TOTALL: high cost of allergic rhinitis-a national Swedish population-based questionnaire study.

Allergic rhinitis is a global illness with a well-recognised impact on quality of life and work performance. Comparatively little is known about the extent of its economic impact on society. The TOTALL study estimates the total cost of allergic rhinitis using a sample representing the entire Swedish population of working age. A questionnaire focused on allergic rhinitis was mailed out to a random population of Swedish residents, aged 18-65 years. Health-care contacts, medications, absenteeism (absence from work) and presenteeism (reduced working capacity at work) were assessed, and the direct and indirect costs of allergic rhinitis were calculated. Medication use was evaluated in relation to the ARIA guidelines. In all, 3,501 of 8,001 (44%) answered the questionnaire, and 855 (24%) of these reported allergic rhinitis. The mean annual direct and indirect costs because of allergic rhinitis were €210.3 and €750.8, respectively, resulting in a total cost of €961.1 per individual/year. Presenteeism represented 70% of the total cost. Antihistamines appear to be used in excess in relation to topical steroids, and the use of nasal decongestants was alarmingly high. The total cost of allergic rhinitis in Sweden, with a population of 9.5 million, was estimated at €1.3 billion annually. These unexpectedly high costs could be related to the high prevalence of disease, in combination with the previously often underestimated indirect costs. Improved adherence to guidelines might ease the economic burden on society.

Co-phenylcaine Forte spray: innovative ways of minimising cost.

OBJECTIVE: To investigate whether multiple-use Co-phenylcaine Forte® spray was more cost-effective than single-use vials. METHODS: A literature review was conducted to determine the risk of cross-contamination associated with multiple-use topical nasal anaesthetic spray. The costs of multiple-use Co-phenylcaine Forte and single-use co-phenylcaine were compared, and potential savings were calculated. The cost of procuring these drugs from other sources was also examined. RESULTS: Switching to multiple-use Co-phenylcaine Forte spray would lead to at least 40 per cent savings if bought from our local retailer. Potential savings of more than 70 per cent could be made if the drugs were procured from sources other than our local distributor. CONCLUSION: Multiple-use Co-phenylcaine Forte spray is safe to use and more cost-effective than single-use vials. This paper illustrates how money can be saved within the National Health Service through changes in drug procurement. Similar cost savings to those calculated for our department could be made in other ENT departments nationally, depending on their annual consumption of co-phenylcaine.

A comprehensive evaluation of rationality of cough and cold medicines available in Indian market.

To analyse various cough and cold formulations available in the Indian market and to study their pharmacological rationale and cost effectiveness, a cross-sectional, observational study was carried out for evaluation of the drugs listed in Current Index of Medical Specialities (CIMS) India, September 2010.The formulations were assessed for their total number, type of dosage form, number of constituents in each formulation, their pharmacological group and rationality. The total daily cost and its association with type of dosage form was analysed. Out of a total 1297 preparations evaluated, 94% were fixed dose combination. The mean number of constituents was 3.20 +/- 1.03. Liquid oral formulations were largest in number (64.4%). The formulations contained various antitussives (30.30%), expectorants (33.92%), antihistamines (71.09%), mucolytics (35.62%), decongestants (56.28%), bronchodilators (16.81%) and analgesics/antipyretics (31.30%). None of the preparation was listed in the Model list of Essential Medicines, WHO (March 2011) under section 25 of "Medicines acting on the respiratory tract". Only 2% of the preparations had pharmacological rationale for their use in cough and common cold; 9.6% were containing more than one ingredient of the same pharmacological group and 6.85% were containing both antitussive and expectorant having opposing action. Highest number of preparations (36.85%) was having cost of therapy of Rs 6-10 per day. Liquid oral dosage forms had significantly higher cost than solid dosage form (p < 0.0001) and topical nasal dosage forms had significantly higher cost than liquid (p < 0.03) and solid (p < 0.001) dosage forms. It is conducted that various cough and cold medicines available in Indian market lacked therapeutic rationale for their use, leading to wasteful expenditure.

The association of pseudoephedrine sales restrictions on emergency department urine drug screen results in Oklahoma.

On June 15, 2004, Oklahoma became the first state to reclassify pseudoephedrine as a Schedule V drug. Arrests in Oklahoma for the manufacture of methamphetamines in clandestine laboratories precipitously declined. It was hypothesized that a decrease in methamphetamine use could be shown in the patient population in Oklahoma's largest emergency department. To test this hypothesis, all urine drug screen results in the Saint Francis Hospital Trauma Emergency Center from January 2003 through May 2005 were reviewed. There was a significant increase in the total tests performed and the percentage of positive test results for the amphetamine drug class (p = 0.0004, R2 = 0.3785) over time. These results suggest that methamphetamine usage has not decreased in the emergency department patient population. Possibly, methamphetamine usage in Oklahoma has not been impacted by the passage of HB 2176 due to an increase in drug trafficking of methamphetamine into the state.

Cost-effective pharmacotherapy for inhalant allergic rhinitis.

The otolaryngologist is one of the decision leaders for patients who seek to learn more about their problems of respiratory allergy. Although these patients do not have a life-threatening illness, the reduction of quality of life and performance can significantly restrict their overall sense of well being. Patients with allergic rhinitis desire the relief of the bothersome problems without other side effects. Second-generation antihistamines were introduced to reduce the significant impairment brought on by the sedation of the first-generation products. Most physicians prescribe the intranasal corticosteroids as the prescription drug of first choice for most patients with chronic allergic rhinitis. Second-generation H1 receptor antagonists are better for the patient than the first-generation drugs because of the reduced side-effect profile and improved tolerance. Compliance factors certainly need to be addressed with medications that need more than once-daily dosing. Patients with only sporadic problems in season or on limited exposure are best treated with oral antihistamines, topical cromolyn, and short-term decongestant therapy.

The impact of over-the-counter availability of nasal sprays on sales, prescribing, and physician visits.

OBJECTIVE: The aim was to study changes in sales and prescribing of nasal decongestants containing oxymetazoline or xylometazoline, changes in number of physician visits for rhinitis and sinusitis, and changes in public expenditures for physician visits due to the switch of these drugs from prescription to over-the-counter status in Sweden in 1989. DESIGN: Retrospective registry study using the local sales statistics on medicines in the municipality of Tierp from The National Corporation of Swedish Pharmacies and the individual-based computerised registry in Tierp based on health care utilisation and drug use from the Centre for Primary Care. Analyses were carried out during the time period 1988-1995. SETTING: The Swedish community of Tierp with about 20,000 inhabitants. SUBJECTS: The population of Tierp. MAIN OUTCOME MEASURE: Sales of nasal decongestants and dispensed prescriptions of nasal decongestants, physician visits for rhinitis and sinusitis, and public expenditures for these. RESULTS: Sales of nasal sprays increased, while sales of nasal drops decreased. The number of dispensed prescriptions as well as physician visits decreased. The public expenditures estimated for physician visits decreased as well. CONCLUSION: This study shows an increase in sales of nasal decongestants and a significant decrease in prescribing of nasal decongestants and the number of physician visits for rhinitis and sinusitis as well as the public expenditures estimated for these, after the switch from prescription to over-the counter status of nasal sprays in 1989.

Cost-effective pharmacotherapy for allergic rhinitis.

This article provides guidelines for pharmacotherapy to maximize symptom relief from allergic rhinitis. Consideration of frequency, severity, and site of symptoms is important in directing pharmacotherapy efficacy and maximizing cost-effectiveness. The agents available include antihistamines, decongestants, steroids, mast cell stabilizers, anticholinergic agents, and mucolytics. Appropriate indications for each and combinations of various agents are discussed within the context of drug efficacy, side effects, affordability, and ease of compliance. The direct and indirect costs of allergic rhinitis are not well delineated but are explored to put the costs of therapy in perspective.

Promotion of OTC products within a network-model HMO.

The drug benefits of most health plans do not include reimbursement for over-the counter (OTC) drugs. However, one PMB found that significant savings could be obtained if the OTC option was encouraged.

An overview of current pharmacotherapy in perennial rhinitis.

BACKGROUND: Individuals with rhinitis experience significant morbidity due to their disease. Research and clinical care to reduce this suffering are important. OBJECTIVE: To review the pharmacological agents that have been developed for the treatment of perennial rhinitis. METHOD: Literature review of human studies. RESULTS: Medication classes include antihistamines, decongestants, anticholinergics, cromolyn sodium, and corticosteroids. These vary in regard to their pharmacology, efficacy, and adverse effects. Compliance and cost issues are also critical components of the therapeutic regimen. CONCLUSION: Carefully chosen pharmacotherapy based on an understanding of the pathophysiology of the disease, knowledge of the potential of medications, and commitment to an ongoing patient/physician education and monitoring program can lead to improved well-being for individuals with perennial rhinitis.

A pharmacologic continuum in the treatment of rhinorrhea: the clinician as economist.

The economics of medications are now of great concern to health-care providers. Pharmacoeconomic issues are by no means simple, and yet, ironically, they assume greater importance in prescribing for modest disorders like rhinorrhea than for life-threatening conditions. The therapeutic continuum of quality and cost becomes foreshortened, and safety is an additional concern. Choosing the appropriate medication for rhinorrhea, then, can pose a challenge to the clinician, just as choosing a vital medication. This paper reviews the usage, quality, and cost of major therapies for the rhinorrhea that occurs secondary to various conditions, including nasal steroids, antihistamines and anticholinergics, and discusses the role of the clinician in factoring costs into therapy.