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 .
Optimal coronary balloon angioplasty with provisional stenting versus primary stent (OCBAS): immediate and long-term follow-up results.
OBJECTIVE This study sought to compare two strategies of revascularization in patients obtaining a good immediate angiographic result after percutaneous transluminal coronary angioplasty ( PTCA ) : elective stenting versus optimal PTCA . A good immediate angiographic result with provisional stenting was considered to occur only if early loss in minimal luminal diameter ( MLD ) was documented at 30 min post-PTCA angiography . BACKGROUND Coronary stenting reduces restenosis in lesions exhibiting early deterioration ( > 0.3 mm ) in MLD within the first 24 hours ( early loss ) after successful PTCA . Lesions with no early loss after PTCA have a low restenosis rate . METHODS To compare angiographic restenosis and target vessel revascularization ( TVR ) of lesions treated with coronary stenting versus those treated with optimal PTCA , 116 patients were r and omized to stent ( n=57 ) or to optimal PTCA ( n=59 ) . After r and omization in the PTCA group , 13.5 % of the patients crossed over to stent due to early loss ( provisional stenting ) . RESULTS Baseline demographic and angiographic characteristics were similar in both groups of patients . At 7.6 months , 96.6 % of the entire population had a follow-up angiographic study : 98.2 % in the stent and 94.9 % in the PTCA group . Immediate and follow-up angiographic data showed that acute gain was significantly higher in the stent than in the PTCA group ( 1.95 vs. 1.5 mm ; p < 0.03 ) . However , late loss was significantly higher in the stent than the PTCA group ( 0.63+/-0.59 vs. 0.26+/-0.44 , respectively ; p=0.01 ) . Hence , net gain with both techniques was similar ( 1.32 < or = 0.3 vs. 1.24+/-0.29 mm for the stent and the PTCA groups , respectively ; p = NS ) . Angiographic restenosis rate at follow-up ( 19.2 % in stent vs. 16.4 % in PTCA ; p = NS ) and TVR ( 17.5 % in stent vs. 13.5 % in PTCA ; p = NS ) were similar . Furthermore , event-free survival was 80.8 % in the stent versus 83.1 % in the PTCA group ( p = NS ) . Overall costs ( hospital and follow-up ) were US $ 591,740 in the stent versus US $ 398,480 in the PTCA group ( p < 0.02 ) . CONCLUSIONS The strategy of PTCA with delay angiogram and provisional stent if early loss occurs had similar restenosis rate and TVR , but lower cost than primary stenting after PTCA
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 .