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 .
Randomized Comparison of Primary Stenting and Provisional Balloon Angioplasty Guided by Flow Velocity Measurement
Background —Coronary stenting improves outcomes compared with balloon angioplasty , but it is costly and may have other disadvantages . Limiting stent use to patients with a suboptimal result after angioplasty ( provisional angioplasty ) may be as effective and less expensive . Methods and Results —To analyze the cost-effectiveness of provisional angioplasty , patients scheduled for single-vessel angioplasty were first r and omized to receive primary stenting ( 97 patients ) or balloon angioplasty guided by Doppler flow velocity and angiography ( 523 patients ) . Patients in the latter group were further r and omized after optimization to either additional stenting or termination of the procedure to further investigate what is “ optimal . ” An optimal result was defined as a flow reserve > 2.5 and a diameter stenosis < 36 % . Bailout stenting was needed in 129 patients ( 25 % ) who were r and omized to balloon angioplasty , and an optimal result was obtained in 184 of the 523 patients ( 35 % ) . There was no significant difference in event-free survival at 1 year between primary stenting ( 86.6 % ) and provisional angioplasty ( 85.6 % ) . Costs after 1 year were significantly higher for provisional angioplasty ( EUR 6573 versus EUR 5885;P = 0.014 ) . Results after the second r and omization showed that stenting was also more effective after optimal balloon angioplasty ( 1-year event free survival , 93.5 % versus 84.1%;P = 0.066 ) . Conclusions —After 1 year of follow-up , provisional angioplasty was more expensive and without clinical benefit . The beneficial value of stenting is not limited to patients with a suboptimal result after balloon angioplasty
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 .