The incremental effectiveness of treating NIDDM with the goal of normoglycemia is estimated to be approximately $16,000/QALY gained, which is in the range of interventions that are generally considered cost-effective.

A probabilistic model of NIDDM predicts the vascular complications of NIDDM in a cohort representative of the incident cases of diabetes in the U.S. before age 75 years. Predictions of complications and mortality are consistent with the known epidemiology of NIDDM. The model is suitable for evaluating the effect of preventive interventions on the natural history of NIDDM.

Despite substantial evidence regarding the benefits of combined use of inhaled corticosteroids and long-acting b 2 -agonists in asthma, such evidence remains limited for chronic obstructive pulmonary disease (COPD). Observational data may provide an insight into the expected survival in clinical trials of fluticasone propionate (FP) and salmeterol in COPD.Newly physician-diagnosed COPD patients identified in primary care during 1990-1999 aged o50 yrs, of both sexes and with regular prescriptions of respiratory drugs were identified in the UK General Practice Research Database. Three-year survival in 1,045 COPD patients treated with FP and salmeterol was compared with that in 3,620 COPD patients who regularly used other bronchodilators but not inhaled corticosteroids or long-acting b 2 -agonists. Standard methods of survival analysis were used, including adjustment for possible confounders.Survival at year 3 was significantly greater in FP and/or salmeterol users (78.6%) than in the reference group (63.6%). After adjusting for confounders, the survival advantage observed was highest in combined users of FP and salmeterol (hazard ratio (HR) 0.48 (95% confidence interval 0.31-0.73)), followed by users of FP alone (HR 0.62 (0.45-0.85)) and regular users of salmeterol alone (HR 0.79 (0.58-1.07)) versus the reference group. Mortality decreased with increasing number of prescriptions of FP and/or salmeterol.In conclusion, regular use of fluticasone propionate alone or in combination with salmeterol is associated with increased survival of chronic obstructive pulmonary disease patients managed in primary care. Chronic obstructive pulmonary disease (COPD) is a respiratory disorder representing a major healthcare burden [1]. Smoking cessation is the only intervention proven to modify the progressive development of airflow limitation, and, to date, only smoking cessation and long-term oxygen therapy have been shown to delay death. The role of pharmacological interventions in modifying the natural history of COPD has not been well established. Inhaled corticosteroids alone [2] or in combination with long-acting b 2 -agonists (LABAs) have been shown to be effective in asthma [3], but more research is needed in COPD [4]. The place of inhaled corticosteroids and LABAs in COPD management is the subject of current debate [5][6][7]. Many general practitioners (GPs) and respiratory physicians in the UK treat both asthma and COPD patients, accumulating experience and empirical treatments in the care and management of both conditions. Current British Thoracic Society (BTS) guidelines for COPD, published in 1997, recommend short-acting bronchodilators for all symptomatic patients, but state that there is insufficient evidence for the use of inhaled corticosteroids or LABAs [8]. Nevertheless, as much as 48% of COPD patients in the UK are currently receiving long-term inhaled corticosteroid therapy [9].Although the effectiveness of inhaled fluticasone propionate (FP) and salmeterol in mortality reduction in COPD patients is c...

Background-Recent trends in physician diagnosed chronic obstructive pulmonary disease (COPD) in the UK were estimated, with a particular focus on women. Methods-A retrospective cohort of British patients with COPD was constructed from the General Practice Research Database (GPRD), a large automated database of UK general practice data. Prevalence and all-cause mortality rates by sex, calendar year, and severity of COPD, based on treatment only, were estimated from January 1990 to December 1997. Results-A total of 50 714 incident COPD patients were studied, 23 277 (45.9%) of whom were women. From 1990 to 1997 the annual prevalence rates of physician diagnosed COPD in women rose continuously from 0.80% (95% CI 0.75 to 0.83) to 1.36% (95% CI 1.34 to 1.39), (p for trend <0.01), rising to the rate observed in men in 1990. Increases in the prevalence of COPD were observed in women of all ages; in contrast, a plateau was observed in the prevalence of COPD in men from the mid 1990s. Allcause mortality rates were higher in men than in women (106.8 versus 82.2 per 1000 person-years), with a consistently increased relative risk in men of 1.3 even after controlling for the severity of COPD. Significantly increased mortality rates were also observed in adults aged less than 65 years. The mean age at death was 76.5 years; patients with severe COPD died an average of three years before those with mild disease (p<0.01) and four years before the age and sex matched reference population. Conclusions-While prevalence rates of COPD in the UK seem to have peaked in men, they are continuing to rise in women. This trend, together with the ageing of the population and the long term cumulative eVect of pack-years of smoking in women, is likely to increase the present burden of COPD in the UK. (Thorax 2000;55:789-794)