While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
HEEs , as context -specific tools , are not easily generalizable from setting to setting .
Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .
Cost-benefit and efficacy of aprotinin compared with epsilon-aminocaproic acid in patients having repeated cardiac operations: a randomized, blinded clinical trial.
BACKGROUND Aprotinin and epsilon-aminocaproic acid are routinely used to reduce bleeding during cardiac surgery . The marked difference in average wholesale cost between these two drug therapies ( aprotinin , $ 1,080 vs. epsilon-aminocaproic acid , $ 11 ) has generated significant controversy regarding their relative efficacies and costs . METHODS In a multicenter , r and omized , prospect i ve , blinded trial , patients having repeated cardiac surgery received either a high-dose regimen of aprotinin ( total dose , 6 x 10(6 ) kallikrein inactivator units ) or epsilon-aminocaproic acid ( total dose , 270 mg/kg ) . RESULTS Two hundred four patients were studied . Overall ( data are median [ 25th-75th percentiles ] ) , aprotinin-treated patients had less postoperative thoracic drainage ( 511 ml [ 383 - 805 ml ] vs. 655 ml [ 464 - 1,045 ml ] ; P = 0.016 ) and received fewer platelet transfusions ( 0 [ range , 0 - 1 ] vs. 1 [ range , 0 - 2 ] ; P = 0.036 ) . The surgical field was more likely to be considered free of bleeding in aprotinin-treated patients ( 44 % vs. 26 % ; P = 0.012 ) . No differences , however , were seen in allogeneic erythrocyte transfusions or in the time required for chest closure . Overall , direct and indirect bleeding-related costs were greater in aprotinin- than in epsilon-aminocaproic acid-treated patients ( $ 1,813 [ $ 1,476 - 2,605 ] vs. $ 1,088 [ range , $ 511 - 2,057 ] ; P = 0.0001 ) . This difference in cost per case varied in magnitude among sites but not in direction . CONCLUSIONS Aprotinin was more effective than epsilon-aminocaproic acid at decreasing bleeding and platelet transfusions .  Epsilon-aminocaproic acid , however , was the more cost-effective therapy over a broad range of estimates for bleeding-related costs in patients undergoing repeated cardiac surgery . A cost-benefit analysis using the lower cost of half-dose aprotinin ( $ 540 ) still result ed in a significant cost advantage using epsilon-aminocaproic therapy ( P = 0.022 )
While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
HEEs , as context -specific tools , are not easily generalizable from setting to setting .
Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .