Cost-utility analysis of different peg-interferon alpha-2b plus ribavirin treatment strategies as initial therapy for naïve Chinese patients with chronic hepatitis C.

BACKGROUND: Different peg-interferon alpha-2b plus ribavirin treatment strategies are more effective in treating hepatitis C. However, no cost-effectiveness data have been published using the clinical data from the peg-interferon alpha-2b and ribavirin in the treatment of patients with hepatitis C in Taiwan. AIM: To estimate the cost-effectiveness of different treatments with peg-interferon alpha-2b plus ribavirin for the initial treatment of patients with different genotype chronic hepatitis C. METHODS: Individual patient level data from a randomized clinical trial with peg-interferon plus ribavirin were applied to a Markov model to project lifelong clinical outcomes. Economic estimates and quality of life were based on published data and Taiwan patient data. We used a societal perspective and applied a 3% annual discount rate. RESULTS: Compared with different combination therapy strategies, peg-interferon alpha-2b plus weight-based dosing of ribavirin in all patients for 24 weeks is the most cost-effective treatment strategy. If the sustained virological response of peg-interferon plus ribavirin treatment for 48 weeks therapy in genotype 1 patients was higher than 67.8%, the best strategy of treating patients will be the peg-interferon plus weight-based dosing of ribavirin therapy for 48 weeks in genotype 1 patients and for 24 weeks in non-genotype 1 patients. CONCLUSIONS: Peg-interferon alpha-2b plus ribavirin combination for 24 weeks therapy in all genotype patients should reduce the incidence of liver complications, prolong life, improve quality of life and be cost-effective for the initial treatment of chronic hepatitis C.

Psychometric assessment of the Chinese language version of the St. George's Respiratory Questionnaire in Taiwanese patients with bronchial asthma.

BACKGROUND AND PURPOSE: The St. George's Respiratory Questionnaire (SGRQ) is a disease-specific quality-of-life instrument. It was designed to measure quality of life in obstructive pulmonary disease, and its reliability and validity have been demonstrated in different language versions. The purpose of this study was to determine the psychometric properties of a Chinese language version of the SGRQ in Taiwanese asthma patients. METHODS: A convenient sample of 124 asthma patients were recruited from the outpatient asthma clinic of a teaching hospital in the Taipei area. The inclusion criteria were outpatient, coherent, and a clinical diagnosis of asthma. Patients with additional medical conditions considered to impact the quality of life were excluded. Three component scores (symptoms, activity, and impacts) and a total score were calculated to assess the SGRQ's psychometric characteristics. Data including demographic characteristics, history of emergency visits and hospital admissions, asthma severity, and quality of life were collected by questionnaires. Cronbach's formula for the alpha-coefficient was used to estimate the internal consistency and reliability of the SGRQ. Pearson's product-moment correlation was used to estimate the concurrent validity of the SGRQ. The discriminating validity of the SGRQ was determined by the t-test for independent samples. RESULTS: Results showed that the SGRQ was internally consistent, and had good content and face validity. The SGRQ total score was significantly correlated with both the Health Index and the RAND 36-item Health Survey (p < 0.05). The SGRQ discriminated patients with respect to asthma severity (p < 0.001), history of prior emergency visits (p < 0.05), and history of prior hospital admissions (p < 0.05). CONCLUSIONS: This study demonstrated that the Chinese language version of the SGRQ has internal consistency and validity with strong evidence of content, concurrent, and discriminating validity in Taiwanese asthma patients. These findings suggest that it is a useful measure of quality of life in Taiwanese asthma patients.

[Drug interaction between digoxin and bisacodyl].

Digoxin is one of the inotropic agents commonly used to improve cardiac performance in patients with congestive heart failure and to control ventricular response in atrial fibrillation and other supraventricular tachycardias. Bisacodyl (dulcolax), a stimulant laxative, is also commonly prescribed to prevent straining at stool or constipation in these patients. Therapeutic monitoring of digoxin is helpful in the evaluation of clinical response and intoxication of digoxin. For the convenience of serum level measurement, digoxin is usually administered at night before sleep to allow ample time for tissue distribution and then blood sampling the next morning. Concomitant use of these drugs may increase the likelihood of drug interaction. Eleven healthy volunteers, aged 22-26, were studied within 35 days accordingly in four phases. The serum digoxin concentration (SDC) in phase 2 (digoxin and bisacodyl together) showed a significant decrease as compared with phase 1 (digoxin alone) (0.58 +/- 0.03 vs. 0.66 +/- 0.03 ng/ml, M +/- SE, p less than 0.05). The percentage of SDC changes was down to -11.7 +/- 5.4%. Phase 4 (digoxin taken 2 hours before bisacodyl) showed an increase in SDC in comparison with phase 3 (digoxin alone) but was not statistically significant (0.65 +/- 0.03 vs. 0.62 +/- 0.03 ng/ml, M +/- SE, p greater than 0.05). The average frequency of diarrhea was 3.5 times in the first day of phase 2 and 2.7 times in the first day of phase 4. We conclude that in volunteers bisacodyl interacts with digoxin resulting in reduction of the SDC. Interference of the absorption is the most likely mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)