***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Daivobet ® is a once-daily treatment of psoriasis vulgaris containing betamethasone dipropionate and calcipotriol in a new ointment vehicle . Objective : To assess the cost-effectiveness of once-daily treatment with Daivobet ( 4 weeks ) followed by calcipotriol ( 4 weeks ) compared to tacalcitol ( 8 weeks ) . Methods : Re source utilization was assessed within a double-blind 8-week clinical trial ( all treatments for psoriasis , adverse events and concomitant dermatological medication ) , estimated from the French societal perspective . Results : Total direct medical costs for psoriasis were comparable ( Daivobet : EUR 107.53 and tacalcitol EUR 113.50 ) despite a higher acquisition cost for Daivobet . The probability of ≧75 % reduction in the Psoriasis Area and Severity Index ( effectiveness criterion ) was 46.6 % with Daivobet and 13.9 % with tacalcitol at 4 weeks , and 44.6 and 23.8 % , respectively , at 8 weeks ( both : p < 0.001 ) . Over 8 weeks , Daivobet was almost twice as cost-effective  as tacalcitol ( EUR 241.22 per successful treatment vs. EUR 476.70 ) ; this result was robust to sensitivity assumptions . Conclusion : Daivobet  is more effective and less costly  than tacalcitol for treating psoriasis BACKGROUND Overall assessment s of cost-effectiveness are now commonplace in informing medical policy decision making . It is often important , however , also to investigate how cost-effectiveness varies between patient subgroups . Yet such analyses are rarely undertaken , because appropriate methods have not been sufficiently developed . METHODS We propose a coherent set of Bayesian methods to extend cost-effectiveness analyses to adjust for baseline covariates , to investigate differences between subgroups , and to allow for differences between centres in a multicentre study using a hierarchical model . These methods consider costs and effects jointly , and allow for the typically skewed distribution of cost data . The results are presented as inferences on the cost-effectiveness plane , and as cost-effectiveness acceptability curves . RESULTS In applying these methods to a r and omised trial of case management of psychotic patients , we show that overall cost-effectiveness can be affected by ignoring the skewness of cost data , but that it may be difficult to gain substantial precision by adjusting for baseline covariates . While analyses of overall cost-effectiveness can mask important subgroup differences , crude differences between centres may provide an unrealistic indication of the true differences between them . CONCLUSIONS The methods developed allow a flexible choice for the distributions used for cost data , and have a wide range of applicability -- to both r and omised trials and observational studies . Experience needs to be gained in applying these methods in practice , and using their results in decision making Few studies have compared preference values for health states obtained in different countries . The present study compared Spanish and United Kingdom ( UK ) time trade-off values for EuroQol-5D health states . The same preference elicitation protocol was followed in both countries . Differences in values for 43 health states rated directly were analyzed using t tests , and regression coefficients generated by r and om effects modeling were compared by aggregating the 2 value sets and using dummy variables to analyze country effect by dimension and level of severity . For the milder health states , Spanish and UK value assignation was similar ; for intermediate health states , Spanish values were both higher and lower than UK values , whereas for health states worse than death , UK values were generally higher than Spanish values . There were statistically significant differences ( P < 0.01 ) in values for 34.9 % of health states rated directly , and some preference reversals between countries . UK raters ascribed greater importance to dimensions of pain/discomfort and anxiety/depression , whereas Spanish raters placed more importance on functional dimensions of mobility and self-care . Further analysis is required to determine how these differences affect cost-effectiveness and cost-utility analyses Background —In the Eplerenone Post-Acute Myocardial Infa rct ion Heart Failure Efficacy and Survival Study ( EPHESUS ) , aldosterone blockade with eplerenone decreased mortality in patients with left ventricular systolic dysfunction and heart failure after acute myocardial infa rct ion . The present study was performed to evaluate the cost-effectiveness of eplerenone compared with placebo in these patients . Methods and Results —A total of 6632 patients with left ventricular systolic dysfunction and heart failure after acute myocardial infa rct ion were r and omized to eplerenone or placebo and followed up for a mean of 16 months . The co primary end points were all-cause mortality and the composite of cardiovascular mortality/cardiovascular hospitalization . The evaluation of re source use included hospitalizations , outpatient services , and medications . Eplerenone was priced at the average wholesale price , $ 3.60 per day . Survival beyond the trial period was estimated from data from the Framingham Heart Study , the Saskatchewan Health data base , and the Worcester Heart Attack Registry . The incremental cost-effectiveness of eplerenone in cost per life-year and quality -adjusted life-year gained compared with placebo was estimated . The number of life-years gained with eplerenone was 0.1014 based on Framingham ( 95 % CI , 0.0306 to 0.1740 ) , 0.0636 with Saskatchewan ( 95 % CI , 0.0229 to 0.1038 ) , and 0.1337 with Worcester ( 95 % CI , 0.0438 to 0.2252 ) data . Cost was $ 1391 higher over the trial period in the eplerenone arm ( 95 % CI , 656 to 2165 ) because of drug cost . The incremental cost-effectiveness ratio was $ 13 718 per life-year gained with Framingham ( 96.7 % under $ 50 000 per life-year gained ) , $ 21 876 with Saskatchewan , and $ 10 402 with Worcester . Conclusions —Eplerenone compared with placebo in the treatment of heart failure after acute myocardial infa rct ion is effective in reducing mortality and is cost-effective in increasing years of life by commonly used criteria The TOwards a Revolution in COPD Health ( TORCH ) study was a 3-yr multicentre trial of 6,112 patients r and omised to salmeterol ( Salm ) , fluticasone propionate ( FP ) , a Salm/FP combination ( SFC ) or placebo ( P ) .  Here the cost-effectiveness of treatments evaluated in the TORCH study is assessed . For four regions , 3-yr all-cause hospitalisation , medication and outpatient care costs were calculated . The sample was restricted to the 21 countries ( n = 4,237 ) in which European quality of life five-dimension ( EQ-5D ) data were collected in order to estimate the number of quality -adjusted life years ( QALYs ) . Regression models were fitted to survival , study medication cost , other medication cost and EQ-5D data in order to estimate total cost , number of QALYs and cost per QALY , adjusted for missing data and region . SFC had a trial-wide estimate of cost per QALY of 43,600 US dollars ( USD ) compared with P ( 95 % confidence interval 21,400–123,500 USD ) . Estimates for Salm versus P ( 197,000 USD ) and FP versus P ( 78,000 USD ) were less favourable . The US estimates were greater than those from other regions ; for SFC versus P , the cost per QALY was 77,100 ( 46,200–241,700 ) USD compared to 24,200 ( 15,200–56,100 ) USD in Western Europe . Compared with P , SFC has a lower incremental cost-effectiveness ratio than either FP or Salm used alone , and is , therefore , preferred to these monotherapies on the grounds of cost-effectiveness BACKGROUND Allergic rhinoconjunctivitis is a global health problem . Around 14 million people in Spain , France , Italy , and Austria suffer from grass pollen induced allergic rhinitis . St and ard care only provides symptoms relief , while allergen specific immunotherapy ( SIT ) treats the underlying cause of the disease . Grazax from ALK-Abelló is a new , tablet-based , effective route of SIT for home treatment . The objective was to assess the cost-effectiveness of Grazax in four Southern European countries . METHODS A prospect i ve pharmacoeconomic analyses was carried out alongside a multinational , clinical trial measuring the efficacy of Grazax . Pooled data on re source use and health outcomes were collected . A societal perspective was adopted , and the analysis had a nine-year time horizon . The primary outcome measure was quality adjusted life years ( QALYs ) . RESULTS Grazax was superior to st and ard care for all efficacy endpoints , including QALYs gained , and result ed in significantly less use of rescue medication and fewer hours missed from work .  Grazax was cost-effective for all countries for an annual price in the range of 1500 euros - 1900 euros . The result was improved by inclusion of future costs of asthma and exclusion of Spanish trial centers which experienced an exceptionally low pollen season . CONCLUSION The analysis illustrates that allergen SIT with Grazax for grass pollen induced rhinoconjunctivitis is a cost-effective intervention in Southern Europe OBJECTIVES We sought to evaluate the long-term cost-effectiveness of clopidogrel for up to one year after an acute coronary syndrome ( ACS ) without ST-segment elevation . BACKGROUND The efficacy of platelet inhibition with clopidogrel for up to one year after ACS was demonstrated in the Clopidogrel in Unstable angina to prevent Recurrent Events ( CURE ) trial , a r and omized trial of 12,562 patients in 28 countries that was conducted between 1998 and 2000 . Patients were given clopidogrel ( 300-mg load followed by 75 mg/day ) versus placebo , both in addition to aspirin , for a mean of nine months . METHODS We used patient-level clinical outcomes and re source use from the CURE trial and estimates of life expectancy gains as a result of the prevention of the clinical events of death , stroke , and myocardial infa rct ion on the basis of data from external sources . RESULTS Excluding clopidogrel costs , average costs of hospitalizations alone were 325 dollars less for the clopidogrel arm ( 95 % confidence interval -722 dollars to 45 dollars ) using diagnosis-related group-based Medicare reimbursement rates . When including clopidogrel costs ( 766 dollars greater for the clopidogrel arm ) , average total costs were 442 dollars higher for the clopidogrel arm ( 95 % confidence interval 62 dollars to 820 dollars ) . The incremental cost-effectiveness ratio ( ICER ) on the basis of the Framingham Heart Study was 6,318 dollars per life-year gained ( LYG ) with clopidogrel , with 94 % of bootstrap-derived ICER estimates < 50,000 dollars/LYG ; based on Saskatchewan , the ICER was 6,475 dollars/LYG with 98 % of estimates < 50,000 dollars . CONCLUSIONS Platelet inhibition with clopidogrel in patients for up to one year after presentation with an acute coronary syndrome is both effective and cost-effective Abstract : Background : Everolimus decreases acute rejection and cardiac allograft vasculopathy after heart transplantation . We compared within‐trial costs and re source use over 1 yr of follow‐up in de novo heart transplant patients r and omized to everolimus 1.5 mg/d ( n = 209 ) , everolimus 3.0 mg/d ( n = 211 ) , or azathioprine ( n = 214 ) OBJECTIVES We used a U.S. model of health care costs to examine the cost effectiveness of enoxaparin compared with unfractionated heparin ( UFH ) as adjunctive therapy for fibrinolysis in patients with ST-segment elevation myocardial infa rct ion ( STEMI ) . BACKGROUND The ExTRACT-TIMI 25 ( Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infa rct ion Treatment-Thrombolysis In Myocardial Infa rct ion 25 ) study , a large , r and omized , multinational trial , demonstrated a reduction in death or nonfatal myocardial infa rct ion when enoxaparin was used instead of UFH as adjunctive therapy for fibrinolysis in patients with STEMI . METHODS We used patient-level clinical outcomes and re source use from the ExTRACT-TIMI 25 trial and estimates of life expectancy gains as a result of the prevention of the clinical events on the basis of the Framingham Heart Study . RESULTS Index hospitalization costs trended lower by $ 126 in the enoxaparin group ( 95 % confidence interval [ CI ] : -$295 to $ 49 ) . Thirty-day costs trended higher by $ 102 for enoxaparin ( 95 % CI : $ 108 to $ 314 ) . Patients receiving enoxaparin gained an average of 0.12 life-years relative to patients given UFH .  Estimated total lifetime costs were $ 1,207 higher in the enox 
    Output:
    
Conclusion Based on this systematic review , we concluded that the uptake of more advanced statistical methods has been relatively slow , while simpler naïve methods are still routinely employed