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  1. Article ; Online: Web interface-supported transmission risk assessment and cost-effectiveness analysis of postdonation screening: a global model applied to Ghana, Thailand, and the Netherlands.

    van Hulst, Marinus / Hubben, Gijs A A / Sagoe, Kwamena W C / Promwong, Charupon / Permpikul, Parichart / Fongsatitkul, Ladda / Glynn, Diarmuid M / Sibinga, Cees T Smit / Postma, Maarten J

    Transfusion

    2009  Volume 49, Issue 12, Page(s) 2729–2742

    Abstract: Background: The goal of our research was to actively involve decision makers in the economic assessment of screening strategies in their region. This study attempted to accomplish this by providing an easy-to-use Web interface at http://www.bloodsafety ... ...

    Abstract Background: The goal of our research was to actively involve decision makers in the economic assessment of screening strategies in their region. This study attempted to accomplish this by providing an easy-to-use Web interface at http://www.bloodsafety.info that allows decision makers to adapt this model to local conditions.
    Study design and methods: The cost-effectiveness was compared of 1) adding antigen screening to antibody screening for hepatitis C virus (HCV) and human immunodeficiency virus (HIV); 2) adding nucleic acid amplification testing (NAT) on hepatitis B virus (HBV), HCV, and HIV in minipool (pool of 6 [MP6] and 24 [MP24]) to antibody screening and hepatitis B surface antigen (HBsAg) screening; and 3) individual-donation NAT on HBV, HCV, and HIV to antibody screening and HBsAg screening for Ghana, Thailand, and the Netherlands.
    Results: The combination of HCV antibody-antigen combination (combo) and HIV combo added to antibody screening in Ghana and Thailand was cost-effective according to the WHO criteria. MP24-NAT screening in Ghana was also cost-effective. MP24-NAT on HBV, HCV, and HIV was not cost-effective compared to the other screening strategies evaluated for the Netherlands. Large regional differences in cost-effectiveness were found for Thailand.
    Conclusion: The young transfusion recipient population of Ghana in combination with a high risk of viral transmission yields better cost-effectiveness for additional tests. The advanced age of the transfused population of the Netherlands and a small risk of viral transmission gives poor cost-effectiveness for more sensitive screening techniques. It was demonstrated that a global health economic model combined with a Web interface can provide easy access to risk assessment and cost-effectiveness analysis.
    MeSH term(s) Blood Banks/economics ; Blood Donors/statistics & numerical data ; Blood Transfusion/economics ; Blood Transfusion/statistics & numerical data ; Communicable Disease Control/economics ; Communicable Disease Control/statistics & numerical data ; Cost-Benefit Analysis ; Disease Transmission, Infectious/economics ; Disease Transmission, Infectious/statistics & numerical data ; Ghana/epidemiology ; Global Health ; HIV Infections/blood ; HIV Infections/prevention & control ; HIV Infections/transmission ; Hepatitis B/blood ; Hepatitis B/prevention & control ; Hepatitis B/transmission ; Hepatitis C/blood ; Hepatitis C/prevention & control ; Hepatitis C/transmission ; Humans ; Internet ; Models, Econometric ; Netherlands/epidemiology ; Risk Assessment ; Risk Factors ; Thailand/epidemiology ; Transfusion Reaction ; Blood Banking/methods
    Language English
    Publishing date 2009-08-25
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 208417-x
    ISSN 1537-2995 ; 0041-1132
    ISSN (online) 1537-2995
    ISSN 0041-1132
    DOI 10.1111/j.1537-2995.2009.02351.x
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  2. Article ; Online: Cost-effectiveness of tipranavir versus comparator protease inhibitor regimens in HIV infected patients previously exposed to antiretroviral therapy in the Netherlands.

    Hubben, Gijs A A / Bos, Jasper M / Veltman-Starkenburg, Christa A / Stegmeijer, Simon / Finnern, Henrik W / Kappelhoff, Bregt S / Simpson, Kit N / Tramarin, Andrea / Postma, Maarten J

    Cost effectiveness and resource allocation : C/E

    2007  Volume 5, Page(s) 15

    Abstract: Background: This study compares the costs and effects of a regimen with ritonavir-boosted tipranavir (TPV/r) to a physician-selected genotypically-defined standard-of-care comparator protease inhibitor regimen boosted with ritonavir (CPI/r) in HIV ... ...

    Abstract Background: This study compares the costs and effects of a regimen with ritonavir-boosted tipranavir (TPV/r) to a physician-selected genotypically-defined standard-of-care comparator protease inhibitor regimen boosted with ritonavir (CPI/r) in HIV infected patients that were previously exposed to antiretroviral therapy in the Netherlands.
    Methods: We compared the projected lifetime costs and effects of two theoretical groups of 1000 patients, one receiving a standard of care regimen with TPV/r as a component and the other receiving a standard of care regimen with CPI/r. A 3-stage Markov model was formulated to represent three different consecutive HAART regimens. The model uses 12 health states based on viral load and CD4+ count to simulate disease progression. The transition probabilities for the Markov model were derived from a United States cohort of treatment experienced HIV patients. Furthermore, the study design was based on 48-week data from the RESIST-2 clinical trial and local Dutch costing data. Cost and health effects were discounted at 4% and 1.5% respectively according to the Dutch guideline. The analysis was conducted from the Dutch healthcare perspective using 2006 unit cost prices.
    Results: Our model projects an accumulated discounted cost to the Dutch healthcare system per patient receiving the TPV/r regimen of euro167,200 compared to euro145,400 for the CPI/r regimen. This results in an incremental cost of euro21,800 per patient. The accumulated discounted effect is 7.43 life years or 6.31 quality adjusted life years (QALYs) per patient receiving TPV/r, compared to 6.91 life years or 5.80 QALYs per patient receiving CPI/r. This translates into an incremental effect of TPV/r over CPI/r of 0.52 life years gained (LYG) or 0.51 QALYs gained. The corresponding incremental cost effectiveness ratios (iCERs) are euro41,600 per LYG and euro42,500 per QALY.
    Conclusion: We estimated the iCER for TPV/r compared to CPI/r at approximately euro40,000 in treatment experienced HIV-1 infected patients in the Netherlands. This ratio may well be in range of what is acceptable and warrants reimbursement for new drug treatments in the Netherlands, in particular in therapeutic areas as end-stage oncology and HIV and other last-resort health-care interventions.
    Language English
    Publishing date 2007-11-22
    Publishing country England
    Document type Journal Article
    ISSN 1478-7547
    ISSN (online) 1478-7547
    DOI 10.1186/1478-7547-5-15
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  3. Article ; Online: Modelling the costs and effects of selective and universal hospital admission screening for methicillin-resistant Staphylococcus aureus.

    Hubben, Gijs / Bootsma, Martin / Luteijn, Michiel / Glynn, Diarmuid / Bishai, David / Bonten, Marc / Postma, Maarten

    PloS one

    2011  Volume 6, Issue 3, Page(s) e14783

    Abstract: Background: Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health ... ...

    Abstract Background: Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings.
    Methodology/principal findings: A simulation model of MRSA transmission was used to determine costs and effects over 15 years from a US healthcare perspective. We compared admission screening together with isolation of identified carriers against a baseline policy without screening or isolation. Strategies included selective screening of high risk patients or universal admission screening, with PCR-based or chromogenic media-based tests, in medium (5%) or high nosocomial prevalence (15%) settings. The costs of screening and isolation per averted MRSA infection were lowest using selective chromogenic-based screening in high and medium prevalence settings, at $4,100 and $10,300, respectively. Replacing the chromogenic-based test with a PCR-based test costs $13,000 and $36,200 per additional infection averted, and subsequent extension to universal screening with PCR would cost $131,000 and $232,700 per additional infection averted, in high and medium prevalence settings respectively. Assuming $17,645 benefit per infection averted, the most cost-saving strategies in high and medium prevalence settings were selective screening with PCR and selective screening with chromogenic, respectively.
    Conclusions/significance: Admission screening costs $4,100-$21,200 per infection averted, depending on strategy and setting. Including financial benefits from averted infections, screening could well be cost saving.
    MeSH term(s) Humans ; Mass Screening/economics ; Methicillin-Resistant Staphylococcus aureus/pathogenicity ; Patient Admission ; Staphylococcal Infections/diagnosis ; Staphylococcal Infections/microbiology
    Language English
    Publishing date 2011-03-31
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0014783
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  4. Article ; Online: Cost-effectiveness of tipranavir versus comparator protease inhibitor regimens in HIV infected patients previously exposed to antiretroviral therapy in the Netherlands

    Kappelhoff Bregt S / Finnern Henrik W / Stegmeijer Simon / Veltman-Starkenburg Christa A / Bos Jasper M / Hubben Gijs AA / Simpson Kit N / Tramarin Andrea / Postma Maarten J

    Cost Effectiveness and Resource Allocation, Vol 5, Iss 1, p

    2007  Volume 15

    Abstract: Abstract Background This study compares the costs and effects of a regimen with ritonavir-boosted tipranavir (TPV/r) to a physician-selected genotypically-defined standard-of-care comparator protease inhibitor regimen boosted with ritonavir (CPI/r) in ... ...

    Abstract Abstract Background This study compares the costs and effects of a regimen with ritonavir-boosted tipranavir (TPV/r) to a physician-selected genotypically-defined standard-of-care comparator protease inhibitor regimen boosted with ritonavir (CPI/r) in HIV infected patients that were previously exposed to antiretroviral therapy in the Netherlands. Methods We compared the projected lifetime costs and effects of two theoretical groups of 1000 patients, one receiving a standard of care regimen with TPV/r as a component and the other receiving a standard of care regimen with CPI/r. A 3-stage Markov model was formulated to represent three different consecutive HAART regimens. The model uses 12 health states based on viral load and CD4+ count to simulate disease progression. The transition probabilities for the Markov model were derived from a United States cohort of treatment experienced HIV patients. Furthermore, the study design was based on 48-week data from the RESIST-2 clinical trial and local Dutch costing data. Cost and health effects were discounted at 4% and 1.5% respectively according to the Dutch guideline. The analysis was conducted from the Dutch healthcare perspective using 2006 unit cost prices. Results Our model projects an accumulated discounted cost to the Dutch healthcare system per patient receiving the TPV/r regimen of €167,200 compared to €145,400 for the CPI/r regimen. This results in an incremental cost of €21,800 per patient. The accumulated discounted effect is 7.43 life years or 6.31 quality adjusted life years (QALYs) per patient receiving TPV/r, compared to 6.91 life years or 5.80 QALYs per patient receiving CPI/r. This translates into an incremental effect of TPV/r over CPI/r of 0.52 life years gained (LYG) or 0.51 QALYs gained. The corresponding incremental cost effectiveness ratios (iCERs) are €41,600 per LYG and €42,500 per QALY. Conclusion We estimated the iCER for TPV/r compared to CPI/r at approximately €40,000 in treatment experienced HIV-1 infected patients in the Netherlands. ...
    Keywords Medicine (General) ; R5-920
    Subject code 616
    Language English
    Publishing date 2007-11-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
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  5. Article ; Online: Costs and consequences of additional chest x-ray in a tuberculosis prevention program in Botswana.

    Samandari, Taraz / Bishai, David / Luteijn, Michiel / Mosimaneotsile, Barudi / Motsamai, Oaitse / Postma, Maarten / Hubben, Gijs

    American journal of respiratory and critical care medicine

    2010  Volume 183, Issue 8, Page(s) 1103–1111

    Abstract: Rationale: Isoniazid preventive therapy is effective in reducing the risk of tuberculosis (TB) in persons living with HIV (PLWH); however, screening must exclude TB disease before initiating therapy. Symptom screening alone may be insufficient to ... ...

    Abstract Rationale: Isoniazid preventive therapy is effective in reducing the risk of tuberculosis (TB) in persons living with HIV (PLWH); however, screening must exclude TB disease before initiating therapy. Symptom screening alone may be insufficient to exclude TB disease in PLWH because some PLWH with TB disease have no symptoms. The addition of chest radiography (CXR) may improve disease detection.
    Objectives: The objective of the present analysis was to compare the costs and effects of the addition of CXR to the symptom screening process against the costs and effects of symptom screening alone.
    Methods: Using data from Botswana, a decision analytic model was used to compare a "Symptom only" policy against a "Symptom+CXR" policy. The outcomes of interest were cost, death, and isoniazid- and multidrug-resistant TB in a hypothetical cohort of 10,000 PLWH.
    Measurements and main results: The Symptom+CXR policy prevented 16 isoniazid- and 0.3 multidrug-resistant TB cases; however, because of attrition from the screening process, there were 98 excess cases of TB, 15 excess deaths, and an additional cost of U.S. $127,100. The Symptom+CXR policy reduced deaths only if attrition was close to zero; however, to eliminate attrition the cost would be U.S. $2.8 million per death averted. These findings did not change in best- and worst-case scenario analyses.
    Conclusions: In Botswana, a policy with symptom screening only preceding isoniazid-preventive therapy initiation prevents more TB and TB-related deaths, and uses fewer resources, than a policy that uses both CXR and symptom screening.
    MeSH term(s) Antitubercular Agents/economics ; Antitubercular Agents/therapeutic use ; Botswana/epidemiology ; Cost-Benefit Analysis ; Drug Resistance, Multiple, Bacterial ; Health Care Costs/statistics & numerical data ; Humans ; Isoniazid/economics ; Isoniazid/therapeutic use ; Mass Chest X-Ray/economics ; Models, Economic ; Tuberculosis, Pulmonary/diagnostic imaging ; Tuberculosis, Pulmonary/drug therapy ; Tuberculosis, Pulmonary/economics ; Tuberculosis, Pulmonary/prevention & control
    Chemical Substances Antitubercular Agents ; Isoniazid (V83O1VOZ8L)
    Language English
    Publishing date 2010-12-10
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.201004-0620OC
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    In stock of ZB MED Cologne/Königswinter

    Uh II Zs.80: Show issues Location:
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  6. Article ; Online: Modelling the costs and effects of selective and universal hospital admission screening for methicillin-resistant Staphylococcus aureus.

    Gijs Hubben / Martin Bootsma / Michiel Luteijn / Diarmuid Glynn / David Bishai / Marc Bonten / Maarten Postma

    PLoS ONE, Vol 6, Iss 3, p e

    2011  Volume 14783

    Abstract: Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of ... ...

    Abstract Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings.A simulation model of MRSA transmission was used to determine costs and effects over 15 years from a US healthcare perspective. We compared admission screening together with isolation of identified carriers against a baseline policy without screening or isolation. Strategies included selective screening of high risk patients or universal admission screening, with PCR-based or chromogenic media-based tests, in medium (5%) or high nosocomial prevalence (15%) settings. The costs of screening and isolation per averted MRSA infection were lowest using selective chromogenic-based screening in high and medium prevalence settings, at $4,100 and $10,300, respectively. Replacing the chromogenic-based test with a PCR-based test costs $13,000 and $36,200 per additional infection averted, and subsequent extension to universal screening with PCR would cost $131,000 and $232,700 per additional infection averted, in high and medium prevalence settings respectively. Assuming $17,645 benefit per infection averted, the most cost-saving strategies in high and medium prevalence settings were selective screening with PCR and selective screening with chromogenic, respectively.Admission screening costs $4,100-$21,200 per infection averted, depending on strategy and setting. Including financial benefits from averted infections, screening could well be cost saving.
    Keywords Medicine ; R ; Science ; Q
    Subject code 360
    Language English
    Publishing date 2011-03-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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