The clinical use of ondansetron. New South Wales Therapeutic Assessment Group.

OBJECTIVE: To establish guidelines for use of ondansetron. DATA SOURCES: MEDLINE computer search (to July 1993) and information from the manufacturer. DATA EXTRACTION: We circulated a position paper based on our literature review for comment by clinicians and directors of pharmacy in major teaching hospitals in New South Wales who had an interest in ondansetron. DATA SYNTHESIS: Ondansetron is effective in the control of nausea and vomiting occurring 24-48 hours after highly emetogenic chemotherapy and after radiotherapy. There are no data to support its use in delayed emesis. Combination with dexamethasone may improve emetic control. The most commonly reported adverse effects are headache and constipation. Optimal dose, frequency of dosing and route of administration have not been established. The cost for each inpatient treated successfully is about 3% more than conventional antiemetic therapy. CONCLUSIONS: Ondansetron shows clinical benefit in the management of acute nausea and vomiting in patients receiving highly emetogenic chemotherapy, those who have responded poorly to other antiemetics after moderately emetogenic chemotherapy, those who have intolerable side effects with conventional antiemetic agents and those receiving radiotherapy to the upper abdomen. It is also marketed for the prevention and treatment of postoperative nausea and vomiting.

The clinical application of the interferons: a review. NSW Therapeutic Assessment Group.

OBJECTIVES: To review the clinical information on the use of alpha, beta and gamma interferons and to classify the use of alpha interferons in Australia according to approved indications, indications for which there is good supporting evidence and indications where therapy is under investigation; and to estimate the cost of therapy with alpha interferons in New South Wales in 1991. DATA SOURCES: Data were obtained from computerised literature searches. DATA EXTRACTION: A position paper was drafted on behalf of the NSW Therapeutic Assessment Group (NSWTAG). This was circulated to clinicians identified as having a particular interest in the use of the interferons in major NSW teaching hospitals, for comment and amendment where necessary. CONCLUSIONS: Two forms of alpha interferon, interferon alfa-2b and interferon alfa-2a have been approved for use in Australia, interferon alfa-2b for use in the management of hairy cell leukaemia and condylomata acuminata and interferon alfa-2a for use in the management of hairy cell leukaemia and human immunodeficiency virus (HIV) related Kaposi's sarcoma. Applications have been lodged for the use of interferon alfa-2b in HIV related Kaposi's sarcoma, cutaneous basal cell carcinoma and hepatitis B and C and for the use of interferon alfa-2a in the management of hepatitis B, cutaneous T-cell lymphoma and metastatic renal cancer. Interferon alfa-n1 is not available in Australia except for use in a clinical trial in patients who are HIV seropositive. The use of the alpha interferons is currently under investigation in a wide variety of other diseases, with the likelihood that other indications will soon be established. However, the alpha interferons are generally not regarded as first line agents. Beta and gamma interferons have been studied less intensively than the alpha interferons, but it is likely that selected applications for their use will also be defined with the passage of time.

The cost of treating small cell lung cancer.

OBJECTIVE: To determine the cost of treating small cell lung cancer (SCLC) and to assess quality-adjusted survival in these patients. DESIGN: Retrospective analysis. SETTING: Westmead Hospital, a tertiary referral institution. PATIENTS: Consecutive sample of 31 patients with histologically proved SCLC, treated between January 1987 and December 1987. MAIN OUTCOME MEASURES: The cost of investigation, hospitalisation, chemotherapy, radiotherapy and follow-up of patients overall and for those with limited and extensive disease respectively. Quality-adjusted survival was based on a Q-TWiST analysis. RESULTS: The median overall cost per patient was $14,413 (range, $1188-$39,598) for all patients and for limited disease and extensive disease was $18,234 (range, $1914-$39,598) and $13,177 (range, $1188-$32,798) respectively. The two major costs were hospitalisation (42%) and chemotherapy (18%). Radiotherapy accounted for 11% of all costs. The Q-TWiST analysis suggests that for patients with limited disease, quality-adjusted survival is similar to absolute survival. CONCLUSIONS: The treatment of SCLC at our institution was expensive but the cost may be reduced by reduction in the duration of hospitalisation, the use of less expensive combination drug regimens, or the use of "true" outpatient chemotherapy. Despite intensive therapy, patients with limited disease maintained a reasonable quality of life.

Cardiorespiratory and metabolic costs of continuous and intermittent exercise in man.

1. Cardiorespiratory and metabolic responses to paired patterns of continuous and intermittent exercise with the same average power output were studied in eight men. Heart rate, ventilation and pulmonary gas exchange were measured during the different patterns of exercise performed on a cycle ergometer. The recovery oxygen volume was measured over 30 min of loadless pedalling. Needle biopsy samples of the vastus lateralis muscle were taken before, during and after completion of the exercise for measurement of muscle metabolites.2. Heart rate, ventilation, oxygen intake, respiratory exchange ratio, and blood lactate concentration were generally higher with intermittent compared with continuous exercise as were the accumulated totals for heart beats, ventilation and oxygen intake. Muscle biopsy samples tended to have higher lactate and lower phosphocreatine contents in intermittent exercise. The lactate concentration in muscle and blood water was the same during loadless pedalling before exercise but was significantly higher in muscle than blood during exercise. This concentration gradient was larger in intermittent than in continuous exercise.3. Work efficiency, calculated from the total oxygen cost of work in excess of a loadless pedalling control, was significantly lower in intermittent exercise. The explanation is thought to be connected with the observation that when the work was performed at a high rate in short bursts a large part of the oxidative recovery took place after the contraction during the rest periods, whereas in the low intensity continuous exercise the oxygen was mainly utilized while the work was being performed. This indicates that for part of the time in the intermittent exercise the muscle was working under anaerobic conditions. Although the possibility exists that the efficiency of resynthesis of phosphagen may be reduced in this form of activity, it is more likely that the result described is due to the greater amount of lactate formed in the intermittent exercise.