Farmakoekonomické a farmakoepidemiologii aspekty alergie rýmy Léčba a prevence

8 Závěr Cílem racionální farmakoterapie je zajistit bezpečnou a nákladově efektivní léčbu pacientů s alergickou rýmou (AR). Tato dizertační práce se zabývá dvěma aspekty léčby alergické rýmy (1) srovnáním účinků a nákladů sublinguální a subkutánní aplikační formy specifické alergenové imunoterapie (SIT) u pacientů s alergickou rýmou, a (2) systémovými nežádoucími účinky intranazálních kortikosteroidů - konkrétně neuropsychiatrickými potížemi a gynekomastií. 1. Specifická alergenová imunoterapie: účinnost a náklady o Výsledky naší farmakoekonomické studie prokázaly účinnost obou aplikačních forem SIT ve srovnání se standardní farmakologickou léčbou a to ve smyslu zlepšení klinických příznaků a snížení spotřeby symptomatických léků u pacientů se sezónní alergickou rhinokonjunktivitidou. Ačkoliv se účinnost obou aplikačních forem SIT ve třetím roce její aplikace signifikantně nelišila, zlepšení klinického stavu bylo ve skupině léčené subkutánně výraznější. Z ekonomického hlediska, byla SIT aplikována sublinguálně výhodnější než aplikace subkutánní, a to jak z pohledu pacienta a zdravotní pojišťovny, tak i společnosti. Pouze ve specifických případech, kdy pacienti neměli finanční výlohy na cestovné a nepřišli o mzdu z důvodu návštěvy alergologa v pracovní době, byla subkutánní aplikační forma levnější než...7 SUMMARY Rational pharmacotherapy should ensure a safe and cost-effective treatment of patients with allergic rhinitis (AR). Two main aspects of treatment of AR were addressed (1) comparative benefits and costs of subcutaneous and sublingual allergen immunotherapy in patients with allergic rhinitis, and (2) systemic adverse events - neuropsychiatric disorders and gynaecomastia - during intranasal corticosteroid use. (1) Allergen specific immunotherapy: benefits and costs Our pharmacoeconomic study on allergen specific immunotherapy showed that sublingual and subcutaneous immunotherapy reduced clinical symptoms and the need for symptomatic medication in adults with grass pollen induced rhinoconjunctivitis compared to standard pharmacological treatment. The clinical efficacy of the sublingual and subcutaneous immunotherapy was not significantly different in the third year of specific immunotherapy. Nevertheless, the SCIT group exhibited slightly better improvement in visual analogue scale and a greater reduction of systemic antihistamines versus SLIT in the third year compared to the baseline year. Overall, SLIT showed a better cost profile from all three perspectives. SCIT was financially favorable from a patient perspective where no loss of income and travel costs were present. Larger comparative studies...Katedra sociální a klinické farmacieDepartment of Social and Clinical PharmacyFaculty of Pharmacy in Hradec KrálovéFarmaceutická fakulta v Hradci Králov

Pharmacoeconomic and Pharmacoepidemiology Aspects of Allergy Rhinitis Treatment and Prevention

7 SUMMARY Rational pharmacotherapy should ensure a safe and cost-effective treatment of patients with allergic rhinitis (AR). Two main aspects of treatment of AR were addressed (1) comparative benefits and costs of subcutaneous and sublingual allergen immunotherapy in patients with allergic rhinitis, and (2) systemic adverse events - neuropsychiatric disorders and gynaecomastia - during intranasal corticosteroid use. (1) Allergen specific immunotherapy: benefits and costs Our pharmacoeconomic study on allergen specific immunotherapy showed that sublingual and subcutaneous immunotherapy reduced clinical symptoms and the need for symptomatic medication in adults with grass pollen induced rhinoconjunctivitis compared to standard pharmacological treatment. The clinical efficacy of the sublingual and subcutaneous immunotherapy was not significantly different in the third year of specific immunotherapy. Nevertheless, the SCIT group exhibited slightly better improvement in visual analogue scale and a greater reduction of systemic antihistamines versus SLIT in the third year compared to the baseline year. Overall, SLIT showed a better cost profile from all three perspectives. SCIT was financially favorable from a patient perspective where no loss of income and travel costs were present. Larger comparative studies..

Optimising the care for older persons with complex chronic conditions in home care and nursing homes: design and protocol of I-CARE4OLD, an observational study using real-world data

Introduction In ageing societies, the number of older adults with complex chronic conditions (CCCs) is rapidly increasing. Care for older persons with CCCs is challenging, due to interactions between multiple conditions and their treatments. In home care and nursing homes, where most older persons with CCCs receive care, professionals often lack appropriate decision support suitable and sufficient to address the medical and functional complexity of persons with CCCs. This EU-funded project aims to develop decision support systems using high-quality, internationally standardised, routine care data to support better prognostication of health trajectories and treatment impact among older persons with CCCs.Methods and analysis Real-world data from older persons aged ≥60 years in home care and nursing homes, based on routinely performed comprehensive geriatric assessments using interRAI systems collected in the past 20 years, will be linked with administrative repositories on mortality and care use. These include potentially up to 51 million care recipients from eight countries: Italy, the Netherlands, Finland, Belgium, Canada, USA, Hong Kong and New Zealand. Prognostic algorithms will be developed and validated to better predict various health outcomes. In addition, the modifying impact of pharmacological and non-pharmacological interventions will be examined. A variety of analytical methods will be used, including techniques from the field of artificial intelligence such as machine learning. Based on the results, decision support tools will be developed and pilot tested among health professionals working in home care and nursing homes.Ethics and dissemination The study was approved by authorised medical ethical committees in each of the participating countries, and will comply with both local and EU legislation. Study findings will be shared with relevant stakeholders, including publications in peer-reviewed journals and presentations at national and international meetings