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52. Simvastatin after orthotopic heart transplantation. Costs and consequences.

Author

Krobot, K.J., Wenke, K., and Reichart, B.

Subjects
*HEART transplantation, *CHOLESTEROL, *THERAPEUTICS, *DRUG dosage, *ANTILIPEMIC agents, *CLINICAL trials, *COMPARATIVE studies, *CHOLESTEROL content of food, *RESEARCH methodology, *MEDICAL cooperation, *RESEARCH, *SURVIVAL analysis (Biometry), *COST analysis, *EVALUATION research, *RANDOMIZED controlled trials, *SIMVASTATIN
Abstract

Objective: Recent data indicate that the combination of a low cholesterol diet and simvastatin following heart transplantation is associated with significant reduction of serum cholesterol levels, lower incidence of graft vessel disease (GVD) and significantly superior 4-year survival rates than dietary treatment alone. On the basis of this first randomised long term study evaluating survival as the clinical end-point, we investigated the cost effectiveness of the above regimens as well as the long term consequences for the patient and for heart transplantation as a high-tech procedure.Design and Setting: The perspective of the economic analysis was that of the German health insurance fund. Life-years gained were calculated on the basis of the Kaplan-Meier survival curves from the 4-year clinical trial and from the International Society for Heart and Lung Transplantation (ISHLT) overall survival statistics. Incremental costs and incremental cost-effectiveness ratios were determined using various sources of data, and both costs and consequences were discounted by 3% per year. Sensitivity analyses using alternative assumptions were conducted in addition to the base-case analysis.Patients and Participants: As in the original clinical trial, the target population of the economic evaluation comprised all heart transplant recipients on standard triple immunosuppression consisting of cyclosporin, azathioprine and prednisolone, regardless of the postoperative serum lipid profile.Interventions: The therapeutic regimens investigated in the analysis were the American Heart Association (AHA) step II diet plus simvastatin (titrated to a maximum dosage of 20 mg/day) and AHA step II diet alone.Main Outcome Measures and Results: Four years of treatment with simvastatin (mean dosage 8.11 mg/day) translated into an undiscounted survival benefit per patient of 2.27 life-years; 0.64 life-years within the trial period and 1.63 life-years thereafter. Discounted costs per year of life gained were $US1050 (sensitivity analyses $US800 to $US15,400) for simvastatin plus diet versus diet alone and $US18,010 (sensitivity analyses $US17,130 to $US21,090) for heart transplantation plus simvastatin versus no transplantation (all costs reflect 1997 values; $US1 = 1.747 Deutschmarks).Conclusions: Prevention of GVD with simvastatin after heart transplantation was cost effective in all the scenarios examined with impressive prolongation of life expectancy for the heart recipient. Simvastatin also achieved an internationally robust 21% improvement in the cost effectiveness of heart transplantation compared with historical cost-effectiveness data. [ABSTRACT FROM AUTHOR]

Published
1999
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54. Polydimethylsiloxane‐cyclodextrin networks synthesized into a porous polystyrene gel – an investigation by energy filtering transmission electron microscopy

Author

Du Chesne, A., Wenke, K., Lieser, G., and Wenz, G.

Abstract

Crosslinked poly(styrene)‐poly(dimethylsiloxane)‐cyclodextrin systems are a new class of multicomponent polymer networks. They are prepared by swelling a polystyrene gel (PS) with the components of the poly(dimethylsiloxane)‐cyclodextrin network (PDMS(CDX)) and subsequent crosslinking. Electron spectroscopic imaging and elemental mapping are appropriate methods for the investigation of these polymer systems, which contain heteroatoms in one of their components. It is shown that PDMS(CDX) is uniformly distributed within PS. Interpenetration with PS is responsible for the stable anchoring of PDMS(CDX) and prevents phase separation.

Published
1997
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57. Optimalitätsbedingungen

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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58. Two Stage Problems

Author

Kall, Peter, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Kall, Peter

Published
1976
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59. Chance Constrained Programming

Author

Kall, Peter, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Kall, Peter

Published
1976
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60. Schnittverfahren

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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61. Introduction

Author

Kall, Peter, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Kall, Peter

Published
1976
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62. Distribution Problems

Author

Kall, Peter, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Kall, Peter

Published
1976
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63. Prerequisites

Author

Kall, Peter, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Kall, Peter

Published
1976
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64. Dekompositionsverfahren

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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65. Lineare Programmierung

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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66. Einzelschrittverfahren

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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67. Projektions- und Kontraktionsverfahren

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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68. Optimierung ohne Restriktionen

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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69. Das Verfahren der projizierten Gradienten

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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70. Die Verfahren von Zangwill und Dantzig-Cottle

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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71. Mathematische Programme

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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72. Das Verfahren von Beale

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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73. Verfahren der zulässigen Richtungen

Author

Blum, Eugen, Oettli, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Künzi, H.P., editor, Blum, Eugen, and Oettli, Werner

Published
1975
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74. Toward a Normative Theory of Development

Author

Marschak, Thomas, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Marschak, Thomas, Glennan, Thomas K., Jr., and Summers, Robert

Published
1967
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76. The Microeconomic Study of Development

Author

Marschak, Thomas, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Marschak, Thomas, Glennan, Thomas K., Jr., and Summers, Robert

Published
1967
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77. Issues in the Choice of Development Policies

Author

Glennan, Thomas K., Jr., Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, Marschak, Thomas, Glennan, Thomas K., Jr., and Summers, Robert

Published
1967
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79. Maximaler Fluß

Author

Knödel, Walter, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Knödel, Walter

Published
1969
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80. Kürzeste Wege

Author

Knödel, Walter, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Knödel, Walter

Published
1969
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81. Phasenfolgen an Kreuzungen

Author

Knödel, Walter, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Knödel, Walter

Published
1969
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83. Das Rundreiseproblem

Author

Knödel, Walter, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Knödel, Walter

Published
1969
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84. Grundlagen

Author

Knödel, Walter, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Knödel, Walter

Published
1969
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89. Markov processes

Author

Girault, M., Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Girault, M.

Published
1966
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90. Zielfunktionale Sensivititätsanalysen

Author

Dinkelbach, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Dinkelbach, Werner

Published
1969
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91. Poisson processes

Author

Girault, M., Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Girault, M.

Published
1966
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93. Introduction

Author

Girault, M., Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Girault, M.

Published
1966
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94. Parametrische lineare Programmierung

Author

Dinkelbach, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Dinkelbach, Werner

Published
1969
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96. Lineare Programmierung, ein Überblick

Author

Dinkelbach, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Dinkelbach, Werner

Published
1969
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98. Einleitung

Author

Dinkelbach, Werner, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Dinkelbach, Werner

Published
1969
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99. Technologie-Preise

Author

Wittmann, Waldemar, Beckmann, M., editor, Henn, R., editor, Jaeger, A., editor, Krelle, W., editor, Künzi, H. P., editor, Wenke, K., editor, Wolfe, Ph., editor, and Wittmann, Waldemar

Published
1968
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