Expert review of pharmacoeconomics & outcomes research
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Expert Rev Pharmacoecon Outcomes Res · Oct 2004
Idiopathic- and scleroderma-related pulmonary arterial hypertension: outcomes and QOL on bosentan.
Idiopathic pulmonary arterial hypertension (previously known as primary pulmonary hypertension) is a devastating disease of insidious onset, late diagnosis, progressive functional disability and poor prognosis. However, treatment with pulmonary arterial hypertension-specific agents has already changed the outlook wherever these agents are accessible. ⋯ It has additionally undergone a comprehensive quality of life trial and economic evaluation as therapy for idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension associated with scleroderma. This review explores the role of bosentan in providing cost-effective therapy compared with alternative treatments, and addresses the future considerations required to ensure accessible patient care for idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension associated with scleroderma.
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Although headache is the most prevalent pain disorder, the substantial societal and individual burden associated with it has been previously overlooked. The primary headaches including migraine, tension-type and cluster are the most prevalent forms but also a very high number of headaches secondary to analgesic overuse and various brain diseases are ignored without any specific acknowledgement or treatment. Migraine is listed as number 20 of all diseases with regard to years lived with disability, and headache accounts for approximately 20% of lost work days. ⋯ As most headache disorders remain prevalent, disabling, underdiagnosed and undertreated, public health initiatives to improve prevention and treatment are urgently required. Considerable benefits for society can be gained by specific strategies leading to reductions in the amount of sickness absence and impaired working abilities. The burden on affected individuals and their families quality of life may be improved by a general acceptance of the impact of headache disorders and the development of specific treatment strategies.
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Expert Rev Pharmacoecon Outcomes Res · Jun 2003
Behavioral pain assessment and the Face, Legs, Activity, Cry and Consolability instrument.
Difficulties assessing pain in individuals who cannot use self-report scales has led to their exclusion from clinical trials and rendered them vulnerable to undertreatment of pain. Although several observational pain scales are available for use in these populations, many lack the characteristics necessary for routine implementation into practice or research. ⋯ It has been validated in the postoperative setting in children 2-7 years of age and children aged 4-18 years with varying degrees of cognitive impairment. With minor revisions, the Face, Legs, Activity, Cry and Consolability pain scale may be useful to assess acute pain across populations of children and adults who are unable to self-report their pain.
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Expert Rev Pharmacoecon Outcomes Res · Feb 2003
Cost-effectiveness of nonemergency use of phenytoin.
Parenteral phenytoin is an effective agent used to manage seizures, but it is associated with adverse effects and must be given intravenously. Fosphenytoin is higher in drug cost, but is more soluble, better tolerated and can be infused at rates three times that of phenytoin. When infusion rate is not an issue the adverse effect risk becomes a focus of concern, as well as cost. ⋯ Strategies developed to promote the safe use of intravenous phenytoin are based on patient selection, recommended administration methods and patient monitoring. When rapid attainment of serum phenytoin levels is required or in patients at high risk of adverse effects secondary to parenteral phenytoin, fosphenytoin is clearly preferred. This review will focus on the implications of the use of parenteral phenytoin products in the nonemergent setting where potential adverse effects of parenteral phenytoin may be avoided with use of established criteria for patient selection and administration.