Cost implications for the treatment of five oral lesions commonly found in HIV/AIDS.

The objectives of this study were to determine the cost of a prescribed treatment plan; to compare the costs in an academic hospital cost with that of private pharmacy; and to determine the average treatment cost per visit. The descriptive, retrospective study that investigated the cost implications of the treatment of five oral lesions associated with HIV/AIDS: oral candidiasis, oral hairy leukoplakia, periodontal diseases, oral ulcers and Kaposi's sarcoma. One hundred and twenty four cases with oral HIV lesions were selected from the list of 181 HIV patients listed in the attendance registers of three hospitals in the selected study sites. A data capture sheet was used to obtain information related to diagnosis, investigations done, staging of the disease, treatment plan and treatment outcome. None of the patients were on antiretroviral therapy. The association between the number of hospital visits and the total cost of treatment was significant (p < 0.05). Also, there was a significant negative relationship between the outcome of treatment and the total hospital costs (p < 0.05). The lower the hospital treatment cost, the better the outcome. There was no significant association between staging of the disease and the hospital cost (p > 0.05), but the CD4 count significantly influenced the hospital cost (p<0.05). The average hospital treatment and private pharmacy cost was 207.06 and 357.85 rands respectively (16.21 euros and 28.02 euros respectively). There is a need to evaluate the current treatment protocols, as some treatments may be ineffective. Governments should endeavour to provide antiretroviral and other relevant drugs, at no cost, to HIV/AIDS patients.

Oral mucositis and outcomes of autologous hematopoietic stem-cell transplantation following high-dose melphalan conditioning for multiple myeloma.

The purpose of this study was to assess the relationship between oral mucositis (OM) and adverse clinical and economic outcomes of autologous hematopoietic stem-cell transplantation (HSCT) following high-dose melphalan (Alkeran) conditioning in patients with multiple myeloma. A retrospective study of 115 consecutive autologous HSCT recipients with multiple myeloma who received high-dose melphalan conditioning before transplantation was undertaken at a single academic center. OM severity was assessed twice weekly using a validated scale beginning 3-4 days following conditioning and continuing until hospital discharge or day 28, whichever occurred first. OM was graded, based on presence/extent of erythema/ulceration across eight oropharyngeal sites, as follows: 0 = no erythema or ulceration; I = erythema but no ulceration; II = ulceration, 1 site; III = ulceration, 2 sites; IV = ulceration, 3 sites; and V = ulceration, > or = 4 sites. Analyses examined the relationship between worst OM grade and selected clinical and economic outcomes, including days with fever, days of total parenteral nutrition (TPN),days of parenteral narcotic therapy, incidence of significant infection, and inpatient days and charges. The mean age of study subjects was 54 years; 19 patients (17%) received total-body irradiation, and 55 patients (48%) experienced OM grade > or = II (ie, ulceration). The worst OM grade was significantly (P < 0.05) associated with numbers of days of TPN and parenteral narcotic therapy, length of hospitalization, and total inpatient charges. Worst OM grade was not associated with the number of febrile days or the risk of significant infection. OM is associated with worse clinical and economic outcomes in multiple myeloma patients undergoing autologous HSCT following high-dose melphalan conditioning.