***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 and Purpose — Surgical decompression reduces mortality and increases the probability of a favorable functional outcome after space-occupying hemispheric infa rct ion . Its cost-effectiveness is uncertain . Methods — We assessed clinical outcomes , costs , and cost-effectiveness for the first 3 years in patients who were r and omized to surgical decompression or best medical treatment within 48 hours after symptom onset in the Hemicraniectomy After Middle Cerebral Artery Infa rct ion With Life-Threatening Edema Trial ( HAMLET ) . Data on medical consumption were derived from case record files , hospital charts , and general practitioners . We calculated costs per quality -adjusted life year ( QALY ) . Uncertainty was assessed with bootstrapping . A Markov model was constructed to estimate costs and health outcomes after 3 years . Results — Of 39 patients enrolled within 48 hours , 21 were r and omized to surgical decompression .  After 3 years , 5 surgical ( 24 % ) and 14 medical patients ( 78 % ) had died . In the first 3 years after enrollment , operated patients had more QALYs than medically treated patients ( mean difference , 1.0 QALY [ 95 % confidence interval , 0.6–1.4 ] ) , but at higher costs ( mean difference , & OV0556;127 000 [ 95 % confidence interval , 73 100–181 000 ] ) , indicating incremental costs of & OV0556;127 000 per QALY gained . Ninety-eight percent of incremental cost-effectiveness ratios replicated by bootstrapping were > & OV0556;80 000 per QALY gained . Markov modeling suggested costs of ≈&OV0556;60 000 per QALY gained for a patient ’s lifetime . Conclusions — Surgical decompression for space-occupying infa rct ion results in an increase in QALYs , but at very high costs . Clinical Trial Registration — URL : http://www.controlled-trials.com . Unique identifier : IS RCT N94237756 PURPOSE To assess the effectiveness and cost-effectiveness of state-of-the-art noninvasive diagnostic imaging strategies in patients with a transient ischemic attack ( TIA ) or minor stroke who are suspected of having carotid artery stenosis ( CAS ) . MATERIAL S AND METHODS All prospect ively evaluated patients provided informed consent , and the local ethics committee approved this study . Diagnostic performance , treatment , long-term events , quality of life , and costs result ing from strategies employing duplex ultrasonography ( US ) , computed tomographic ( CT ) angiography , contrast material -enhanced magnetic resonance ( MR ) angiography , and combinations of these modalities were modeled in a decision tree and Markov model . Data sources included a prospect i ve diagnostic cohort study , a meta- analysis , and a review of the literature . Outcomes were costs , quality -adjusted life-years ( QALYs ) , incremental cost-effectiveness ratios , and net health benefits ( QALY-equivalents ) , with a willingness-to-pay threshold of euro 50,000 per QALY and a societal perspective . The strategy with the highest net health benefit was considered the most cost effective . Extensive one-way , two-way , and probabilistic sensitivity analyses to explore the effect of varying parameter values were performed . The reference case analysis assumed that patients underwent surgery 2 - 4 weeks after the first symptoms , and the effect of earlier intervention was explored . RESULTS The reference case analysis showed that duplex US combined with CT angiography and surgery for 70%-99 % stenoses was the most cost-effective strategy , with a net health benefit of 13.587 and 15.542 QALY-equivalents in men and women , respectively . In men , the CT angiography strategy with a 70%-99 % cutoff yielded slightly more QALYs , at an incremental cost of euro 71,419 per QALY , compared with duplex US combined with CT angiography . In patients with a high-risk profile , in patients with a high prior probability of disease , and when patients could be treated within 2 weeks after the first symptoms , the CT angiography strategy with surgery for 50%-99 % stenoses was the most cost-effective strategy . CONCLUSION In diagnosing CAS , duplex US should be the initial test , and , if its results are positive , CT angiography should be performed ; patients with 70%-99 % stenoses should then undergo carotid endarterectomy . In patients with a high-risk profile , a high probability of CAS , or who can undergo surgery without delay , immediate CT angiography and surgery for 50%-99 % stenoses is indicated BACKGROUND Statins are lipid-lowering drugs that reduce the risk of cardiovascular events in patients with diabetes . OBJECTIVES The objective of this study was to determine whether statin treatment for primary prevention in newly diagnosed type 2 diabetes is cost-effective , taking nonadherence , baseline risk , and age into account . METHODS A cost-effectiveness analysis was performed by using a Markov model with a time horizon of 10 years . The baseline 10-year cardiovascular risk was estimated in a Dutch population of primary prevention patients with newly diagnosed diabetes from the Groningen Initiative to Analyse Type 2 Diabetes Treatment ( GIANTT ) data base , using the United Kingdom Prospect i ve Diabetes Study risk engine . Statin adherence was measured as pill days covered in the IADB.nl pharmacy research data base . Cost-effectiveness was measured in costs per quality -adjusted life-year ( QALY ) from the health care payers ' perspective . RESULTS For an average patient aged 60 years , the base case , statin treatment was highly cost-effective at € 2245 per QALY . Favorable cost-effectiveness was robust in sensitivity analysis . Differences in age and 10-year cardiovascular risk showed large differences in cost-effectiveness from almost € 100,000 per QALY to almost being cost saving . Treating all patients younger than 45 years at diabetes diagnosis was not cost-effective ( weighted cost-effectiveness of almost € 60,000 per QALY ) . CONCLUSIONS Despite the nonadherence levels observed in actual practice , statin treatment is cost-effective for primary prevention in patients newly diagnosed with type 2 diabetes . Because of large differences in cost-effectiveness according to different risk and age groups , the efficiency of the treatment could be increased by targeting patients with relatively higher cardiovascular risk and higher ages Objective : To evaluate the safety and cost-effectiveness of short-stay intensive care ( SSIC ) treatment for low-risk coronary artery bypass patients . Design : R and omized clinical equivalence trial . Setting : University Hospital Maastricht , the Netherl and s. Patients : Low-risk coronary artery bypass patients . Interventions : A total of 600 patients were r and omly assigned to undergo either SSIC treatment ( 8 hrs of intensive care treatment ) or control treatment ( care as usual , overnight intensive care treatment ) . Measurements : The primary outcome measures were intensive care readmissions and total hospital stay . The secondary outcome measures were total hospital costs , quality of life , postoperative morbidity , and mortality . Hospital costs consisted of the cost of hospital admission or admissions and outpatient costs . Main Results : The difference in intensive care readmission between the two groups of 1.13 % was very small and not significantly different ( p = .241 ; 95 % confidence interval , −0.9 % to 2.9 % ) . The total hospital stay ( p = .807 ; 95 % confidence interval , 1.2 to −0.4 ) and postoperative morbidity were comparable between the groups . The SSIC  group 's quality of life improved more compared with the control group 's quality of life ( p = .0238 ; 95 % confidence interval , 0.0012 to 0.0464 ) . The total hospital costs  for SSIC were significantly lower ( 95 % confidence interval , & U20AC;−1,581 to & U20AC;−174 ) compared with those for the control group ( & U20AC;4,625 and & U20AC;5,441 , respectively ) . The estimated incremental cost-effectiveness ratio ( cost/delta quality -adjusted life months ) thus showed the dominance of SSIC . Bootstrap and sensitivity analyses confirm the robustness of the study findings . Conclusions : Compared with usual care , SSIC  is a safe and cost-effective approach . SSIC can be considered as an alternative for conventional postoperative intensive care treatment for low-risk coronary artery bypass graft patients Objective This study aims to systematic ally evaluate available evidence regarding direct medical costs of treating cardiovascular ( CV ) events in Germany after 2003 on an individual patient basis and from a payer perspective . The CV events of interest were myocardial infa rct ion ( MI ) , unstable angina , heart failure ( HF ) , stroke , and peripheral artery disease ( PAD ) . Method A systematic literature search was performed in the following data bases according to Preferred Reporting Items for Systematic Review s and Meta- Analysis ( PRISMA ) guidelines - Medline , Embase , Centre for Review s and Dissemination , TIBORDER , and German dissertation data base from January 2003 to October 2013 . Both observational studies and r and omized clinical trials were considered for the review . All values stated in € are inflation adjusted to 2014 € unless stated otherwise . Result This review included 13 articles . For newly occurred MI patients , the average hospitalization costs during the acute phase were reported to be between € 6790 and € 8918 per admission . In the first year after a MI event , direct medical costs were € 13,838–14,792 per patient . Direct medical costs of chronic HF patients were found to be between € 3417 and 5576 per patient per year . Treatment costs increase with disease progression . The average treatment costs  for hospitalized PAD in the acute phase were reported to be € 4963 per admission , € 2535 per patient during month 1–6 after the initial hospitalization , € 1601 in month 7–12 , and € 1390 in month 13–18 . For stroke of all types , total direct medical costs in the 1st year after an event were reported to be € 13,273 per patient . Total direct medical costs during the 1st year after an ischemic stroke event were € 17,399–21,954 per patient , € 6260 in month 13–18 , and € 6496 per year in the subsequent 4 years . Conclusion MI , unstable angina , HF , stroke and PAD have a high financial impact on the German health care system . Treatment costs of these diseases are mostly incurred during the acute phase of events and tend to decrease over time . Hospitalization and rehabilitation costs were two major cost drivers . Medication costs was one of the smallest cost component reported BACKGROUND Despite the growing interest in haemodiafiltration ( HDF ) , there is no information on the costs and cost-utility of this dialysis modality yet . It was therefore our objective to study the cost-utility of HDF versus haemodialysis ( HD ) . METHODS A cost-utility analysis was performed using a Markov model . It included data from the Convective Transport Study ( CONTRAST ) , a r and omized controlled trial that compared online HDF with low-flux HD . Costs were estimated using a societal perspective . Probabilistic sensitivity analyses were performed to study uncertainty . RESULTS Total annual costs  for HDF and HD were € 88 622±19,272 and € 86,086±15,945 , respectively ( in 2009 euros ) . When modelled over a 5-year period , the incremental cost per quality -adjusted life year ( QALY )  of HDF versus HD was € 287,679 . Sensitivity analyses revealed that this amount will not fall below € 140,000 , even under the most favourable assumptions like a high-convection volume ( > 20.3 L ) . CONCLUSIONS Based on accepted societal willingness-to-pay thresholds , HDF can not be considered a cost-effective treatment for patients with end-stage renal disease at present . Apparently , minor additional costs of HDF are not counterbalanced by a relevant QALY gain Background Economic evaluation of stroke services indicates that such services may lead to improved quality of life at affordable cost . The present study assesses lifetime health impact and cost consequences of stroke in an integrated service setting . Methods The EDISSE study is a prospect i ve non-r and omized controlled cluster trial that compared stroke services ( n = 151 patients ) to usual care ( n = 187 patients ) .  Health status and cost trial- data were entered in multi-dimensional stroke life-tables . The tables distinguish four levels of disability which are defined by the modified Rankin scale . Quality -of-life scores ( EuroQoL-5D ) , transition and survival probabilities are based on concurrent Dutch follow-up studies . Outcomes are quality -adjusted life years lived and lifetime medical cost by disability category . An economic analysis compares outcomes from a successful stroke service to usual care , by bootstrapping individual costs and effects data from patients in each arm . Results Lifetime costs and QALYs after stroke depend on age-of-onset of first-ever stroke . Lifetime QALYs after stroke are 2.42 ( 90 % CI - 0.49 - 2.75 ) for male patients in usual care and 2.75 ( -0.61 ; 6.26 ) for females . Lifetime costs for men in the usual care setting are € 39,335 ( 15,951 ;  
    Output:
    
The most expensive clinical events were related to renal failure , while TIA was the least expensive event .
Generally , there was substantial variation in reported cost estimates for T2DM-related events .