Evaluación económica de la monoterapia con tocilizumab frente a adalimumab en artritis reumatoide.

BACKGROUND Tocilizumab (TCZ) was superior to adalimumab (ADA), as monotherapy, in reducing signs and symptoms of adult rheumatoid arthritis (RA) when methotrexate (MTX) treatment is poorly tolerated or inappropriate. The aim of the study was to analyze the cost-effectiveness of TCZ vs ADA in these patients. METHODS Economic evaluation of the cost per response or remission of TCZ vs ADA from ADACTA (time horizon: 24 weeks). Clinical response criteria ACR or disease remission criteria, DAS28. PERSPECTIVE National Health System. The costs included (acquisition, administration and monitoring of medicines; € 2012) were obtained from Spanish sources. Simple univariate sensitivity analyzes were performed. RESULTS ACR20, ACR50 and ACR70 response rates with TCZ and ADA were obtained in 65% and 49.4% (p <0.01), 47.2% and 27.8% (p <0.01); and 32.5% and 17.9% (p <0.01) of patients, respectively. DAS28 remission occurred in 39.9% and 10.5%, respectively (p <0.0001). The cost per response was lower with TCZ than with ADA (ACR20: € 8,105 and € 11,553; ACR50: € 11,162 and € 20,529; ACR70: € 16,211 and € 31,882) respectively. The cost of DAS28 remission was € 13,204 and € 54,352, respectively. Treatment with TCZ was dominant (more effective, with lower costs vs ADA) in all scenarios analyzed. CONCLUSIONS According to this analysis, in Spain TCZ monotherapy is an efficient strategy vs ADA for treating RA patients intolerant to MTX or in which there is inappropriate response.

Using the costs of drug therapy to screen patients for a community pharmacy-based medication review program

Objectives: To measure the positive predictive value (PPV) of the cost of drug therapy (threshold = 2000 Swiss francs [CHF], US$1440, <euro>1360) as a screening criterion for identifying patients who may benefit from medication review (MR). To describe identified drug-related problems (DRPs) and expense problems (EPs), and to estimate potential savings if all recommendations were accepted. Setting Five voluntary Swiss community pharmacies. Methods: Of 12,680 patients, 592 (4.7%) had drug therapy costs exceeding 2000 CHF over a six-month period from July 1 to December 31, 2002. This threshold limit was set to identify high-risk patients for DRPs and EPs. Three pharmacists consecutively conducted a medication review based on the pharmaceutical charts of 125 sampled patients who met the inclusion criterion. Main outcome measure: The PPV of a threshold of 2000 CHF for identifying patients who might benefit from a MR: true positives were patients with at least one DRP, while false positives were patients with no DRP. Results: The selection based on this criterion had a PPV of 86% for detecting patients with at least one DRP and 95% if EPs were also considered. There was a mean of 2.64 (SD = 2.20) DRPs per patient and a mean of 2.14 (SD = 1.39) EPs per patient. Of these patients, 90% were over 65 years old or were treated with at least five chronic medications, two common criteria for identifying patients at risk of DRPs. The main types of DRPs were drug-drug interactions, compliance problems and duplicate drugs. Mean daily drug cost per patient was CHF 14.87 (US$10.70, <euro>10.10). A potential savings of CHF 1.67 (US$1.20, <euro>1.14) per day (11%) was estimated if all recommendations to solve DRPs and EPs suggested herein were implemented. Conclusion: Further studies should investigate whether the potential benefit of medication reviews in preventing DRPs and containing costs in this patient group can be confirmed in a real practice environment. [Authors]

An Examination of Iowa's School Liaison Program, 2001

In the early 1990’s the Chief Juvenile Court Officers (JCOs) and other key players desired to provide services, such as school support, family support, and community support to both juvenile court and at-risk youths within the school setting. With strong support from both Iowa’s Attorney General and Governor the Iowa State Legislature first appropriated funds for school liaisons in 1994. The liaison program is currently funded with 75 percent state dollars appropriated to the Department of Human Services and a minimum of 25 percent match from the local school districts. In some cases the schools do not actually match funds with “school money,” rather they may utilize community money from other sources, such as the local decategorization process. In 1994, the state legislature funded this effort at $400,000. Since that time the amount has grown to more than $3,000,000. In the early years there were just a handful of liaisons working in a few school districts, but by the beginning of the 2000-2001 school year there were 304 schools served by 147 liaisons. The cost per liaison, including salary and benefits, was estimated at approximately $34,324 including both the DHS and school contributions. It was a desire of the Chief JCOs to place the liaisons under the school districts and thus allow them to be independent of the juvenile court. Agreements were developed between the schools and juvenile court regarding employee status, funding, information sharing, and other such issues.

Drama i espectacle operístic : la dialèctica entre espai i temps en el Parsifal de Herheim i el ritus com a obra d’art del futur

Parsifal és, segons la manera en què es mire, l’excepció dins el llistat de drames musicals wagnerians pel tractament sense precedents que fa de motius catòlics en un lloc i un moment com la recentment unificada Alemanya, on la construcció de la identitat nacional passava per un model social i cultural concret i, per tant, també religiós. Però una òptica diferent ens pot apropar a una ingent quantitat de paral·lelismes entre el model artístic expressat per Wagner en els seus escrits teòrics de joventut i alguns dels elements estètics i ideològics de la seua darrera obra. L’espectacle operístic en l’actualitat continua sent fruit de la societat en què es gesta i per això Stefan Herheim utilitza una visió diacrònica de la recepció d’aquesta obra wagneriana com a un dels motius principals sobre els quals construirà una dramatúrgia densa i meditada en què es durà a terme fins a les seues últimes conseqüències una revisió en clau contemporània del concepte d’obra d’art del futur.

Procedures’ costs related to outpatient chemotherapy treatment of women suffering from breast cancer

To identify the direct cost of procedures related to an outpatient chemotherapy treatment for women with breast cancer. Method: This is a quantitative research, using the case study methodology, performed in an outpatient chemotherapy of a private hospital. The total cost was calculated by multiplying the time spent by professionals involved in therapeutic procedures, the unit cost of direct labor, adding to the cost of materials, drugs and solutions. For performing the calculations, we used the Brazilian currency (R$). Results: The average total cost per chemotherapy session corresponded to R$ 1,783.01 (100%), being R$ 1,671.66 (93,75%) spent with drugs, R$ 74,98 (4.21%) with materials, R$ 28.49 (1.60%) with labor and R$ 7.88 (0.44%) with solutions. Conclusion: The results may support discussions and decision making for the management of costs related to chemotherapy aimed at reducing expenses and eliminating waste without harm to the care provided. 


Elaboració del Codi deontològic del Col·legi Oficial de Bibliotecaris-Documentalistes de Catalunya

S'expliquen les línies directrius i el procediment de redacció del Codi deontològic del Col·legi Oficial de Bibliotecaris-documentalistes de Catalunya. La comissió redactora va optar per un model de codi educacional i que cobrís les qüestions més representatives i incorporés els valors intrínsecs de la nostra professió. Es precisa l'abast dels termes ètica i deontologia, es comenten les declaracions genèriques de la Unesco i la IFLA sobre drets relacionats amb la professió, i codis deontològics ja existents, com el de l'ALA. S'esmenta la utilitat d'un codi deontològic i els tipus possibles de codi. A continuació, s'explica el procés d'elaboració del codi, la tria del model educacional, que enumera i interpreta principis generals, la tria d'altres codis que servissin com a referència, i dels valors ètics i professionals que s'hi havien de considerar.

Treatment patterns and health care resource utilization in a 1-year observational cohort study of outpatients with schizophrenia at risk of nonadherence treated with long-acting injectable antipsychotics

Purpose: To describe (1) the clinical profiles and the patterns of use of long-acting injectable (LAI) antipsychotics in patients with schizophrenia at risk of nonadherence with oral antipsychotics, and in those who started treatment with LAI antipsychotics, (2) health care resource utilization and associated costs. Patients and methods: A total of 597 outpatients with schizophrenia at risk of nonadherence, according to the psychiatrist's clinical judgment, were recruited at 59 centers in a noninterventional prospective observational study of 1-year follow-up when their treatment was modified. In a post hoc analysis, the profiles of patients starting LAI or continuing with oral antipsychotics were described, and descriptive analyses of treatments, health resource utilization, and direct costs were performed in those who started an LAI antipsychotic. Results: Therapy modifications involved the antipsychotic medications in 84.8% of patients, mostly because of insufficient efficacy of prior regimen. Ninety-two (15.4%) patients started an LAI antipsychotic at recruitment. Of these, only 13 (14.1%) were prescribed with first-generation antipsychotics. During 1 year, 16.3% of patients who started and 14.9% of patients who did not start an LAI antipsychotic at recruitment relapsed, contrasting with the 20.9% who had been hospitalized only within the prior 6 months. After 1 year, 74.3% of patients who started an LAI antipsychotic continued concomitant treatment with oral antipsychotics. The mean (median) total direct health care cost per patient per month during the study year among the patients starting any LAI antipsychotic at baseline was 1,407 ( 897.7). Medication costs (including oral and LAI antipsychotics and concomitant medication) represented almost 44%, whereas nonmedication costs accounted for more than 55% of the mean total direct health care costs. Conclusion: LAI antipsychotics were infrequently prescribed in spite of a psychiatrist-perceived risk of nonadherence to oral antipsychotics. Mean medication costs were lower than nonmedication costs.

State Public Defender's Office Performance Report, FY 2013

This report pursuant to Department of Management procedures provides an overview of the State Public Defender’s fiscal year 2013 operations related to court-appointed counsel, claims processing, and other indigent defense matters. This information, in accordance with the Accountable Government Act, is meant to help improve decision making and increase accountability to stakeholders and the citizens of Iowa. Iowa’s indigent defense system remains strong. The more than 200 employees of the State Public Defender System have been efficiently providing high quality representation on more cases than ever before. In Fiscal Year 2013, public defender offices closed more than 91,000 cases, at an average cost per case of $282.02, and there was a final finding of ineffective assistance of counsel in less than .002% of these cases. Similarly, more than 1,000 contract attorneys continue to provide high quality representation throughout all 99 of Iowa’s counties. In Fiscal Year 2013, 60,929 claims were submitted to the indigent defense fund, at an average cost per claim of $507.86. This was an decrease of nearly 350 claims from Fiscal Year 2012, and the total amount spent from the indigent defense fund increased slightly.

DRGs in hospital management.

One of the traditional tasks of district and hospital managers has been to attempt to explain variations in average length of stay, average cost per day and average cost per case, between different hospitals. The need for such explanations has become more acute as a result of the recent emphasis on 'performance indicators' as measures of the efficiency of hospitals. The task of explaining these differences has not been rendered easier by the lack of appropriate management information for this purpose.

Ammonium Phosphate/Fly Ash Road Base Construction, HR-294, 1993

The objective of this research project was to evaluate the construction and service performance of ammonium phosphate/fly ash (APFA) treated base courses of crushed fines and/or unprocessed sand. Specific test results related to construction of the test sections were included in the 1987 construction report by Iowa State University. The performance of the experimental sections is dealt with in this final report. This 1986 project demonstrated that in all cases the control sections utilizing a Type B base experienced dramatically less cracking in the surface than the APFA treated base sections. The cost per mix and subsequent surface maintenance costs for the APFA base sections, especially those having a substantial amount of limestone, were higher than the Type B base control sections. This type of construction may prove to be economical only when petroleum product costs escalate.

Experimental Use of Calcium Magnesium Acetate, HR-253, 1983

The Iowa Department of Transportation Materials Laboratory personnel announced in early 1982 a process to produce a road deicer consisting of sand grains coated with calcium magnesium acetate (CMA). From that point forward the Iowa DOT began searching for a means of economically producing CMA to their concept. During 1983 and 1984 the first attempts devised for commercially producing CMA were attempted by the W.G. Block Company, Davenport, Iowa, under Iowa Highway Research Board Project HR-253. This first attempt at commercially producing CMA was accomplished by the use of concrete transit mixer equipment. Even though this procedure proved successful in the batch mixing of CMA, the need for higher production rates to reduce the cost per ton still existed. During the fall of 1984, Cedarapids Inc, Cedar Rapids, Iowa, proposed to Iowa DOT personnel the application of their technology to a continuous mixing concept for CMA. Arrangements were made for the continuous test mixing of 60 to 100 tons of CMA/sand deicer. This report covers the production effort, description and results of procedures outlined in Cedarapids Inc's proposal of September 19, 1984. The objectives of this research were: 1. To produce the CMA/sand deicer concept on a continuous mixing basis to Iowa DOT CMA concentration levels. 2. To evaluate the results of preheating the carrying vehicle (sand) prior to CMA ingredient introduction. 3. To analyze the feasibility of production equipment and procedures necessary for portable and/or stationary applications of continuous mixing concepts.

Gestió dels costos a la regidoria de cultura de l'Ajuntament de Ripoll

El treball de fi de grau “La Gestió dels Costos a la regidoria de cultura de l’Ajuntament de Ripoll” ha estat elaborat mitjançant la col·laboració de l’Ajuntament de la vila de Ripoll i el projecte planteja elaborar un estudi que serveixi per a portar un control exhaustiu dels costos a una regidoria en concret d’aquest ajuntament, la regidoria de cultura, que engloba les àrees de cultura i joventut, fires i festes. Per tant, mitjançant aquesta gestió dels costos s’ha pogut determinar quin és el cost per habitant en aquestes tres àrees de la regidoria de cultura i quins ingressos s’han obtingut al llarg del període 2011.

Performance of Holstein heifers fed sugarcane silages treated with urea, sodium benzoate or Lactobacillus buchneri

The objective of this work was to evaluate the performance of heifers fed sugarcane silages produced with and without additives. Thirty-two Holstein heifers were randomly assigned, in a block design, to evaluate rations (46% silage; 54% concentrate; 12% crude protein) containing silages treated with (fresh basis) urea (0.5%), sodium benzoate (0.1%) or Lactobacillus buchneri (3.64x10(5) cfu g-1 ). Inoculation with L. buchneri improved daily gain (1.24 vs. 0.94 kg day-1 ), and the addition of benzoate resulted in better feed conversion (7.6 vs. 9.4 kg of dry matter per kg of live weight), in relation to the untreated silage (control). Treatments did not affect dry matter intake (mean of 2.19% of live weight). Rations containing silages treated with benzoate or L. buchneri showed lower cost per kg of weight gain. Treatment with urea did not improve animal performance, but the cost per kg of weight gain was lower than that of the control ration.

Investigation of Video Crack and Patch Surveying for Pavement Management, MLR-92-01, 1992

The Iowa DOT has been using the AASHTO Present Serviceability Index (PSI) rating procedure since 1968 to rate the condition of pavement sections. A ride factor and a cracking and patching factor make up the PSI value. Crack and patch surveys have been done by sending crews out to measure and record the distress. Advances in video equipment and computers make it practical to videotape roads and do the crack and patch measurements in the office. The objective of the study was to determine the feasibility of converting the crack and patch survey operation to a video recording system with manual post processing. The summary and conclusions are as follows: Video crack and patch surveying is a feasible alternative to the current crack and patch procedure. The cost per mile should be about 25 percent less than the current procedure. More importantly, the risk of accidents is reduced by getting the people and vehicles off the roadway and shoulder. Another benefit is the elimination of the negative public perceptions of the survey crew on the shoulder.

Available evidence and outcome of off-label use of rituximab in clinical practice

Purpose: To analyze the therapeutic indications for off-label use of rituximab, the available evidence for its use, the outcomes, and the cost. Methods: This was a retrospective analysis of patients treated with rituximab for off-label indications from January 2007 to December 2009 in two tertiary hospitals. Information on patient characteristics, medical conditions, and therapeutic responses was collected from medical records. Available evidence for the efficacy of rituximab in each condition was reviewed, and the cost of treatment was calculated. Results: A total of 101 cases of off-label rituximab use were analyzed. The median age of the patients involved was 53 [interquartile range (IQR) 37.568.0] years; 55.4 % were women. The indications for prescribing rituximab were primarily hematological diseases (46 %), systemic connective tissue disorders (27 %), and kidney diseases (20 %). Available evidence supporting rituximab treatment for these indications mainly came from individual cohort studies (53.5 % of cases) and case series (25.7 %). The short-term outcome (median 3 months, IQR 24 months) was a complete response in 38 % of cases and partial response in 32.6 %. The highest short-term responses were observed for systemic lupus erythematosus and membranous glomerulonephritis, and the lowest was for neuromyelitis optica, idiopathic thrombocytopenic purpura, and miscellaneous indications. Some response was maintained in long-term follow-up (median 23 months IQR 1230months) in 69.2%of patients showing a short-term response. Median cost per patient was 5,187.5 (IQR 5,187.57,781.3). Conclusions: In our study, off-label rituximab was mainly used for the treatment of hematological, kidney, and systemic connective tissue disorders, and the response among our patient cohort was variable depending on the specific disease. The level of evidence supporting the use of rituximab for these indications was low and the cost was very high. We conclude that more clinical trials on the off-label use of rituximab are needed, although these may be difficult to conduct in some rare diseases. Data from observational studies may provide useful information to assist prescribing in clinical practice.