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To determine the cost-effectiveness of home-based point-of-care self-monitoring compared to clinic-based care for patients managed on long-term warfarin medication. Current evidence is inconsistent; results should reduce uncertainty and inform service delivery.
Methods:
A Markov model compared self-testing and self-management, using point-of-care devices to usual care in patients with atrial fibrillation and mechanical heart valves. The primary clinical end-points were stroke and mortality avoided; costs and utilities were associated with these events. The costs of warfarin monitoring were included in the model.
Results:
Over 10 years, self-monitoring saved £1187 per person compared to usual care. Patients who self-monitored had notably fewer strokes and deaths. The results were sensitive to life-years gained and cost of the device. If the NHS purchased the device, financial break-even was achieved at the end of the second year; if the patient bought the device the NHS saved money every year. If 10% of the current 950,000 patients switched to point-of-care devices for 10 years, the NHS could save over £112million.
Limitations:
Clinical studies had a relatively short duration and only data on composite end-points were reported.
Conclusions:
With training, self-testing and self-management are safe, reliable, and cost-effective for a sizable proportion of patients receiving long-term warfarin. Compared to clinic-based services, self-monitoring offers the NHS the potential to make cost savings and release bed-days by reducing the number of strokes experienced by these high-risk patients. 相似文献
To enrich the knowledge of the value of ethical leadership in a more entrepreneurial setting, we focus on technology-based young firms and theorize through the lens of CEO-TMT interface whether and how founder-CEOs’ ethical leadership influences young firms’ ambidexterity. We argue that founder-CEOs’ ethical leadership can enhance young firms’ ambidexterity in an indirect way, through promoting top management team (TMT) members’ advice-seeking behavior and team satisfaction. Data from a multi-source and time-lagged survey of founder-CEOs and all TMT members in 81 Chinese technology-based young firms supported our predictions. We discuss the theoretical and practical implications of our study to the extant research.
相似文献Marketer interest in using virtual reality (VR) as a persuasion tactic continues to rise. Notably, one sector at the forefront of utilizing this tactic for persuasive means is nonprofit marketing. Many charities have devoted considerable resources to creating VR appeals under the assumption that this medium will increase donations over and above present tactics. However, research has not yet examined the persuasive consequences VR may provide over more traditional channels. This research seeks to understand the opportunities and limitations this emerging tactic can offer marketers. Specifically, we examine the donation effectiveness of three real VR charitable appeals by assessing actual donation behaviors, and find that VR appeals increase donations compared to a two-dimensional (2D) format. This work addresses a timely and relevant issue for practitioners and opens doors to future research investigating VR’s applications to marketing.
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