Cost and health consequences of treatment of primary biliary cirrhosis with ursodeoxycholic acid in a Norwegian patient population
Notice bibliographique
Résumé
Background/aims: Primary biliary cirrhosis (PBC) is a chronic, cholestatic liver disease that progresses to liver cirrhosis. Patients who develop end-stage liver disease are candidates for\nliver transplantation. Several studies have supported the view that ursodeoxycholic acid (UDCA) prolongs survival in PBC, but results have been challenged in other reports. Nevertheless, UDCA is currently recommended as standard therapy in PBC. The aims of this\nstudy were to 1) evaluate the effect of UDCA on the clinical course in a Norwegian cohort of PBC patients and to 2) estimate cost-effectiveness of UDCA therapy in the perspective of\npublic health service.\nPatients and methods: 180 Norwegian PBC patients (90% females; mean age 56.2 ± 8.9 years; Mayo risk score 4.38) were included in a five-year open-label study of UDCA therapy. The observed survival of the UDCA-treated patients was compared with survival predicted from the Mayo prognostic model for PBC and with survival (at four years) of the placebo group in a previous Canadian trial of UDCA in PBC (n = 111; 95% females; mean age 55.4 years; Mayo risk score 4.4). The frequencies of major events in the UDCA group were compared with those of the combined placebo groups in the Canadian trial and a previous study from the Mayo Clinic (n = 91; 87% females; Mayo risk score 5.2). The hospital costing model for Rikshospitalet University Hospital was applied to estimate average annual costs (2005 NOK) of major events. A spread sheet model was constructed for the calculations of costs. Cost-effectiveness was expressed as the ratio of incremental cost of UDCA therapy as compared with standard therapy, to the incremental gain in life expectancy during the four\nyears of study.\nResults: The observed survival of the UDCA-treated patients was significantly higher than that of the control group (P < 0.001; log-rank test). Within the four-year perspective, the life expectancy was 3.92 years in patients on UDCA therapy and 3.54 years in those receiving standard treatment (discounted, 3.57 years and 3.22 years, respectively). The life expectancey of the UDCA-treated patients according to the Mayo prognostic model was 3.79 years (discounted 3.45 years). The net total discounted cost per patient of the UDCA strategy was NOK 73 000 as compared with NOK 302 000 of standard treatment. Thus, the incremental discounted cost of UDCA therapy as compared with standard therapy was minus NOK 229 000, and the incremental discounted gain in life expectancy was 0.35 years. One-way\nsensitivity analysis revealed that even the upper bound cost estimate in the UDCA group (NOK 205 000) was slightly less that the lower bound estimate in the control group (NOK 210 000).\nConclusions: The results of this study indicate that UDCA therapy in PBC confers reduced morbidity, gain in life expectancy as well as cost savings comparedwith standard therapy and thus represents a dominant strategy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».