Comparative efficacy of levonorgestrel and deslorelin contraceptive implants in free-ranging eastern grey kangaroos (Macropus giganteus)

2016 ◽  
Vol 43 (3) ◽  
pp. 212 ◽  
Author(s):  
Michelle E. Wilson ◽  
Graeme Coulson
Keyword(s):  
Fertility Control ◽  
Control Group ◽  
Natural Fertility ◽  
Cost Of Treatment ◽  
Contraceptive Effect ◽  
Contraceptive Implants ◽  
The Cost ◽  
Free Ranging ◽  
Equivalent Field

Context Fertility control of females with levonorgestrel or deslorelin implants shows promise for managing populations of overabundant eastern grey kangaroos (Macropus giganteus). Although these implants have been tested separately in captive and free-ranging kangaroos, there has been no direct comparison under equivalent field conditions. Aims We investigated the long-term efficacy of levonorgestrel and deslorelin implants, together with the cost of treatment, ease of administration, and the welfare of the animals, in a side-by-side trial under realistic management conditions. Methods We captured 65 adult female kangaroos over 11 days at a golf course in Anglesea, Victoria, Australia. We assigned each female to one of the following three experimental groups: levonorgestrel (210 mg, n = 18), deslorelin (9.4 mg, n = 24) or procedural control (n = 23). We monitored reproductive success for 8 years, by observing young in the pouch in winter and spring. Key results Natural fertility was high; in most years, less than 20% of control females failed to reproduce. For deslorelin-treated females, the odds of failing to reproduce were four times higher than for the control group; for levonorgestrel-treated females, these odds were 74 times higher. Deslorelin was ineffective after 3 years, whereas levonorgestrel was effective for at least 5 years. Conclusions Levonorgestrel was markedly superior in efficacy, as shown by a stronger contraceptive effect persisting for longer. In other respects, the two implants were comparable, being similar in cost and ease of delivery, and equally safe. Implications Only levonorgestrel implants fulfill their promise for non-lethal, long-term control of kangaroo populations. Deslorelin implants cannot be recommended for this purpose.

Long-term efficacy of levonorgestrel implants for fertility control of eastern grey kangaroos (Macropus giganteus)

2008 ◽  
Vol 35 (6) ◽  
pp. 520 ◽  
Author(s):  
Graeme Coulson ◽  
Christopher D. Nave ◽  
Geoff Shaw ◽  
Marilyn B. Renfree
Keyword(s):  
Urban Areas ◽  
Fertility Control ◽  
The Other ◽  
Control Group ◽  
Acceptable Alternative ◽  
Term Efficacy ◽  
Adult Females ◽  
Free Ranging ◽  
Over Time

Overabundant populations of kangaroos pose substantial management problems in small parks on the fringe of urban areas in Australia. Translocation is impractical and culling is often not publicly acceptable, but fertility control offers an acceptable alternative. One potential contraceptive is levonorgestrel, which provides effective long-term contraception in women, and prevents births in some marsupials for up to five years. We evaluated the long-term efficacy of levonorgestrel in free-ranging eastern grey kangaroos (M. giganteus) at two sites in Victoria, Australia. We trapped 25 adult females at one site (Portland Aluminium), treating 18 with two subcutaneous 70-mg levonorgestrel implants and seven with control (inert) implants. We darted 25 adult females at the other site (Woodlands Historic Park), treating all with two 70-mg levonorgestrel implants. We monitored the reproductive status of the kangaroos, as indicated by the obvious presence of a pouch young, in spring each year for up to seven years. In the first three years at Portland, 81–86% of levonorgestrel-treated females were infertile, compared with 12–29% in the control group, but the effectiveness of fertility control declined over time. At this site, the proportions of treated females breeding in the fourth, fifth, sixth and seventh years of the trial were 36%, 50%, 67% and 100% respectively. Fecundity at Woodlands was similar. Although this protocol achieved fertility control for several years, it was likely that more than one treatment or a higher dose rate would be required for effective fertility control in this long-lived species.

scholarly journals Why Do Some Firms Spend So Much on Medical Care? Accounting for Variation

2000 ◽  
Vol 3 (1) ◽  
Author(s):  
Matthew Eichner ◽  
Mark McClellan ◽  
David A. Wise
Keyword(s):  
Health Care ◽  
Health Care Cost ◽  
Health Care Expenditures ◽  
Cost Of Treatment ◽  
Consistent Method ◽  
The Difference ◽  
The Cost ◽  
Cost Differences ◽  
Average Expenditure

We are engaged in a long-term project to analyze the determinants of health care cost differences across firms. An important first step is to summarize the nature of expenditure differences across plans. The goal of this article is to develop methods for identifying and quantifying those factors that account for the wide differences in health care expenditures observed across plans.We consider eight plans that vary in average expenditure for individuals filing claims, from a low of $1,645 to a high of $2,484. We present a statistically consistent method for decomposing the cost differences across plans into component parts based on demographic characteristics of plan participants, the mix of diagnoses for which participants are treated, and the cost of treatment for particular diagnoses. The goal is to quantify the contribution of each of these components to the difference between average cost and the cost in a given firm. The demographic mix of plan enrollees accounts for wide differnces in cost ($649). Perhaps the most noticeable feature of the results is that, after adjusting for demographic mix, the difference in expenditures accounted for by the treatment costs given diagnosis ($807) is almost as wide as the unadjusted range in expenditures ($838). Differences in cost due to the different illnesses that are treated, after adjusting for demographic mix, also accounts for large differences in cost ($626). These components of cost do not move together; for example, demographic mix may decrease expenditure under a particular plan while the diagnosis mix may increase costs.Our hope is that understanding the reasons for cost differences across plans will direct more focused attention to controlling costs. Indeed, this work is intended as an important first step toward that goal.

Short-Term Cost Per Responder among New Tyrosine Kinase Inhibitors for Imatinib-Resistant CML in Chronic Phase (CML-CP) — Canada and Germany Perspectives.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4587-4587
Author(s):  
Kim Carpiuc ◽  
Khalid El Ouagari ◽  
Jennifer Stephens ◽  
Marc Botteman ◽  
WeiWei Feng ◽  
...  
Keyword(s):  
Cytogenetic Response ◽  
Sensitivity Analyses ◽  
Short Term ◽  
Cost Of Treatment ◽  
Imatinib Resistant ◽  
Cost Per Responder ◽  
Grade 3 ◽  
The Cost

Abstract BACKGROUND: For indications such as imatinib-resistant CML where data on durability of response or survival is still emerging, an alternative to modeling long-term cost-effectiveness is to perform a short-term analysis estimating average cost per responder based on cytogenetic responses, as the first 6–12 months have been shown to be a useful surrogate marker for treatment efficacy. This study incorporates cytogenetic response (MCyR or CCyR) with drug and adverse event (AE) costs to compare the 6-month cost per responder between dasatinib and nilotinib in patients with CML-CP. METHODS: The average cost per responder was estimated by dividing the 6-month cost of treatment with cytogenetic response. Total cost of treatment included drug costs only for the primary analysis, but adding the cost of managing grade 3/4 AEs in sensitivity analyses. Based on time to event information, AEs were assumed to occur within the first 6 months of treatment. As no head-to-head comparison studies for nilotinib and dasatinib exist, data were obtained from studies believed to have the most comparable patient populations and similar length of study follow-up. Data on dasatinib were obtained from the published dasatinib phase II START-C study and the dasatinib FDA Oncologic Drug Advisory Committee (ODAC) briefing document. Two alternative cost perspectives were taken representing two cost structures. Dasatinib daily drug cost (140 mg/day) was assumed at Can$150.94 and Germany €146.66. For nilotinib, data were obtained from the nilotinib phase II 120-day efficacy and safety update clinical study reports submitted for registration, with daily drug (800 mg/day) cost based upon price parity with 800 mg/day imatinib. The model was developed from a payer perspective considering direct medical costs only. RESULTS: Short-term (6-month) MCyR and CCyR rates for imatinib-resistant patients treated with 140 mg daily dasatinib were reported to be 31% and 22%. The corresponding numbers for 800 mg daily nilotinib were 51% and 31%, respectively. Primary cost drivers for AEs were myelosuppression events. Excluding the cost of AEs, the 6-month cost per MCyR was estimated to be Can$87,641 for dasatinib and Can$72,226 for nilotinib (Germany: €85,157 for dasatinib, €59,259 for nilotinib). The 6-month cost per CCyR was Can$123,480 for dasatinib, and Can$118,823 for nilotinib (Germany: €119,995 for dasatinib, €97,490 for nilotinib). Costs of treatment-related AEs for dasatinib and nilotinib were estimated at Can$10,429 and Can$4,861, respectively. Including AE costs in sensitivity analyses increased the cost per responder by 39% for dasatinib (7–17% for Germany) and by 13% for nilotinib (6–7% for Germany). CONCLUSION: The average 6-month cost per MCyR and CCyR is lower for nilotinib compared to dasatinib when daily drug costs for nilotinib are assumed at price parity with imatinib 800mg regardless of whether AEs are included. The analysis incorporating AEs may be conservative considering only severe grade 3/4 AEs were included and indirect costs were not addressed. In the absence of head-to-head studies, these analyses should be updated as longer follow-up data become available, with ideal analyses using total costs and cytogenetic response rates at 1 year of follow-up, as well as expansion into long-term cost effectiveness analyses.

scholarly journals Greater Attendance at a Community Weight Loss Programme over the First 12 Weeks Predicts Weight Loss at 2 Years

Obesity Facts ◽  
2020 ◽  
Vol 13 (4) ◽  
pp. 349-360
Author(s):  
Carmen Piernas ◽  
Fiona MacLean ◽  
Paul Aveyard ◽  
Amy L. Ahern ◽  
Jenny Woolston ◽  
...  
Keyword(s):  
Weight Loss ◽  
Linear Model ◽  
Control Group ◽  
Average Weight ◽  
Face To Face ◽  
Session Attendance ◽  
Weight Loss Programme ◽  
The Cost ◽  
To Receive

<b><i>Background:</i></b> There is considerable heterogeneity in long-term weight loss among people referred to obesity treatment programmes. It is unclear whether attendance at face-to-face sessions in the early weeks of the programme is an independent predictor of long-term success. <b><i>Objective:</i></b> To investigate whether frequency of attendance at a community weight loss programme over the first 12 weeks is associated with long-term weight change. <b><i>Methods:</i></b> Participants were randomised to receive brief support only (control, <i>n</i> = 211), or a weight loss programme for 12 weeks (<i>n</i> = 530) or 52 weeks (<i>n</i> = 528). This study included participants with data on session attendance over the first 12 weeks (<i>n</i> = 889) compared to the control group. The association between attendance (continuously) and weight loss was explored using a linear model. A multi-level mixed-effects linear model was used to investigate whether attendance (categorised as 0, 1, 2–5, 6—9, and 10–12 sessions) was associated with weight loss at 3, 12, and 24 months compared to the control. <b><i>Results:</i></b> For every session attended in the first 12 weeks, the average weight loss was –0.259 kg/session at 24 months (<i>p</i> = 0.005). Analysis by attendance group found only those attending 10–12 sessions had significantly greater weight loss (–7.5 kg [95% CI –8.1 to –6.9] at 12 months; –4.7 kg [95% CI –5.3 to –4.1] at 24 months) compared to the control group (–3.4 [95% CI –4.5 to –2.4] at 12 months, –2.5 [95% CI –3.5 to –1.5] at 24 months). Early attendance was higher for people ≥70 years, but there was no evidence of a difference by gender, ethnicity, education, or income. <b><i>Conclusions:</i></b> Greater attendance at a community weight loss programme in the first 12 weeks is associated with enhanced weight loss up to 24 months. Regular attendance at a programme could be used as a criterion for continued provision of weight loss services to maximise the cost-effectiveness of interventions.

Subfertile effects of quinestrol and levonorgestrel in male rats

2012 ◽  
Vol 24 (2) ◽  
pp. 297 ◽  
Author(s):  
Ming Liu ◽  
Xinrong Wan ◽  
Yimeng Yin ◽  
Yu-xia Li ◽  
Fei Sun ◽  
...  
Keyword(s):  
Fertility Control ◽  
Male Rats ◽  
Control Group ◽  
Sprague Dawley ◽  
Wild Rodents ◽  
Contraceptive Effect ◽  
Germ Cell Differentiation ◽  
Sprague Dawley Rats ◽  
Genetic Abnormalities ◽  
Effective Contraceptive

The contraceptive regimen consisting of levonorgestrel and quinestrol (EP-1) has been shown to be effective in several types of wild rodents. In the present study, we investigated the effect of EP-1 and its two components on fertility and spermatogenesis to elucidate the mechanisms underlying its contraceptive effect. Sprague-Dawley rats were treated with 0.33 mg kg–1 quinestrol (E group), 0.67 mg kg–1 levonorgestrel (P group) or their combination (EP group) for 7 days and then killed on Days 21 or 42 after treatment for tissue analysis. On Day 21, the weight of the cauda epididymis decreased significantly, while the weight of the adrenal gland increased significantly in the E and EP groups compared with the weights in the control group. In addition, there was a significant decrease in sperm number in the E and EP groups compared with the control group and there was less staining for the androgen receptor and Wilms’ tumour nuclear protein 1 in the E and EP groups. The primary defects in E- or EP-treated rats were abnormal spermiogenesis, lack of elongating spermatids, and pachytene spermatocyte arrest. Analysis of MutL homologue 1 revealed that EP treatment inhibited chromosome recombination during meiosis, but did not cause obvious genetic abnormalities. These data demonstrate that quinestrol, alone or in combination with levonorgestrel, induces subfertility in male rats mainly by interfering with germ cell differentiation. Thus, EP-1 or E alone may be effective contraceptive regimens for fertility control in rodents.

scholarly journals Nasal bone fracture – timely interventon is a need

2013 ◽  
Vol 19 (1) ◽  
pp. 11-13
Author(s):  
KN Manjunath
Keyword(s):  
Bone Fracture ◽  
Nasal Bone ◽  
Cost Of Treatment ◽  
Bone Deformity ◽  
The Face ◽  
Bony Injury ◽  
Tissue Changes ◽  
Soft Tissue Changes ◽  
The Cost

Nose is acentral projection in the face with fragile skeleton. A trivial trauma canose is acentral projection in the face with fragile skeleton. A trivial trauma can result in a significant deformity. Although majority suffer a bony injury, overlying swelling masks the deformity. If such deformity is not identified and intervened, it can lead to soft tissue changes as well as bone deformity, which may require septoplasty or rhinoplasty later hence in nasal bone fracture intervention in the timely manner is a must to reduce the long term morbidity and the cost of treatment result in a significant deformity. Although majority suffer a bony injury, overlying swelling masks the deformity. If such deformity is not identified and intervened, it can lead to soft tissue changes as well as bone deformity, which may require septoplasty or rhinoplasty later hence in nasal bone fracture intervention in the timely manner is a must to reduce the long term morbidity and the cost of treatment. DOI: http://dx.doi.org/10.3329/bjo.v19i1.12066 Bangladesh J Otorhinolaryngol 2013; 19(1): 11-13

Fertility control in the koala, Phascolarctos cinereus: the impact of slow-release implants containing levonorgestrel or oestradiol on the production of pouch young

2003 ◽  
Vol 30 (3) ◽  
pp. 207 ◽  
Author(s):  
David R. Middleton ◽  
Bryan Walters ◽  
Peter Menkhorst ◽  
Patrick Wright
Keyword(s):  
Large Scale ◽  
Slow Release ◽  
Management Strategies ◽  
Cost Effective ◽  
Fertility Control ◽  
Control Group ◽  
Phascolarctos Cinereus ◽  
Custom Made ◽  
Free Ranging ◽  
The Impact

Two hormone-based fertility-control treatments were trialed on free-ranging female koalas. Either levonorgestrel or oestradiol-17β was administered in a cylindrical, silastic, sub-dermal implant. Levonorgestrel was administered in a commercially produced implant (Norplant 2, Leiras). Two different doses of oestradiol were administered via custom-made implants of different length (1 cm and 0.5 cm). Treatments were randomly applied to 58 females (each koala receiving a single implant) and a control group of 27 female koalas received no implant. Fertility, as determined by the presence of pouch young, was recorded following capture and examination during June 1998, 1999, 2000 and 2001. Fertility was reduced in all treatment groups but remained high (90%) in the untreated group. Fertility was lowest in koalas that received levonorgestrel (0%) and longer oestradiol implants (5%). The results demonstrate that slow-release implants containing either of these two steroid hormones have the ability to significantly lower fertility of wild koalas for at least four breeding seasons following treatment. No adverse side effects were apparent in any of the treated individuals. Compared with the cost of current management strategies for over-abundant koala populations, their deployment on a large scale should be cost-effective.

Deslorelin implants in free-ranging female eastern grey kangaroos (Macropus giganteus): mechanism of action and contraceptive efficacy

2013 ◽  
Vol 40 (5) ◽  
pp. 403 ◽  
Author(s):  
Michelle E. Wilson ◽  
Graeme Coulson ◽  
Geoff Shaw ◽  
Marilyn B. Renfree
Keyword(s):  
Follicular Development ◽  
Fertility Control ◽  
Ovarian Follicles ◽  
Management Technique ◽  
Contraceptive Efficacy ◽  
Effective Population ◽  
Contraceptive Effect ◽  
Reproductive Life ◽  
Lethal Management ◽  
Free Ranging

Context Fertility control offers a non-lethal management technique for iconic yet overabundant wildlife. Slow-release hormonal implants containing deslorelin show promise for managing free-ranging populations, particularly in peri-urban reserves, but most studies have been limited to captivity. Aims We investigated the efficacy and mechanism of deslorelin implants in free-ranging female eastern grey kangaroos (Macropus giganteus) under realistic management conditions. Methods We assigned females to a deslorelin (9.4 mg, n = 53) or placebo (n = 56) group at three peri-urban sites in Victoria, Australia, and monitored reproductive success for 3 years by observing young in the pouch. We tested the plasma LH response of control and treated females to exogenous GnRH, and compared the size of ovarian follicles between the two groups. Key results Deslorelin implants reduced fertility at all three sites. No deslorelin-treated females bred in Year 1 at Anglesea and Serendip versus 42% and 44% of control females respectively. At Plenty Gorge, 60% of deslorelin-treated females bred in Year 1 versus 100% of control females. In Year 2, between 11% and 39% of the treated females bred versus between 82% and 100% of control females at all sites. The contraceptive efficacy reduced by Year 3 when between 43% and 57% of the treated females bred versus between 85% and 100% of controls. A GnRH challenge elicited higher plasma LH concentrations in control than in treated females, and unlike untreated females, treated females lacked ovarian follicles >2 mm. Conclusions Deslorelin implants reduced fertility in free-ranging female eastern grey kangaroos over three successive breeding seasons. Chronic exposure to deslorelin desensitised the pituitary gland to GnRH and suppressed follicular development, but did not inhibit the development of a blastocyst, pregnancy or lactation in at least some females that had conceived before treatment. Implications Effective population management using deslorelin implants will require females to be re-treated on multiple occasions because the contraceptive effect lasts only a portion of their reproductive life. This would be practical only at sites where kangaroos are relatively easy to capture. The timing of treatment is also important in a species that undergoes embryonic diapause, particularly at sites providing high-quality habitat.

scholarly journals COVID-19: economic aspects of influenza vaccine prevention

2021 ◽  
pp. 16-21
Author(s):  
E. A. Zhidkova ◽  
E. M. Gutor ◽  
Yu. A. Tkachenko ◽  
I. V. Rogova ◽  
I. A. Popova ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Average Cost ◽  
Inpatient Treatment ◽  
Cost Savings ◽  
Cost Effective ◽  
Control Group ◽  
Cost Of Treatment ◽  
Coronavirus Infection ◽  
Flu Shot ◽  
The Cost

Relevance. A viral pandemic caused by the SARS-CoV-2 coronavirus has led to the development of a new coronavirus disease-2019 (COVID-19). The COVID-19 pandemic has forced the mobilization of all available health system resources. There are separate publications on reducing the risk of developing coronavirus infection in people vaccinated against influenza. Objective: to study the cost-effectiveness of influenza vaccination in the conditions of the» first « wave of COVID-19. Materials and methods. The archival data of 2,452 people from among the sick employees of JSC «Russian Railways» were analyzed. The control group consisted of 2,911 employees who were not infected with COVID-19, comparable by gender, age and territory of residence. Scores on the Charlson comorbidity scale were calculated for all individuals. The pharmacoeconomical cost of the patient’s treatment was predicted using the Markov model. Results. Having a flu shot reduced the likelihood of getting COVID-19 by 1.3 times. In the presence of a diagnosis of coronavirus infection, inpatient treatment for influenza vaccinated patients was required 2 times less often than for unvaccinated patients. Compared to the situation of the absence of vaccinated persons, in the «first wave», the estimated cost savings for the treatment of patients with coronavirus infection amounted to 124 million rubles. When the number of points on the comorbidity scale increased from 1 to 8, the average cost of treatment of patients without previous influenza vaccination increased by 2 times, and in the presence of vaccination, the average cost of treatment increased by 1.7 times. Conclusion. Thus, this study shows that influenza vaccination is cost-effective against COVID-19. The effect is achieved by reducing the likelihood of getting a coronavirus infection in the presence of a flu shot.

Levonorgestrel, not etonogestrel, provides contraception in free-ranging koalas

2010 ◽  
Vol 22 (6) ◽  
pp. 913 ◽  
Author(s):  
E. F. Hynes ◽  
K. A. Handasyde ◽  
Geoff Shaw ◽  
Marilyn B. Renfree
Keyword(s):  
Breeding Season ◽  
Follicular Development ◽  
Urogenital Sinus ◽  
Control Group ◽  
Phascolarctos Cinereus ◽  
Plasma Progesterone ◽  
Contraceptive Effect ◽  
Cytological Smear ◽  
Vaginal Cytology ◽  
Free Ranging

Management of high-density koala (Phascolarctos cinereus) populations is essential because of the browsing damage they inflict on their habitat. We have tested two types of gestagen implant, namely levonorgestrel and etonogestrel, as contraceptives for koalas. Free-ranging female koalas were given either a control, levonorgestrel (70 mg) or etonogestrel (34 or 68 mg) implant before the breeding season. Koalas were monitored every 4–12 weeks for births. Plasma progesterone was measured and a cytological smear of the urogenital sinus was taken. Fertility was high in the control group and the two etonogestrel-treated groups, with approximately 90% of females giving birth. In contrast, no levonorgestrel-treated female produced young during the study. Removal of levonorgestrel implants from six females reversed the contraceptive effect in the next breeding season, whereas the eight females in which the levonorgestrel implants were left in remained infertile for six breeding seasons. Vaginal cytology showed evidence of oestrous cycles during the breeding season in all females from all groups and there was no difference seen in the prevalence of cornified epithelial cells in the oestrous smears. This indirectly suggests that levonorgestrel does not prevent follicular development and oestrous cycling. Plasma progesterone in levonorgestrel-treated females remained low all year, but rose in controls concurrent with the onset of the breeding season. This suggests that levonorgestrel prevents pregnancy by blocking ovulation. Etonogestrel had absolutely no contraceptive effect at the two doses delivered and so is not suitable for controlling koala populations. In contrast, levonorgestrel was effective as a long-term, reversible contraceptive in wild koalas.

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