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Hasvold LP, Bodegård J, Thuresson M, Stålhammar J, Hammar N, Sundström J, Russell D, Kjeldsen SE. Diabetes and CVD risk during angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker treatment in hypertension: a study of 15,990 patients. J Hum Hypertens 2014; 28:663-9. [PMID: 25211055 PMCID: PMC4191159 DOI: 10.1038/jhh.2014.43] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 04/25/2014] [Accepted: 05/01/2014] [Indexed: 01/06/2023]
Abstract
Differences in clinical effectiveness between angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in the primary treatment of hypertension are unknown. The aim of this retrospective cohort study was to assess the prevention of type 2 diabetes and cardiovascular disease (CVD) in patients treated with ARBs or ACEis. Patients initiated on enalapril or candesartan treatment in 71 Swedish primary care centers between 1999 and 2007 were included. Medical records data were extracted and linked with nationwide hospital discharge and cause of death registers. The 11 725 patients initiated on enalapril and 4265 on candesartan had similar baseline characteristics. During a mean follow-up of 1.84 years, 36 482 patient-years, the risk of new diabetes onset was lower in the candesartan group (hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.69–0.96, P=0.01) compared with the enalapril group. No difference between the groups was observed in CVD risk (HR 0.99, 95% CI 0.87–1.13, P=0.86). More patients discontinued treatment in the enalapril group (38.1%) vs the candesartan group (27.2%). In a clinical setting, patients initiated on candesartan treatment had a lower risk of new-onset type 2 diabetes and lower rates of drug discontinuation compared with patients initiated on enalapril. No differences in CVD risk were observed.
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Russell IT, Edwards RT, Gliddon AE, Ingledew DK, Russell D, Whitaker R, Yeo ST, Attwood SE, Barr H, Nanthakumaran S, Park KGM. Cancer of Oesophagus or Gastricus - New Assessment of Technology of Endosonography (COGNATE): report of pragmatic randomised trial. Health Technol Assess 2014; 17:1-170. [PMID: 24034150 DOI: 10.3310/hta17390] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Endoscopic ultrasonography is recommended for staging gastro-oesophageal cancers, but has never been evaluated. OBJECTIVE COGNATE (Cancer of Oesophagus or Gastricus - New Assessment of Technology of Endosonography) therefore aimed to evaluate whether adding 'endoscopic ultrasound' (EUS) to the usual staging algorithm changes treatment, improves (quality-adjusted) survival, and uses resources cost-effectively. DESIGN Pragmatic parallel-group trial. Patients with gastro-oesophageal cancer received standard staging algorithms. Multidisciplinary teams chose provisional management plans from endoscopic mucosal resection, immediate surgery, surgery after chemotherapy, or chemotherapy and radiotherapy. We used dynamic randomisation to allocate consenting patients remotely by telephone in equal proportions between EUS and not. Thereafter we recorded changes in management plan, use of health-care resources, and three aspects of participant-reported quality of life: generic [measured by European Quality of Life - 5 Dimensions (EQ-5D)], cancer related [Functional Assessment of Cancer Therapy - General scale (FACT-G)] and condition-specific [FACT - Additional Concerns scale (FACT-AC)]. We followed participants regularly until death or the end of the trial - for between 1 and 4.5 years. We devised a quality assurance programme to maintain standards of endosonographic reporting. SETTING Eight British hospitals, of which two - one Scottish teaching hospital and one English district general hospital - contributed 80% of participants; we combined the other six for analysis. PARTICIPANTS Patients were eligible if they had a diagnosis of gastro-oesophageal cancer, had not started treatment, were free of metastatic disease, were fit for surgery (even if not planned) and had American Society of Anesthesiologists and World Health Organization grades of less than 3. INTERVENTIONS Intervention group: standard staging algorithm plus EUS; control group: standard staging algorithm. MAIN OUTCOME MEASURES Primary: quality-adjusted survival. Secondary: survival; health-related quality of life (EQ-5D, FACT-G and FACT-AC scales); changes in management plan; and complete resection rate. Although blinding participants was neither possible nor desirable, those responsible for analysis remained blind until the Trial Steering Committee had reviewed the definitive analysis. RESULTS We randomised 223 patients, of whom 213 yielded enough data for primary analysis. EUS improved survival adjusted for generic quality of life with a hazard ratio of 0.705 [95% confidence interval (CI) 0.499 to 0.995], and crude survival with a hazard ratio of 0.706 (95% CI 0.501 to 0.996). The benefits of EUS were significantly greater for those with poor initial quality of life, but did not differ between centres. EUS reduced net use of health-care resources by £2860 (95% 'bootstrapped' CI from -£2200 to £8000). Combining benefits and savings shows that EUS is likely to be cost-effective, with 96% probability of achieving the National Institute for Health and Care Excellence criterion of costing of < £20,000 to gain a QALY. There were no serious adverse reactions attributable to EUS. EUS enhanced the management plan for many participants, increased the proportion of tumours completely resected from 80% (44 out of 55) to 91% (48 out of 53), and improved the survival of those who changed plan; although underpinning the significant differences in outcome, none of these process differences was itself significant. CONCLUSION Endoscopic ultrasound significantly improves (quality-adjusted) survival, has the potential to reduce health-care resource use (not statistically significant) and is probably cost-effective (with 96% probability). We recommend research into the best time to evaluate new technologies. TRIAL REGISTRATION ISRCTN1444215. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 39. See the HTA programme website for further project information.
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Hurcombe SD, Welch BR, Williams JM, Cooper ES, Russell D, Mudge MC. Dark‐field microscopy in the assessment of large colon microperfusion and mucosal injury in naturally occurring surgical disease of the equine large colon. Equine Vet J 2014; 46:674-80. [DOI: 10.1111/evj.12202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/11/2013] [Indexed: 11/29/2022]
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Nash L, Tacey M, Liew D, Jones C, Truesdale M, Russell D. Impact of emergency access targets on admissions to general medicine: a retrospective cohort study. Intern Med J 2013; 43:1110-6. [DOI: 10.1111/imj.12260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
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Fanning K, Edwards D, Netzel M, Stanley R, Netzel G, Russell D, Topp B. INCREASING ANTHOCYANIN CONTENT IN QUEEN GARNET PLUM AND CORRELATIONS WITH IN-FIELD MEASURES. ACTA ACUST UNITED AC 2013. [DOI: 10.17660/actahortic.2013.985.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lund CG, Aamodt AH, Russell D. Patient selection for intra-arterial cerebral revascularization in acute ischemic stroke. Acta Neurol Scand 2012. [PMID: 23190294 DOI: 10.1111/ane.12052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In acute ischemic stroke, rapid revascularization of the cerebral 'penumbra volume' is the key to better patient outcome. The largest and most proximal cerebral thrombotic artery occlusions can in most cases only be opened by intra-arterial intervention. The use of intra-arterial revascularization is rapidly expanding throughout Europe and North America, despite the risk for serious complications and the fact that the benefit of this treatment has not yet been proven in large, randomized clinical trials. Oslo University Hospital has performed approximately 60 intra-arterial procedures annually in acute ischemic stroke during the last few years. In this paper, we discuss important clinical and ethical aspects learned from our own experience. The future of intra-arterial cerebral revascularization will depend on an accurate preintervention patient selection.
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Atherton M, Russell D, Turner G. Playing to the flag: a history of deaf football and deaf footballers in Britain. THE SPORTS HISTORIAN 2012; 19:38-60. [PMID: 22439223 DOI: 10.1080/17460269909445807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Russell D. Frank Richard Russell. Assoc Med J 2012. [DOI: 10.1136/bmj.e4772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Goldberg I, Auriel E, Russell D, Korczyn AD. Microembolism, silent brain infarcts and dementia. J Neurol Sci 2012; 322:250-3. [PMID: 22429666 DOI: 10.1016/j.jns.2012.02.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
Abstract
Cognitive decline becomes more prevalent than ever in parallel with the increasing life expectancy of the population. Alzheimer' disease (AD) and cerebral vascular lesions are common in the elderly and represent, with increased age, the most frequent contributors to cognitive decline. It is now believed that these pathologies frequently coexist in the same brain. The border discriminating vascular dementia from AD is blurred and challenges our understanding of these clinical entities. Further research, at both basic and clinical levels, is mandatory in order to better understand the interactions of vascular ischemic injury and primary degenerative physiopathologies of the brain, in order to prevent and better manage patients with cognitive decline. We review recent published clinical evidence of silent brain ischemia as a contributor to cognitive decline and dementia. Microemboli, from both cardiac and vascular origins, have been shown to be associated with structural changes in the brain. The role of transcranial Doppler as an objective tool for detecting and quantifying microemboli is discussed in light of recent clinical evidence.
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Seibyl J, Russell D, Jennings D, Marek K. The molecular basis of dopaminergic brain imaging in Parkinson's disease. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2012; 56:4-16. [PMID: 22460156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The central role of dopamine neuronal loss in Parkinson's disease provides a clear pathologic framework and rationale for imaging the system both to interrogate dynamic pathophysiologic changes as well as to aid in diagnosis and clinical management. Recent post mortem studies of Parkinson's brain provide a much fuller depiction of the inexorable and progressive topology of pathophysiologic changes, including brain alpha-synuclein deposition. This informs PET and SPECT evaluations for testing hypotheses regarding the course of degeneration in longitudinal studies of Parkinson's disease patients. Recent work has underscored the subtlety of change in the dopaminergic neuronal system and its neural connections as a function of disease status and treatment. The interplay between other neurochemical brain systems and dopamine elucidates potential new targets for therapeutic intervention across the stages of the disease.
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Darlison L, Moore S, Hunt P, Russell D, Gledhill D, Brighton D. 119 Improving the care of patients with mesothelioma: development of an online educational resource for health care professionals. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70120-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Russell D, Garry E, Taberner A, Budgett D, Malpas S. Chronic monitoring of brain tissue oxygen in freely moving rats from a fully implanted telemetry system. Auton Neurosci 2011. [DOI: 10.1016/j.autneu.2011.05.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lee G, Russell D, Parker P, Sesterhenn I, Cullen J, Furusato B, Dobi A, McLeod D, Srivastava S, Moncur J. UP-02.194 Improved Detection of Prostate Cancer by the Combined Application of ERG and AMACR Immunohistochemical Stainings in Prostate Biopsy Specimens. Urology 2011. [DOI: 10.1016/j.urology.2011.07.1012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Peat R, Boote S, Maines P, Russell D, Greenwood J, Ledson M, Walshaw M. 232 A new method for monitoring spirometry – implications for cystic fibrosis care. J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Holm S, Ueland T, Dahl T, Michelsen A, Skjelland M, Russell D, Krogh-Sørensen K, Clausen O, Atar D, Januzzi J, Aukrust P, Jensen J, Halvorsen B. 614 FATTY ACID BINDING PROTEIN 4 AS A BIOMARKER OF CAROTID ATHEROSCLEROSIS AND OUTCOME IN PATIENTS WITH ACUTE ISCHEMIC STROKE. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Snooks H, Russell D, Brown C, Nair A, Moore C, Lewis A, Thomas G, al-Sulaiti M, Thomas M, Griffith-Noble F. 015 How can we prevent overdoses and what works? a systematic review of interventions for non fatal poisonings. Emerg Med J 2011. [DOI: 10.1136/emj.2010.108605.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Russell D, Hoare ZSJ, Whitaker R, Whitaker CJ, Russell IT. Generalized method for adaptive randomization in clinical trials. Stat Med 2011; 30:922-34. [PMID: 21284014 DOI: 10.1002/sim.4175] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 11/17/2010] [Indexed: 12/22/2022]
Abstract
A flexible, generalized method of treatment allocation is proposed. The method uses a set of controlling parameters that enables the generic algorithm to produce a family of possible outcomes ranging from simple randomization to deterministic allocation. The method controls balance at stratum level, stratification level and overall without detriment to the predictability of the method. The paper lists the desirable characteristics of allocation methods and shows that the proposed method fulfils the majority and is easy to use in the clinical context, once the coding has been established. An explanation of the method for 2, 3 and 4 treatment group allocations is given. Simulations demonstrate the flexibility of the method.
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Sandrini G, Friberg L, Coppola G, Jänig W, Jensen R, Kruit M, Rossi P, Russell D, Sanchez del Rìo M, Sand T, Schoenen J. Neurophysiological tests and neuroimaging procedures in non-acute headache (2nd edition). Eur J Neurol 2010; 18:373-81. [PMID: 20868464 DOI: 10.1111/j.1468-1331.2010.03212.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE A large number of instrumental investigations are used in patients with non-acute headache in both research and clinical fields. Although the literature has shown that most of these tools contributed greatly to increasing understanding of the pathogenesis of primary headache, they are of little or no value in the clinical setting. METHODS This paper provides an update of the 2004 EFNS guidelines and recommendations for the use of neurophysiological tools and neuroimaging procedures in non-acute headache (first edition). Even though the period since the publication of the first edition has seen an increase in the number of published papers dealing with this topic, the updated guidelines contain only minimal changes in the levels of evidence and grades of recommendation. RESULTS (i) Interictal EEG is not routinely indicated in the diagnostic evaluation of patients with headache. Interictal EEG is, however, indicated if the clinical history suggests a possible diagnosis of epilepsy (differential diagnosis). Ictal EEG could be useful in certain patients suffering from hemiplegic or basilar migraine. (ii) Recording evoked potentials is not recommended for the diagnosis of headache disorders. (iii) There is no evidence warranting recommendation of reflex responses or autonomic tests for the routine clinical examination of patients with headache. (iv) Manual palpation of pericranial muscles, with standardized palpation pressure, can be recommended for subdividing patient groups but not for diagnosis. Pain threshold measurements and EMG are not recommended as clinical diagnostic tests. (v) In adult and pediatric patients with migraine, with no recent change in attack pattern, no history of seizures, and no other focal neurological symptoms or signs, the routine use of neuroimaging is not warranted. In patients with trigeminal autonomic cephalalgia, neuroimaging should be carefully considered and may necessitate additional scanning of intracranial/cervical vasculature and/or the sellar/orbital/(para)nasal region. In patients with atypical headache patterns, a history of seizures and/or focal neurological symptoms or signs, MRI may be indicated. (vi) If attacks can be fully accounted for by the standard headache classification (IHS), a PET or SPECT scan will normally be of no further diagnostic value. Nuclear medical examinations of the cerebral circulation and metabolism can be carried out in subgroups of patients with headache for the diagnosis and evaluation of complications, when patients experience unusually severe attacks or when the quality or severity of attacks has changed. (vii) Transcranial Doppler examination is not helpful in headache diagnosis. CONCLUSION Although many of the examinations described in the present guidelines are of little or no value in the clinical setting, most of the tools, including thermal pain thresholds and transcranial magnetic stimulation, have considerable potential for differential diagnostic evaluation as well as for the further exploration of headache pathophysiology and the effects of pharmacological treatment.
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Evans A, Snooks H, Russell D, Brown C, Nair A, Moore C, Lewis A. P69 How to stop drug users dying from an overdose: a systematic review of treatment and prevention interventions in the community. Br J Soc Med 2010. [DOI: 10.1136/jech.2010.120477.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Russell I, Attwood S, Barr H, Edwards RT, Gliddon A, Ingledew D, Park K, Russell D, Yeo ST, Whitaker R. P08 Cancer of oesophagus or gastricus--new assessment of technology of endosonography: findings. Br J Soc Med 2010. [DOI: 10.1136/jech.2010.120477.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Peat R, Coutts J, Russell D, Ledson M, Walshaw M. Accuracy of perception of changes in lung function in adults with cystic fibrosis. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Malone E, Ledbetter E, Rassnick K, Kim S, Russell D. Disseminated Canine Herpesvirus-1 Infection in an Immunocompromised Adult Dog. J Vet Intern Med 2010; 24:965-8. [DOI: 10.1111/j.1939-1676.2010.0512.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Henriksson M, Russell D, Bodegard J, Kjeldsen S, Hasvold P, Stålhammar J, Levin LÅ. Health-care costs of losartan and candesartan in the primary treatment of hypertension. J Hum Hypertens 2010; 25:130-6. [PMID: 20376078 PMCID: PMC3023072 DOI: 10.1038/jhh.2010.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A recent study of two widely used angiotensin receptor blockers reported a reduced risk of cardiovascular events (−14.4%) when using candesartan compared with losartan in the primary treatment of hypertension. In addition to clinical benefits, costs associated with treatment strategies must be considered when allocating scarce health-care resources. The aim of this study was to assess resource use and costs of losartan and candesartan in hypertensive patients. Resource use (drugs, outpatient contacts, hospitalizations and laboratory tests) associated with losartan and candesartan treatment was estimated in 14 100 patients in a real-life clinical setting. We electronically extracted patient data from primary care records and mandatory Swedish national registers for death and hospitalization. Patients treated with losartan had more outpatient contacts (+15.6%), laboratory tests (+13.8%) and hospitalizations (+13.8%) compared with the candesartan group. During a maximum observation time of 9 years, the mean total costs per patient were 10 369 Swedish kronor (95% confidence interval: 3109–17 629) higher in the losartan group. In conclusion, prescribing candesartan for the primary treatment of hypertension results in lower long-term health-care costs compared with losartan.
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Brand C, Lam SKL, Roberts C, Gorelik A, Amatya B, Smallwood D, Russell D. Reply. Intern Med J 2010. [DOI: 10.1111/j.1445-5994.2010.02191.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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