Posted by James
BACKGROUND
Coronary heart disease (CHD) affects approximately 13.5 million people in the United States. This accounts for significant morbidity and mortality, including approximately 900,000 myocardial infarctions and 250,000 deaths each year. A major goal for physicians caring for patients with CHD focuses on the management of risk factors known to be associated with recurrent cardiovascular events. Diabetes and hypertension have long been associated with coronary disease, and the benefit of controlling these diseases has been well documented. However, in the past 10 years, hyperlipidemia has emerged as another risk factor strongly associated with coronary disease. There is now sufficient evidence that aggressive control of hyperlipidemia has a beneficial effect. Several large, multicenter trials have shown that lipid-lowering medications are safe and effective in reducing CHD morbidity and mortality. In addition, a meta-analysis of five studies showed that the benefits of lipid-lowering is demonstrated in both men and women and in those age >65. Long-term clinical benefits have also been shown for lipid-lowering in the primary prevention setting, including patients with normal-to-only-moderately-elevated lipid levels.
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Posted by James
California Cancer Registry collects information on every case of cancer diagnosed or treated in California. Standard data are abstracted from the medical record for each case by trained tumor registrars, according to Cancer Reporting in California: Volume 1, Abstracting and Coding Procedures for Hospitals and computerized using C/NET, a software package developed for tumor registries. C/NET meets all reporting requirements of the Surveillance, Epidemiology and End Results (SEER) program, the American College of Surgeons and the California Cancer Reporting System. The quality of data is maintained through periodic training programs for hospital registrars and field abstractors, reabstraction of a 10% sample of case finding, and computer edits for completion and consistency. Additional audits of case finding and data abstraction are conducted by the California Department of Health Services. Completeness of coverage is Completeness is estimated to be higher than 99% annually from 1988 through 1998.
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Posted by James
Modeling
Cost-effectiveness modeling of colorectal screening programs was done using a model developed at the Office for Technology Assessment (Washington, DC) and described in detail elsewhere. This model estimates the net present value of lifetime costs and years of life gained in a cohort of 100,000 50-year-old persons over a 35-year period from different colorectal cancer screening strategies using specified assumptions about the natural history of colorectal cancer and the adenoma or carcinoma sequence, the sensitivity and specificity of each screening technology for early cancer and polyps, the cost of screening, follow-up and postpolypecto-my surveillance procedures, and the incremental costs of treating colorectal cancer. Costs were taken from 2000 Medicare reimbursement rates. Costs were discounted to their present value at 5% per year. The main assumptions of the model are summarized in Table 1. Justification of model assumptions are based on reviews of the published literature. Read the rest of this entry »
Posted by James
Cancer screening in the United States has evolved to include the use of gender and race/ethnicity to stratify patient risk. Mammography is recommended only in women because of the low incidence of male breast cancer. Prostate cancer screening is recommended for most men at age 50 but is recommended for black men at age 45 because of high age-specific incidence rates in this group. We have shown that gender-specific racial/ethnic colorectal cancer disease patterns affect the cost-effectiveness of colorectal screening. Colorectal screening was much more cost-effective in black men than in other groups. Screening black men beginning at age 45 was similar in cost-effectiveness to screening white men and black women and more cost-effective than screening Latino and Asian men and nonblack women beginning at age 50. Differences were robust and persisted after doubling the polyp incidence rate for black men. The favorable cost-effectiveness ratio of screening black men largely reflected high age-specific colorectal cancer incidence rates in this group.
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Posted by James
Table 2 and Table 3 list age-specific incidence rates of colorectal cancer in California from 1988-1995 for men and women, respectively, of each of four racial and ethnic groups. Age-specific colorectal cancer incidence rates were highest in black men and lowest in Latino women. For most ages between 45-85, the rank of incidence rates was consistent (black men > white men > Asian men > black women > white women > Latino men > Asian women > Latino women).
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Posted by James
INTRODUCTION
Colorectal cancer will be diagnosed in approximately 131,000 Americans this year, and about 55,000 will die of the disease, making this cancer the second leading cause of death from cancer in this country. Colorectal cancer screening allows the detection of asymptomatic cancers that are more amenable to curative therapy and also allows the removal of adenomas that could subsequently develop into invasive cancer. Colorectal screening programs are proven to reduce the mortality from colorectal cancer. Nearly every case of colon cancer could be prevented if every American were to undergo periodic total colonic evaluation starting at a very young age. Such a program is impractical, however, and working groups of the American Cancer Society and others have published colorectal cancer screening guidelines that balance the medical benefits of screening against its costs.
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Posted by James
The various guidelines have defined the role of LABAs as adjunctive, given concurrently with an inhaled corticosteroid, and the combination is now considered preferred therapy for moderate and severe persistent asthma. This is supported by a large body of evidence that adding a LABA to the inhaled corticosteroid in patients poorly controlled on just the inhaled corticosteroid is superior to doubling the dose of the inhaled corticosteroids. These studies have been extensively reviewed elsewhere. Most were of short duration (12-24 weeks) and, while virtually all demonstrated greater improvements in symptom control and lung function with combination therapy than with inhaled corticosteroid monotherapy at the same or increased dosage, their short duration precluded definitive analysis of effects on rates of asthma exacerbation. When the studies were grouped together and subjected to meta-analysis, however, these studies collectively suggested that the combination of a LABA and an inhaled corticosteroid decreased the rate of asthma exacerbations overall.
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