or control groups . The intervention consisted of visits at home by nurses who gave health and lifestyle advice to the participants . The economic evaluation was considered from a health services and patient perspective . Direct and indirect costs were calculated as incremental . Effectiveness was measured in terms of cost per millimetre of mercury reduced . RESULTS Three hundred and forty five participants were allocated to the intervention group and compared with 338 controls . At the end of the intervention period the difference in the mean change in systolic blood pressure was 3.31 mm Hg ( 95 % CI 6.32 , 0.29 ; p = 0.03 ) comparing with the control group . In diastolic blood pressure the difference was 3.67 ( 95 % CI 5.22 , 2.12 ; p < 0.001 ) . The total cost of the intervention was 101 901.66 pesos . The intervention cost per patient was 34.61 pesos ( US$ 3.78 ) , ( CI 95 % 34.44 , 35.46 ) . The cost-effectiveness ratios was 10.46 pesos ( US$ 1.14 ) for systolic ( CI 95 % 129.31 , 5.51 ) and 9.43 ( US$ 1.03 ) for diastolic ( CI 95 % 19.90 , 2.49 ) . CONCLUSIONS The reduction in blood pressure obtained may well justify the small incremental cost of the intervention A r and omized controlled trial was carried out for 1 y in three tertiary and teaching hospitals , in Addis Ababa ( Ethiopia ) , Yogyakarta ( Indonesia ) and Merida ( Mexico ) , to study the effectiveness , feasibility , acceptability and cost of kangaroo mother care ( KMC ) when compared to conventional methods of care ( CMC ) . About 29 % of 649 low birthweight infants ( LBWI ; 1000‐1999 g ) died before eligibility . Of the survivors , 38 % were excluded for various reasons , 149 were r and omly assigned to KMC ( almost exclusive skin‐to‐skin care after stabilization ) , and 136 to CMC ( warm room or incubator care ) . There were three deaths in each group and no difference in the incidence of severe disease . Hypothermia was significantly less common in KMC infants in Merida ( 13.5 vs 31.5 episodes/100 infants/d ) and overall ( 10.8 vs 14.6 ) . Exclusive breastfeeding at discharge was more common in KMC infants in Merida ( 80 % vs 16 % ) and overall ( 88 % vs 70 % ) . KMC infants had a higher mean daily weight gain ( 21.3 g vs 17.7 g ) and were discharged earlier ( 13.4 vs 16.3 d after enrolment ) . KMC was considered feasible and presented advantages  over CMC  in terms of maintenance of equipment . Mothers expressed a clear preference for KMC and health workers found it safe and convenient . KMC was cheaper  than CMC in terms of salaries ( US$ 11 788 vs US$ 29 888 ) and other running costs ( US$ 7501 vs US$ 9876 ) . This study confirms that hospital KMC for stabilized LBWI 1000‐1999 g is at least as effective and safe as CMC , and shows that it is feasible in different setting s , acceptable to mothers of different cultures , and less expensive . Where exclusive breastfeeding is uncommon among LBWI , KMC may bring about an increase in its prevalence and duration , with consequent benefits for health and growth . For hospitals in low‐income countries KMC may represent an appropriate use of scarce re sources BACKGROUND Second generation cephalosporins ( CFPs ) are more active in the treatment of acute pyelonephritis during pregnancy but their cost is considerably higher than their predecessors . Cefuroxime , a second generation CFP with oral and parenteral presentations , might offer significant advantages and become a first choice antimicrobial in this setting . AIM To compare the efficacy , safety and cost of cefuroxime and cephradine in the treatment of acute pyelonephritis in pregnancy . PATIENTS AND METHODS Hospitalized women with 12 to 34 weeks of pregnancy , with clinical and bacteriological diagnosis of acute pyelonephritis , were r and omly assigned to receive cefuroxime ( Curocef(r ) , Glaxo Wellcome ) 750 mg t.i.d , i.v . or cephradine 1 g q.i.d . , i.v . If the isolated organism was resistant to the assigned drug the patient was excluded . Once patients were afebrile , they were switched to an oral form of the same antimicrobial . They were discharged according to the clinical status and treated for a total of 14 days . laboratory tests , including urine culture were requested during controls and at the end of follow-up at 28 days . RESULTS One hundred and one patients were r and omized : 49 to receive cephradine and 52 to receive cefuroxime . Patients in the cefuroxime group he d fewer febrile days ( mean 1.7 vs 2.2 , p < 0.05 ) , faster clinical recovery ( mean 2.7 vs 3.1 days , p < 0.05 ) , a higher rate of bacteriological cure at 28 days ( 78.8 % and 59.2 % , p < 0.05 ) and lower rate of failure ( 21.2 % vs 40.8 % p < 0.05 ) . The rate of resistance of isolated uropathogens was 14 % to cephradine and 1 % to cefuroxime . CONCLUSIONS Cefuroxime can be considered as a first choice option in the treatment of acute pyelonephritis during pregnancy due to its tolerance , microbiological activity and efficacy OBJECTIVE To assess the cost-effectiveness ratio of ceftriaxone and cefotaxime to treat moderate to severe community acquired pneumonia ( CAP ) . METHODS A clinical trial was done in five hospitals of the Instituto Mexicano del Seguro Social , at the metropolitan area of Mexico City .  Ceftriaxone and cefotaxime were compared to treat moderate to severe CAP , and the costs of purchasing , preparation , administration , hospitalization , and therapeutic success were quantified . Cost-effectiveness ratio was calculated , and sensitivity analysis and incremental analysis were done . RESULTS The main isolated germs were Streptococcus pneumoniae ( 23.6 % ) and Staphylococcus aureus ( 18.5 % ) . Most of the microorganisms were sensitive to ceftriaxone , ceftazidime , and cefotaxime , and were resistant to penicillin , ampicillin , and erythromycin . Therapeutic success was 98 % in the ceftriaxone group and 83 % in the cefotaxime group ( p = 0.0091 ) . Cost-effectiveness ratio for per cent unit of success was $ 19,458.62 Mexican pesos in the ceftriaxone group and $ 29,218.08 in the cefotaxime group . Sensitivity analysis showed consistently a lower cost-effectiveness ratio in the ceftriaxone group . Incremental analysis based on the treatment of 55 patients showed that using ceftriaxone instead of cefotaxime result ed in saving $ 35,170.79 per each additional cured patient . CONCLUSIONS Ceftriaxone has a lower cost-effectiveness ratio than cefotaxime to treat patients with CAP and bad prognosis criteria requiring hospitalization Twenty-four patients with acute visceral leishmaniasis and leukopenia ( < 1500 neutrophils/mm3 ) due to Leishmania chagasi were studied , 4 in an open-label pilot study and 20 in a double-blind , placebo-controlled trial . Patients received granulocyte-macrophage colony-stimulating factor ( GM-CSF ) , 5 micrograms/kg daily , or placebo for 10 days , plus 10 - 20 mg/kg pentavalent antimony daily for 20 days . In GM-CSF recipients , neutrophil counts increased threefold and fourfold over baseline at 5 and 10 days , respectively , and were significantly higher than those in placebo recipients ( P < .02 ) . Eosinophil and monocyte counts were significantly increase in GM-CSF recipients at 10 days ( P < or = .03 ) . Secondary infections occurred in 3 GM-CSF and in 8 placebo recipients ( P = .04 ) . All patients had complete resolution of their leishmaniasis at 3 months . Few adverse events were recorded . GM-CSF , 5 micrograms/kg daily for 10 days , was safe , rapidly reversed neutropenia , and reduced the number of secondary infections in patients with leishmaniasis BACKGROUND We undertook a multicentre r and omised controlled trial that compared the st and ard model of antenatal care with a new model that emphasises actions known to be effective in improving maternal or neonatal outcomes and has fewer clinic visits . METHODS Clinics in Argentina , Cuba , Saudi Arabia , and Thail and were r and omly allocated to provide either the new model ( 27 clinics ) or the st and ard model currently in use ( 26 clinics ) . All women presenting for antenatal care at these clinics over an average of 18 months were enrolled . Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions . Those who did not require further specific assessment or treatment were offered the basic component of the new model , and those deemed at higher risk received the usual care for their conditions ; however , all were included in the new-model group for the analyses , which were by intention to treat . The primary outcomes were low birthweight ( < 2500 g ) , pre-eclampsia/eclampsia , severe postpartum anaemia ( < 90 g/L haemoglobin ) , and treated urinary-tract infection . There was an assessment of quality of care and an economic evaluation . FINDINGS Women attending clinics assigned the new model ( n=12568 ) had a median of five visits compared with eight within the st and ard model ( n=11958 ) . More women in the new model than in the st and ard model were referred to higher levels of care ( 13.4 % vs 7.3 % ) , but rates of hospital admission , diagnosis , and length of stay were similar . The groups had similar rates of low birthweight ( new model 7.68 % vs st and ard model 7.14 % ; stratified rate difference 0.96 [ 95 % CI -0.01 to 1.92 ] ) , postpartum anaemia ( 7.59 % vs 8.67 % ; 0.32 ) , and urinary-tract infection ( 5.95 % vs 7.41 % ; -0.42 [ -1.65 to 0.80 ] ) . For pre-eclampsia/eclampsia the rate was slightly higher in the new model ( 1.69 % vs 1.38 % ; 0.21 [ -0.25 to 0.67 ] ) . Adjustment by several confounding variables did not modify this pattern . There were negligible differences between groups for several secondary outcomes . Women and providers in both groups were , in general , satisfied with the care received , although some women assigned the new model expressed concern about the timing of visits . There was no cost increase , and in some setting s the new model decreased cost . INTERPRETATIONS Provision of routine antenatal care by the new model seems not to affect maternal and perinatal outcomes . It could be implemented without major resistance from women and providers and may reduce cost Between August 1994 and June 1999 , 56 patients were prospect ively r and omized to receive ifosfamide 10 g/m2 + GM-CSF 5 μg/kg/day ( IFO+GM-CSF n = 28 ) and cyclophosphamide 4 g/m2 + GM-CSF 5 μg/kg/day ( CY+GM-CSF n = 28 ) . Both groups were comparable for age , gender , diagnosis , disease stage and previous chemotherapy . The IFO+GM-CSF group demonstrated a shorter median interval between therapy and apheresis ( 10 days ( 8–14 ) vs 13 days ( 8–25 ) P = 0.002 ) , median number of doses of GM-CSF ( 9 ( 7–13 ) vs 15 ( 9–31 ) P = 0.001 ) , median of days with aplasia ( 0.5 ( 0–10 ) vs 6 ( 0–21 ) P = 0.001 ) , median days with fever ( 0 ( 0–6 ) vs 3 ( 0–9 ) P = 0.006 ) and median of days using i.v . antibiotics ( 0 ( 0–11 ) vs 7.5 ( 0–19 ) P = 0.002 ) . The median MNC yield was similar in both groups . The CD34 + cell yield was better in the CY+GM-CSF group ( 3.14 ( 0.9–11.8 ) vs 5.33 ( 0.08–32 ) ) but not at significant levels ( P = 0.1 ) . White blood cell hematopoietic recovery was more rapid in the CY+GM-CSF group ( 16 ( 10–22 ) vs13 ( 10–24 ) P = 0.02 ) . Platelet engraftment was similar in both groups . Costs of mobilization and transplantation were almost the same : $ 28 570 ( $ 18 527–$47 028 ) and $ 30 020 ( $ 17 281–$67 591 ) , respectively ( P = 0.9 ) . There were no differences in disease-free survival and overall survival between both groups . Mild and transient non-hematological toxicity ( hemorrhagic cystitis , decrease in serum creatinine clearance and CNS dysfunction ) was seen most frequently in the IFO+GM-CSF group . Bone Marrow Transplantation ( 2000 ) 25 , 1141–1146 BACKGROUND One-year follow-up data from the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events ( ESSENCE ) trial show that use of low-molecular-weight heparin ( enoxaparin ) compared with unfractionated heparin in patients hospitalized with unstable angina or non-Q-wave myocardial infa rct ion is associated with a 10 % reduction in the cumulative 1-year risk of death , myocardial infa rct ion , or recurrent angina . Given the higher acquisition cost of enoxaparin relative to unfractionated heparin , we assessed whether the reduced use of revascularization procedures and related care makes enoxaparin a cost-saving therapy in Canada . METHODS AND RESULTS We analyzed cumulative 1-year re source use data on the 1259 ESSENCE patients enrolled in Canadian centers ( 40 % of the total ESSENCE sample ) . Patient-specific data on use of drugs , diagnostic cardiac catheterization , percutaneous transluminal coronary angioplasty , coronary artery bypass grafting , and hospital days were available from the initial hospital stay and cumulative to 1 year . Hospital re sources were costed with the use of data from a teaching hospital in southern Ontario that is a participant in the Ontario Case Costing Project . During the initial hospital stay , use of enoxaparin was associated with reduced use of diagnostic catheterization and revascularization procedures , with the largest effect being reduced use of percutaneous transluminal coronary angioplasty ( 15.0 % vs 10.6 % ; P = .03 ) . At 1 year , the reduced risk and costs of revascularization more than offset increased drug costs for enoxaparin , producing a cost-saving per patient of $ 1485 ( 95 % confidence interval $ -93 to $ 3167 ; P = .06 ) . Sensitivity analysis with lower hospital per diem costs from a community hospital in Ontario still predicts cost savings of $ 1075 per patient over a period of 1 year . CONCLUSIONS The acquisition and administration cost of enoxaparin is higher than for unfractionated heparin ( $ 101 vs $ 39 ) , but in patients with acute coronary syndrome , the reduced need for hospitalization and revascularization over a period of 1 year more than offsets this initial difference in cost . Evidence from this Canadian sub study of ESSENCE supports the view that enoxaparin is less costly and more effective than unfractionated heparin in this indication BACKGROUND Aprotinin and epsilon-aminocaproic acid are routinely used to reduce bleeding during cardiac surgery . The marked difference in average wholesale cost between these two drug therapies ( aprotinin , $ 1,080 vs. epsilon-aminocaproic acid , $ 11 ) has generated significant controversy regarding their relative efficacies and costs . METHODS In a multicenter , r and omized , prospect i ve , blinded trial , patients having repeated cardiac surgery received either a high-dose regimen of aprotinin ( total dose , 6 x 10(6 ) kallikrein inactivator units ) or epsilon-aminocaproic acid ( total dose , 270 mg/kg ) . RESULTS Two hundred four patients were studied . Overall ( data are median [ 25th-75th percentiles ] ) , aprotinin-treated patients had less postoperative thoracic drainage ( 511 ml [ 383 - 805 ml ] vs. 655 ml [ 464 - 1,045 ml ] ; P = 0.016 ) and received fewer platelet transfusions ( 0 [ range , 0 - 1 ] vs. 1 [ range , 0 - 2 ] ; P = 0.036 ) . The surgical field was more likely to be considered free of bleeding in aprotinin-treated patients ( 44 % vs. 26 % ; P = 0.012 ) . No differences , however , were seen in allogeneic erythrocyte transfusions or in the time required for chest closure . Overall , direct and indirect bleeding-related costs were greater in aprotinin- than in epsilon-aminocaproic acid-treated patients ( $ 1,813 [ $ 1,476 - 2,605 ] vs. $ 1,088 [ range , $ 511 - 2,057 ] ; P = 0.0001 ) . This difference in cost per case varied in magnitude among sites but not in direction . CONCLUSIONS Aprotinin was more effective than epsilon-aminocaproic acid at decreasing bleeding and platelet transfusions .  Epsilon-aminocaproic acid , however , was the more cost-effective therapy over a broad range of estimates for bleeding-related costs in patients undergoing repeated cardiac surgery . A cost-benefit analysis using the lower cost of half-dose aprotinin ( $ 540 ) still result ed in a significant cost advantage using epsilon-aminocaproic therapy ( P = 0.022 ) PURPOSE We assessed the cost-effectiveness of routine ureteral stenting after ureteroscopic stone removal . MATERIAL S AND METHODS Of 295 consecutive patients who underwent rigid ureteroscopic stone removal 133 in group 1 and 162 in group 2 were r and omized to receive and not receive a stent , respectively , after the procedure . Operative time , stone size , stone location , success rate , postoperative pain and complications were analyzed in each group . RESULTS There were no statistically significant differences in the 2 groups regarding stone size , stone location , success rate , postoperative pain or complications . However , in group 1 operative time was significantly longer than in group 2 ( chi-square test p = 0.019 ) . The hospital charge per patient when placing and not placing a stent after ureteroscopy for stone removal was $ 9,900.95 and $ 3,661.78 , respectively . The female patients with a stent without a suture required an extra charge for stent removal in the operating room , while no men had a stent with a suture . CONCLUSIONS Routine catheter placement after ureteroscopic stone removal increased operative time and did not seem to improve patient outcome . The cost was 30 % that without a stent OBJECTIVE To compare early and late results and costs of  outpatient haemorrhoidectomy under local anaesthesia  with those of  inpatient haemorrhoidectomy .  DESIGN Prospect i ve study with historical controls . SETTING University hospital , Brazil . SUBJECTS 51 patients who required haemorrhoidectomy . INTERVENTIONS Outpatient haemorrhoidectomy under local anaesthesia . MAIN OUTCOME MEASURES Early and late results and comparative costs . RESULTS One patient was withdrawn from the study because of hypertension and subsequently lost to follow-up . The remaining 50 patients were discharged a mean of 68 ( 23 ) minutes after operation . Twelve patients complained of severe pain , one had faecal impaction and 2 developed bleeding . One patient developed urinary retention , compared with 18 in the historical group ( p < 0.001 ) . Forty-two patients ( 84 % ) were thoroughly satisfied with their treatment . Late complications did not differ significantly from those observed in the historical group . The estimated hospital costs were US$ 313.6 for outpatient , and US$ 716 for inpatient treatment . CONCLUSION Outpatient haemorrhoidectomy under local anaesthesia was safe and comfortable for most patients , with complication rates comparable to or better than those observed after inpatient treatment and at less than half the cost BACKGROUND The objective of this study was to analyze hospitalization costs , morbidity , disability , and mortality in patients with acquired immunodeficiency syndrome ( AIDS ) treated with protease inhibitors ( PI ) .  METHODS This is a self-controlled , ambispective study of a total of 581 patients with human immunodeficiency virus (HIV)/AIDS seen at the Hospital de Infectología , Centro Médico La Raza , IMSS , in Mexico City during 1997 . A total of 210 ( 36.14 % ) patients initiated protease inhibitor ( PI ) treatment at the onset of the study . Thirty-eight patients satisfied the inclusion criteria for this study and were analyzed retrospectively during the year prior to PI treatment , and then prospect ively throughout the year on PI treatment . As concerns main outcome measures , financial costs , number of hospitalizations , number of infections , and productivity and laboratory parameters ( CD4(+ ) counts and viral load ) were analyzed during the year prior to PI treatment and then prospect ively during the year on PI prescription . Our hypothesis was that the hospital costs , morbidity , disability , and mortality of patients with AIDS decreased while on PI treatment . RESULTS During the year prior to PI prescription , the 38 patients enrolled in the study were admitted on a total of 59 occasions ( 1.55 hospitalizations/patient ) , whereas during the year on PI therapy , all 38 patients had only seven admissions ( 0.18 hospitalizations/patient ) . Hospitalization costs decreased 35 % when annual PI costs for the 38 patients studied were taken into account . The number of microorganisms detected during hospitalization decreased from 24 prior to PI to five on PI . The number of disability days involved in patients on PI decreased significantly ( p < 0.0002 ) . None of the 38 patients studied died during the year of follow-up under PI treatment . Mortality decreased significantly , from 116/481 ( 23.2 % ) in 1996 , to 77/581 ( 13.2 % ) in 1997 , to 40/740 ( 6.4 % ) in 1998 . There were no deaths among the 38 patients studied during the 1-year follow-up period ; when the observation period was extended 1 additional year , only one patient died ( 2.63 % ) . Only six ( 3.48 % ) of the 172 PI-treated patients with AIDS not included in the study died during the same period . CD4(+ ) cell counts increased from 190.56 + /- 169.5 cells/mm(3 ) to 235.00 + /- 112.65 cells/mm(3 ) ( p < 0.05 ) after 12 months of PI treatment . Viral loads decreased from 5 logs to 2.4 logs at 12 months of PI treatment ( p < 0.001 ) . CONCLUSIONS Introduction of PI to antiretroviral treatment in patients with AIDS was associated with a lower rate of hospital admissions , lower costs , and a lesser number of infections/year , disabilities , and mortalities . Increase of CD4(+ ) cell counts and decrease in viral loads in the 38 patients were associated with decreased morbility and mortality BACKGROUND Strains of Helicobacter pylori that express the CagA protein are associated with a threefold increased gastric cancer risk as compared to H. pylori strains that do not express CagA. Screening and treatment only for CagA antibodies should target those individuals at highest gastric cancer risk while reducing the number of patients requiring antibiotics . We compared the costs and benefits of screening asymptomatic 50-year-old individuals for CagA , screening for all H. pylori strains , and no screening , both in the United States and abroad . MATERIAL S AND METHODS We employed Markov cost-effectiveness analysis using data from r and omized , case-control , and cohort studies . RESULTS In the United States , CagA screening would result in 1.5 million fewer antibiotic treatments but would prevent 1,400 fewer gastric cancers than would screening for all H. pylori . The incremental cost-effectiveness of CagA screening is $ 23,900 per life-year gained ; for H. pylori screening , it is $ 25,100 . Screening in countries with epidemiological characteristics similar to those of Colombia , Finl and , and Japan costs less than $ 5,000 per life-year gained , and the difference between CagA and H. pylori screening is smaller than that in the United States . CONCLUSIONS Screening only for CagA-positive H. pylori is not substantially better than is screening for all H. pylori , either in the United States nor abroad . Screening is substantially more cost-effective outside the United States . Whether population screening is justified , however , is uncertain pending conclusive data regarding the reduction in gastric cancer risk from antibiotics BACKGROUND The multicentre , r and omised Benestent-II study investigated a strategy of implantation of a heparin-coated Palmar-Schatz stent plus antiplatelet drugs compared with the use of balloon angioplasty in selected patients with stable or stabilised unstable angina , with one or more de-novo lesions , less than 18 mm long , in vessels of diameter 3 mm or more . METHODS 827 patients were r and omly assigned stent implantation ( 414 patients ) or st and ard balloon angioplasty ( 413 patients ) . The primary clinical endpoint was event-free survival at 6 months , including death , myocardial infa rct ion , and the need for revascularisation . The secondary endpoints were the restenosis rate at 6 months and the cost-effectiveness at 12 months . There was also one-to-one subr and omisation to either clinical and angiographic follow-up or clinical follow-up alone . Analyses were by intention to treat . FINDINGS Four patients ( one stent group , three angioplasty group ) were excluded from analysis since no lesion was found . At 6 months , a primary clinical endpoint had occurred in 53 ( 12.8 % ) of 413 patients in the stent group and 79 ( 19.3 % ) of 410 in the angioplasty group ( p=0.013 ) . This significant difference in clinical outcome was maintained at 12 months . In the subgroup assigned angiographic follow-up , the mean minimum lumen diameter was greater in the stent group than in the balloon-angioplasty group , ( 1.89 [ SD 0.65 ] vs 1.66 [ 0.57 ] mm , p=0.0002 ) , which corresponds to restenosis rates ( diameter stenosis > or = 50 % ) of 16 % and 31 % ( p=0.0008 ) . In the group assigned clinical follow-up alone , event-free survival rate at 12 months was higher in the stent group than the balloon-angioplasty group ( 0.89 vs 0.79 , p=0.004 ) at a cost of an additional 2085 Dutch guilders ( US$ 1020 ) per patient . INTERPRETATION Over 12-month follow-up , a strategy of elective stenting with heparin-coated stents is more effective but also more costly than balloon angioplasty OBJECTIVES The purpose of this study was to report the 3-year follow-up results of the ERACI trial ( Argentine R and omized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease ) . BACKGROUND Although coronary angioplasty has been used with increased frequency in patients with multivessel coronary artery disease , its value , compared with bypass graft surgery , has not been established . Thus , controlled , r and omized clinical trials such as the ERACI are needed . METHODS In this trial 127 patients who had multivessel coronary artery disease and clinical indication of myocardial revascularization were r and omized to undergo coronary angioplasty ( n = 63 ) or bypass surgery ( n = 64 ) . The primary end point of this study was event-free survival ( survival with freedom from myocardial infa rct ion , angina and new revascularization procedures ) for both groups of patients at 1 , 3 and 5 years of follow-up . RESULTS Freedom from combined cardiac events ( death , Q-wave myocardial infa rct ion , angina and repeat revascularization procedures ) was significantly greater for the bypass surgery group than the coronary angioplasty group ( 77 % vs. 47 % ; p < 0.001 ) . There were no differences in overall ( 4.7 % vs. 9.5 % ; p = 0.5 ) and cardiac ( 4.7 % vs. 4.7 % ; p = 1 ) mortality or in the frequency of myocardial infa rct ion ( 7.8 % vs. 7.8 % ; p = 0.8 ) between the two groups . However , patients who had bypass surgery were more frequently free of angina ( 79 % vs. 57 % ; p < 0.001 ) and required fewer additional re interventions ( 6.3 % vs. 37 % ; p < 0.001 ) than patients who had coronary angioplasty . CONCLUSIONS 1 ) Freedom from combined cardiac events at 3-year follow-up was greater in patients who had bypass surgery than in those who had coronary angioplasty . 2 ) The coronary angioplasty group had a higher incidence of recurrence of angina and the need for repeat revascularization procedures . 3 ) Cumulative cost at 3-year follow-up was greater for the bypass surgery group than for the coronary angioplasty group Background —Coronary stenting improves outcomes compared with balloon angioplasty , but it is costly and may have other disadvantages . Limiting stent use to patients with a suboptimal result after angioplasty ( provisional angioplasty ) may be as effective and less expensive . Methods and Results —To analyze the cost-effectiveness of provisional angioplasty , patients scheduled for single-vessel angioplasty were first r and omized to receive primary stenting ( 97 patients ) or balloon angioplasty guided by Doppler flow velocity and angiography ( 523 patients ) . Patients in the latter group were further r and omized after optimization to either additional stenting or termination of the procedure to further investigate what is “ optimal . ” An optimal result was defined as a flow reserve > 2.5 and a diameter stenosis < 36 % . Bailout stenting was needed in 129 patients ( 25 % ) who were r and omized to balloon angioplasty , and an optimal result was obtained in 184 of the 523 patients ( 35 % ) . There was no significant difference in event-free survival at 1 year between primary stenting ( 86.6 % ) and provisional angioplasty ( 85.6 % ) . Costs after 1 year were significantly higher for provisional angioplasty ( EUR 6573 versus EUR 5885;P = 0.014 ) . Results after the second r and omization showed that stenting was also more effective after optimal balloon angioplasty ( 1-year event free survival , 93.5 % versus 84.1%;P = 0.066 ) . Conclusions —After 1 year of follow-up , provisional angioplasty was more expensive and without clinical benefit . The beneficial value of stenting is not limited to patients with a suboptimal result after balloon angioplasty The Losartan Heart Failure ELITE Study recently found that in patients with symptomatic heart failure and a left ventricular ejection fraction of ≤0.40  , losartan compared to captopril  improved survival with better tolerability . The objective of this study was to perform an economic evaluation of losartan versus captopril based on the results of the Losartan Heart Failure ELITE Study . The Losartan Heart Failure ELITE Study was a multinational , double-blind , r and omized 48-week study comparing the safety and efficacy of losartan to captopril in angiotensin-converting enzyme-inhibitor-naive patients ≥65 years with symptomatic heart failure . Data on health care re source 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 OBJECTIVE This study sought to compare two strategies of revascularization in patients obtaining a good immediate angiographic result after percutaneous transluminal coronary angioplasty ( PTCA ) : elective stenting versus optimal PTCA . A good immediate angiographic result with provisional stenting was considered to occur only if early loss in minimal luminal diameter ( MLD ) was documented at 30 min post-PTCA angiography . BACKGROUND Coronary stenting reduces restenosis in lesions exhibiting early deterioration ( > 0.3 mm ) in MLD within the first 24 hours ( early loss ) after successful PTCA . Lesions with no early loss after PTCA have a low restenosis rate . METHODS To compare angiographic restenosis and target vessel revascularization ( TVR ) of lesions treated with coronary stenting versus those treated with optimal PTCA , 116 patients were r and omized to stent ( n=57 ) or to optimal PTCA ( n=59 ) . After r and omization in the PTCA group , 13.5 % of the patients crossed over to stent due to early loss ( provisional stenting ) . RESULTS Baseline demographic and angiographic characteristics were similar in both groups of patients . At 7.6 months , 96.6 % of the entire population had a follow-up angiographic study : 98.2 % in the stent and 94.9 % in the PTCA group . Immediate and follow-up angiographic data showed that acute gain was significantly higher in the stent than in the PTCA group ( 1.95 vs. 1.5 mm ; p < 0.03 ) . However , late loss was significantly higher in the stent than the PTCA group ( 0.63+/-0.59 vs. 0.26+/-0.44 , respectively ; p=0.01 ) . Hence , net gain with both techniques was similar ( 1.32 < or = 0.3 vs. 1.24+/-0.29 mm for the stent and the PTCA groups , respectively ; p = NS ) . Angiographic restenosis rate at follow-up ( 19.2 % in stent vs. 16.4 % in PTCA ; p = NS ) and TVR ( 17.5 % in stent vs. 13.5 % in PTCA ; p = NS ) were similar . Furthermore , event-free survival was 80.8 % in the stent versus 83.1 % in the PTCA group ( p = NS ) . Overall costs ( hospital and follow-up ) were US $ 591,740 in the stent versus US $ 398,480 in the PTCA group ( p < 0.02 ) . CONCLUSIONS The strategy of PTCA with delay angiogram and provisional stent if early loss occurs had similar restenosis rate and TVR , but lower cost than primary stenting after PTCA Advances in immunosuppressive therapy have substantially improved one-year clinical outcomes for renal transplantation.1 However , acute rejection still occurs in up to 50 % of kidney transplantation recipients during the first year,2 and it remains the major contributor to chronic rejection and long-term graft failure . [ 3 ] , [ 4 ] and [ 5 ] Although episodes of acute rejection are reversible with heightened doses of steroids and antibody therapy , the implication s for increased healthcare costs and poor long-term outcome underscore the importance of developing therapies to reduce acute rejection . Basiliximab ( Simulect , Novartis , Basel , Switzerl and ) is a high-affinity chimeric antiinterleukin-2 receptor monoclonal antibody that is indicated for the prophylaxis of acute rejection after renal transplantation . [ 6 ] and [ 7 ] R and omised clinical trials have demonstrated that basiliximab is highly effective in suppressing acute rejection when used in combination with dual therapy of cyclosporin and steroids . [ 8 ] and [ 9 ] Recently , a phase III international multi-centre trial was performed to evaluate the effectiveness of  basiliximab  in renal transplantation patients receiving a st and ard triple therapy regimen of cyclosporin , steroids , and azathioprine.10  An economic evaluation of the trial was undertaken alongside the clinical studies . We determined the economic impact of adding basiliximab to triple therapy . Our objectives were to compare within-trial re source use between basiliximab-treated and placebo-treated patients within six months of renal transplantation and to evaluate the cost implication s of basiliximab use , relative to clinical outcomes INTRODUCTION In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage ( SC ) for uterine evacuation . In many of the developing countries , including Brazil , sharp curettage ( SC ) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital . The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring . Two hypotheses are examined : the first , that the use of manual vacuum aspiration (MVA)--a variation of the vacuum aspiration , would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital ; and the second , that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay . METHODOLOGY Thirty women with diagnosis of first trimester incomplete abortion were r and omly allocated to the SC or MVA group . Rapid- assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay . RESULTS AND CONCLUSION The results of the study show that , overall , patients treated for incomplete abortion with MVA spent 77 % less time in the hospital and consumed 41 % fewer re sources than similarly diagnosed patients treated with SC . Recommendations are made as to the need of certain changes in patient management . Particularly necessary is information regarding cultural perception and concepts of abortion treatment
target: While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
  Analysis or description of place-to-place variability was infrequent .
background: Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
  Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
  HEEs , as context -specific tools , are not easily generalizable from setting to setting .
  Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
  Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .