Management of influenza in adults older than 65 years of age: cost-effectiveness of rapid testing and antiviral therapy

Article Abstract:

Background: Although antiviral therapy is cost-effective in adults, its cost-effectiveness in older adults has not been studied. Objective: To determine the cost-effectiveness of influenza testing and treatment strategies for older adults. Design: Cost-utility decision model. Data Sources: Clinical trials of antiviral drugs and epidemiologic data. Target Population: Noninstitutionalized adults older than 65 years of age with influenza-like illness. Time Horizon: Lifetime. Perspective: Societal. Interventions: Rapid diagnostic testing or empirical therapy with antiviral drugs. Outcome Measures: Cost per quality-adjusted life-year (QALY) saved. Results of Base-Case Analysis: Compared with no intervention, empirically treating an unvaccinated 75-year-old patient with amantadine increased life expectancy by 0.0014 QALY at a cost of $1.57, a cost-effectiveness ratio of $1129 per QALY saved. Compared with amantadine, rapid diagnostic testing followed by treatment with oseltamivir cost $5025 per QALY saved and empirical treatment with oseltamivir cost $10 296 per QALY saved. Testing and treatment strategies were less cost-effective if the patient was vaccinated, ranging from $2483 per QALY saved with amantadine to $70 300 per QALY saved with oseltamivir. Results of Sensitivity Analysis: The decision was sensitive to the probability of influenza, the efficacy of oseltamivir in preventing hospitalizations, and hospitalization and case-fatality rates. The decision was not sensitive to the probability or severity of medication side effects, the quality of life for influenza illness or hospitalization, the efficacy of antiviral therapy in shortening influenza illness, or the rapid diagnostic test characteristics. Conclusions: For unvaccinated or high-risk vaccinated patients during the influenza season, empirical oseltamivir treatment is cost-effective. For other patients, rapid diagnostic testing followed by treatment with oseltamivir is cost-effective. Empirical amantadine treatment offers a low-cost alternative if patients cannot afford oseltamivir.

Care and treatment, Economic aspects, Influenza, Medical care, Cost of, Health care costs, Cost benefit analysis, Amantadine, Author Abstract

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Does increased blood pressure cause left ventricular hypertrophy or vice versa?

Article Abstract:

Hypertension, or abnormally high blood pressure, increases the risk of developing heart and circulatory disorders. Complications of hypertension occur more frequently in patients with left ventricle hypertrophy, or enlargement. (The left ventricle pumps freshly oxygenated blood from the heart into the body's circulation.) Studies show that the size of the left ventricle is increased in 20 to 40 percent of mildly hypertensive patients, and serves as a better indicator of hypertensive complications than blood pressure or other circulation-related risk factors. The size of the left ventricle is closely related to the blood pressure in the arteries during normal activity, and is increased by obesity, high sodium intake, blood viscosity or thickening, and increased blood volume. Left ventricular hypertrophy worsens myocardial infarction, the deterioration of heart tissue due to cessation of blood supply. In addition, enlargement of the left ventricle may be genetically determined and involved in causing hypertension. One study showed that the left ventricle is increased in men with abnormally high blood pressure during exercise, which may be associated with mental stress. Hypertrophy of the heart and blood vessels may contribute to blood pressure increases during exercise and mental stress, and persistent hypertension may worsen hypertrophy and blood pressure responses and lead to blood vessel damage and other complications. The detection of hypertrophy and exaggerated blood pressure responses in a patient warrants an evaluation for hypertension, but antihypertensive treatment may not be necessary if blood pressure is high only during exercise. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Complications and side effects, Heart enlargement, Heart hypertrophy, Heart ventricles, editorial

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Blood pressure in older adults after meals and standing up

Article Abstract:

A meal can increase the drop in blood pressure that occurs when elderly people stand up, according to a study of 50 elderly people. This drop in blood pressure caused by a change in position is called orthostatic hypotension.

Health aspects, Ingestion, Hypotension, Orthostatic, Orthostatic hypotension

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