[Clinical trials of the new skin test Diaskintest for the diagnosis of tuberculosis].

A new reagent for a skin test given the name Diaskintest has been designed for the screening diagnosis of tuberculosis and preclinical and clinical trials conducted. Preclinical trials were carried out on 315 laboratory animals (guinea-pigs, albino mice). The reagent Diaskintest was ascertained to be nontoxic, to have no sensitizing properties, to be safe and specific, and to induce no positive reactions in BCG-vaccinated animals and healthy guinea-pigs. Its specific activity was comparable with that of the national reference--purified tuberculin PPD-L-2. With progression of tuberculous lesions, the guinea-pigs showed higher responses to Diaskintest dilution and the BCG-vaccinated animals lacked responses to Diaskintest with increased delayed type hypersensitivity. The clinical trial was permitted by the Federal Service for Surveillance in Health Care and Social Development of the Russian Federation. Clinical trials were conducted in 150 persons. The safety, specificity, sensitivity of Diaskintest were first examined in the clinical studies and its action was compared with the results of tuberculin skin test (Mantoux test) with 2 TE of PPD L-2. Diaskintest was ascertained to be highly sensitive when given in a dose of 0.2 microg in 0.1 ml. In patients with active tuberculosis and new cases of Mycobacterium tuberculosis infection, the agent induced a positive skin reaction (a papule of more than 10 mm) in 98-100% of cases (p < 0.05). The agent caused no reaction associated with BCG vaccination. The specificity of the test was 93-100% with 95% significance. The rate of overexuberant reactions (vesicular necrotic changes, lymphangitis, and lymphadenitis) was 4-14% with 95% significance. Tuberculosis patients with significant immunopathological disorders might have no skin sensitivity to Diaskintest, as to PPD L-2 (a negative test). The findings substantiate the use of Diaskintest for mass epidemiological surveys for the differential diagnosis of tuberculosis and BCG vaccination-associated complications. The agent may be also used to evaluate the activity of the process in patients with tuberculosis and the efficiency of treatment in combination with other methods and to make a differential diagnosis of tuberculosis.

[Efficacy of arbidol in prophylaxis and treatment of acute respiratory viral infections in servicemen]. / Effektivnost' arbidola v profilaktike i lechenii ostrykh respiratornykh virusnykh infektsii u voennosluzhashchikh.

The authors present the results of study of arbidolum therapeutic-and-prophylactic effectiveness in acute respiratory viral infections (ARVI) under conditions of military staff with determination of economic expediency. Coefficient of effectiveness of arbidolum prophylactic use was 25% and efficiency index--1.33. In experimental group the ARVI complicated forms were noted in 3% of the patients and in control group--in 5%. Due to decreased expenses on the treatment of non-complicated and complicated ARVI forms the cost of therapy of one servicemen in the first group was 290.6 rubles, in the second group--323 rubles, in the third group--336 rubles and in the fourth group--368 rubles. The results of investigation have shown the significant advantage of arbidolum therapeutic-and-prophylactic use compared with other variants. Its use permitted to decrease the febrile period, to reduce the manifestation of symptoms of intoxication and affection of upper respiratory tract.

[Pharmacoeconomic model of the use of rifabutin in new cases of pulmonary tuberculosis]. / Farmakoékonomicheskaia model' primeneniia rifabutina u bol'nykh s vpervye vyiavlennym tuberkulezom legkikh.

The formalized procedures to commensurate the results and expenditures were used to make a comprehensive evaluation of the clinical efficiency and economical expediency of purposeful application of rifabutin in new cases of disseminated and destructive pulmonary tuberculosis.

[Pharmacoeconomic aspects of use of structum in osteoarthrosis]. / Farmakoékonomicheskie aspekty primeneniia struktuma pri osteoartroze.

AIM: To study cost-effect efficiency of structum in patients with knee and hip joint osteoarthrosis (OA) in a multicenter trial. MATERIAL AND METHODS: The trial enrolled 192 patients with OA. 110 patients had knee joint OA and 82 patients hip joint OA. The patients received structum for 6 months. Efficacy of the treatment was assessed before use of structum and after it by standard methods. Integral effect of therapy was estimated according to the special program complex. The cost of the drug therapy included the cost of structum and nonsteroid anti-inflammatory drugs (NSAID) on conversion to 1 mg of diclofenac plus the cost of treating side effects. The efficacy per unit cost was calculated by the formula: E1xC2/E2xC1, where E1--integral efficacy of therapy before using structum, E2--integral efficacy of therapy in administration of structum, C1--cost of drug therapy, C2--cost of drug therapy in using structum. RESULTS: E2 was equal to 94% for knee joints OA and 92% for hip joint OA, E1 and C1--21 and 19%, respectively. C2 was equal to 108.43$ for knee joint OA and 106.97 for hip joint OA, C1--29.3 and 27.44, respectively. The efficacy per unit cost for knee joint OA was 94 x 29.3/21 x 108.3 = 1.21, for hip joint OA 92 x 27.44/19 x 106.97 = 1.24. The figures evidence for much higher efficacy per unit cost of structum vs routine NSAID. CONCLUSION: The multicenter trial gave grounds not only for clinical efficacy of structum vs NSAID but also for cost-effect advantage of structum in therapy of OA.

[The economic expenses related to bronchial asthma morbidity]. / Ekonomicheskie zatraty, sviazannye s zabolevaemost'iu bronkhial'noi astmoi.

Estimations of the cost of bronchial asthma treatment per 1 patient in Samara Province made up an annual average of 520 dollars and 531 dollars in 1993 and 1994, respectively. 70% of the expenditures were medical, 30% social. It is demonstrated that updated approaches to diagnosis and treatment of asthma unless the patients are noncompliant provided good results at reduced expenses. The economic-mathematical model is proposed basing on which one can predict prevalence of bronchial asthma, cost-effect treatment relations for 5 years to come. The model reflects both current and forthcoming trends in care for bronchial asthma.