Transplantation is considered by the general public to be a spectacular achievement of modern med... more Transplantation is considered by the general public to be a spectacular achievement of modern medicine. Transplantation can be seen as a representation of the power of medicine to prolong life. Nature appears defeated if parts of the body which no longer function properly can be replaced. The idea that substitute organs are derived from the remains of a person who has lost his/her life may increase the perception of transplantation as a victory over death. Mankind recreates itself by performing transplants. The capacity of the human body to reject tissue from outside the body is controlled. The implanted organ, which is normally attacked by the immunosuppressive system, survives because the destructive and deadly process of rejection is disrupted by immunosuppressive agents. There is then a second victory over death when organ failure is prohibited and the implanted organ is permitted to survive, enabling the transplanted patient to live.
Organ Replacement Therapy: Ethics, Justice Commerce, 1991
Since World War II, the right to health care has become increasingly important as becomes apparen... more Since World War II, the right to health care has become increasingly important as becomes apparent when the embodiment of this right in several treaties and constitutions is taken into account. It is a social right. Such a right gives, in principle, access to health care facilities to all citizens. It has, however, its limits. One of the limits is the limited availability of financial means. Another limit is the absolute scarcity of available donor organs. This leads to conflicts in several forms. One expression of these conflicts are the legal procedures which have been started by some patients [1].
Current Medical Research and Opinion, Jan 13, 2010
This study assesses the costs and effects of combination treatment with clopidogrel and aspirin i... more This study assesses the costs and effects of combination treatment with clopidogrel and aspirin in comparison to aspirin alone in patients with an ST-segment elevation myocardial infarction (STEMI) in a Dutch setting. A decision tree model is used to combine data from different sources about efficacy, epidemiology and costs. In the short-run, cost-effectiveness is based on efficacy data derived from the CLARITY trial. The cost-effectiveness of continued treatment is addressed by analysing which conditions need to be fulfilled to deem the strategy 'cost-effective', and discussing whether it is likely that it is. Estimates concerning the benefits of preventing events are derived from Swedish registries. Approximations of both direct and indirect costs are derived from the literature. Effects are expressed as life years gained and Quality Adjust Life Years (QALYs). Uncertainties are addressed by uni- and multivariate sensitivity analyses with and without taking account of the dependency between the separate ischaemic events. A treatment regimen similar to that of the CLARITY trial, including patients similar to those in the trial, is estimated to result in 0.05 additional life years and 0.062 additional quality adjusted life years for a cost that is euro1929 lower than aspirin therapy. Continuation of treatment outside the trial period is expected to result in ICERs of below euro20,000 per QALY as long as the real risk reduction of combination treatment is greater than 0.487% per year. The results indicate that clopidogrel therapy combined with aspirin, according to the regimen seen in CLARITY, and using data from Swedish registries to inform the model, is cost-effective. Sensitivity analyses suggest that the model is robust to a wide range of parameter estimates, including those based on data from Swedish registries. Continued treatment is very likely to be cost effective in light of all the indirect evidence.
Preference-based instruments for measuring HRQoL of life have been deve10ped in different countri... more Preference-based instruments for measuring HRQoL of life have been deve10ped in different countries and applied in empirical research in a much wider range of countries. A major concem in this context has been whether the valuations (values or utility weights) elicited for the instrument in 1 country are applicable in another, that is, whether the valuations in terms of the relative values/utilities of different health states are similar or not. If they are, an instrument that has been valued in country A can be applied in country B without having to carry out a very cumbersome and expensive process of eliciting the valuations in country B. However, if the valuations differ, the use of an instrument with valuations from country A in country B, for example in the evaluation ofhealth interventions, may lead to different results and a different order of preference among the interventions from those should valuations from country B have been available.
INTRODUCTION: The recent FENOC comparative trial (Astermark et al. 2007) reported comparable effi... more INTRODUCTION: The recent FENOC comparative trial (Astermark et al. 2007) reported comparable efficacy for rFVIIa and APCC in the treatment of joint bleeds in patients with hemophilia complicated by inhibitors. A systematic review was combined with a Bayesian meta-regression analysis to place the FENOC results within the context of earlier non-comparative studies and to identify key variables influencing treatment efficacy. METHODS: A systematic literature search was performed using electronic databases, web based trial registers, and grey literature. Clinical studies and/or trials in hemophilia patients with inhibitors receiving on-demand treatment with rFVIIa or APCC were included. Outcome of interest was the time of successfully stopping joint bleeds taking explicit account of repeated dosing. To model the latter, the regression model included a repeating Gompertz hazard function to compare the efficacy of standard rFVIIa treatment (one 90 μg/kg rFVIIa infusion every 3 hrs) with s...
Established in 1987, the EuroQol Group initially comprised a network of international, multilingu... more Established in 1987, the EuroQol Group initially comprised a network of international, multilingual and multidisciplinary researchers from seven centres in Finland, the Netherlands, Norway, Sweden and the UK. Nowadays, the Group comprises researchers from Canada, Denmark, Germany, Greece, Japan, New Zealand, Slovenia, Spain, the USA and Zimbabwe. The process of shared development and local experimentation resulted in EQ-5D, a generic measure of health status that provides a simple descriptive profile and a single index value that can be used in the clinical and economic evaluation of health care and in population health surveys. Currently, EQ-5D is being widely used in different countries by clinical researchers in a variety of clinical areas. EQ-5D is also being used by eight out of the first 10 of the top 50 pharmaceutical companies listed in the annual report of Pharma Business (November/December 1999). Furthermore, EQ-5D is one of the handful of measures recommended for use in cost-effectiveness analyses by the Washington Panel on Cost Effectiveness in Health and Medicine. EQ-5D has now been translated into most major languages with the EuroQol Group closely monitoring the process.
The Measurement and Valuation of Health Status Using EQ-5D: A European Perspective, 2003
Preference-based instruments for measuring HRQoL of life have been developed in different countri... more Preference-based instruments for measuring HRQoL of life have been developed in different countries and applied in empirical research in a much wider range of countries. A major concern in this context has been whether the valuations (values or utility weights) elicited for the instrument in 1 country are applicable in another, that is, whether the valuations in terms of the relative values/utilities of different health states are similar or not. If they are, an instrument that has been valued in country A can be applied in country B without having to carry out a very cumbersome and expensive process of eliciting the valuations in country B. However, if the valuations differ, the use of an instrument with valuations from country A in country B, for example in the evaluation of health interventions, may lead to different results and a different order of preference among the interventions from those should valuations from country B have been available.
The Measurement and Valuation of Health Status Using EQ-5D: A European Perspective, 2003
It will be evident from the contents of this book, which reports on the work accomplished by the ... more It will be evident from the contents of this book, which reports on the work accomplished by the EuroQol Group in the context of Biomed II funding — the EQ-net project — that the measurement and valuation of health-related quality of life is a comprehensive undertaking, even for a measurement instrument, the EQ-5D, which is probably the simplest and shortest of the generic instruments currently available. This final chapter summarises the EQ-net project, highlighting some of the key points and issues in what proved a complex set of inter-locking tasks. The opportunity is also taken to reflect upon the current status of the Group’s work with EQ-5D and how this might proceed.
... Health Research, Barcelona, Spain Naoki Ikegami Department of Health Policy & Management ... more ... Health Research, Barcelona, Spain Naoki Ikegami Department of Health Policy & Management - Keio University ... Department of Allied Sciences - University of Cape Town, Cape Town, South Africa ... viii List of contributors Paul Kind Outcomes Research Group - Centre for Health ...
Transplantation is considered by the general public to be a spectacular achievement of modern med... more Transplantation is considered by the general public to be a spectacular achievement of modern medicine. Transplantation can be seen as a representation of the power of medicine to prolong life. Nature appears defeated if parts of the body which no longer function properly can be replaced. The idea that substitute organs are derived from the remains of a person who has lost his/her life may increase the perception of transplantation as a victory over death. Mankind recreates itself by performing transplants. The capacity of the human body to reject tissue from outside the body is controlled. The implanted organ, which is normally attacked by the immunosuppressive system, survives because the destructive and deadly process of rejection is disrupted by immunosuppressive agents. There is then a second victory over death when organ failure is prohibited and the implanted organ is permitted to survive, enabling the transplanted patient to live.
Organ Replacement Therapy: Ethics, Justice Commerce, 1991
Since World War II, the right to health care has become increasingly important as becomes apparen... more Since World War II, the right to health care has become increasingly important as becomes apparent when the embodiment of this right in several treaties and constitutions is taken into account. It is a social right. Such a right gives, in principle, access to health care facilities to all citizens. It has, however, its limits. One of the limits is the limited availability of financial means. Another limit is the absolute scarcity of available donor organs. This leads to conflicts in several forms. One expression of these conflicts are the legal procedures which have been started by some patients [1].
Current Medical Research and Opinion, Jan 13, 2010
This study assesses the costs and effects of combination treatment with clopidogrel and aspirin i... more This study assesses the costs and effects of combination treatment with clopidogrel and aspirin in comparison to aspirin alone in patients with an ST-segment elevation myocardial infarction (STEMI) in a Dutch setting. A decision tree model is used to combine data from different sources about efficacy, epidemiology and costs. In the short-run, cost-effectiveness is based on efficacy data derived from the CLARITY trial. The cost-effectiveness of continued treatment is addressed by analysing which conditions need to be fulfilled to deem the strategy 'cost-effective', and discussing whether it is likely that it is. Estimates concerning the benefits of preventing events are derived from Swedish registries. Approximations of both direct and indirect costs are derived from the literature. Effects are expressed as life years gained and Quality Adjust Life Years (QALYs). Uncertainties are addressed by uni- and multivariate sensitivity analyses with and without taking account of the dependency between the separate ischaemic events. A treatment regimen similar to that of the CLARITY trial, including patients similar to those in the trial, is estimated to result in 0.05 additional life years and 0.062 additional quality adjusted life years for a cost that is euro1929 lower than aspirin therapy. Continuation of treatment outside the trial period is expected to result in ICERs of below euro20,000 per QALY as long as the real risk reduction of combination treatment is greater than 0.487% per year. The results indicate that clopidogrel therapy combined with aspirin, according to the regimen seen in CLARITY, and using data from Swedish registries to inform the model, is cost-effective. Sensitivity analyses suggest that the model is robust to a wide range of parameter estimates, including those based on data from Swedish registries. Continued treatment is very likely to be cost effective in light of all the indirect evidence.
Preference-based instruments for measuring HRQoL of life have been deve10ped in different countri... more Preference-based instruments for measuring HRQoL of life have been deve10ped in different countries and applied in empirical research in a much wider range of countries. A major concem in this context has been whether the valuations (values or utility weights) elicited for the instrument in 1 country are applicable in another, that is, whether the valuations in terms of the relative values/utilities of different health states are similar or not. If they are, an instrument that has been valued in country A can be applied in country B without having to carry out a very cumbersome and expensive process of eliciting the valuations in country B. However, if the valuations differ, the use of an instrument with valuations from country A in country B, for example in the evaluation ofhealth interventions, may lead to different results and a different order of preference among the interventions from those should valuations from country B have been available.
INTRODUCTION: The recent FENOC comparative trial (Astermark et al. 2007) reported comparable effi... more INTRODUCTION: The recent FENOC comparative trial (Astermark et al. 2007) reported comparable efficacy for rFVIIa and APCC in the treatment of joint bleeds in patients with hemophilia complicated by inhibitors. A systematic review was combined with a Bayesian meta-regression analysis to place the FENOC results within the context of earlier non-comparative studies and to identify key variables influencing treatment efficacy. METHODS: A systematic literature search was performed using electronic databases, web based trial registers, and grey literature. Clinical studies and/or trials in hemophilia patients with inhibitors receiving on-demand treatment with rFVIIa or APCC were included. Outcome of interest was the time of successfully stopping joint bleeds taking explicit account of repeated dosing. To model the latter, the regression model included a repeating Gompertz hazard function to compare the efficacy of standard rFVIIa treatment (one 90 μg/kg rFVIIa infusion every 3 hrs) with s...
Established in 1987, the EuroQol Group initially comprised a network of international, multilingu... more Established in 1987, the EuroQol Group initially comprised a network of international, multilingual and multidisciplinary researchers from seven centres in Finland, the Netherlands, Norway, Sweden and the UK. Nowadays, the Group comprises researchers from Canada, Denmark, Germany, Greece, Japan, New Zealand, Slovenia, Spain, the USA and Zimbabwe. The process of shared development and local experimentation resulted in EQ-5D, a generic measure of health status that provides a simple descriptive profile and a single index value that can be used in the clinical and economic evaluation of health care and in population health surveys. Currently, EQ-5D is being widely used in different countries by clinical researchers in a variety of clinical areas. EQ-5D is also being used by eight out of the first 10 of the top 50 pharmaceutical companies listed in the annual report of Pharma Business (November/December 1999). Furthermore, EQ-5D is one of the handful of measures recommended for use in cost-effectiveness analyses by the Washington Panel on Cost Effectiveness in Health and Medicine. EQ-5D has now been translated into most major languages with the EuroQol Group closely monitoring the process.
The Measurement and Valuation of Health Status Using EQ-5D: A European Perspective, 2003
Preference-based instruments for measuring HRQoL of life have been developed in different countri... more Preference-based instruments for measuring HRQoL of life have been developed in different countries and applied in empirical research in a much wider range of countries. A major concern in this context has been whether the valuations (values or utility weights) elicited for the instrument in 1 country are applicable in another, that is, whether the valuations in terms of the relative values/utilities of different health states are similar or not. If they are, an instrument that has been valued in country A can be applied in country B without having to carry out a very cumbersome and expensive process of eliciting the valuations in country B. However, if the valuations differ, the use of an instrument with valuations from country A in country B, for example in the evaluation of health interventions, may lead to different results and a different order of preference among the interventions from those should valuations from country B have been available.
The Measurement and Valuation of Health Status Using EQ-5D: A European Perspective, 2003
It will be evident from the contents of this book, which reports on the work accomplished by the ... more It will be evident from the contents of this book, which reports on the work accomplished by the EuroQol Group in the context of Biomed II funding — the EQ-net project — that the measurement and valuation of health-related quality of life is a comprehensive undertaking, even for a measurement instrument, the EQ-5D, which is probably the simplest and shortest of the generic instruments currently available. This final chapter summarises the EQ-net project, highlighting some of the key points and issues in what proved a complex set of inter-locking tasks. The opportunity is also taken to reflect upon the current status of the Group’s work with EQ-5D and how this might proceed.
... Health Research, Barcelona, Spain Naoki Ikegami Department of Health Policy & Management ... more ... Health Research, Barcelona, Spain Naoki Ikegami Department of Health Policy & Management - Keio University ... Department of Allied Sciences - University of Cape Town, Cape Town, South Africa ... viii List of contributors Paul Kind Outcomes Research Group - Centre for Health ...
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