***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: The aim of this study was to assess the lifetime cost effectiveness of recombinant activated factor VII vs placebo as adjunctive therapy for control of bleeding in patients with severe blunt trauma in the UK . We developed a cost‐effectiveness model based on patient level data from a 30‐day international , r and omised , placebo‐controlled Phase II trial . The data were supplemented with secondary data from UK sources to estimate lifetime costs and benefits . The model produced a baseline estimate of the incremental cost per life year gained with recombinant activated factor VII relative to placebo of £ 12 613 . The incremental cost per quality adjusted life year gained was £ 18 825 . These estimates are sensitive to the choice of discount rate and health state utility values used . Preliminary results suggest that relative to placebo , recombinant activated factor VII may be a cost‐effective therapy to the UK National Health Service Fifteen anaesthetists were observed while providing anaesthesia for 15 pairs of adult cardiac surgical operations , using conventional methods for one of each pair and a new drug administration system design ed to reduce error for the other . Aspects of each method were rated by users on 10‐cm visual analogue scales ( 10 being best ) . The new system was rated more favourably than conventional methods in terms of safety ( median [ range ] = 8.1 [ 6.8–9.7 ] vs. 7.1 [ 2.6–9.3 ] cm ; p = 0.001 ) and usability ( 8.5 [ 5.9–9.4 ] vs. 7.5 [ 3.2–9.8 ] cm ; p = 0.027 ) . The new system saved preparation time both before anaesthesia ( median [ range ] = 180 [ 32–480 ] vs. 360 [ 120–600 ] s ; p = 0.013 ) and during anaesthesia ( 10 [ 2–38 ] vs. 12 [ 10–60 ] s ; p = 0.009 ) . Prefilled syringes for the new system increased costs by € 23.00 per anaesthetic ( p = 0.041 ) , but this increase is likely to be offset by the potential of the new system to decrease costly iatrogenic harm by preventing drug error Oral capecitabine ( Xeloda ® ) is an effective drug with favourable safety in adjuvant and metastatic colorectal cancer .  Oxaliplatin-based therapy is becoming st and ard for Dukes ' C colon cancer in patients suitable for combination therapy , but is not yet approved by the UK National Institute for Health and Clinical Excellence ( NICE ) in the adjuvant setting . Adjuvant capecitabine is at least as effective as 5-fluorouracil/leucovorin ( 5-FU/LV ) , with significant superiority in relapse-free survival and a trend towards improved disease-free and overall survival . We assessed the cost-effectiveness of adjuvant capecitabine from payer ( UK National Health Service ( NHS ) ) and societal perspectives . We used clinical trial data and published sources to estimate incremental direct and societal costs and gains in quality -adjusted life months ( QALMs ) . Acquisition costs were higher for capecitabine than 5-FU/LV , but higher 5-FU/LV  administration costs result ed in 57 % lower chemotherapy costs for capecitabine . Capecitabine vs 5-FU/LV-associated  adverse events required fewer medications and hospitalisations ( cost savings £ 3653 ) . Societal costs , including patient travel/time costs , were reduced by > 75 % with capecitabine vs 5-FU/LV ( cost savings £ 1318 ) , with lifetime gain in QALMs of 9 months . Medical re source utilisation is significantly decreased with capecitabine vs 5-FU/LV , with cost savings to the NHS and society . Capecitabine is also projected to increase life  expectancy vs 5-FU/LV  . Cost savings and better outcomes  make capecitabine a preferred adjuvant therapy for Dukes ' C colon cancer . This pharmacoeconomic analysis strongly supports replacing 5-FU/LV with capecitabine in the adjuvant treatment of colon cancer in the UK OBJECTIVE To determine the cost of achieving pregnancy with different gonadotropin preparations . DESIGN Cost-minimization analysis of a prospect i ve r and omized clinical trial . SETTING Twenty-two centers in six countries . PATIENT(S ) Women 18 to 36 years of age with infertility for more than 1 year who were undergoing IVF or ICSI . INTERVENTION(S ) Highly purified hMG or recombinant FSH . RESULT ( S ) Mean cost of achieving an ongoing pregnancy . The mean cost per patient treatment cycle was estimated to be pound 2423 with highly purified hMG ( 95 % CI , pound 2356 to pound 2495 ) and pound 2745 with recombinant FSH ( 95 % CI , pound 2658 to pound 2830 ) . The ongoing pregnancy rate was 22 % with highly purified hMG and 19 % with recombinant FSH . The cost per ongoing pregnancy was pound 10781 with highly purified hMG ( 95 % CI , pound 9056 to pound 12919 ) and pound 14284 with recombinant FSH ( 95 % CI , pound 11883 to pound 17891 ) . CONCLUSION ( S ) Highly purified hMG and recombinant FSH are equally effective , but highly purified hMG is less expensive per cycle . Using highly purified hMG instead of recombinant FSH would translate into a 13 % increase in the number of cycles that could be offered This study was design ed to assess the cost-effectiveness of erlotinib compared with docetaxel in the second-line management of advanced non-small-cell lung cancer ( NSCLC ) within the UK National Health Service ( NHS ) . A health-state transition model , based on two r and omized phase III studies of erlotinib or docetaxel versus best supportive care , was used to estimate total direct costs , quality -adjusted life years ( QALYs ) and the subsequent net monetary benefit . Erlotinib was associated with a reduction in total costs ( £ 13 730 versus £ 13 956 ) and improved outcomes ( total QALYs of 0.238 versus 0.206 ) compared with docetaxel . Sensitivity analyses demonstrated the robustness of this analysis . In summary , erlotinib appeared to generate similar overall survival , an increase in QALYs and a small reduction in total NHS costs  compared with docetaxel , due to lower adverse event and drug administration costs . Consequently , from a health economics perspective for the treatment of relapsed stage III - IV NSCLC patients in the UK , erlotinib has advantages over docetaxel The National Institute for Health and Clinical Excellence ( NICE ) issues m and atory guidance on health technologies to the UK NHS , based on clinical evidence , cost-effectiveness and other considerations . However , the exact factors considered , their relative importance and tradeoffs between them are not made explicit . Previous research modelled NICE decisions as a binary choice ( accept/reject ) dependent on cost-effectiveness , amongst other variables . This paper proposes and tests an alternative model of decision-making that may better represent the " yes , but ... " nature of many NICE decisions . Decisions were categorised as " recommended for routine use " , " recommended for restricted use " or " not recommended " . The NICE appraisal process was modelled as a single decision between the three categories .  Multinomial logistic regression techniques were used to evaluate the impact of : quantity/ quality of clinical evidence ; cost-effectiveness ; decision date ; existence of alternative treatments ; budget impact ; technology type . Results suggest that interventions supported by more r and omised trials are more likely to be recommended and endorsed for routine use . Higher cost-effectiveness ratios increased the likelihood of interventions being rejected rather than recommended for restricted use but did not significantly affect the decision between routine and restricted use . Pharmaceuticals , interventions appraised early in the NICE programme and those with more systematic review s were also less likely to be rejected , while patient group su bmi ssions made a recommendation for routine rather than restricted use more likely . The presence of factors affecting the decision between routine and restricted use but not that between routine use and rejection suggests that modelling these three outcomes reflects NICE decision-making more closely than binary-choice analyses OBJECTIVES To estimate the cost-effectiveness of temsirolimus compared to interferon-alpha for first line treatment of patients with advanced , poor prognosis renal cell carcinoma , from the perspective of the UK National Health Service . METHODS A decision-analytic model was developed to estimate the cost-effectiveness of temsirolimus . The clinical effectiveness of temsirolimus compared with interferon-alpha and the utility values ( using EQ-5D tariffs ) were taken from a recent phase III r and omized clinical trial . Cost data were obtained from published literature and based on current UK practice . The effect of parameter uncertainty on cost-effectiveness was explored through extensive one-way and probabilistic sensitivity analyses . RESULTS Compared to interferon-alpha , temsirolimus treatment result ed in an incremental cost per QALY gained of pound94,632 ; based on an estimated mean gain of 0.24 quality -adjusted life years ( QALYs ) per patient , at a mean additional cost of pound22,331 ( inflated to 2007/8 ) . The cost per QALY for patient subgroups ranged from pound74,369 to pound154,752 . The probability that temsirolimus is cost-effective compared to interferon-alpha at a willingness to pay threshold of pound30,000 per QALY for all patient groups is expected to be close to zero . The cost per QALY was sensitive to the clinical effectiveness parameters , health state utilities , drug costs and the cost of administration of temsirolimus . CONCLUSIONS Temsirolimus has been shown to be clinical ly effective compared to interferon-alpha offering additional health benefits , however , with a cost per QALY in excess of pound90,000 , it may not be regarded as a cost-effective use of re sources in some health care setting 
    Output:
    
We found evidence of variation in the way that administration costs were measured , and that this affected the magnitude of costs reported , which could then influence cost effectiveness .
Conclusions Our findings suggested that manufacturers of biologic medicines should pay attention to formulation issues and their impact on administration costs , because these affect the total costs of healthcare delivery and cost effectiveness