Background: Stroke is a leading cause of morbidity and mortality not only in our country but in other countries as well imposing a substantial economic burden on individuals and society overall. The financial cost of stroke is considerable but few cost effectiveness studies are available to guide clinical practice. It is the aim of this research then to provide comparison of cost-effectiveness or cost-benefit in stroke care to cast new light on which methods are better than others. Objectives: To compare cost-effectiveness of Home care versus Hospital care program in stroke patients age 35-70 years old at General Hospital from January 1998 to January 1999. Perspective: The study was done in a program perspective for the General Hospital. Methods: A decision analysis based on available published information was formulated. The probable outcomes were 1) probability of survival, 2) probability of good quality of life, 3) probability of poor quality of life and 4) probability of mortality after 1 year. Effectiveness measure was evaluated as the product of 1 year survival and good quality of life for both home care and hospital-based care. The cost of each branch was then divided by these 2 outcomes. The cost-effectiveness was compared between the 2 alternative programs. Results: The probability of 1 year survival for home care is 0.84 while in hospital care, probability was higher at 0.87. The probability of dying from stroke in 1 year for home care was .16 while only 0.13 was noted in hospital care. It is apparent that hospital care is more effective than home care alternative. In contrast to the results of the decision analysis, the cost-effectiveness of home care was P56,900.45 per stroke patient with good quality of life in contrast to hospital care which was higher at P65,291.70 per stroke patient with good quality of life. Although hospital-based care was more effective, incremental analysis showed that the cost of the advantage was P669,462. Conclusion: Hospitals are more effective than home care based on probability analysis while cost-effectiveness analysis favors the home care alternative.
Human ; Aged ; Middle Aged ; Adult ; HOME CARE SERVICES ; COST-BENEFIT ANALYSIS ; STROKE

Spider venoms and toxins are valuable sources of lead compounds for drug development due to their essential role in cellular and physiological processes targeting various receptors. Here, we present the protein profile of the venom of Phlogiellus bundokalbo, an endemic Philippine tarantula, to screen and characterize its cytotoxicity against MCF-7 cells, secretory phospholipase a2 (sPLA2), and neurotoxicity to evaluate its potential anticancer properties. Spider venom was extracted via electrical stimulation. Venom components were fractionated by reversed-phase high-performance liquid chromatography and characterized through liquid chromatography-mass spectrometry (LC-MS) and SDS-PAGE analysis before assay. The resulting five venom fractions were amphiphilic peptides showing cytotoxicity against MCF-7 cells in a concentrationdependent manner (IC50 ranging from 52.25μg/ml to 110.20μg/ml) after 24-hour incubation. Cells appeared detached, rounded, and shrunk with cytoplasmic condensation upon overnight incubation with venom fractions. The sPLA2 was observed in all the venom fractions tested for cytotoxicity. Venom fractions revealed a predominant mass of ~3-5 kDa with LC-MS analysis. Results showed distinct similar mass as μ- theraphotoxin-Phlo1a, an Australian tarantula, Phlogiellus sp. toxin with inhibitor cystine knot motif. The venom fractions exhibit excitatory neurotoxins that might activate presynaptic voltage-gated ion channels, such as an agonist or gating modifier toxins that slow down the channel inactivation similar to spider toxins. In conclusion, the spider venom of P. bundokalbo exhibits cytotoxic, phospholipase A2, and neuroactive properties suggesting that its venom components, upon further purification and structure-function analysis, can be potential tools in the development of targeted breast chemotherapeutics.
Spider Venoms ; Phospholipases