Treatment, health care utilization and health outcomes among primary care patients with generalized anxiety disorder in the United Kingdom

The purpose of this study was to determine treatment patterns for primary care patients with Generalized Anxiety Disorder (GAD) in the United Kingdom. Associations between drug treatments, demographic characteristics, clinical outcomes, resource utilization and other economic outcomes were examined. A 12-month retrospective study using a sample of GAD patients from the General Practice Research Database during 1997–99 was conducted. 2,678 patients treated with benzodiazepines (38.1%), serotonin reuptake inhibitors (SRIs) (11.5%), tricyclic antidepressants (TCAs) (13.0%), beta-blockers (30.4%), buspirone (3.3%) and thioxanthene (3.3%) were included. Benzodiazepines were more frequently prescribed to women (p \u3c 0.048), older patients (p \u3c 0.0001), patients with GAD history (p \u3c 0.0153) and history of substance abuse (p \u3c 0.0197), and to patients from Wales, Scotland and Northern Ireland compared to England (p \u3c 0.001). Among 2,499 patients treated with benzodiazepines, SRIs, TCAs and beta-blockers, 20.6 percent experienced some treatment failure, defined as treatment switches or augmentations and/or mental disease related referrals, hospitalizations or emergency visits. Treatment success, physician recorded patient improvement, was seen in 5.4 percent of the patients. There were no differences in likelihood of treatment failure or time-to-treatment failure between drug classes after controlling for risk factors including age, gender, region, dose, prior mental or somatic illnesses and health services utilization. Physician recorded improvement was six times more likely in patients treated with SRIs (p \u3c 0.0001) than in those treated with benzodiazepines after adjusting for risk factors. SRIs also had higher improvement rates than TCAs and beta-blockers (both p \u3c 0.01). However, patients treated with beta-blockers received significantly fewer prescriptions and incurred significantly fewer outpatient visits compared to other groups (both p \u3c 0.0001) after adjustment for risk factors. Costs related to GAD drugs and mental-health services use were significantly higher in the SRIs group primarily due to higher drug costs (£168 [£152–£184], p \u3c 0.0001). Likelihood of mental-health related work-loss was significantly higher in patients treated with TCAs (7.7%) compared to those on beta-blockers (3.5%). Mean mental-health related absence among all GAD patients was 2.4 days and 55.7 days among patients with at least one mental-health related work absence. No differences between treatment groups were noted after adjustment for risk factors. Given the results of this study, there is no clear evidence that treatment with any particular drug provides better long-term clinical outcomes among GAD patients although physicians recorded higher improvement following treatment with SRIs. Treatment costs were substantial, and higher in GAD patients treated with SRIs than in any other group. Despite likely incomplete recording of work-absence data, GAD is responsible for significant work-loss

Healthcare Utilisation and Costs Associated with Adding Montelukast to Current Therapy in Patients with Mild to Moderate Asthma and Co-Morbid Allergic Rhinitis: PRAACTICAL Study

Objective: To evaluate the healthcare resource use and costs associated with adding montelukast to therapy in patients with mild to moderate persistent asthma and co-morbid seasonal allergic rhinitis whose asthma is inadequately controlled by their current asthma therapy. Methods: A multicentre, pre-post retrospective cohort study was conducted in three European countries (Italy, Poland and Spain). Consecutive patients who were receiving inhaled corticosteroid therapy (monotherapy or combination therapy with long-acting beta2-adrenoceptor agonists) and who started concomitant treatment with montelukast between January 1999 and December 2002 were identified from clinical charts. Asthma/seasonal allergic rhinitis-related concomitant medications and asthma-related outpatient care, ED visits and hospitalisations for the periods 12 months before and 12 months after montelukast initiation were recorded from patient charts and combined with country-specific published unit costs (adjusted to 2004 values). The analysis was performed from a third-party-payer perspective and thus direct healthcare resource utilisation due to asthma/seasonal allergic rhinitis and associated costs for each country were estimated. Results: A total of 98 physicians provided data for 696 asthmatic patients with seasonal allergic rhinitis (Italy: n = 158; Poland: n = 334; and Spain: n = 204). The mean age of patients was 32.7 years, 57.5% were female and patients had asthma that was considered either mild-persistent (54.5%) or moderate-persistent (45.5%) according to the Global Initiative for Asthma classifications. The introduction of montelukast (10 mg/day daily cost range _0.8-1.68) was associated with increases in the total annual mean healthcare cost per patient of 11.9%, 60.4% and 5.5% for Italy, Poland and Spain, respectively. However, mean annual costs for asthma-related outpatient care, ED visits and hospitalisations dropped significantly in all three countries (Italy: from _805.00 to _281.60 [p_Allergic-rhinitis, Asthma, Cost-analysis, Montelukast, Resource-use

Association between asthma control in children and loss of workdays by caregivers

International audienceBACKGROUND: Although the economic burden of pediatric asthma is a significant public health issue, the loss of workdays by caregivers because of their children's asthma remains scarcely investigated. OBJECTIVES: To evaluate asthma-related loss of workdays incurred by caregivers of asthmatic children and its association with the level of asthma control. METHODS: A retrospective observational study was conducted based on a French computerized general practitioners' database and a survey questionnaire. Children aged 6 to 16 years with persistent asthma (Global Initiative for Asthma grade \\textgreater or = 2) were included in the study. Level of children's asthma control was evaluated from recent asthma symptoms. Caregivers reported the number of workdays lost because of their child's asthma during the 12-month study. RESULTS: Nearly 30% of caregivers lost workdays during the study because of their children's asthma. More than 13% of caregivers lost more than 5 days. Caregiver absenteeism significantly correlated with all components of asthma control (use of relievers, nocturnal symptoms, impairment of activities, and asthma crises). A significant 8-fold risk of losing more than 5 workdays by caregivers was observed when the child's asthma was poorly controlled (odds ratio, 8.6; 95% confidence interval, 2.4-30.5); caregivers' absenteeism also increased significantly with the number of episodes of oral corticosteroid use during the study. CONCLUSIONS: Caregivers' loss of workdays owing to their children's asthma is substantial and is highly correlated with the level of asthma control. These findings highlight the necessity of educational programs for children with poor asthma control and their caregivers to prevent severe asthma attacks that lead to caregiver absenteeism