Successful efforts in improving breastfeeding initiation rates at an urban teaching hospital prompted the hospital to create a lactation consultant (LC) position in the outpatient setting to focus on breastfeeding duration. This article reviews the complexity of the clinic setting, with the challenges and benefits of the consultant's first year in one of the hospital's outpatient clinics. Preliminary data collected by the consultant suggest that patients counseled by the LC in the outpatient clinic setting have longer breastfeeding duration rates.

OBJECTIVES:To estimate the average (CER) and incremental (ICER) cost-effectiveness ratios of surfactant rescue treatment of premature infants with Respiratory Distress Syndrome (RDS) who are covered by the New Generation Medical Insurance . METHODS: A cost-effectiveness evaluation was conducted from the perspective of the Mexican Ministry of Health (SSA). The comparisons were between bovine surfactant therapy and the alternative of not using it. A decision tree model with a two-year time horizon was used, where the measurements of effectiveness were life years gained (LYG) and quality adjusted life years (QALY). The effectiveness figures are taken from a systematic review, the resource usage patterns were obtained from data registered in the SSA hospital files on care, and costs from official sources in SSA 2009. A 5% discount rate was considered for costs and health outcomes. Deterministic and probabilistic analyses were conducted. RESULTS: ICER ratios for surfactant therapy per LYG and per QALY were $61,392 and $62,110, respectively. CONCLUSIONS: Surfactant therapy was confirmed as a cost-effective strategy, in accordance to WHO criteria of 3 Per-capita GDP per QALY in premature infants with RDS in Mexico. OBJECTIVES:To estimate the cost effectiveness of dienogest versus GnRH analogue (GnRH-a) for the treatment of endometriosis-associated chronic pelvic pain in Slovakia from a payer perspective. METHODS: A cost-utility Markov model based on results of randomized controlled trial (AU19) was adapted to a Slovakian setting. The AU19 trial, which compared dienogest and GnRH-a (leuprolide) in the treatment of endometriosis-associated chronic pelvic pain over a 6 month period, showed no statistically significant differences in response rates. The dienogest annual relapse rate was derived from 52-weeks extension study, while relapse rates for the GnRH-a were derived from the literature. Local cost data was based on published price lists, clinical guidelines, product labels and expert opinion. QoL related utilities were derived from individual patient SF-36 scores from AU19 dataset. Effectiveness was measured in quality-adjusted life years (QALY). Time horizon was set at 2 years and a payers' perspective was adopted. Discount rate was 5% per year for both costs and effects according to valid Ministry of Health (MoH) guidelines for health economic evaluation. Both one-way and probabilistic sensitivity analyses were performed. RESULTS: Dienogest showed that it was costeffective compared to a GnRH-a, with an overall cost reduction of 506 € and a QALY gain of 0.002 per patient. Cost reduction was due to both the differences in the average drug cost during the two year period (GnRH-a: 1 248 € and dienogest: 969 €) and the average laparoscopy cost (GnRH-a: 274 € and dienogest: 103 €). In probabilistic sensitivity analysis 69 % of simulations were below 18 000 €/QALY, which is the officially published threshold for willingness to pay in Slovakia. CONCLUSIONS: Dienogest is a cost-effective alternative to GnRH analogue for the ...

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