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(2) MAJOR
INEQUALITIES IN ACCESS TO KIDNEY
TRANSPLANT
WAITING LIST REVEALED
(3) HEART
DISEASE RISK IN BRITISH MEN IS
OVERESTIMATED
(4) ASPIRIN
IS MOST COST EFFECTIVE WAY TO
PREVENT HEART
DISEASE
(1) NHS MAKES BAD USE OF HOSPITAL BEDS
(Hospital bed utilisation in the
NHS, Kaiser Permanente,
and the US Medicare programme: analysis
of routine
data)
http://bmj.com/cgi/content/full/327/7426/1257
(Editorial: Making sense of Kaiser
Permanente: lessons
for the NHS)
http://bmj.com/cgi/content/full/327/7426/1241
The NHS uses up to three and a half times
the number of
hospital bed days for conditions such
as stroke and hip
fracture as health organisations in the
United States,
according to researchers in this week's
BMJ.
They compared the NHS with two health organisations
(Kaiser Permanente in California and the
Medicare
Programme in California and the United
States) using
data on admission rates, lengths of stay,
and bed days
for 11 leading causes of use of acute
beds in people
aged over 65.
They found that the NHS uses three and
a half times the
number of acute bed days as Kaiser Permanente,
twice
the number as Medicare in California,
and 50% more
than Medicare in the United States for
these causes.
These findings confirm that there is scope
for acute
hospital beds to be used differently in
the NHS, say the
authors. They suggest that the NHS can
learn from
Kaiser's integrated approach and their
experience of
engaging doctors in developing and supporting
this
model of care.
Contact:
Chris Ham, Director, Strategy Unit, Department
of
Health, London, UK
Email: Chris.Ham@doh.gsi.gov.uk
(2) MAJOR INEQUALITIES
IN ACCESS TO KIDNEY
TRANSPLANT WAITING LIST REVEALED
(Equity of access to renal transplant
waiting list and renal
transplantation in Scotland: cohort
study)
http://bmj.com/cgi/content/full/327/7426/1261
Major inequalities exist in access to the
kidney (renal)
transplant waiting list and renal transplantation
in
Scotland, finds a study in this week's
BMJ. These
inequalities may also exist elsewhere
in the United
Kingdom.
Researchers identified 4,523 adults starting
renal
replacement therapy in Scotland between
January 1989
and December 1999. They followed them
to placement
on the waiting list, transplantation,
death, or end of the
study (31 December 2000).
A total of 1,736 (38%) of patients were
placed on the
waiting list for renal transplantation
and 1,095 (24%)
underwent transplantation during the study
period.
Patients were less likely to be placed
on the list if they
were female, older, had diabetes, were
socially
deprived, or were treated in a hospital
with no transplant
unit. Patients living furthest away from
the transplant
centre were listed more quickly.
This is the first time that inequalities
in access to the renal
transplant waiting list have been identified
in this way in
the United Kingdom, say the authors.
These inequalities may also exist elsewhere
in the United
Kingdom because of similarities in the
management of
patients with end stage renal failure,
referral patterns for
transplantation, and the transplantation
process, they
conclude.
Contact:
John Forsythe, Consultant Surgeon, Transplant
Unit,
New Royal Infirmary of Edinburgh, Edinburgh,
Scotland
Email: john.forsythe@luht.scot.nhs.uk
(3) HEART DISEASE
RISK IN BRITISH MEN IS
OVERESTIMATED
(Predictive accuracy of the Framingham
coronary risk
score in British men: prospective
cohort study)
http://bmj.com/cgi/content/full/327/7426/1267
(Editorial: Risk factor scoring for
coronary heart disease)
http://bmj.com/cgi/content/full/327/7426/1238
Current scoring methods over-predict the
risk of death
from coronary heart disease in British
men, according to
a study in this week's BMJ.
Researchers assessed the accuracy of the
Framingham
risk equation for coronary heart disease
in 6,643 British
men aged 40-59 years. All men were initially
free of
heart disease.
Over a 10 year period, 2.8% of men died
from coronary
heart disease compared with 4.1% predicted
± a
overestimation of 47%. A fatal or non-fatal
coronary
heart disease event occurred in 10.2%
of the men
compared with 16% predicted ± an overestimation
of
57%.
The degree of over-prediction was similar
at all risk
levels, so that overestimation of absolute
risk was
greatest for people at highest risk. However,
a simple
adjustment by the authors improved the
level of
accuracy.
These finding have important implications,
say the
authors. For instance, an overestimated
assessment of
coronary heart disease risk will undermine
a patient's
ability to make an informed choice about
starting
preventive treatment, may cause unnecessary
anxiety,
and may affect life insurance premiums.
Contact:
Peter Brindle, Wellcome Training Fellow
in Health
Services Research, Department of Social
Medicine,
University of Bristol, Bristol, UK
Email: peter.brindle@bristol.ac.uk
(4) ASPIRIN IS
MOST COST EFFECTIVE WAY TO
PREVENT HEART DISEASE
(Coronary heart disease prevention:
insights from
modelling incremental cost effectiveness)
http://bmj.com/cgi/content/full/327/7426/1264
(Editorial: What do we gain from
the sixth coronary heart
disease drug?)
http://bmj.com/cgi/content/full/327/7426/1237
Aspirin and blood pressure lowering drugs
can prevent
heart disease at a fraction of the cost
of cholesterol
lowering drugs (statins) and clopidogrel
(an anti-clotting
drug), finds a study in this week's BMJ.
Estimates of cost and effectiveness were
obtained for
aspirin, antihypertensive drugs, statins
and clopidogrel.
Cost per coronary event was calculated
for treatments
individually and in combination for patients
at various
levels of risk.
The most cost effective preventive treatments
were
aspirin and antihypertensive drugs, whereas
simvastatin
and clopidogrel were the least cost effective.
For instance, cost per coronary event prevented
in a
patient at 10% risk over five years was
£3,500 for
aspirin, £12,500 for initial antihypertensives,
£18,300 for
intensive antihypertensives, £60,000
for clopidogrel, and
£61,400 for simvastatin.
These results cast doubt on present policy,
says the
author. A more efficient prevention strategy
would be to
offer most men over 55 and most women
over 65 aspirin
than to give statins to a few high-risk
patients.
Contact:
Tom Marshall, Clinical Lecturer, Department
of Public
Health and Epidemiology, University of
Birmingham, UK
Email (can be picked up from Boston):
T.P.Marshall@bham.ac.uk
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