Objective: To determine the better cost-effective treatment strategy for ureteral stones in a health district of Eastern Spain.Methods: A total of 180 patients were treated between June 2012 and December 2013 for ureteral stones using two different strategies (SWL as initial treatment and URS as rescue technique vs URS and laser lithotripsy (up to 2 procedures). We performed an economic evaluation through a cost effectiveness analysis comparing costs and outcome. We performed a differentiating model in patients with lithiasis less than 1 cm or equal to or larger than 1 cm. The effectiveness parameter was the stone free rate (SFR), defined as the absence of lithiasis fragments or the presence of clinically insignificant residual fragments (CIRFs) -less than 3 mm at the 3 month follow up. A decision tree was developed and a Monte Carlo simulation was performed to establish uncertainty. Results:The SWL as first line was equally or more effective and cheaper than URS as first line of treatment for ureteral stones regardless of location or size. The overall cost for SWL (plus URS as second line) was 1,445,86 € and its SFR was 99.7%, and 2,369,21 and 97.62% for URS group. After the Montecarlo sensitivity analysis, the SWL showed dominance or cost-effectiveness in the vast majority of times, for each position and size.Conclusions: SWL as first line of treatment was more efficient in terms of cost effectiveness than first line URS with Ho: YAG laser lithotripsy for ureteral stones. Given its level of stone clearance, a non-invasive, outpatient based treatment like lithotripsy should remain the first-line treatment option for ureteral stones.

Purpose To analyze the efficiency and cost-utility profile of ureteroscopy versus shock wave lithotripsy for treatment of reno-ureteral stones smaller than 2 cm. Methods Patients treated for urinary stones smaller than 2 cm were included in this study (n = 750) and divided into two groups based on technique of treatment. To assess the cost-utility profile a sample of 48 patients (50% of each group) was evaluated. Quality of life survey (Euroqol 5QD-3L) before-after treatment was applied, Markov model was designed to calculate quality of life in each status of the patients (stone or stone-free with and without double-J stent) and to estimate the incremental cost-utility. Monte carlo simulation was conducted for a probabilistic sensitivity analysis. Chi-square was used for comparing qualitative variables and T student's for continuous variables. Results Shock wave lithotripsy group had 408 (54.4%) and ureteroscopy group had 342 (45.6%) patients. Of them, 56.3% were treated for renal stones and 43.7% for ureteral stones. Ureteroscopy produced slightly higher overall quality of patients' life, but produced a significant higher overall cost per quality-adjusted life year (QALY) than shock wave lithotripsy, exceeding the cost-utility threshold (20,000€/QALY). Sensitivity analysis confirmed results in 93.65% of cases. Difference was maintained in subgroup analysis (ureteral vs renal stones). Conclusions Results suggest that in our clinical setting shock wave lithotripsy has better cost-utility profile than ureteroscopy for treatment of reno-ureteral stones less than 2 cm, but excluding waiting times, in ideal clinical setting, ureteroscopy would have better cost-utility profile than shock wave lithotripsy.

lithiasis or it was expulsable (¼ 4mm) on radiography or non-enhanced contrast TC. The study variables were: age, gender and body mass index (BMI) of the patient, side, location, size and Hounsfield Units (HU) of the stone, number of waves per session, total waves applied to resolution, number of sessions required, stone-free rate (SFR), and major and minor complication rate (Clavien-Dindo classification). The data of the global expenditure was extracted from the hospital's economic information department. A decision tree analysis was modelled for each alternative. Using this model, we estimated the incremental cost effectiveness ratio (ICER) and we conducted a Monte Carlo Simulation for a probabilistic sensitivity analysis RESULTS: Both groups were comparable in terms of age, gender and BMI of the patient, side, HU, location and size of lithiasis. The global SFR was 71% and 86,3% in groups A and B respectively (p¼0.001). There were no differences in the complication rate (26,5% vs 26,2%, p¼0,9) and severity between the two groups, neither in renal damage indicators. The average cost of the SWL in group B was 1039,06 vs 1270,58 euros in group A. The estimated ICER showed that SWL with a extended number of shockwaves (group B) was dominant versus standard SWL treatment (group A). After performing the Monte Carlo simulation, the dominance of extended SWL treatment prevalied regardless of the size or location (renal or ureteral) of stone.CONCLUSIONS: The increase of focal shock wave energy through an expanded number of shockwaves per session in treating urinary lithiasis with extracorporeal lithotripsy is more cost-effective than standard treatment with similar safety.

A469published Canadian literature. Deterministic and probabilistic sensitivity analyses were performed. Results: Mirabegron 50mg dominated tolterodine ER 4mg: incremental cost savings were CA$118.91 (MOH perspective) and CA$140.48 (societal); and 0.005 QALYs (MoH and societal) were gained. ICERs were robust over a wide range of sensitivity analyses, but were most sensitive to micturition symptom levels for tolterodine and to costs of subsequent therapy. ConClusions: Treatment with mirabegron 50mg is cost-effective compared with tolterodine ER 4mg in a population previously treated for OAB from Canadian health care and societal perspectives.objeCtives: The prevalence of prostate cancer in the Chinese population with abnormal prostate-specific antigen (PSA) levels of 4.0-10.0 ng/ml is low. The diagnosis can only rely on transrectal ultrasound-guided prostate biopsies (TRUS-Bx) which may cause major complications. We assess the cost-effectiveness of two diagnostic strategies for prostate cancer detection in Chinese men with abnormal PSA levels of 4.0-10.0 ng/ml and normal digital rectal examination of prostate (DRE). Methods: Using a decision tree model, we performed a cost-effectiveness analysis to compare the two strategies: 1) direct prostate biopsies (TRUS-Bx) and 2) percent free PSA testing prior to TRUS-Bx. A systematic review of 855 patients with PSA levels of 4.0-10.0 ng/ml and normal DRE enrolled in a single medical institute from Jan 2002 to December 2005 was conducted. The outcome measures were the incremental cost-effectiveness ratio, and costs were calculated through activity-accumulation costing based on National Insurance Scheme Bill Size. A one-way sensitivity analysis was undertaken. The effectiveness was measured by means of the number of detected cases and actual cases (detected cases minus lost cases). A threshold analysis is used to illustrate the value of a given variable of which the two strategies have equal outcomes or costs. Results: The strategy of percent free PSA with TRUS-Bx was dominant and found to be the most cost-effective. The incremental cost-effectiveness ratio for free PSA + TRUS-Bx compared with TRUS-Bx was USD 3,871.58. Strategy 2 (TRUS-Bx) would be more cost-effective if the cost of percent free PSA increased to USD 36.78 or if prostate cancer prevalence increased to 42%. ConClusions: The use of percent free PSA prior to TRUS-Bx is the most cost-effective diagnostic strategy and will become more cost-effective as prostate cancer prevalence increases in the ageing population and the free PSA test costs down.

Abstract:The Indian education system is one of the oldest and largest in the world. Some progress has been made in the field of women's education. A recent trend shows that a huge number of female students are enrolling into higher education: 79.44 % Undergraduate, 11.39% for Post graduate & 0.72 % for Ph. D. The sex ratio in has increased; Gender Parity Index up to 0.88 in 2012. Women's enrolment pattern has changed, currently it is much higher in Bachelor of Arts / Science / Commerce / Education than in non-technical / non-professional fields. A similar trend is being seen in Engineering Management and Technology in professional courses with less enrolment of women. This paper is an attempt to present the overall status of women in higher education.