ABSTRACT
UNLABELLED: Although allogeneic haematopoietic stem cell transplantation (allo-HSCT) offers a unique curative potential, it may be connected with high treatment-related morbidity and mortality. Besides many organ complications, allo-HSCT may significantly affect quality of life (QOL). PATIENTS AND METHODS: Between January 2011 and December 2012, five hundred and ninety patients (pts) from 6 transplant centers in the Czech Republic filled in the questionnaire for the quantitative measurement of QOL using Functional Assessment of Cancer Therapy-General (FACT-G) version 4. Study cohort characteristics were as follows: 325 males, 340 pts received myeloablative conditioning, 383 pts received PBPC, representation of diagnoses; acute leukemia (n=270), bone marrow failure (n=36), chronic myeloid leukemia (n=74), myelodysplastic/myeloproliferative syndrom (n=110), lymphoproliferative disease (n=93). The median age at allo-HSCT was 43 years (range: 1.7 - 71.0), the median time from allo-HSCT to questionnaire completing was 3.8 years (range: - 0.2 - 21.6). The earliest allo-HSCT was performed in November 1989, the last in September 2012. In this retrospective study, we investigated the impact of various factors on the QOL after allo-HSCT: age, gender, diagnosis, type of conditioning, time from diagnosis to allo-HSCT, disease stage, graft type, donor type, time from allo-HSCT to questionnaire completing, GVHD, relapse. Only data from patients who were more than 3 months after allo-HSCT were used for the multivariate analysis. The overall results of the total FACT-G score (median=85.0; range: 29-108) as well as the results of each specific dimension - PWB (median=23.0; range: 5-28), SWB (median=24.0; range: 7-28), EWB (median= 19.0; range: 4-24), FWB (mean=21.0; range: 2-28) showed a value in the highest quartile of the possible evaluation. In multivariate analysis, an inferior QOL score was reported for patients with aGVHD (p=0.002), cGVHD (p<0.001), QOL decreased with increasing age (p=0.048) and increased with time elapsed since allo-HSCT (p<0.001).Allogeneic HSCT represents an important intervention into the overall integrity of the organism. In particular, the development of GVHD can cause very serious organ, but also mental problems which can significantly reduce the QOL. The QOL is steadily increasing with increasing interval from allo-HSCT but improvement and disappearance of these complications may take many years, and sometimes these effects may probably persist permanently.
Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/psychology , Quality of Life/psychology , Adult , Aged , Czech Republic , Female , Graft vs Host Disease/pathology , Humans , Male , Middle Aged , Retrospective Studies , Surveys and Questionnaires , Transplantation, HomologousABSTRACT
BACKGROUND: Almost 100 novel cancer medicines have been approved in Europe over the last decade. Limited public health care resources in countries in Central and Eastern Europe (CEE) call for a prioritization of access to effective medicines. We investigated how both reimbursement status and waiting time to reimbursement correlate with the magnitude of clinical benefit provided by novel medicines in four selected countries (Czechia, Hungary, Poland, and Slovakia). MATERIALS AND METHODS: A total of 124 indications of 51 cancer medicines with marketing authorization by the European Medicines Agency in 2011-2020 were included and followed up until 2022. Data on reimbursement status and waiting time to reimbursement (i.e. time from marketing authorization to national reimbursement approval) were collected for each country. Data were analyzed in relation to clinical benefit status (i.e. substantial versus nonsubstantial clinical benefit) of indications according to the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). RESULTS: The degree of reimbursement differed between countries with 64% of indications with reimbursement in Czechia, 40% in Hungary, 51% in Poland, and 19% in Slovakia. In all countries, a significantly greater proportion of indications with a substantial clinical benefit was reimbursed (P < 0.05). The median waiting time to reimbursement ranged from 27 months in Poland to 37 months in Hungary. No significant differences in waiting time in relation to clinical benefit were observed in any country (P = 0.25-0.84). CONCLUSIONS: Cancer medicines with a substantial clinical benefit are more likely to be reimbursed in all four CEE countries. Waiting times to reimbursement are equally long for medicines with or without a substantial clinical benefit, indicating a lack of prioritization of fast access to medicines delivering a substantial benefit. Incorporation of the ESMO-MCBS in reimbursement assessments and decisions could aid in better utilization of limited resources to deliver more effective cancer care.
Subject(s)
Neoplasms , Humans , Neoplasms/drug therapy , Europe , Medical Oncology , PolandABSTRACT
BACKGROUND: Information about cost of multiple sclerosis (MS) is available from a number of European countries, but no data from the Czech Republic have been published so far. OBJECTIVE: The objective of this study was to establish the cost of MS in the Czech Republic, overall and by level of disease severity. METHODS: Data on demographics, disease history, resource consumption and production losses were collected from 909 patients recruited in 7 MS centres in the Czech Republic. Annual costs were estimated in the societal perspective, using 2007 unit costs. To evaluate the relationship between disability and costs, patients were stratified into those with mild (67%), moderate (27%) and severe (10%) disability using the Expanded Disability Status Scale. RESULTS: Mean total annual costs per patient were 12,272, of which 51% were direct medical costs, 4% direct non-medical costs and 45% indirect costs. The average annual costs in patients with mild, moderate and severe disability amounted to 9905, 14,064 and 22,880, respectively. CONCLUSION: The total costs of MS in the Czech Republic are estimated at 208.6 million per year. Consistent with other studies, the costs increase significantly with the severity of MS.
Subject(s)
Health Care Costs , Multiple Sclerosis/economics , Multiple Sclerosis/therapy , Absenteeism , Adult , Ambulatory Care/economics , Analysis of Variance , Chi-Square Distribution , Cost of Illness , Czech Republic/epidemiology , Disability Evaluation , Drug Costs , Employment/economics , Female , Home Care Services/economics , Hospital Costs , Humans , Income , Male , Middle Aged , Models, Economic , Multiple Sclerosis/diagnosis , Multiple Sclerosis/epidemiology , Office Visits/economics , Pensions , Prevalence , Prognosis , Prospective Studies , Retrospective Studies , Self-Help Devices/economics , Severity of Illness Index , Sick Leave/economics , Time FactorsABSTRACT
The health burden of malignancies is greater in Central-Eastern Europe than in Western Europe. Furthermore, these countries have more limited healthcare resources, and therefore transparent decision criteria for innovative cancer therapies, including the assessment of cost-effectiveness, are an absolute necessity. Transferability of good-quality technology assessment reports, especially those prepared by National Institute for Health and Clinical Excellence (NICE) in the UK, could be highly beneficial to prevent duplication of efforts and save resources for local technology assessment. Our objective was to summarise key factors influencing the transferability of NICE recommendations in oncology for policy makers and oncologists in Central-Eastern Europe without personal experience in health technology assessment. In general, NICE recommendations are not transferable without adjustment of the analyses to local data. Even if the recommendation is positive, the conclusion can still be negative in lower-income countries, mainly due to relative price differences and the significance of the local budget impact. Technologies with negative NICE recommendations can still be cost-effective in Central-Eastern Europe due to the worse health status and therefore the greater potential health gain of the targeted population. The appropriateness of reimbursement decisions must be improved in Central-Eastern Europe, but copying NICE recommendations without local adjustment may do more harm than good.
Subject(s)
Antineoplastic Agents/therapeutic use , Neoplasms/drug therapy , Technology Assessment, Biomedical/standards , Decision Making , Europe , Humans , Internationality , Policy Making , Technology Assessment, Biomedical/organization & administrationABSTRACT
INTRODUCTION: Bladder outlet obstruction (BOO) due to prostatic hyperplasia is often accompanied by overactive bladder (OAB) symptoms, which often disappear after specific BOO pharmacotherapy. The aim of this study was to map out the spectrum in BOO pharmacotherapy to find out the occurrence of OAB in this population and to find its treatment. MATERIALS AND METHODS: Follow-up consists of a retrospective and a prospective part, which includes all the patient's data related to the lower urinary tract symptoms in BOO and OAB. In all, 654 data record forms were distributed during the study and 98% of those were validated. RESULTS: According to our observations, alpha-blockers were used most frequently at the beginning of BOO treatment (73%), followed by phytopharmaca (19.9%) and finally finasteride (5.5%). If the treatment is changed, the proportion of finasteride increases. Only a small number of patients with BOO and OAB are treated in combination with antimuscarinics. CONCLUSIONS: A combined therapy (alpha-blocker + antimuscarinics) is effective in a majority of men with infravesical obstruction and symptoms of OAB. However, OAB in our study was primarily underdiagnosed in almost 50% of all patients treated for LUTS.
Subject(s)
Prostatic Hyperplasia/pathology , Urinary Bladder, Overactive/complications , Urinary Bladder, Overactive/diagnosis , Adult , Aged , Aged, 80 and over , Czech Republic , Finasteride/pharmacology , Humans , Male , Middle Aged , Muscarinic Antagonists/pharmacology , Prevalence , Prospective Studies , Retrospective Studies , Urinary Bladder Neck Obstruction/drug therapy , Urinary Bladder Neck Obstruction/pathologyABSTRACT
Knowledge on the involvement of spinal COX-1 and COX-2 in pain due to osteoarthritis could be useful for better understanding of its pathogenesis and therapy. In this study we have investigated a long-term pattern of expression and production of spinal COX-1 and COX-2 in the model of osteoarthritis induced in rats by injection of monoiodoacetate (MIA) into the knee joint. MIA injection produced thermal hyperalgesia (assessed by the plantar test) and tactile allodynia (measured with von Frey hairs). The pain measures reached maximum on the fifht day, then remained relatively stable. The expression of spinal COX-2 mRNA reached maximum on day 5 (5.2 times; P<0.001) and remained increased until day 31 (4.9 times; P<0.001). Expression of spinal COX-1 mRNA increased gradually reaching maximum on the day 31 (4.5 times; P<0.001) when the relative expression of both genes was almost equal. The production of both proteins was almost similar at the beginning of the experiment. The highest production of COX-2 protein was observed on day 5 after the induction of osteoarthritis (increased 3.9 times). The levels of COX-1 protein increased gradually with maximum on day 31 (3.4 times). The present findings indicate that not only expression of COX-2 mRNA but also that of COX-1 mRNA is significantly increased in the spine during osteoarthritis pain. Thus, in contrast to inflammatory pain, the upregulation of spinal COX-1 may be important in osteoarthritis pain.
Subject(s)
Cyclooxygenase 1/biosynthesis , Cyclooxygenase 2/biosynthesis , Hyperalgesia/enzymology , Membrane Proteins/biosynthesis , Osteoarthritis, Knee/enzymology , Pain/enzymology , Spinal Cord/enzymology , Animals , Cyclooxygenase 1/genetics , Cyclooxygenase 2/genetics , Disease Models, Animal , Enzyme Induction , Hyperalgesia/chemically induced , Hyperalgesia/genetics , Iodoacetic Acid , Male , Membrane Proteins/genetics , Osteoarthritis, Knee/chemically induced , Osteoarthritis, Knee/genetics , Pain/chemically induced , Pain/genetics , Pain Measurement , Pain Threshold , RNA, Messenger/metabolism , Rats , Rats, Wistar , Reaction Time , Time FactorsABSTRACT
The analysis of direct medical care costs in the conditions of the Czech Republic has demonstrated that the average annual costs per type II diabetic patient amounts to 25,858 CZK. Thanks to its high prevalence and incidence, it represents 10% of total medical care costs. The hospital treatment of diabetic complications takes up the major share in these costs, similarly as in other advanced European countries. It is therefore evident that type II diabetes has not only health but also economic and social impacts and from this point of view, preventative and therapeutical strategies need to be evaluated.
Subject(s)
Diabetes Mellitus, Type 2/economics , Health Care Costs , Czech Republic , HumansABSTRACT
BACKGROUND: Proper management of multiple sclerosis (MS) requires feedback from clinical practice via registries. OBJECTIVE: To introduce the Czech national multiple sclerosis registry, ReMuS, and explore the availability and use of disease-modifying drugs (DMD). METHODS: The analysis focused on patients who started their first DMD, either with first-line or second-line medication and was based on reimbursement criteria set by Czech regulators. Baseline information was used to predict relapses after DMD initiation and to compare patients that started DMD in different years. RESULTS: A total of 3,328 patients started DMD treatment for MS between 2013 and 2016; 3,203 on first-line and 125 on second-line medication. The proportion of patients starting on second-line drugs increased from 1.8% in 2013 to 4.7% in 2016. The occurrence of a relapse within one year of DMD initiation was significantly related to (1) the Expanded Disability Status Scale (EDSS) score immediately prior to starting DMD and (2) the number of previous relapses. Both parameters were significantly lower in patients starting in later years of the explored interval. CONCLUSION: Data from the ReMuS registry highlights improvements made in the management of MS in the Czech Republic. However, a relatively low percentage of patients started treatment using second-line drugs, in contrast to trends in other countries.
Subject(s)
Immunologic Factors/therapeutic use , Multiple Sclerosis/drug therapy , Adult , Czech Republic , Disease Progression , Female , Humans , Male , Middle Aged , Recurrence , Registries , Treatment Outcome , Young AdultABSTRACT
BACKGROUND/OBJECTIVES: Phenylketonuria (PKU) and several other inherited metabolic diseases (IMD) require a lifelong low-protein diet (LPD), otherwise they lead to many health complications. LPDs, however, carry a significant economic burden for patients and their families. The objective of this study was to explore the costs of low-protein foods (LPFs) necessary for LPD as well as dietary patterns and compliance towards an LPD. SUBJECTS/METHODS: A detailed questionnaire was created in cooperation with National Association of PKU and other IMD (NSPKU), and consequently sent to all NSPKU members treated with an LPD (n=303). A total of 184 respondents from the Czech Republic were included in the study (174 had PKU, 10 had other IMD). RESULTS: The average daily consumption of LPF was equal to 411.7 g (PKU) and 345.6 g (other IMD), which corresponds to energy value of 5558 kJ and 4438 kJ, respectively, per patient per day. Patients mostly consumed low-protein flour (≈30% of energy intake), pasta (≈18%), basic pastry (≈15%) and sweets (≈10%). The average monthly costs of LPDs were equal to [euro ]130 (PKU) and [euro ]129 (other IMD) per patient per month. The compliance with LPD was decreasing with increasing age (P<0.0001). CONCLUSIONS: This is the largest study examining costs and dietary patterns of LPDs in patients with PKU and the first study of this kind in other IMD patients requiring an LPD. The study clearly showed that an LPD carries a very high economic burden for families, which may lead to less LPD compliance and potential severe health consequences.
Subject(s)
Adolescent Nutritional Physiological Phenomena , Child Nutritional Physiological Phenomena , Cost of Illness , Diet, Protein-Restricted , Metabolism, Inborn Errors/diet therapy , Patient Compliance , Phenylketonurias/diet therapy , Adolescent , Adolescent Nutritional Physiological Phenomena/ethnology , Adult , Caregivers , Child , Child Nutritional Physiological Phenomena/ethnology , Child, Preschool , Costs and Cost Analysis , Czech Republic , Diet, Protein-Restricted/economics , Diet, Protein-Restricted/ethnology , Female , Food Supply/economics , Humans , Intellectual Disability/economics , Intellectual Disability/ethnology , Intellectual Disability/etiology , Intellectual Disability/prevention & control , Male , Metabolism, Inborn Errors/economics , Metabolism, Inborn Errors/ethnology , Metabolism, Inborn Errors/physiopathology , Patient Compliance/ethnology , Phenylketonurias/economics , Phenylketonurias/ethnology , Phenylketonurias/physiopathology , Rare Diseases/diet therapy , Rare Diseases/economics , Rare Diseases/ethnology , Rare Diseases/physiopathology , Self Report , Young AdultABSTRACT
A reduced-intensity conditioning allogeneic stem cell transplantation was given to 19 patients (aged 15-59 years) in the first chronic phase and one patient in the accelerated phase with chronic myeloid leukemia (CML) after a regimen consisting of fludarabine (Flu), busulfan (Bu) and ATG Fresenius. The median follow-up was 27 months. Until day +100, no transplant-related mortality was recorded. The incidence of acute and chronic graft-versus-host disease (GvHD) was 55 and 75%, respectively. Two patients (10%) died from GvHD. Fourteen (70%) patients achieved molecular remission. Additional post-transplant intervention (donor lymphocyte infusion, imatinib) was necessary, however, in 10 patients (50% of the patients; non-achievement of stable molecular remission or later relapses). The total direct cost of the transplantation treatment for all of the patients came to 1,572,880 euro. If the patients had been treated with imatinib and followed-up with the same time period as they were following a transplantation, the direct cost of the imatinib treatment would have been 2,005,117 euro. The transplantation treatment appears to be less expensive after approximately 2 years of follow-up. Flu+Bu+ATG is a low-toxicity regimen for patients with CML. However, a close follow-up is necessary and about 50% of the patients require further therapeutic intervention.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hematopoietic Stem Cell Transplantation/economics , Hospital Costs/statistics & numerical data , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Transplantation Conditioning , Adolescent , Adult , Antilymphocyte Serum/administration & dosage , Busulfan/administration & dosage , Czech Republic , Female , Graft vs Host Disease/prevention & control , Hematopoietic Stem Cell Transplantation/methods , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/economics , Male , Middle Aged , Myeloablative Agonists/administration & dosage , Philadelphia Chromosome , Retrospective Studies , Survival Analysis , Transplantation Conditioning/economics , Transplantation Conditioning/methods , Transplantation, Homologous/economics , Transplantation, Homologous/methods , Vidarabine/administration & dosage , Vidarabine/analogs & derivativesABSTRACT
AIM OF INVESTIGATION: Guaifenesin is used as an expectorant and it has been reported to possess muscle relaxant and sedative activity. Guaifenesin has been used as a component of composite OTC analgesics containing paracetamol for many years. The aim of our study was to ascertain effects of guaifenesin on paracetamol analgesic activity and locomotor performance. METHODS: Antinociceptive efficacy was tested in mice using an acetic acid (0.7%) writhing test. Locomotor performance was tested in rota-rod test and activity cage. All drugs were given orally and tested in mice. RESULTS: In combination with a subeffective dose of guaifenesin (200 mg/kg), the ED(50) for paracetamol in the writhing test was significantly lower (82.2 mg/kg) than that of paracetamol administered alone (233.7 mg/kg). Guaifenesin alone did not show an analgesic effect. Guaifenesin did not produce statistically significant locomotor impairment in the rota-rod test at doses enhancing analgesic activity of paracetamol, although there was a trend for decreased locomotor activity in activity cage. CONCLUSION: The present results indicate that guaifenesin may enhance analgesic activity of paracetamol.
Subject(s)
Acetaminophen/pharmacology , Analgesics/pharmacology , Guaifenesin/pharmacology , Pain Measurement/drug effects , Animals , Drug Synergism , Male , Mice , Motor Activity/drug effects , Motor Activity/physiology , Pain Measurement/methodsABSTRACT
The reports of analgesic effects of benzodiazepines are inconsistent. There is evidence of a hyperalgesic effect induced by activation of supraspinal GABAA receptors and an antinociceptive effect induced by activation of receptors located in the spinal cord (dorsal horns). The aim of the study was to discover whether the systemic administration of a benzodiazepine agent alprazolam increases the systemic analgesic efficacy of non-opioid analgesic ibuprofen. Experimental studies combining these agents have not yet been published. We used three experimental methods - writhing test (with acetic acid), tail-flick test and plantar test to assess analgesic action. The drugs were administered orally. Augmentation of the analgesic effect of ibuprofen by alprazolam was proved for the writhing test at a dose of 30 mg/kg of ibuprofen and alprazolam 1 mg/kg. The reaction time of the combination was significantly prolonged in comparison with ibuprofen alone. The results of the tail-flick test and plantar test were negative. The effect of ibuprofen was not enhanced by alprazolam in tests of acute thermal pain. Our results have demonstrated that the analgesic action of ibuprofen is only weakly enhanced by alprazolam.
Subject(s)
Alprazolam/pharmacology , Analgesics, Non-Narcotic/pharmacology , GABA Modulators/pharmacology , Ibuprofen/pharmacology , Pain/drug therapy , Acetic Acid , Acute Disease , Administration, Oral , Animals , Disease Models, Animal , Dose-Response Relationship, Drug , Drug Synergism , Male , Mice , Mice, Inbred Strains , Nociceptors/drug effects , Pain/chemically induced , Receptors, GABA-A/physiologyABSTRACT
An analysis of serial sections is an important method applied in all fields of biology studying objects divided into sections, especially at light and electron microscopy levels. It affords a qualitative and quantitative information on spatial organization of tissues, cells and organelles. This study describes simple and cheap ways of obtaining computer-aided three-dimensional reconstructions of biological objects from serial sections.
Subject(s)
Computer Graphics , Histological Techniques , Image Processing, Computer-Assisted/methods , Computer Systems , SoftwareABSTRACT
The authors submit the overview of the actual situation in the glaucoma therapy. They follow up the trends in antiglaucomatic treatment in the last period including financial aspects of medicament and surgical treatment. Attention is paid especially to medicaments management, actual overview of available antiglaucomatic drugs, function and position of generic drugs and differences among them, the daily dose of benzalconium chloride in glaucoma treatment, actual average of patients supplementary payments at the drug purchase in the pharmacy, surgical treatment costs and legal issues. Pharmacologists viewpoints and the Czech State Drug Control Authority (SÚKL) opinions complete the professionals point of the view and facilitate his/her complete orientation in glaucoma therapy issues. Key words: glaucoma, prescription, surgical treatment, treatment costs, legal issues.