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Table 12 summary of effects rr 95% ci ; of bisphosphonates on non-vertebral fracture in corticosteroid-induced osteoporosis agent study sample size treatment etidronate geusens, 1998139 roux, 1998135 subtotala cohen, 1989153 reid, 2000154 subtotala totala 18 59 77 control 19 58 77 weight % ; rr 95% ci.
The studies reviewed here concentrate largely on direct costs those arising from provision of treatment ; . Indirect costs loss of earnings and pension payments for those who survive ; are not likely to be as great as in some other chronic conditions since CHF is concentrated in older people. Intangible costs, that reflect the drawbacks of CHF such as pain, depression and reduced QoL, are very difficult to quantify. If indirect and intangible costs were included in the economic analyses of pharmacological therapies such as ACE inhibitors and beta-blockers they would be likely to produce even more favourable cost effectiveness ratios. Increasing the use of effective pharmacological therapies in eligible patients will increase treatment costs but some, or all, of these will be offset, largely by reduced hospitalisation. If the savings are not large enough to offset the increase in cost, the net increase in costs has to be considered against benefits such as life years gained LYG ; , or quality adjusted life years QALYs ; . The focus here is on LYG, as there is little data on QoL in CHF that can be used in economic evaluation for example SF-36 or EQ-5D scores ; to apply a quality weighting to LYG. The years of life saved are still associated with significant disability. This is important when comparing the cost-effectiveness of beta-blockers and ACE inhibitors with treatments, like statins, that prevent the transition from full health to disease and misoprostol. Delivery is not available to alaska or hawaii!