Pharmacogenetic information in Swiss drug labels - a systematic analysis.

Implementation of pharmacogenetics (PGx) and individualization of drug therapy is supposed to obviate adverse drug reactions or therapy failure. Health care professionals (HCPs) use drug labels (DLs) as reliable information about drugs. We analyzed the Swiss DLs to give an overview on the currently available PGx instructions. We screened 4306 DLs applying natural language processing focusing on drug metabolism (pharmacokinetics) and we assigned PGx levels following the classification system of PharmGKB. From 5979 hits, 2564 were classified as PGx-relevant affecting 167 substances. 55% (n = 93) were classified as "actionable PGx". Frequently, PGx information appeared in the pharmacokinetics section and in DLs of the anatomic group "nervous system". Unstandardized wording, appearance of PGx information in different sections and unclear instructions challenge HCPs to identify and interpret PGx information and translate it into practice. HCPs need harmonization and standardization of PGx information in DLs to personalize drug therapies and tailor pharmaceutical care.

Trends in incidence and medical resource utilisation in patients with chronic lymphocytic leukaemia: insights from the UK Clinical Practice Research Datalink (CPRD).

Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in European adults. We aimed to evaluate time trends in CLL incidence and medical resource utilisation of CLL patients in the UK. We conducted a retrospective, observational cohort analysis using the UK Clinical Practice Research Datalink (CPRD) comprising mainly primary care data. We included adult patients with newly diagnosed CLL between January 2000 and June 2012. Descriptive and trend analyses of CLL incidence and medical resource utilisation were performed. A total of 2576 patients with CLL met the eligibility criteria. At diagnosis, the majority of patients (71.7 %) were above 65 years of age. The European age-standardised CLL incidence rate in the CPRD was 6.2/100,000 (95 % confidence interval [CI] 6.0, 6.5/100,000) person-years. There was no statistically significant increase over time. The CLL patients had on average 74.6 general practitioner visits during a median follow-up of 3.3 years. Between 2000 and 2012, the average number of recorded hospitalisations and referrals per year corrected for duration of follow-up significantly (p < 0.001) increased by 8.1 % (95 % CI 6.8 %, 9.3 %) and 16.4 % (95 % CI 15.4 %, 17.3 %), respectively. Referrals and hospitalisations in the second year compared to the first year following the CLL diagnosis significantly decreased. CLL incidence rates in the CPRD were stable over the period from 2000 to 2012. Medical resource utilisation in UK primary care was well documented, but further research is needed to describe secondary and tertiary care medical resource utilisation e.g. chemotherapy administration, which is inadequately captured in the CPRD.

Impact of genetic variability and treatment-related factors on outcome in early breast cancer patients receiving (neo-) adjuvant chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide, and docetaxel.

To assess the impact of patient-related factors, including genetic variability in genes involved in the metabolism of chemotherapeutic agents, on breast cancer-specific survival (BCSS) and recurrence-free interval (RFI). We selected early breast cancer patients treated between 2000 and 2010 with 4-6 cycles of (neo-)adjuvant 5-fluorouracil, epirubicin, and cyclophosphamide (FEC) or 3 cycles FEC followed by 3 cycles docetaxel. Tumor stage/subtype; febrile neutropenia and patient-related factors such as selected single nucleotide polymorphisms and baseline laboratory parameters were evaluated. Multivariable Cox regression was performed. Of 991 patients with a mean follow-up of 5.2 years, 152 (15.3 %) patients relapsed and 63 (6.4 %) patients died. Advanced stage and more aggressive subtype were associated with poorer BCSS and RFI in multivariable analysis (p < 0.0001). Associations with worse BCSS in multivariable analysis were: homozygous carriers of the rs1057910 variant C-allele in CYP2C9 (hazard ratio [HR] 30.4; 95 % confidence interval [CI] 6.1-151.5; p < 0.001) and higher white blood cell count (WBC) (HR 1.2; 95 % CI 1.0-1.3; p = 0.014). The GT genotype of the ABCB1 variant rs2032582 was associated with better BCSS (HR 0.5; 95 % CI 0.3-0.9, p = 0.021). Following associations with worse RFI were observed: higher WBC (HR 1.1; 95 % CI 1.0-1.2; p = 0.026), homozygous carriers of the rs1057910 variant C-allele in CYP2C9 (HR 10.9; 95 % CI 2.5-47.9; p = 0.002), CT genotype of the CYBA variant rs4673 (HR 1.8; 95 % CI 1.2-2.7; p = 0.006), and G-allele homozygosity for the UGT2B7 variant rs3924194 (HR 3.4; 95 % CI 1.2-9.7, p = 0.023). Patient-related factors including genetic variability and baseline white blood cell count, impacted on outcome in early breast cancer.

Potential health economic impact of intravenous iron supplementation to erythropoiesis-stimulating agent treatment in patients with cancer- or chemotherapy-induced anemia.

BACKGROUND: Intravenous (i.v.) iron supplementation significantly improves the response to erythropoiesis-stimulating agent (ESA)-based therapies in patients with cancer- or chemotherapy-induced anemia. The economic implications of adding i.v. iron to ESA treatment are less well investigated. Published randomized controlled trials do not provide sufficient data for a comprehensive cost-effectiveness analysis. METHODS: Preliminary cost calculations from the Swiss health care system perspective based on a meta-analysis and published results of eight randomized controlled trials without correction for decreased ESA need provide a conservative cost-effectiveness estimate. RESULTS: The additional total cost of i.v. iron supplementation ranged from EUR 417 to EUR 901 per patient depending on the evaluated iron-carbohydrate complex. Considering a 24% absolute increase in the proportion of ESA responders, the incremental cost-effectiveness ratios per additional responder are EUR 1,704-3,686. In routine practice, better values may be achieved due to ESA dose savings. CONCLUSION: Supplementation of ESAs with i.v. iron appears to be an economically viable treatment option in anemic cancer patients. Additional research on ESA dose savings and cost-effectiveness is required.

Trastuzumab beyond progression: a cost-utility analysis.

BACKGROUND: The continuation of trastuzumab beyond progression in combination with capecitabine as secondary chemotherapy for HER2-positive metastatic breast cancer (MBC) prolongs progression-free survival without a substantial increase in toxicity. PATIENTS AND METHODS: A Markov cohort simulation was used to follow the clinical course of typical patients with MBC. Information on response rates and major adverse effects was derived, and transition probabilities were estimated, based on the results of the Breast International Group 03-05 clinical trial. Direct costs were assessed from the perspective of the Swiss health care system. RESULTS: The addition of trastuzumab to capecitabine is estimated to cost on average an additional of €33,980 and to yield a gain of 0.35 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio of €98,329/QALYs gained. Probabilistic sensitivity analysis showed that the willingness-to-pay threshold of €60,000/QALY was reached in 12% of cases. CONCLUSION: The addition of trastuzumab to capecitabine in MBC patients is more expensive than what is typically regarded as cost-effective but falls within the value ranges found for established regimens in the treatment of MBC.

Disparities in influenza vaccination coverage rates by target group in five European countries: trends over seven consecutive seasons.

BACKGROUND: The primary objective of this study was to measure influenza vaccination coverage rates in the general population, including children, and in high-risk groups of five European countries during the season 2007/2008. An additional aim was to analyze coverage trends over seven consecutive seasons and to gain an understanding of the primary drivers and barriers to immunization. METHODS: Community-based telephone and mail surveys have been conducted in the UK, Germany, Italy, France, and Spain, yearly, since 2001/2002. Approximately 2,000 individuals per country and season were interviewed who were considered to be representative of the adult population aged 14 years and older. Data on the vaccination status of children were obtained by proxy interviews. The questionnaire used was essentially the same for all seven seasons. Five target groups were identified for the study: (1) persons aged > or = 65 years; (2) elderly suffering from a chronic illness; (3) patients suffering from a chronic illness; (4) persons working in the health care sector; (5) children. RESULTS: In the season 2007/2008, vaccination coverage rates in the general population remained stable in Germany. Compared to the coverage rates of the previous season, increases of 3.7%, 2.0%, and 1.8% were observed for the UK, Spain, and France, respectively, while a decrease of -1.5% was observed for Italy. Across all five countries, vaccination rates in the predefined target groups decreased to some extent (elderly) or increased slightly (chronically ill and health care workers). Vaccination rates among children varied strongly between countries and ranged from 6.1% in UK to 19.3% in Germany. The most powerful motivation for getting vaccinated in all countries was advice from a family doctor (58.6%) and the perception of influenza as a serious illness (51.9%). The major reasons why individuals did not become vaccinated were (1) the feeling of not being likely to catch influenza (39.5%) and (2) never having considered the option of being vaccinated (35.8%). CONCLUSIONS: The change in general influenza vaccination coverage in the 2007/2008 season compared to the previous season was small, but decreases were seen in some target groups. The underlying motivations for and against vaccination did not substantially change. An effort to activate those driving forces that would encourage vaccination as well as dealing with barriers that tend to prevent it may help enhance coverage rates in Europe in the future.

Trends in influenza vaccination coverage rates in the United Kingdom over six seasons from 2001-2 to 2006-7.

In order to understand motivations and barriers to vaccination, and to identify people's intentions to get vaccinated for season 2007-8, influenza vaccination coverage was assessed in the United Kingdom (UK) from 2001 to 2007. Between 2001 and 2007 representative household surveys were performed by telephone interview with 12,143 individuals aged 16 or older. The overall influenza vaccination coverage rate dropped non-significantly from 25.9% in 2005-6 to 25.0% in 2006-7 (p=0.510). In the elderly (>/=65 years) the rate decreased from 78.1% to 65.3% (p=0.001), and the odds ratio of being vaccinated compared to those not belonging to any of the risk groups targeted by vaccination decreased from 36.6 to 19.9. Healthcare workers and chronically ill persons had odds ratios of 2.0 and 15.5, respectively. The most important reason for getting vaccinated was a recommendation by the family doctor or nurse, and this was also perceived as the major encouraging factor for vaccination. No recommendation from the family doctor was the main reason for not getting vaccinated. A total of 38.4% of the respondents intended to get immunised against influenza in 2007-8. From 2001 to 2006 a slightly increasing trend (p for trend across seasons <0.0001) in vaccination coverage was observed in the UK, but in 2006-7 the rates returned to the level of 2004-5. Less media attention to the threat of avian influenza after 2005 may have contributed to the recent decrease of vaccination rates.

[Evolution of influenza vaccination coverage in France from 2001 to 2006]. / Evolution du taux de couverture vaccinale contre la grippe en France : de 2001 à 2006.

INTRODUCTION: The increased risk of a new influenza pandemic has raised awareness of the need for high influenza vaccination rates. OBJECTIVES: This study aims at assessing trends in influenza vaccination coverage from 2001 to 2006 in France, at understanding the drivers and barriers, and to identify vaccination intentions for 2006/2007. METHODS: We conducted a mail-based household survey on 9,835 persons representative of the population from age 15. Essentially, the same questionnaire was used in all seasons. RESULTS: The influenza vaccination coverage rate slightly increased, reaching 24.2% in 2005/2006 (70.1% in patients over 65). In the last two seasons the fact that the vaccination was provided for free was the most frequent reason for getting vaccinated. Older age, considering influenza as a serious disease and recommendations from the family doctor or nurse were also important drivers for vaccination. Only 2% of those vaccinated in 2005/2006 indicated the threat of avian influenza as a reason. The reasons for non-vaccination among persons never vaccinated before were feeling too young for vaccination, never having considered vaccination before and absence of recommendation by the family doctor. Among those who were previously vaccinated but not in the current season, the reasons for not being vaccinated were not finding vaccination necessary, forgetfulness and having influenza-like illness despite vaccination. CONCLUSION: Stable vaccination rates were observed from 2001 to 2006. France is well on its way to reach the international vaccination goal set by the WHO (75% in the elderly population), but continuously effort is needed for others.

Developments in influenza vaccination coverage in Italy over five seasons (2001-2006).

This study aims at assessing trends in influenza vaccination coverage from 2001 to 2006 in Italy, at understanding the drivers and barriers to vaccination, and to identify vaccination intentions for season 2006/07. We conducted telephone-based household surveys representative of the population from age 14. Total sample size was 10,026 persons. The influenza vaccination coverage rate in Italy increased over the years, reaching 24.1% in season 2005/06. In the elderly (> 65), the vaccination rate reached 63.4% in 2005/06. The increase between seasons 2004/05 and 2005/06 was statistically significant. A recommendation for the doctor/nurse, considering influenza as a serious illness, older age and not being in very good health were the most frequent reasons for getting vaccinated. Four percent of those vaccinated in 2005/06 indicated the threat of avian flu as a reason. For the winter 2006/07, 30% of the population intended to get vaccinated, indicating the potential to increase vaccination coverage next year. The threat of avian influenza may have contributed to a substantial recent increase in season 2005/06 as compared to the year before. Despite of this positive evolution, major effort is still needed to reach WHO objectives for 2010 (75% vaccination coverage rate in the elderly population).

Pharmacoeconomics of anticoagulation therapy for stroke prevention in atrial fibrillation: a review.

INTRODUCTION: Atrial fibrillation (AF) increases the risk of ischemic stroke 5-fold and may not only be responsible for as many as 15% of all strokes that occur but also for larger and more disabling strokes than those attributable to other causes which increase the associated costs of care. Anticoagulation with warfarin in the target INR of 2.5 is a major clinical challenge in real-life practice, given that the complex relationship between warfarin dosage and response is readily altered by a variety of factors such as concurrent medications, illnesses, genetic influences, and dietary/lifestyle changes. Consequently, INR values are out of the target range approximately half of the time in real-life studies compared to clinical trial setting. Current anticoagulation therapies are less likely to be cost-effective in routine clinical practice and need improvement. The aim of this review is to discuss the pharmacoeconomic consequences of this management strategy by analysing the optimal treatment option within specific age and risk groups, confirming current guidelines for a health economic perspective and considering the economic impact on health care policy. METHODS: An electronic search of the Medline/PubMed database from 1966 to 2005 was performed to identify articles dealing with all pharmacoeconomic aspects of stroke prevention in atrial fibrillation. The following search terms were used: 'atrial fibrillation', 'stroke', 'cost', 'warfarin'. RESULTS: Treatment with warfarin is cost-effective (versus aspirin or no therapy) in patients with AF at moderate-to-high risk of stroke. The cost-effectiveness of anticoagulation therapy is driven by the achieved risk reduction rather than the potential benefits estimated from clinical trials. Failure to maintain optimal anticoagulation places patients at risk of complications, the management of which is a significant cost driver. CONCLUSION: Improvement could be achieved by optimising physicians and patient's knowledge driven through prevention campaigns by health care policy.

[Coverage rates of influenza vaccination in France: a population-based cross-sectional analysis of seasons 2001-2002 and 2002-2003]. / Taux de couverture vaccinale contre la grippe en France: analyse démographique transversale des saisons 2001-2002 et 2002-2003.

INTRODUCTION: Influenza is a serious health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. OBJECTIVES: The authors had for aim to assess influenza vaccination coverage during two seasons in France, to understand the incentives and barriers to vaccination and to determine vaccination intentions for the following winter. METHODS: A random-sampling, mail-based household survey was made among non-institutionalised individuals aged 15 and over. The surveys for 2001-2002 and 2002-2003 used the same questionnaire and were subsequently pooled. Three target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field and (3) persons aged 65 and over or working in the medical field. RESULTS: Influenza vaccination coverage in France decreased from 23.0% in 2001-2002 to 22.4% in 2002-2003. Most frequent reasons for being vaccinated were advice from the family doctor (50.8%), influenza considered as a serious illness (45.3%) and free vaccine (44.1%). Reasons for not being vaccinated mentioned by people who had never been vaccinated were young age (27.0%), not considering vaccination (18.9%), and not expecting to catch influenza (13.9%). CONCLUSION: Vaccination coverage decreased during the 2002-2003 season in comparison to the 2001-2002 season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.

[Coverage rates of influenza vaccine in Italy during the 2002/3 and 2003/04 seasons: a cross-sectional study]. / La copertura da vaccino influenzale in Italia: indagine trasversale sulla popolazione Italiana nelle stagioni vaccinali 2002/3 e 2003/4.

The objective of this survey was to assess the level of influenza vaccination coverage in the season 2002/ 2003 compared with the season 2003/2004 in Italy, to understand the drivers and barriers to vaccination and to determine the intention for vaccination for the following winter. We conducted a random-sampling, telephone-based household survey among non-institutionalised individuals representative of the population aged 14 years and above. The surveys for 2002/2003 and 2003/2004 used the same questionnaire and were subsequently pooled. Four target groups were determined for analysis: (1) persons aged 65 years and above; (2) people working in the medical field; (3) persons suffering from a chronic illness and (4) all other groups. The overall sample consisted of 4010 people. The influenza vaccination coverage rate in Italy increased from 19.6% in season 2002/2003 to 22.2% in season 2003/2004. The most frequent reasons mentioned by vaccinees to get vaccinated were advice received from the family doctor or nurse (48.9%), influenza being considered a serious illness which people did not want to contract (38.5%) and not wanting to pass the influenza bug to family and friends (29.2%). Reasons mentioned by never vaccinated people for not getting vaccinated were the fact that people did not consider it before (34.9%), the opinion that one was not very likely to catch influenza (32.2%) and influenza not being a serious illness (23.4%). Options encouraging an influenza vaccination are a recommendation by the family doctor or nurse (58.4%), more available information on the vaccine regarding efficacy and tolerance (34.4%) and more available information on the disease (24.3%). We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself in order to enable them to actively inform their patients on these topics accordingly.

Cost-effectiveness analysis of paclitaxel and cisplatin versus cyclophosphamide and cisplatin as first-line therapy in advanced ovarian cancer. A European perspective.

Paclitaxel is a new cytotoxic agent that has demonstrated significant activity in advanced ovarian cancer. The aim of this study was to determine the cost structure of advanced ovarian cancer and the cost-effectiveness of paclitaxel-cisplatin (PC) combination therapy compared with a standard cyclophosphamide-cisplatin (CC) regimen at first-line therapy. The analysis was performed separately for six European countries: Germany, Spain, France, Italy, The Netherlands and the U.K. The study was conducted from the national health service payer's perspective. The total cost of treatment per patient (six cycles of chemotherapy) in the six European countries varied between a minimum of US$4,926 in the U.K. and US$12,578 in Germany for the CC regimen and between US$13,038 and US$24,487 for the PC regimen (April 1996). Since the new regimen improved life expectancy by 1.283 years compared with CC, the incremental cost-effectiveness of PC was calculated to be between US$6,403 per 5-year saved in the U.K. and US$11,420 per life-year saved in Italy. Overall, the cost-effectiveness of PC compares favourably with other oncological interventions. The findings of this study suggest that healthcare decision makers should consider paclitaxel, in combination with cisplatin, as a cost-effective first-line therapy for patients with advanced ovarian cancer.

Pharmacoeconomics of angiotensin converting enzyme inhibitors in heart failure.

As a result of the increasing cost of health care and the limited resources available, it has become more difficult to allocate resources efficiently and effectively in the health care system. This environment has led to the development of pharmacoeconomic studies, which have been designed in response to the need for assessment of the economic benefits of a product prior to its acceptance in the market. The field of pharmacoeconomics has grown rapidly, especially in relation to the development of new pharmacological products. Economic analysis is now routinely incorporated into many clinical trials, and this type of information, in conjunction with the usual safety and efficacy data, is becoming more important to pharmaceutical companies, regulatory authorities, third party payers, and end-users. The cost-effectiveness of angiotensin converting enzyme (ACE) inhibitors for the treatment of heart failure has been evaluated on the basis of a number of large-scale studies, including the Survival and Ventricular Enlargement (SAVE) study and the Veterans Administration Cooperative Vasodilator Heart Failure Trials (V-HeFT I and II). The cost-effectiveness of the ACE inhibitor captopril compares favorably with other cardiac interventions, reducing both mortality and the incidence of congestive heart failure (CHF). Captopril also appears to be cost-effective in the treatment of patients with left ventricular dysfunction after acute myocardial infarction. In addition, analysis of more recent studies of the treatment of fosinopril in patients with mild to moderate CHF have been performed and have proved this newer ACE inhibitor to be cost-saving in these patients.

Medical economic considerations of supportive cancer care.

In an era of increasing cost containment in health care, it has become extremely important to allocate resources as efficiently as possible. This implies that formal health economic considerations are taken into account. One of increasing importance is the field of economic appraisal, which allows to quantify the value for money of medical interventions. This research is extremely useful in the field of supportive care of cancer patients. Economic considerations, social, political and ethical issues will also have to be addressed. The sum of these activities will enable us to make better choices in health care and ensure that sufficient resources are allocated to supportive cancer treatment. Cancer patients have physical, social, spiritual and emotional needs. They may suffer from severe physical symptoms, from social isolation, spiritual abandonment, and emotions such as sadness and anxiety, or feelings of deception, helplessness, anger and guilt. In some of them, the disease is rapidly progressing and ultimately they die. Their demanding care evokes intense feelings in health care providers, all the more since these incurable patients represent a challenge, which could be condensed under the heading "the challenge of medical omnipotence". The complexity of the matter, the interdisciplinary approach and the emergence of an increasingly cost conscience health care environment put supportive cancer care in a difficult realm.

The estimated economic burden of genital herpes in the United States. An analysis using two costing approaches.

BACKGROUND: Only limited data exist on the costs of genital herpes (GH) in the USA. We estimated the economic burden of GH in the USA using two different costing approaches. METHODS: The first approach was a cross-sectional survey of a sample of primary and secondary care physicians, analyzing health care resource utilization. The second approach was based on the analysis of a large administrative claims data set. Both approaches were used to generate the number of patients with symptomatic GH seeking medical treatment, the average medical expenditures and estimated national costs. Costs were valued from a societal and a third party payer's perspective in 1996 US dollars. RESULTS: In the cross-sectional study, based on an estimated 3.1 million symptomatic episodes per year in the USA, the annual direct medical costs were estimated at a maximum of $984 million. Of these costs, 49.7% were caused by drug expenditures, 47.7% by outpatient medical care and 2.6% by hospital costs. Indirect costs accounted for further $214 million. The analysis of 1,565 GH cases from the claims database yielded a minimum national estimate of $283 million direct medical costs. CONCLUSIONS: GH appears to be an important public health problem from the health economic point of view. The observed difference in direct medical costs may be explained with the influence of compliance to treatment and possible undersampling of subpopulations in the claims data set. The present study demonstrates the validity of using different approaches in estimating the economic burden of a specific disease to the health care system.

Global healthcare financing for type II diabetes: are there ways out of the crisis?

This article focuses on the overall situation with regard to healthcare financing in the field of diabetes. Worldwide efforts on cost containment have severely influenced the management of chronic illness. An answer as to whether or not the expected financial crisis can be prevented will be difficult to obtain. However, use of the modern tools of management sciences and health economics can bring more transparency into the picture. Solutions will have to be based increasingly on empirical economic data, which, so far, are only in the process of being generated in many countries. A research agenda is proposed that might trigger the compilation of additional data in order to ensure adequate future financing of diabetes care.

Resource utilisation in the management of dyslipidaemia.

In Western countries, cardiovascular disease accounts for substantial morbidity and mortality. In the US, where medical costs and intervention rates are the highest in the world, the direct and indirect costs of cardiovascular disease and stroke have been estimated at $US274 billion (1998 dollars), with the costs of hospitalisation ($US119.9 billion) and lost productivity because of early mortality ($US77.9 billion) representing the largest proportions of this amount. Dyslipidaemia is an important risk factor for coronary heart disease (CHD), a condition which accounts for $US39.3 billion and $US37.9 billion (1998 dollars) in hospitalisation/nursing home costs and lost productivity, respectively, annually in the US. Similarly, the UK National Health Service spends more than 500 million pounds sterling annually on the treatment of CHD. Numerous studies have shown the benefit of lowering cholesterol levels in terms of decreasing CHD-associated morbidity and mortality; however, drug therapy costs for dyslipidaemia can be high. US and European treatment guidelines for dyslipidaemia recommend aggressive treatment for those at highest CHD event risk. Because of the high prevalence of dyslipidaemia in Western countries, these recommendations impact on a substantial proportion of the population and have increased the use of cholesterol-lowering medications. In a limited number of economic studies using clinical data from large prevention trials, the cost of drug therapy was nearly offset by the reduction in costs associated with hospitalisation and revascularisation procedures. Therefore, it appears that the strategy of identifying and treating individuals at highest risk for CHD, although expensive in terms of drug costs, would be expected to reduce the substantial direct and indirect costs associated with this condition.

Influenza. The role of burden-of-illness research.

Influenza is associated with a significant economic burden on both society and the individual, resulting in considerable healthcare costs and loss of productivity, as well as intangible costs such as suffering, grief and social disruption. The incidence and severity of influenza infection depend, at least in part, on the age and health status of the population. For example, the incidence of influenza is relatively high among children and young adults, but serious complications are much more likely to occur among the very young (< 1 year of age) and the elderly (> 65 years of age). School absenteeism tends to peak in the first half of a typical 6- to 8-week influenza epidemic, followed by workplace absenteeism in the latter half as school-aged children pass the infection to family members. Cost-of-illness studies are used by policy-makers to justify budgets and set priorities for prevention programmes, research and other expenditures. On the basis of German Sickness Fund data, recent estimates indicate that the cost of an influenza epidemic in that country is approximately 2 billion Deutschmarks (approximately $US1.4 billion). The bulk of these costs reflects indirect costs associated with lost productivity, a finding also noted in an earlier French cost-of-illness study of influenza. Thus, the main economic burden of influenza falls on infected individuals, their employers and their relatives. Methodology used in cost-of-illness studies can be quite variable. For example, two main approaches are used in measuring indirect costs (human capital and willingness to pay), although there is controversy as to which is the preferred method. Thus, investigators involved in cost-of-illness studies must be explicit regarding study methodology in order to allow for appropriate interpretation of study results by interested parties.

Socioeconomic evaluation in medicine in Europe. Core economic concepts.

In most European countries, healthcare cost-containment programmes have failed to meet their targets on a long term basis. For this reason, decision-makers sought effective and rational strategies to assist in the optimal allocation of available resources. The scholarly discipline of economics provides methods and instruments for investigating the rational use of limited resources. In the context of these efforts, socioeconomic evaluations of healthcare programmes have become increasingly important during the last decade. A socioeconomic evaluation is an analysis of all costs and consequences over a relevant time-period for a particular healthcare intervention. For example, a socioeconomic evaluation of an influenza prevention programme should consider the total costs of preventing influenza (costs of the vaccine, vaccination programme and treatment of adverse events), as well as the benefits of such a programme (costs saved as a result of cases of influenza avoided). In general, socioeconomic evaluations usually compare costs and benefits relative to alternative treatment strategies. The core concepts of socioeconomic analyses are as follows: costs and consequences, discounting, marginal and incremental costs, and externalities (spill-over effects). All these concepts are fixed components of published guidelines and should be considered when conducting a socioeconomic evaluation.