Enteroviral meningitis. Cost of illness and considerations for the economic evaluation of potential therapies.

With limited financial resources available, it is now becoming more acceptable to evaluate medical innovations in terms of incremental economic value. The purpose of this paper is to provide an overview of enteroviral meningitis and to summarise the economic literature to identify relevant costs and outcomes. Enteroviral meningitis is the most common cause of aseptic meningitis, and occurs in 4.5 to 30 per 100,000 population annually with a duration of illness lasting between 1 and 2 weeks after onset of initial symptoms. The major resource categories that contribute to the overall direct costs of management of enteroviral meningitis include physician visits, hospital admissions, emergency room visits, medications, procedures such as lumbar puncture and computed tomography scans, re-hospitalizations and follow-up physician visits. Indirect costs are incurred in terms of school or work days missed or restrictions in daily activities. The total direct costs of an episode of enteroviral meningitis range from $US450 for outpatients to $US5093 for inpatient management (1996 values). The total indirect costs of an episode of enteroviral meningitis are estimated to be equivalent to 5 to 7 activity-restricted days. Interventions that improve early diagnosis or decrease the duration and need for hospitalisation will significantly affect the cost of managing enteroviral meningitis. Additional prospective studies are needed to study the impact of interventions on the burden of enteroviral meningitis.

Drugs and the elderly, Part 2: Strategies for improving prescribing in a managed care environment.

OBJECTIVE: In part 1 of "Drugs and the Elderly" (December 2000 issue), we reviewed and summarized the vast amount of clinical information on medication use in the elderly for healthcare providers and administrators within managed care. In part 2, we explore the literature on improving prescribing, focusing on those approaches most likely to be useful within a managed care environment. STUDY DESIGN: We reviewed the general literature on medication use in the elderly, focusing on problems and systems approaches to the improvement of medication use in managed care. We created a topic list of general interest to health professionals within managed care and fit the available information into those topics. Thus, the result is an authoritative review rather than a systematic literature review. PATIENTS AND METHODS: Nonquantitative evaluation of the medical literature. RESULTS: We identified several hundred articles describing issues related to medication use in the elderly but only a trivial number that in any way addressed the managed care community directly. There is very little literature on how managed care can best incorporate the lessons of geriatric pharmacology and pharmacy. CONCLUSIONS: There is a paucity of literature for the managed care community of health professionals regarding pharmacology, pharmacoepidemiology, drug utilization review, and other issues related to the use of medication in the elderly population.

Drugs and the elderly, Part 1: The problems facing managed care.

OBJECTIVE: In part 1 of "Drugs and the Elderly," we review and summarize the vast amount of clinical information on medication use in the elderly for healthcare providers and administrators within managed care. In part 2, we explore the literature on improving prescribing, focusing on those approaches most likely to be useful within a managed care environment. STUDY DESIGN: We reviewed the general literature on medication use in the elderly, focusing on problems and systems approaches to the improvement of medication use in managed care. We created a topic list of general interest to health professionals within managed care and fit the available information into those topics. Thus, the result is an authoritative review rather than a systematic literature review. PATIENTS AND METHODS: Nonquantitative evaluation of the medical literature. RESULTS: We identified several hundred articles describing issues related to medication use in the elderly but only a trivial number that in any way addressed the managed care community directly. There is very little literature on how managed care can best incorporate the lessons of geriatric pharmacology and pharmacy. CONCLUSIONS: There is a paucity of literature for the managed care community of health professionals regarding pharmacology, pharmacoepidemiology, drug utilization review, and other issues related to the use of medication in the elderly population.