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Outcome prediction in childhood acute lymphoblastic leukemia by molecular quantification of residual disease at the end of induction
Abstracts f r o m the literature
-The Journal of Pediatrics Volume 125, Number 1
nation program). The program's cost-effectiveness was sensitive to the vaccination coverage rate and vaccine price but was relatively insensitive to assumptions about vaccine efficacy. Conclusions: The analysis shows that the desirability of the program depends on whose perspective is taken. From the health care payer's perspective, varicella vaccination appears less cost-effective than other vaccination programs, but from the societal perspective it appears more costeffective than many other prevention programs that have been studied. Comment: A previous cost-benefit analysis suggested that a varicella vaccine program that provided lifelong immunity would save $7 in costs to society for every dollar invested, l It also found that from a health care payer's perspective the program would not save money. This study confirms these results, taking into account current evidence about vaccine efficacy, the effects of expected changes in the age distribution of disease, and updated information on the costs of medical care and work loss from varicella. The methods employed in the study appear to be appropriate and valid. All the key elements of a sound economic evaluation are included. A major limitation of the study, which is recognized by the authors, is the lack of sufficient data to evaluate the main goal of a varicella vaccination program: to prevent suffering from chickenpox or from major complications. The authors have not attempted to place a value on the intangible costs of pain and suffering from varicella or to convert the costs of morbidity from chickenpox and nonfatal complications into quality-adjusted life-years.
Charles Begley, PhD University o f Texas School o f Public Health Houston, T X 77225
165
REFERENCE 1. Preblud SR, Orenstein WA, Koplan JP, Bart K J, Hinman AR.
A benefit-cost analysis of a childhood varicella vaccination programme. Postgrad Med 1985;61:71-22. ALSO NOTED
Nebulised racemic adrenaline in the treatment of acute bronchiolitis in infants and toddlers Kristjansson S, Lodrup Carlsen KC, Wennergren G, Strannegard I-L, Carlsen K-H. Arch Dis Child 1993;69:650-4. In this randomized, placebo-controlled trial, the authors found significant improvement in oxygenation and clinical score in infants 2 to 18 months of age with bronchiolitis after the use of nebulized racemic epinephrine, in comparison with the use of Vaponefrin carrier solution placebo. There was no difference in heart rate, but a small increase in mean systolic blood pressure was observed with drug compared with placebo.
Outcome prediction in childhood acute lymphoblastic leukemia by molecular quantification of residual disease at the end of induction Brisco M J, Condon J, Hughes E, etal. Lancet 1993;343:196200. Using polymerase chain reaction to detect rearranged immunoglobulin (representing minimal residual disease) present at the time of first remission in children with acute lymphoblastic leukemia, the authors were able to predict 81% of relapses and 78% of nonrelapses in patients with acute lymphoblastic leukemia. They also found that the extent of minimal residual disease correlated with the likelihood of relapse. These data should be useful in individualizing the treatment of acute lymphoblastic leukemia in children.
-The Journal of Pediatrics Volume 125, Number 1
nation program). The program's cost-effectiveness was sensitive to the vaccination coverage rate and vaccine price but was relatively insensitive to assumptions about vaccine efficacy. Conclusions: The analysis shows that the desirability of the program depends on whose perspective is taken. From the health care payer's perspective, varicella vaccination appears less cost-effective than other vaccination programs, but from the societal perspective it appears more costeffective than many other prevention programs that have been studied. Comment: A previous cost-benefit analysis suggested that a varicella vaccine program that provided lifelong immunity would save $7 in costs to society for every dollar invested, l It also found that from a health care payer's perspective the program would not save money. This study confirms these results, taking into account current evidence about vaccine efficacy, the effects of expected changes in the age distribution of disease, and updated information on the costs of medical care and work loss from varicella. The methods employed in the study appear to be appropriate and valid. All the key elements of a sound economic evaluation are included. A major limitation of the study, which is recognized by the authors, is the lack of sufficient data to evaluate the main goal of a varicella vaccination program: to prevent suffering from chickenpox or from major complications. The authors have not attempted to place a value on the intangible costs of pain and suffering from varicella or to convert the costs of morbidity from chickenpox and nonfatal complications into quality-adjusted life-years.
Charles Begley, PhD University o f Texas School o f Public Health Houston, T X 77225
165
REFERENCE 1. Preblud SR, Orenstein WA, Koplan JP, Bart K J, Hinman AR.
A benefit-cost analysis of a childhood varicella vaccination programme. Postgrad Med 1985;61:71-22. ALSO NOTED
Nebulised racemic adrenaline in the treatment of acute bronchiolitis in infants and toddlers Kristjansson S, Lodrup Carlsen KC, Wennergren G, Strannegard I-L, Carlsen K-H. Arch Dis Child 1993;69:650-4. In this randomized, placebo-controlled trial, the authors found significant improvement in oxygenation and clinical score in infants 2 to 18 months of age with bronchiolitis after the use of nebulized racemic epinephrine, in comparison with the use of Vaponefrin carrier solution placebo. There was no difference in heart rate, but a small increase in mean systolic blood pressure was observed with drug compared with placebo.
Outcome prediction in childhood acute lymphoblastic leukemia by molecular quantification of residual disease at the end of induction Brisco M J, Condon J, Hughes E, etal. Lancet 1993;343:196200. Using polymerase chain reaction to detect rearranged immunoglobulin (representing minimal residual disease) present at the time of first remission in children with acute lymphoblastic leukemia, the authors were able to predict 81% of relapses and 78% of nonrelapses in patients with acute lymphoblastic leukemia. They also found that the extent of minimal residual disease correlated with the likelihood of relapse. These data should be useful in individualizing the treatment of acute lymphoblastic leukemia in children.