摘要:

The costs of epilepsy, one of the most common neurological diseases, affect society as a whole as well as patients themselves. Approximately 15% of patients with epilepsy are considered to have difficult-to-treat or treatment-refractory epilepsy, and their impact on healthcare systems is disproportionate to their number. It could be assumed that treating these patients would be cost effective, because of the significant disability that results from nontreatment.The cost of antiepileptic drugs can be a significant problem in itself, particularly since epilepsy is a chronic condition. In addition. Other direct (e.g. professional fees, investigation and hospitalisation expenses) and indirect (e.g. loss of productivity and impairment in quality of life) costs should not be overlooked when assessing the overall costs of the illness. Indirect costs are often significantly greater than direct costs.Recently, there has been increasing interest in the use of newer anticonvulsant drugs and surgery in the management of patients with apparently intractable epilepsy. Despite some general agreement about the indications for each of these therapies, systematic assessments of their relative cost effectiveness are still needed. Cost effectiveness in the use of newer, as well as older, therapies implies paying attention to the efficacy of the therapy, direct and indirect costs, patient quality of life (including cognition, behaviour, self-esteem, daily functioning and social activities), and the relationships that patients have with their families and society.Appropriate choice of therapy and judicious use of newer diagnostic procedures are important factors in planning the treatment of individual patients and developing treatment guidelines.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Diabetes is a serious chronic disease. It is the fourth leading cause of death by disease and is the leading cause of blindness in people between the ages of 20 and 74 years. Diabetes is responsible for over one-third of patients on dialysis, and accounts for over half of all nontraumatic lower extremity amputations. It doubles the risk of stroke and increases the chances for a heart attack 2-fold in men and 4- to 5-fold in women.Sadly, much of these devastating complications need not happen if only certain evidence-based outcome and performance measures for good diabetes care are followed. Ten of these are presented and discussed. Some are quantitative outcomes (glycaemia, lipids, renal evaluation and blood pressure) and the evidence for each is summarised. If these outcomes are not achieved, additional action is required, an approach not included in previous promulgations of guidelines for diabetes care. Others are process measures so closely linked to outcomes that few could argue about their importance are presented as surrogate end-points (office visits, eye and foot examinations, measurement of weight and assessment of smoking).The establishment of a Provider Recognition Program by the American Diabetes Association as an inducement for physicians to improve their level of diabetes care is described. The recent cosponsorship of this programme by the National Committee of Quality Assurance, the accrediting body of health maintenance organisations, is likely to play a major role in the improvement of diabetes care in managed care organisations.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

This paper reviews the most recent epidemiological, clinical services and economic literature on depression. The epidemiological section discusses the intriguing question if there has been a change in the frequency of depression during the last decade and concludes that there is not enough empirical evidence to support the presence of an epidemic in depression. The clinical services section addresses the issue of the unmet need for treatment and finds that to date, no criteria have been developed to decide who should be treated if not everybody can be treated due to scarce resources. The economic section describes the various approaches used to estimate the economic burden of depression on society. The paper points out that the discrepancy between diagnostic and treated prevalence implies that many untreated cases are hidden for various reasons and this results in unnecessary, hidden economic loss.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Migraine with or without aura can be debilitating to the individual and costly to society. It is most common in women and in persons at the peak of their productive working lives. Many migraineurs are never diagnosed and most are undertreated. Nonpharmacological measures such as eliminating suspected dietary trigger factors and lifestyle modification may be helpful, but pharmacotherapy is often required.For treating acute attacks, most patients rely on over-the-counter remedies such as simple analgesics plus an antiemetic; fewer than half use prescription drugs on a routine basis. Simple analgesics are effective for mild attacks, but moderate to severe migraine should be treated with drugs such as NSAIDs, combination analgesics, serotonin (5-hydroxytryptamine; 5-HT) agonists, either nonselective (ergot alkaloids) or selective (sumatriptan), or phenothiazines.Sumatriptan relieves headache pain and accompanying nonheadache symptoms in moderate to severe acute migraine headache with or without aura. It has a rapid onset of action, particularly when given subcutaneously or intranasally; these formulations are particularly suitable for patients unable to take oral drugs or suppositories because of vomiting or diarrhoea. Sumatriptan is effective in some difficult-to-treat forms of migraine, such as early morning attacks and menstrual migraine. The drug is generally well tolerated and remains effective during repeated long term use.Sumatriptan is at least as effective as other agents with which it has been compared. Limited evidence suggests that newer selective serotonin agonists may offer some advantages over oral sumatriptan, but broader clinical experience is needed to assess this.Provision of an effective treatment which patients can self-administer for acute migraine episodes can reduce the likelihood of emergency room treatment being required. Both the acquisition cost and the incidence of headache recurrence associated with sumatriptan are relatively high. However, these considerations need to be weighed against benefits such as improved functional ability and quality of life and reductions in lost productivity when deciding whether sumatriptan therapy is appropriate and rational from clinical and economic perspectives.At present, sumatriptan remains a valuable therapy for managing moderate to severe acute migraine attacks, including those which do not respond to other treatments. Whether it is used as first- or second-line therapy is likely to depend on severity of migraine and economic, rather than efficacy, factors among different countries and institutions.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS