Cost-effectiveness analysis of three different combinations of inhalers for severe and very severe chronic obstructive pulmonary disease patients at a tertiary care teaching hospital of South India.

BACKGROUND: This study aims at simplifying the practical patient management and offers some general indications for pharmacotherapeutic choice by the implementation of (Global Initiative for Chronic Lung Disease) guidelines. This study was designed to evaluate the clinical and economic consequences of salmeterol/fluticasone (SF), formoterol/budesonide (FB), and formoterol/fluticasone (FF) in severe and very severe chronic obstructive pulmonary disease (COPD) patients. OBJECTIVES: The aim was to find out the most cost-effective drug combination between the three combinations (SF/FB/FF) in COPD patients. MATERIALS AND METHODS: A prospective observational comparative study (cost-effectiveness analysis), in which 90 severe (30 ≤ forced expiratory volume in 1 s [FEV1] <50% predicted) and very severe (FEV1 < 30% predicted) COPD patients (outpatients/inpatients) who are prescribed with any one of the following combinations (SF/FB/FF) were selected. In our study, we have divided 90 COPD patients into three groups (Group I, Group II, and Group III) each group consisting of 30 patients. Group I was prescribed with medication SF, Group II with medication FB, and Group III with medication FF. We used five different parameters such as spirometry test (mean FEV1 initial and final visit), number of symptom-free days (SFDs), number of moderate and severe exacerbations, Number of days of hospitalization and direct, indirect, and total cost to assess the cost-effectiveness of SF/FB/FF. Comparison of cost and effects was done during the period of 6 months of using SF/FB/FF. RESULTS: The average FEV1 for Group I, Group II, and Group III subjects at initial visit was 33.47%, 33.73%, and 33.20% and was increased to 36.60%, 35.8%, and 33.4%, respectively. A 3% increment in FEV1 was reported for Group I subjects (SF) and was highly significant statistically (t = -8.833, P = 0.000) at 95% CI. For Group II subjects (FB), a 2% increment in FEV1 was reported and was highly significant statistically (t = -9.001, P = 0.000) at 95% CI. For Group III (FF) subjects 0.2% increment in FEV1. The overall mean total cost for Group I, Group II, and Group III subjects during the 6 months period was found to be Rs. 29,725/-, Rs. 32,602/- and Rs. 37,155/-. Incremental cost-effectiveness of FB versus SF was Rs. 37,781/- per avoided exacerbation and Rs. 661/-per SFD. CONCLUSION: This study highlights the favorable therapeutic performance of combined inhaled bronchodilators and corticosteroids (SF/FB/FF), thus suggesting that healthcare costs would be also affected positively. Results from our study showed that SF and FB were the most effective strategies in the treatment of COPD, with a slight clinical superiority of SF. The FF strategy was not much effective (i.e. associated with fewer outcomes and higher costs).

Comparision of uroprotective activity of reduced glutathione with mesna in ifosfamide induced hemorrhagic cystitis in rats.

BACKGROUND: Ifosfamide (IFO) is widely used DNA-alkylating agents in cancer chemotherapy for management of solid tumors and hematological malignancies. However, hemorrhagic cystitis limits the use of IFO. OBJECTIVES: To compare the efficiency of reduced glutathione with 2-Mesna in reducing Ifosfamide (IFO) induced hemorrhagic cystitis (HC) in wistar rats. MATERIALS AND METHODS: Ifosfamide and 2-Mesna were dissolved in sterile water for injection and administered to wistar rats of albino strains. The rats were randomly assigned to one of the four groups of 6 rats each: Group I: Vehicle control; Group II: 120 mg/kg of IFO alone by intraperitoneal injection (i.p); Group III: 40 mg/kg Mesna i.p., at the same time and at 4 and 8 h after IFO administration; Group IV: 500 mg/kg of glutathione i.p., 30 min prior to IFO as above. The animals were observed for 5 days. On 6th day, rats were sacrificed by dissecting the intrajugular vein. The bladders were macroscopically and histopathologically evaluated. RESULTS: Control animals had normal bladders with assigned scores of '0' for the three parameters of edema, hemorrhage and histopathological changes. All the animals receiving IFO (group II) had evidence of HC as evidenced by alterations of edema and hemorrhages. These alterations were almost abolished (P < 0.001) by the glutathione (group III) or Mesna (group IV) in IFO-treated animals. CONCLUSION: Glutathione could be as useful as Mesna in the preventive management of IFO-induced HC.

Outcomes among patients with sex cord stromal tumour of ovary: experience from Pakistan.

BACKGROUND: Ovarian sex cord-stromal tumours (SCST) are relatively uncommon neoplasms that account for approximately 5-7% of all primary ovarian tumours. The aim was to report experience with sex cord stromal tumours (SCST) of ovary in a low and middle income country. METHODS: Clinical records of 56 patients with histopathologically-established SCST of ovary admitted to a tertiary care cancer hospital in Pakistan between April 1995 and December 2011 were reviewed. RESULTS: Median age at presentation was 41 years (Range 4-77). Forty one (73%) patients were premenopausal and 15 (26.8%) were postmenopausal. The most common presenting complaint was abdominal pain (28.1%). Thirty seven patients (66%) had stage-I, 2 had stage II and II each, and 15 (26.8%) had stage IV disease. Five years survival in patients with early stage (stages I & II) was 91% while in those in the late stage (II & IV) was 84% (p=0.79). Histopathologically, 49 patients (85.7%) had Granulosa cell tumour, and 7 (12.5%) had Sertoli Lyedig cell tumour. CA-125 was high only in 8 patients (14.3%). Adjuvant chemotherapy was give in 16 (28.6%). Thirty six (64%) were disease free at last follow up, 10 (18%) succumbed to disease and 10 (18%) were alive with disease. On univariate and multivariate analyses, late stage at presentation was the sole factor significantly associated with mortality. CONCLUSION: Ovarian sex cord-stromal tumours of ovary are relatively uncommon malignancies with good prognosis if diagnosed early and treated adequately. Survival in our study was comparable to those reported elsewhere. Among various factors, late stage of tumour at presentation was found to be the only factor significantly associated with mortality.