Direct cost for initial management of prostate cancer: a systematic review.

BACKGROUND: Prostate cancer (pca) is the most common non-skin cancer among men in Canada and other Western countries. Increased prevalence and higher cost of newer treatments have led to a significant rise in the economic burden of pca. The objectives of the present study were to systematically review the literature on direct costs for the initial management of pca, and to examine the methodologic considerations across studies. METHODS: Bibliographic databases were systematically searched for peer-reviewed articles in English. Studies were reviewed for methodologic considerations and mean direct cost of active surveillance or watchful waiting (as/ww) and initial treatments. Direct cost was standardized to 2011 Canadian dollars. RESULTS: After a review of abstracts and full-text papers, seventeen articles met the eligibility criteria and were included in the review. Studies were published during 1992-2010. The studies reported on health care systems in the United States, France, the United Kingdom, German, Italy, and Spain. Our review identified a lack of methodologic consensus, leading to variation in direct costs between studies. Nevertheless, results indicate a significant direct cost of pca treatments. CONCLUSIONS: The existing literature lacks methodologically rigorous studies on the direct costs of pca treatments specific to publicly funded health care systems. Additional studies are required to appreciate the direct costs of newer treatments and the impact of their adoption on the growing economic burden of pca management.

The intended and unintended consequences of benzodiazepine monitoring programmes: a review of the literature.

WHAT IS KNOWN AND OBJECTIVE: Concern has been expressed regarding the potential over-prescription of benzodiazepines (BZDs) and their potential for misuse and abuse. Patterns of BZD use can be tracked by prescription monitoring programmes (PMPs). This study reviews the literature examining the impact of PMPs on the use of BZDs. METHODS: Studies published in English from January 1980 to April 2009 were identified though PubMed, EMBASE, IPA, CINHL and Web of Science using MeSH terms: 'Benzodiazepines' OR 'Benzodiazepines/supply and distribution' AND ('Social Control, Formal/legislation, jurisprudence'); Emtree terms: 'drug control'/exp AND 'benzodiazepine derivative'/exp/mj. A broad search strategy was also used: benzodiazepines; triplicate prescription program; prescription monitoring program; triplicate prescribing; and triplicate prescription policy. RESULTS AND DISCUSSION: This search identified 32 relevant articles that addressed the impact of implementation of a PMP for BZDs in New York State in 1989. Overall, BZD prescribing declined following implementation, but the decline was not consistent across population groups. In particular, marginalized and vulnerable populations, such as persons with chronic mental health disorders, may be disproportionately affected. WHAT IS NEW AND CONCLUSION: We provide a critical review of the impact of PMPs on the use of BZDs. PM decreases overall use of BZDs, but may have unintended consequences that differentially impact certain populations. Furthermore, research is warranted to understand better the long-term costs and benefits.

Primary carcinoma of fallopian tube after prolonged retention of Lippes loop.

PIP: Although a small number of uterine malignancies have been reported in long-term IUD users, a cause-effect relationship is difficult to establish. This article presents a case of primary carcinoma of the fallopian tubes with a coexisting Lippes loop. The 50-year-old patient presented to Seth Sukhlal Karnani Memorial Hospital (Calcutta, India) 5 years after menopause with complaints of occasional vaginal bleeding for the past 2 months. A Lippes loop had been inserted 20 years earlier, with no follow-up after the first year of use. Total hysterectomy was performed. Gross cut-section revealed the Lippes loop inside the uterine cavity. The distal parts of both fallopian tubes showed multiple small cystic spaces filled with fluid, with features of papillary adenocarcinoma arising from mucosa infiltrating the wall and projecting into the lumen. The distorted tubes also showed features of hydrosalpinx follicularis. Although the ovaries were adherent to the tubes, they were not malignant. The atrophic endometritis present in this case suggests that carcinoma was preceded by salpingitis, in turn possibly initiated by prolonged IUD retention.^ieng