Objective : To examine the cost-effectiveness of interferon αcon-1 [consensus interferon (CIFN)] for chronic hepatitis C patients with genotype lb and high-titer.
Design : Cost-effectiveness analysis.
Methods : Data from a randomized clinical trial comparing the efficacy of CIFN to interferon-αn 1 (IFN-αn 1) for chronic hepatitis C patients were applied to a cohort simulation by Markov model to project lifelong clinical and economic outcomes from the payer's perspective. Natural history model and decision analytical model were built based on published literature and actual healthcare reimbursement data.
Results : From the randomized trial, sustained response proportion and biochemical response proportion were 16.7%and 18.2%for patients receiving CIFN, compared with 3.3%and 18.0%for IFN-αn 1, respectively. The simulation model showed that CIFN should prolong life expectancy by 0.4 year at negative incremental costs, compared to IFN-αn 1 strategy. Compared to no IFN strategy, CIFN should prolong life expectancy by 1.2year at an incremental cost-effectiveness ratio of ¥1, 320, 000 per life year gained. The results were robust, with CIFN remaining cost-effective in sensitivity analysis compared to IFN-αn 1 and no IFN treatment.
Conclusion : For chronic hepatitis C patients with genotype 1b and high-titer, CIFN should prolong life and be cost effective in comparison with IFN-αn 1 and no IFN treatment.

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Objective : To investigate the safety and effects of long-term administration of denopamine, β-1 stimulant, on the activities of daily living in heart failure patients.
Design : Case-series.
Methods : One hundred forty patients with mild to moderate chronic heart failure were administered denopamine at dose of 5 to 10 mg three times daily for 24 weeks. Concomitant circulatory system drugs such as digitalis, diuretics, vasodilator drugs, etc., were used without changing the administration method and dose. However, the use of a concomitant β-blocker was prohibited.
Results : Following administration of denopamine, the NYHA cardiac function classification improved by one degree or more in 50 patients (35.7%). The body weight decreased significantly from 54.9± 10.2kg (mean±SD) before administration to 54.0±10.2kg after administration (P<0.05), and the cardiothoracic ratio also decreased from 58.0±7.3% to 56.6±7.2% (P<0.001). No significant changes were observed in the heart rate, systolic blood pressure, or diastolic blood pressure. The activities of daily living improved by one level or more for 49 patients (51.6%). There were 36 withdrawal or dropout cases (patients' own convenience : 12 cases ; complications/accidental symptoms : 7 cases) during the investigation period. Four patients (2.9%) exhibited adverse reactions.
Conclusion : Denopamine seemed to improve the quality of life, which is one of the therapeutic purposes for patients with chronic cardiac failure. A large-scale study including investigation of the long-term prognosis for such patients needs to be performed.

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Here we report the results of a long-term analytical study on the utilization of antihypertensive and antibacterial agents, which was performed using the Integrated Medical Information System (IMIS) developed by Kochi Medical School. The results indicate clear (increasing or decreasing) patterns in the numbers of patients and the dosages. Specifically, the total amount of antibacterials recently prescribed is significantly lower than in the year analysis began (1983). This reduction provides evidence of a steady improvement in the quality of medication and is particularly important for macrocosmic evaluation of the primary focus of our study, which was the “proper use of drugs”. Furthermore, the results also showed medication prescribed by non-specialists to be less inventive than that prescribed by specialists. This study highlights the importance of reforming institutions providing medical treatment from the perspective of effectively utilizing medical resources (by employing specialist personnel) and the proper use of medications. Because non-specialists prescribe medication in numerous medical facilities throughout Japan, these issues must be seriously considered.

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