Tadalafil gehört zur Gruppe der PDE5-Hemmer und wirkt über eine hochselektive Blockade des Enzyms Phosphodiesterase Typ 5. Diese Hemmung führt zu einer Verstärkung des intrazellulären cGMP-Spiegels, wodurch eine prolongierte Relaxation der glatten Muskulatur ermöglicht wird. Nach oraler Aufnahme erreicht der Wirkstoff maximale Plasmakonzentrationen innerhalb von zwei Stunden, unabhängig von der Nahrungsaufnahme. Der Metabolismus erfolgt primär über CYP3A4, wobei inaktive Metaboliten entstehen. Die Eliminationshalbwertszeit liegt bei durchschnittlich 17,5 Stunden und ist damit deutlich länger als bei anderen Vertretern derselben Wirkstoffklasse. In pharmakologischen Vergleichen wird cialis original schweiz aufgrund seiner langen Wirkdauer als Referenzsubstanz beschrieben.
Economic analysis of interventions for reducing postpartum hemorrhage
October 3, 2006 Research Team Principal Investigators: Technical Committee Members: Country Investigators: October 3, 2006 Objectives of the Presentation
1) What are the cost-effectiveness ratios of PPH
2) What are the benefit-cost ratios of PPH interventions?
3) What information should we considered in choosing PPH
4) What are the recommended interventions?
October 3, 2006 Methods: Types of Interventions Included October 3, 2006 Methods: Types of Analysis
• Country studies: economic and policy analysis in four
• Global analysis (developing countries): economic
assessment (the focus of this presentation)
October 3, 2006 Methods: Cost
• Incremental cost: additional cost added to the existing system for
• Costs included:
– Logistic costs (wastage, storage and transportation)
• Costs excluded:
– Capital cost (building, equipment, vehicle)
– Cost of side-effects (for both suffer and treatments)
October 3, 2006 Methods: Effectiveness and Benefit
• Effectiveness
• Benefit
– Prevention: treatment cost averted + productivity loss
– Benefit excluded: suffer averted, and averted negative
consequences to family members and relatives
October 3, 2006 Methods: Data and Assumptions
• Distribution of birth delivery by location
• Rate of protection against PPH morbidity and morbidity
• Availability and best possible coverage of intervention
• Wastage, transportation and storage costs
October 3, 2006 Methods: Data Analysis
• Spreadsheet-based tool (Economic Assessment of Post Partum Hemorrhage Interventions (EAPPH))
• The tool consists of three modules: inputs, calculation,
• Results are reported in 18 tables, which are categorized
– PART I: Effectiveness of PPH Interventions– PART II: Cost Associated with PPH Interventions– PART III: Cost-Effectiveness of PPH Interventions– PART IV: Benefits of Interventions– PART V: Cost-Benefits of Interventions
October 3, 2006 Results: Preventive Interventions Table 1. Cost-effectiveness and cost-benefit analysis of preventive interventions Total benefit Total cost of Cost per Benefit/C Ranking intervention ost ratio averted intervention averted ($) October 3, 2006 Results: Curative Interventions Table 2. Cost-effectiveness and cost-benefit analysis of curative interventions Total benefit Total cost of Cost per Benefit/C Ranking intervention ost ratio intervention averted ($) October 3, 2006 Results: Sensitivity Analysis Figure 1. Cost per DALY of preventive interventions with protection rate +/- 5% points of the point estimate r DA e 30 $ p Oxytocin (Uniject) Oxytocin Oxytocin Syntometrine Ergometrine Misoprostol (oral) Misoprostol (monodose) (multidosel) (rectal) Interventions October 3, 2006 Results: Choosing preventive Interventions Table 3. Choosing preventive PPH interventions Efficiency Exclusiveness Total health outcomes October 3, 2006 Results: Choosing Curative Interventions Table 4. Choosing preventive PPH interventions Efficiency Exclusiveness Total health outcomes October 3, 2006 Choosing interventions: Oxy or Miso or Both? Figure 2. The number of PPH case prevented of different interventions (per year) . o f cases ( Oxytocin Misoprostol Oxy+Miso October 3, 2006 3. The health benefit of combined use of oxytocin and misoprostol Misoprostol Health Benefit Oxytocin October 3, 2006 Recommendations
• For prevention of PPH
– Misprostol should be provided where oxytocin is not
• For treatment of PPH:
– Syntometrine/oxytocin monodose (IV drip) or oxytocin in
– Misprostol (either oral or rectal) is recommended for
settings where injectable uterotonics are not available
– Other uterotonics can be considered as 2nd line drugs
– Balloon temponade and anti-shock garment should be
October 3, 2006 Thank You October 3, 2006
O que é a febre? Causas da febre Como medir a TEMPERATURA CORPORAL A temperatura corporal pode termometros de ouvido têm embebido em alcool, antes e mento das instruções de utili-depois da cada utilização. Os zação (rectificação do canal A produção de pirogéneos pode resultar de exposição ex-cessiva ao calor ( excesso de roupa, sobreaquecimento do Paracetamol –
Diagnosed with MGUS May 2003 followed by AL Amyloidosis diagnosis October 2006SCT at BUMC 1/5/2007Achieved partial response Jacqueline Mendels Birn My Amyloidosis My illness started with the discovery in May 2003 of something wrong in my blood during my yearly check-up. My internist Dr. Robert Enelow, first requested a 24 hour urine specimen and then he sent me to the oncologist
October 3, 2006
Research Team
Objectives of the Presentation
Methods: Types of Interventions Included
Methods: Types of Analysis
Methods: Cost
Methods: Effectiveness and Benefit
Methods: Data and Assumptions
Methods: Data Analysis
Results: Preventive Interventions
Results: Curative Interventions
Results: Sensitivity Analysis
Results: Choosing preventive Interventions
Results: Choosing Curative Interventions
Choosing interventions: Oxy or Miso or Both?
3. The health benefit of combined use of oxytocin 
Recommendations
Thank You