Mixed dyslipidemias in primary care patients in France

Laurent Laforest1, Baishali M Ambegaonkar2, Thierry Souchet3, Vasilisa Sazonov2, Eric Van Ganse11Lyon University, Lyon, France; 2Merck and Co Inc, Whitehouse Station, NJ, USA; 3Merck, Sharp & Dohme, Paris, FranceObjective: To determine the prevalence of single and mixed dyslipidemias among patients treated with statins in clinical practice in France.Methods: This is a prospective, observational, cross-sectional, pharmacoepidemiologic study with a total of 2544 consecutive patients treated with a statin for at least 6 months.Main outcome measures: Prevalence of isolated and mixed dyslipidemias of low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides among all patients and among patients at high cardiovascular risk; clinical variables associated with attainment of lipid targets/normal levels in French national guidelines.Results: At least one dyslipidemia was present in 50.8% of all patients and in 71.1% of high-risk patients. Dyslipidemias of LDL-C, HDL-C, and triglycerides were present in 27.7%, 12.4%, and 28.7% of all patients, respectively, and in 51.0%, 18.2%, and 32.5% of high-risk patients, respectively. Among all subjects with any dyslipidemia, 30.9% had mixed dyslipidemias and 69.4% had low HDL-C and/or elevated triglycerides, while 30.6% had isolated elevated LDL-C; corresponding values for high-risk patients were 36.8%, 58.9%, and 41.1%. Age, gender, body mass index and Framingham Risk Score >20% were the factors significantly associated with attainment of normal levels for ≥2 lipid levels.Conclusions: At least one dyslipidemia persisted in half of all patients and two-thirds of high cardiovascular risk patients treated with a statin. Dyslipidemias of HDL-C and/or triglycerides were as prevalent as elevated LDL-C among high cardiovascular risk patients.Keywords: cholesterol, triglycerides, dyslipidemias, prevalence, treatment outcome, Franc

Una checklist per la gestione dei costi nel trattamento dell’HIV

The human immunodeficiency virus (HIV) infection is currently one of the major health problems in the world. Since the first occurrence of the infection 17 years ago until today, many people have died of its devastating consequences and an enormous amount of health-related funds have been spent on the problem. The pandemic is still growing in some areas, and its negative impact on society is in-creasing. This is the main reason why scientists are trying to find the best way to reduce costs and still keep the same level of management or, in some ways, even improve it (e.g., new combination of drugs in one pill—fewer pills to be taken per day). Since HIV infection has been. a fatal, severe, and widespread disease, a so-called global problem, very early in the course of the pandemic the idea of economic evaluation was raised. Published studies mostly presented the antiretroviral drugs in the frames of pharmacoeconomic models or costs of HIV/AIDS according to development of the disease through longer time periods. The cost sections that have to be considered in any pharmacoeconomic study of HIV management are briefly presented. Often the presented costs are confusing and could be misleading. Direct, indirect, and intangible costs are described

Effect of Allergic Rhinitis on the Use and Cost of Health Services by Children with Asthma

Purpose: Allergic rhinitis (AR) is common among children with asthma and exacerbates asthma symptoms. To assess the incremental utilization and cost of asthma-related health services due to concomitant AR among asthmatic children. Materials and Methods: Asthma-related claims were extracted from the Korean National Health Insurance (NHI) claims database, which covers 97 % of the population. Per-capita utilization and costs of asthma-related services were determined from the societal perspective. Results: Of 319,714 children (1- 14 years old) with chronic asthma in 2003, 195,026 had concomitant AR (prevalence 610 per 1,000 asthmatic children). Children with AR had 1.14 times more outpatient visits, 1.30 times more emergency department (ED) visits, and 1.49 times more hospitalizations than children without AR. More children with AR used general hospitals (7.17%) than children without AR (3.23%). The ratios of unit pharmaceutical costs per outpatient visit, ED visit, and admission between children with and without AR were 1.27, 1.20, and 1.14. Total annual expenditure combining direct health care, transportation, and caregivers ' costs, were $273 and$217 for children with and without AR, respectively. Conclusion: Health service utilization and costs for asthma were greater for asthmatic children with AR. More frequent ED visits and admissions among asthmatic children with AR suggest poorer control and more frequent exacerbations. Higher unit cost of pharmaceuticals during visits, tendency to receive asthma care from a higher-level facility, and greater risk of ED visit or admission all contributed to the additional economic burden of AR

Rates of asthma attacks in patients with previously inadequately controlled mild asthma treated in clinical practice with combination drug therapy: an exploratory post-hoc analysis

<p>Abstract</p> <p>Background</p> <p>Differences could exist in the likelihood of asthma attacks in patients treated with inhaled corticosteroid (ICS), long-acting beta-agonist (LABA), and montelukast (MON) (ICS/LABA/MON) and patients treated with an inhaled corticosteroid (ICS) and montelukast (MON) (ICS/MON).</p> <p>Methods</p> <p>This was a post-hoc analysis of a pretest-posttest retrospective cohort study. Patients with mild persistent asthma and allergic rhinitis, who were taking an ICS either alone or in combination with a LABA, started concomitant MON treatment as part of their routine care. Rates of asthma- and allergic rhinitis-related medical resource use in the 12-months after the initial (index) MON prescription were compared in the ICS/MON and ICS/LABA/MON groups. An asthma attack was defined as an asthma-related hospitalization, ER visit, or use of an oral corticosteroid.</p> <p>Results</p> <p>Of the total of 344 patients, 181 (53%) received ICS/MON and 163 (47%) received ICS/LABA/MON in the post-index period for means of 10.5 and 11.4 months, respectively, (P < 0.05). Short-acting beta-agonists were used by 74.6% in the ICS/MON and 71.8% in the ICS/LABA/MON groups (P > 0.05). An asthma attack occurred in 4.4% of the ICS/MON group and 6.8% of the ICS/LABA/MON group (P > 0.05). The adjusted odds of an asthma attack in the post-index period in the ICS/LABA/MON group relative to the ICS/MON group was 1.24, 95% confidence interval 0.35–4.44.</p> <p>Conclusion</p> <p>In this observational study of combination drug treatment of mild persistent asthma and allergic rhinitis, no difference was observed between LABA/ICS/MON combination therapy and the ICS/MON combination without LABA use, for the rate of asthma attacks over one year.</p

Prevalence of lipid abnormalities before and after introduction of lipid modifying therapy among Swedish patients with dyslipidemia (PRIMULA)

<p>Abstract</p> <p>Background</p> <p>Data on the prevalence of dyslipidemia and attainment of goal/normal lipid levels in a Swedish population are scarce. The objective of this study is to estimate the prevalence of dyslipidemia and attainment of goal/normal lipid levels in patients treated with lipid modifying therapy (LMT).</p> <p>Methods</p> <p>This longitudinal retrospective observational study covers time periods before and after treatment. Data were collected from 1994-2007 electronic patient records in public primary healthcare centers in Uppsala County, Sweden. Patients were included if they had been treated with LMT and had at least one lipid abnormality indicating dyslipidemia and if complete lipid profile data were available. Thresholds levels for lipids were defined as per Swedish guidelines.</p> <p>Results</p> <p>Among 5,424 patients included, at baseline, the prevalence of dyslipidemia (≥1 lipid abnormality) was by definition 100%, while this figure was 82% at follow-up. At baseline, 60% had elevated low-density lipoprotein (LDL-C) combined with low high-density lipoprotein (HDL-C) and/or elevated triglycerides (TG s), corresponding figure at follow-up was 36%. Low HDL-C and/or elevated TGs at follow-up remained at 69% for patients with type 2 diabetes mellitus (T2DM), 50% among patients with coronary heart disease (CHD) and 66% among patients with 10 year CHD risk >20%. Of the total sample, 40% attained goal levels of LDL-C and 18% attained goal/normal levels on all three lipid parameters.</p> <p>Conclusions</p> <p>Focusing therapy on LDL-C reduction allows 40% of patients to achieve LDL-C goal and helps reducing triglyceride levels. Almost 60% of patients experience persistent HDL-C and/or triglyceride abnormality independently of LDL-C levels and could be candidates for additional treatments.</p

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

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

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