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1.
Ann Pharmacother ; 34(3): 304-8, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10917374

RESUMO

OBJECTIVE: To assess the relationship between level of use of recombinant deoxyribonuclease I (rhDNase) therapy and costs of respiratory-related care in patients with cystic fibrosis. DESIGN: Retrospective, cohort study using healthcare claims data from a large New England health insurer. PATIENTS: All cystic fibrosis patients five years of age and older who began therapy with rhDNase in 1994 (the year it was first marketed in the US). Healthcare claims were compiled for six months prior to first receipt of rhDNase (pretreatment) and for 30 months subsequently (follow-up). Patients were stratified according to their level of rhDNase use during follow-up, based on whether it was above or below the median number of therapy days for the sample. MAIN OUTCOME MEASURES: Costs of rhDNase, all antibiotics, and all respiratory-related outpatient (physician, home health, hospital outpatient) and inpatient care were included. All costs were expressed on an annualized basis. RESULTS: Twenty-four patients with cystic fibrosis who began treatment with rhDNase in 1994 met all entry criteria; the median number of therapy days over a 30-month period was 355. Among patients with low (i.e., below the median) rhDNase use (n = 12), mean +/- SD annualized costs of respiratory-related care increased by almost $17,000 between pretreatment and follow-up, from $29,251 +/- $37,919 to $46,109 +/- $40,944. Among high-use patients (n = 12), costs decreased by approximately $2500, from $37,178 +/- $48,476 to $34,592 +/- $22,591. The change in both groups was accounted for primarily by a change in the number of respiratory-related hospitalizations. CONCLUSIONS: Prolonged use of rhDNase may reduce costs of respiratory-related care in patients with cystic fibrosis; further study is required, however, to confirm these findings.


Assuntos
Fibrose Cística/complicações , Fibrose Cística/economia , Desoxirribonuclease I/economia , Desoxirribonuclease I/uso terapêutico , Doenças Respiratórias/tratamento farmacológico , Doenças Respiratórias/economia , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Masculino , New England , Proteínas Recombinantes/economia , Proteínas Recombinantes/uso terapêutico , Doenças Respiratórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
2.
N Engl J Med ; 341(26): 1966-73, 1999 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-10607813

RESUMO

BACKGROUND: Immune responses mediated by IgE are important in the pathogenesis of allergic asthma. A recombinant humanized monoclonal antibody (rhuMAb-E25) forms complexes with free IgE and blocks its interaction with mast cells and basophils. We studied the efficacy of rhuMab-E25 as a treatment for moderate-to-severe allergic asthma. METHODS: After a 4-week run-in period, we randomly assigned 317 subjects (age range, 11 to 50 years) who required inhaled or oral corticosteroids (or both) to receive either placebo or one of two regimens of rhuMAB-E25: high-dose rhuMAb-E25 (5.8 microg per kilogram of body weight per nanogram of IgE per milliliter or low-dose rhuMAb-E25 (2.5 microg per kilogram per nanogram of IgE per milliliter) intravenously on days 0 (half a dose), 4 (half a dose), and 7 (full dose) and then once every 2 weeks thereafter for 20 weeks. For the first 12 weeks of the study, the subjects continued the regimen of corticosteroids they had received before enrollment. During the following eight weeks, the doses of corticosteroids were tapered in an effort to discontinue this therapy. The primary outcome measure was an improvement in the asthma symptom score at 12 weeks, according to a 7-point scale, in which a score of 1 indicated no symptoms and a score of 7 the most severe symptoms. RESULTS: A total of 106 subjects were assigned to receive a high dose of rhuMAb-E25, 106 were assigned to receive a low dose, and 105 were assigned to receive placebo. At base line, the mean asthma symptom score was 4.0. After 12 weeks of therapy, the mean (+/-SE) scores were 2.8+/-0.1 in the high-dose group (P=0.008) and 2.8+/-0.1 in the low-dose group (P=0.005), as compared with 3.8+/-0.1 in the placebo group. At 20 weeks, the mean scores were 2.7+/-0.1 in both the high-dose group (P=0.048) and the low-dose group (P=0.14), as compared with 2.9+/-0.1 in the placebo group. More subjects in the two rhuMAb-E25 groups were able to decrease or discontinue their use of corticosteroids than in the placebo group, but only some of the differences were significant. After 20 weeks, serum free IgE concentrations decreased by a mean of more than 95 percent in both rhuMAb-E25 groups. The therapy was well tolerated. After 20 weeks, none of the subjects had antibodies against rhuMAb-E25. CONCLUSIONS: A recombinant humanized monoclonal antibody directed against IgE has potential as a treatment for subjects with moderate or severe allergic asthma.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Asma/terapia , Imunoglobulina E/imunologia , Administração por Inalação , Administração Oral , Adolescente , Agonistas Adrenérgicos beta/uso terapêutico , Adulto , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Asma/tratamento farmacológico , Asma/imunologia , Criança , Método Duplo-Cego , Feminino , Volume Expiratório Forçado , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Qualidade de Vida
3.
Ann Pharmacother ; 30(9): 926-34, 1996 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8876849

RESUMO

OBJECTIVE: To develop a precise, interval level scale of the clinical significance of drug-drug interactions that reflects the professional judgments of practicing pharmacists. PARTICIPANTS: A convenience sample of 63 practicing pharmacists representing hospital (clinical and staff) and retail (chain and independent) practice settings. METHOD: Pharmacists judged the similarity among 15 interaction categories that have been commonly used to classify drug-drug interactions. A multidimensional scaling technique produced a spatial representation (i.e., a psychological map) of the structure inherent in those similarity judgments. Pharmacists' ratings of clinical significance were projected onto that same spatial representation using a multiple regression procedure, and the resulting information was used to develop a scale of clinical significance. RESULTS: The clinical significance scale developed from pharmacists' judgments was substantially different from a comparison scale published in a popular reference. The new scale was more precise than the comparison scale, and it also approximated an interval level of measurement. The judgments used to produce the new clinical significance scale were not reliably influenced by pertinent demographic characteristics of the sample. CONCLUSIONS: Inconsistencies between published clinical significance scales and the professional judgments of practitioners could affect patient care to the degree that a summary measure of clinical significance affects a practitioner's response to a potential drug-drug interaction. The clinical significance scale developed in this study has good measurement characteristics and reflects the professional judgments of practicing pharmacists. Use of the new scale is recommended on these grounds, although further assessment of its generality is warranted.


Assuntos
Interações Medicamentosas , Julgamento , Farmacêuticos/psicologia , Monitoramento de Medicamentos , Previsões , Humanos , Farmacêuticos/normas , Reprodutibilidade dos Testes , Responsabilidade Social
4.
Pharmacoeconomics ; 10(1): 4-13, 1996 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10172730

RESUMO

The purpose of this article is to review the literature related to economic outcomes associated with treating allergic rhinitis. A literature review was conducted using 'Medline' and the in-house database of the publishers of this journal for articles published between January 1991 and January 1996. Only 3 cost-outcome analyses that compared alternative treatments for allergic rhinitis were found. Given the limited number of full economic evaluations, much of this article focuses on issues related to direct and indirect costs and outcome measures that should be considered when performing an economic evaluation of allergic rhinitis. We conclude that more comprehensive analyses using a wide array of costs and outcomes are needed. At present, it is not possible to draw general conclusions regarding the economic value of alternative treatments for allergic rhinitis.


Assuntos
Rinite Alérgica Perene/economia , Rinite Alérgica Perene/terapia , Rinite Alérgica Sazonal/economia , Rinite Alérgica Sazonal/terapia , Análise Custo-Benefício , Custos e Análise de Custo , Antagonistas dos Receptores Histamínicos H1/economia , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Imunoterapia/economia , Avaliação de Resultados em Cuidados de Saúde , Procedimentos Cirúrgicos Operatórios/economia
5.
Pharmacoeconomics ; 4(2): 92-103, 1993 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10146971

RESUMO

The rising cost of healthcare has strained the resources of governments, private third parties and individuals with responsibility to pay for it. Various strategies have been used in an attempt to control costs. This article examines the economic impact of 4 such strategies: (a) cost sharing; (b) prescription limits; (c) rebates; and (d) cost limits. Cost sharing has been successful at reducing utilisation of prescription drugs, although the effects have not been uniform across therapeutic categories. However, the long term effect on cost and utilisation of other medical services, and the impact on overall health status, remain largely unknown. Some evidence suggests that utilisation of other services may increase. The available data regarding drug rebate programmes have been descriptive in nature. However, the designs employed in this research do not establish a direct causal relationship between rebate programmes and changes in Medicaid drug expenditure. Furthermore, still unknown is the degree of cost shifting and the effect of the rebate programme on other large public and private drug purchasers. The Maximum Allowable Cost programme led to direct savings in drug costs, but the size of these savings was variable and uncertain because of administrative costs of the programme. The Estimated Acquisition Cost programme has not resulted in significant savings.


Assuntos
Controle de Custos/métodos , Reembolso de Seguro de Saúde , Controle de Custos/tendências , Custo Compartilhado de Seguro/tendências , Uso de Medicamentos , Farmacoeconomia , Previsões , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/tendências , Honorários por Prescrição de Medicamentos , Estados Unidos
6.
Phys Ther ; 57(2): 143-7, 1977 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-834770

RESUMO

Physical therapists have been criticized for ignoring patients with acute or chronic chest diseases, or chest surgery, at a time when increasing numbers of patients having chest diseases are challenging the health professions. A questionnaire survey of 63 physical therapy schools was made to explore this problem. Results of the survey showed that a majority of schools did not offer a course in chest physical therapy. A number failed to teach the treatment of each chest disease or allowed too little time for adequate preparation of the student. Suggestions are offered for more adequate preparation of the student. Suggestions are offered for more adequate treatment of these patients and greater involvement of the physical therapist on the chest team.


Assuntos
Modalidades de Fisioterapia/métodos , Doenças Respiratórias/reabilitação , Currículo , Humanos , Modalidades de Fisioterapia/educação
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