***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 
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    ***EXAMPLES*** 
    Input: BACKGROUND The objective of this study was to assess the cost-effectiveness of pravastatin therapy in survivors of myocardial infa rct ion with average cholesterol levels . METHODS We performed a cost-effectiveness analysis based on actual clinical , cost , and health-related quality -of-life data from the Cholesterol and Recurrent Events ( CARE ) trial . Survival and recurrent coronary heart disease events were modeled from trial data in Markov models , with the use of different assumptions regarding the long-term benefit of therapy . RESULTS Pravastatin therapy increased quality -adjusted life expectancy at an incremental cost of $ 16,000 to $ 32,000 per quality -adjusted life-year gained . In subgroup analyses , the cost-effectiveness of pravastatin therapy was more favorable for patients > 60 years of age and for patients with pretreatment low-density lipoprotein cholesterol levels > 125 mg/dL. Results were sensitive to the cost of pravastatin and to assumptions about long-term survival benefits from pravastatin therapy . CONCLUSIONS The cost-effectiveness of pravastatin therapy in survivors of myocardial infa rct ion with average cholesterol levels compares favorably with other interventions BACKGROUND Chronic heart failure is associated with a poor prognosis and reduced survival rates . The addition of vasodilator drug therapy to conventional therapy for congestive heart failure has result ed in improved survival . METHODS Adopting a societal viewpoint , we design ed a decision analytic model to analyze the costs and effectiveness of three therapies available for the treatment of congestive heart failure : st and ard therapy ( digoxin and diuretic therapy ) plus ( 1 ) no vasodilator agents , ( 2 ) hydralazine hydrochloride-isosorbide dinitrate combination , and ( 3 ) enalapril . In addition , we performed sensitivity analyses to determine which model variables were influential in determining incremental cost-effectiveness ratios ( cost of drug , cost of hospitalization , efficacy of agents , etc ) . We used data from three major r and omized controlled trials to estimate treatment efficacy , mortality rates , and hospitalization rates . RESULTS An additional year of life gained by a patient receiving hydralazine-isosorbide combination therapy compared with st and ard therapy required an additional expense ( incremental cost-effectiveness ratio ) of $ 5600 . Compared with the hydralazine-isosorbide combination therapy , the incremental cost-effectiveness ratio for enalapril therapy was $ 9700 per year of life saved . These results were insensitive to wide variations in our baseline assumptions . CONCLUSIONS The cost per year of life saved by vasodilator therapy is much lower than that of other accepted medical therapies . Although the cost per year of life saved for hydralazine-isosorbide combination therapy is lower than that for enalapril therapy , enalapril therapy saves more lives , and the incremental cost of enalapril therapy is justified by the added benefits CONTEXT Several treatment interventions can reduce complications of type 2 diabetes , but their relative cost-effectiveness is not known . OBJECTIVE To estimate the incremental cost-effectiveness of intensive glycemic control ( relative to conventional control ) , intensified hypertension control , and reduction in serum cholesterol level for patients with type 2 diabetes . DESIGN , SETTING , AND PATIENTS Cost-effectiveness analysis of a hypothetical cohort of individuals living in the United States , aged 25 years or older , who were newly diagnosed as having type 2 diabetes . The results of the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) and other studies were used to create a model of disease progression and treatment patterns . Costs were based on those used in community practice s in the United States . INTERVENTIONS Insulin or sulfonylurea therapy for intensive glycemic control ; angiotensin-converting enzyme inhibitor or beta-blocker for intensified hypertension control ; and pravastatin for reduction of serum cholesterol level . MAIN OUTCOME MEASURES Cost per quality -adjusted life-year ( QALY ) gained . Costs ( in 1997 US dollars ) and QALYs were discounted at a 3 % annual rate . RESULTS The incremental cost-effectiveness ratio for intensive glycemic control is $ 41 384 per QALY ; this ratio increased with age at diagnosis from $ 9614 per QALY for patients aged 25 to 34 years to $ 2.1 million for patients aged 85 to 94 years . For intensified hypertension control the cost-effectiveness ratio is -$1959 per QALY . The cost-effectiveness ratio for reduction in serum cholesterol level is $ 51 889 per QALY ; this ratio varied by age at diagnosis and is lowest for patients diagnosed between the ages of 45 and 84 years . CONCLUSIONS Intensified hypertension control reduces costs and improves health outcomes relative to moderate hypertension control . Intensive glycemic control and reduction in serum cholesterol level increase costs and improve health outcomes . The cost-effectiveness ratios for these 2 interventions are comparable with those of several other frequently adopted health care interventions Abstract In this paper the Rotterdam Elderly Study is presented . The aim of the study is to investigate determinants of disease occurrence and progression in the elderly . In addition to contributing to our underst and ing of the etiology of geriatric illnesses , the study is expected to lead to specific recommendations for intervention . The study focusses on causally related determinants of major diseases in the elderly . Fields of interest for the Rotterdam Elderly Study are- conditions which interfere the most with the quality of life for the elderly . The aims of the Rotterdam Elderly Study are:(1)To investigate , by means of epidemiologic , clinical and basic research , the determinants of diseases in order to assess their etiologic significance .(2)To investigate potentially modifiable determinants in order to be able to develop preventive strategies by providing specific recommendations for intervention studies . The Rotterdam Elderly Study focusses on four primary areas of research : neurogeriatric diseases , cardiovascular diseases , locomotor diseases and ophthalmologic diseases . It is a prospect i ve follow-up study , in which determinants of disease and determintants of progression of disease will be investigated in the total population of 55 years or over of the district of Ommoord in Rotterdam . It is anticipated that about 1–0,000 people will participate in the study and they will be examined in the period of 1991 to 1995 Patients who survive a first stroke are often left with permanent disabilities , and have significant needs for rehabilitation and long-term care . Antihypertensive treatment reduces the risk of cardiovascular events such as stroke . The purpose of this study was to investigate the cost-effectiveness of c and esartan-based antihypertensive treatment for the prevention of nonfatal stroke . The cost-effectiveness analysis was based on data from Study on COgnition and Prognosis in the Elderly ( SCOPE ) , where patients were r and omly assigned to receive the angiotensin receptor blocker c and esartan or placebo , with open-label active antihypertensive treatment added as needed . The analysis was carried out using a Markov model , which combined clinical and re source utilization data from SCOPE with Swedish retail prices for drugs and unit costs for in-patient stays , and outpatient visits . The cost per patient was 1949 EUR in the c and esartan group and 1578 EUR in the control group . The largest share of the cost was attributed to antihypertensive treatment in the c and esartan group and to the long-term cost of stroke in the control group . C and esartan-based antihypertensive treatment was associated with 0.0289 additional quality -adjusted life-years ( QALYs ) per patient and an incremental cost per QALY gained of approximately 13 000 EUR . Sensitivity analyses showed that these results were fairly stable . In conclusion , the cost per QALY gained with c and esartan-based antihypertensive treatment lies within the range of society 's willingness to pay for health gains . The results indicate that c and esartan-based antihypertensive treatment is cost-effective for the prevention of nonfatal stroke Abstract Objective : To estimate the economic efficiency of using pravastatin to prevent the transition from health to cardiovascular disease in men with hypercholesterolaemia . Design : Economic benefit analysis based on data from the West of Scotl and coronary prevention study . Treatment specific hazards of developing cardiovascular disease according to various definitions were estimated . Scottish record linkage data provided disease specific survival . Cost estimates were based on extracontractual tariffs and event specific average lengths of stay calculated from the West of Scotl and coronary prevention study . Subjects : Men with hypercholesterolaemia similar to the subjects in the West of Scotl and coronary prevention study . Main outcome : Cost consequences , the number of transitions from health to cardiovascular disease prevented , the number needed to start treatment , and cost per life year gained . Results : If 10 000 of these men started taking pravastatin  , 318 of them would not make the transition from health to cardiovascular disease ( number needed to treat , 31.4 ) , at a net discounted cost of £ 20 m over 5 years . These benefits imply an undiscounted gain of 2460 years of life , and thus £ 8121 per life year gained , or £ 20 375 per life year gained if benefits are discounted . Restriction to the 40 % of men at highest risk reduces the number needed to treat to 22.5 ( £ 5601 per life year gained ( undiscounted ) and £ 13 995 per life year gained ( discounted ) ) . Conclusions : In subjects without evidence of prior myocardial infa rct ion but who have hypercholesterolaemia , the use of pravastatin yields substantial health benefits at a cost that is not prohibitive overall and can be quite efficient in selected high risk subgroups . Key messages The West of Scotl and coronary prevention study showed that pravastatin can prevent cardiovascular disease in men with hypercholesterolaemia So far , reports have deemed this prevention unjustified due to adverse economic implication s This analysis , based on data from the West of Scotl and coronary prevention study and extensive data from the Scottish record linkage system , shows that using pravastatin in this way is worth considering because of its substantial clinical benefit at a reasonable cost Practitioners must now consider using pravastatin to prevent cardiovascular disease in men with hypercholesterolaemia Increased economic efficiency may be obtained by restricting prevention to patients with additional risk The recently published " Survival and Ventricular Enlargement " ( SAVE ) , prospect i ve controlled trial over 4 years including over 2,000 patients , has shown that long-term treatment with captopril reduced cardiovascular mortality ( - 19 % ) and morbidity in patients with post-infa rct ion left ventricular dysfunction without signs of cardiac failure . Based on the trial data , the extra cost of treating the patients with captopril compared with the placebo branch is estimated at 9.3 million french francs . This expense is compensated by a reduction in the cost of hospitalisation for cardiac failure of 1.6 million francs and a reduction in the cost of further coronary events of 3.4 million francs . Above all , the extra cost is compensated by a gain of 47 deaths avoided , corresponding to about 493.5 years of life saved . The cost-effectiveness of captopril administration is therefore about 8.750 francs per year per life saved . The ratio is significantly less than that of other primary or secondary prevention therapeutic strategies . On this basis , we conclude that captopril therapy of high risk post-infa rct ion patients is a solution that is not only medically effective but also economically sound OBJECTIVE To estimate the costs and effects of preventive treatment with captopril compared with the current treatment policy in patients with asymptomatic left ventricular dysfunction after a myocardial infa rct ion . METHODS Estimates of effects are based on the results of the SAVE trial . Costs are estimated on the basis of current treatment patterns in four Dutch hospitals . All knowledge is incorporated in a mathematical model extrapolating the SAVE results to 20 years . RESULTS AND CONCLUSIONS Captopril treatment is expected to increase survival at certain costs . The average additional costs per patient are estimated at DF1 2,491 in 4 years and at DF1 8,723 in 20 years of treatment . Costs per additional survivor after 4 years are estimated at DF1 69,126 . After extrapolation of the results of the SAVE trial to 20 years , costs per life-year gained can be estimated at DF1 15,799 . From univariate sensitivity analysis it appears that the results are highly sensitive for the costs of treatment with captopril and the occurrence and prevention of clinical heart failure . Varying all estimates r and omly between upper and lower limits-in 5,000 simulations-an estimate of costs per life-year gained of DF1 15,729 is made for 20 years of treatment , with 95 % of all estimates between DF10 and DF1 50 , 000 . On a national level , undiscounted costs are expected to increase up to approximately DF1 42 million annually during the first 40 years after introduction of the preventative strategy We estimated the cost effectiveness of adding the ACE inhibitor ramipril to conventional treatment in patients with heart failure after acute myocardial infa rct ion . These estimates were based on the Acute Infa rct ion Ramipril Efficacy ( AIRE ) study and on complementary Swedish healthcare re source use data for a subset of patients . The average follow-up period was 15 months ( minimum 6 months , maximum 3.8 years ) . The perspective of the analysis was that of the county councils ( 
    Output:
    
RESULTS The guideline does not consider the most recent economic evidence but does consider cost-effectiveness based on economic evaluations performed in conjunction with clinical trials .
Their conclusions are largely in agreement with the most recent economic evidence .