No abstract

These results suggest that the systematic suppression of fever may not be useful in patients without severe cranial trauma or significant hypoxemia. Letting fever take its natural course does not seem to harm patients with systemic inflammatory response syndrome or influence the discomfort level and may save costs.

Metamizol, propacetamol, and external cooling equally reduced temperature. Considering the undesirable hemodynamic effects, metamizol should not be considered the first antipyretic choice in unstable patients. Propacetamol or external cooling should be preferred, although the latter should be avoided in patients unlikely to tolerate the increased metabolic demand induced by external cooling.

From a health economy viewpoint PROSIT is superior to standard management. Early recognition of albuminuria and the introduction of a multifactorial treatment strategy make it possible to delay progression to terminal renal failure. In addition to its clinical benefits, prevention of dialysis and transplantation would reduce the annual savings of the health care system by several billion DM.

OBJECTIVES: Optimization of type 2 diabetes intervention strategies in Germany based on stepwise prognoses of expected medical and economic outcomes in population subgroups. METHODS: A published, editable diabetes model was used to assess the outcomes of different degrees of secondary prevention measures for different diabetes type 2 patient sub‐groups in Germany. Clinical data were derived from German diabetes quality of care circles. Incremental cost‐effectiveness ratios (ICERs) were calculated as the differences of average lifetime cost divided by the difference of average life expectancy. Optimization was approximated by calculating ICERs for stepwise modified prevention strategies, including screening and complication treatments for variable population risk characteristics. RESULTS: Compared to the prognosis of overall life expectancy and cost consequences the more refined stepwise approach generates a series of results for all combinations of intervention strategy and population subgroup. At certain risk levels the ICER based treatment recommendation may change if subgroup prognosis is applied. But for all age groups of diabetes patients secondary prevention of complication is the dominant variant. Medical outcomes and incremental cost‐effectiveness are improved by additional secondary prevention measures except for patients with non‐reversible risks. The potential savings from improved prevention amount to 10% of total expenditures for diabetes care in Germany, i.e., DEM 3000 million. CONCLUSIONS: With the stepwise assessment of subgroup outcomes a treatment optimization and optimal allocation of diabetes management to patient subgroups is feasible. Using average data to calculate overall ICER for the total diabetes population may ignore the best treatment strategy in different population subgroups. Subgroup analysis represents a helpful tool in the health economic evaluation of diabetes treatment strategies when variable population risk characteristics and baseline complications affect the clinical and economic outcome.