Despite the perception of many people that lasers represent the cutting edge of high-technology medicine, this form of medical technology has been subject to relatively little rigorous evaluation. This dearth of research relates particularly to economic evaluation, where there have been few attempts to justify the high cost of laser equipment. This paper details an economic evaluation of the use of laser technology as a secondary adjunct to angioplasty to treat peripheral arterial occlusions. Using data from a range of sources, including a published randomized trial, a cost-utility model is developed to estimate the costs and benefits of the laser, relative to standard angioplasty. The best available data indicate a cost-effective role for the laser, but important areas of uncertainty exist, including the laser's secondary recanalization rate, which has been estimated on the basis of limited numbers of patients. This uncertainty suggests that further research is required before widespread diffusion of the laser for use in this clinical context.

The SECCAT survey assessed the Socio-Economic Costs and Consequences of Alcoholism Treatment. Basic demographic and health service resource use data (for a previous 6-month period) were obtained fro a cohort of 586 eligible patients who had had treatment at the Alcohol Problems Clinic (APC) in Edinburgh. The cohort was 75% male with a mean age of 46.0 years. Seventy-six per cent had an initial diagnosis of alcohol dependence and 21% alcohol abuse. Use of health services was highly variable. Thirty-six per cent agreed to be interviewed to provide data on their level of abstinence, on resource use, on quality of life (SF-36), on socio-economic characteristics and key adverse events. These 212 individuals had similar age and sex ratios to the full cohort, but alcohol abusers were under-represented. Nineteen patients reported no days of abstinence and 41 were abstinent over the whole 6-month period. Patients experienced a much poorer quality of life than a normal population in terms of all dimensions of the SF-36. The average total health care costs of the interviewed patients were 1134 pounds of which 38% were related to treatment at the APC. Analysis suggests that alcohol-dependent patients make substantially more costly use of resources than abusers and experience a much poorer quality of life. No clear relationship of cost to degree of abstinence has been found. There is a clear and consistent relationship of SF-36 scores and drinking behavior.

587 Background: Patient survival is impacted by several factors, one of which is stage at diagnosis. From 1976 to 2014, CRC death rate in the United States (US) declined by 51%. This retrospective study was conducted using US Surveillance, Epidemiology and End Results (SEER) data to evaluate 1- and 5-year relative survival for patients with CRC by American Joint Committee on Cancer (AJCC) stage, age and sex at diagnosis. Methods: The study included adults (age ≥20 years) in the SEER-18 registry diagnosed with CRC in 2004-2014. One- and 5-year relative survival rates were stratified by AJCC stage, age group (20-64 vs. ≥65 years) and sex. Results: One- and 5-year survival was calculated by age and stage at diagnosis (Table), and by sex (data not shown). Overall, 5-year survival rates declined compared to 1-year rates, with the biggest decline observed in stage IV patients. Survival was higher in the younger cohort than in patients ≥65 years of age regardless of stage. Both men and women diagnosed with stage IIB CRC had lower 1- and 5-year survival compared to stage IIIA and IIIB groups, consistent with previous findings. Patients with stage IV had the lowest survival irrespective of age or sex. Conclusions: Overall trends in 1- and 5-year relative survival for CRC varied by AJCC stage, age and sex. Since survival is lowest among CRC patients diagnosed at stage IV, particularly in elderly patients, it reinforces the need for early diagnosis and availability of innovative late stage therapies in this population. [Table: see text]

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An interview was obtained with 212 patients who had, at a point 12 months previously, been in contact with an alcohol problems clinic. Quality of life (SF-36) was measured and for the preceding 6 months the cost of health and social service resource use was estimated, together with the total abstinent (or controlled drinking) days accrued. Alcohol related health, personal and social problems experienced during that period were elicited using a brief 11-item questionnaire, the Alcohol Related Problems Questionnaire (ARPQ). The estimate of costs correlated more strongly with the ARPQ score (r = -0.32, P = 0.0001) than with abstinent days (r = 0.03, n.s.) or controlled drinking months (r = -0.21, P = 0.002). The lack of relation of total abstinent days to cost is partly because abstainers tended to use considerable alcohol problems clinic resources. ARPQ scores indicating more problems were associated with lower quality of life. The ARPQ can serve as a proxy for resource use and quality of life in alcoholism treatment.