1
C URR ENT I SS U ES associated costs, patients are treated either at home or at a general practitioner's (GP) surgery. Among 31 patients attending an outpatient clinic al the hospital, 29 receive IV therapy and I patient each receives SC and 1M therapy. or those patients receiving IV immunoglobulins. 7 are treated at home and II at a GP's surgery. The annual costs of immuno- globulin therapy are 5U55380 and SUS9530/palieni for SC and IV administration, respectively - this is based on an average of 18g of immunoglobulin every 4 weeks. In contrast, Scandinavian researchers favour the use of SC immunoglobulin therapy.2 They report that use of the se. rather than the IV, route reduced annual treatment costs by $USIO I 28/0utpatient in Sweden.' • See PhannacoResources 23; 8. 25 Feb /995 I. Dams ETh\1. e\ aI. SuOCu\.aIlCO\lS immunoglobulin replacement in patients with prinwy antibody dcflCicocies. Unce\ 34S: 864. L Apr 1995 1. Ganlulf A. CI aI. Sub:.:u\Jll1eOUS immunoglobulin n:placement in patients with primary antibody dcflCicocics: safely and COSIS. Unce1 34S: 365-369. II Feb 1995 Screening and TB prophylaxis are counterproductive School-based programmes of screening for tuberculosis and providing isoniazid prophylaxis are counterproductive when they divert key resources away from successful tuberculosis control programmes, says EM Taylor from Medical Emergency Reli ef International. 'False sense of security' Th e o r ganisat ion is co ncerned about a sc reening and prophylaxis strategy on the basis of poor efficacy, efficiency and, in particular. high opportunity co sts. Such a programme could give health workers a 'false sense of sec urity', as well as increase primary resistance. Also the Mantoux screening lest is not reproducible, and resu lts can be confounded by a number of factors. EM Taylor be li eves thai Madico et al. * are optimistic in suggesting that isoniazid prophylaxis wou ld prevent active disease in 1 0-15 % of cases. Furthermore, their analysis did not include the costs associated with inves ti gation and follow-up . Different focus suggested EM Taylor suggests thai public health programmes in developing countries should focus on ensuring that patients with a diagnosis of tuberculosis receive r egu l ar supplies of the necessary medication. This is in agreement with Dr J Mark Fitzgerald from the British Columb ia Centre for Disease Contro l in Vancouver, Canada, who believes that isoniazid prophylaxis s h ould not be r out inely recommended in developing countri es. ** • See PhannocoResou rr:es 24: 6, II Mar 1995 ** See PhannacoResourr:es 24: 6, 11 Mar 1995 1'Iylor EM. screening ror tuben:ulolSis. Lancet 345: 9)0.931. 8 Apr 1995 -'" ,------------------, Did you know •.. ? Affect ive disorders impose a l arge burden on societal resources in the US, accord ing to Drs DP Ri ce and lS M il ler from the University of Calif orn ia, US. They suggest that substanti al savings could be made if patients with affecti ve di sorders receive 'timely and appropriate treatment interventions '. This conclusion was based on the following cost estimates . "" The economic impact of affective di sorders in the US was estimated at SUS20.8 billion in 1985. d" Between 1985 and 1 990, the estimated cost of affective disorders rose by 48% to reach $US30.4 billion. d" Direct treatment costs aa:ounted lor 58% of the 1985 total, morbidity costs comPI'ise:d 8%, mortality costs 29%, and other related costs (e.g. cost of crime and lost p roductivity due to imprisonment) 5%. d" In 1985, around one-quarter of d irect costs, or $US3.1 billion , was spent on short-stay hospital care , with another $32 binion spent on care in speciality institutions. Q" In contrast, p rescription drug costs were estimated at $US269 minion , or 2% of d irect costs . d" Overall , affective disorders ao::ounted for 21% of the cost of aU mental illnesses. Direct, indirect and other related costs of affective disorders comprised 29%, 13% and 22%, respectively, of the total cost of mental illness in the US. Ria: OP, Milb !.S. The burden of affective di$ordl:n. British Jwrnal of Psydtiatry 166 (Suppl. 27): 34-42. Apr 1995 - News in brief ... Early endoscopy may prove mo re cost effective than delaying investigation, suggest UK-based investigators. An Australian trial found no difference in clinical and financial ou tcomes between patients who received empirical therapy with endoscopy when needed and those who received early endoscopy followed by appropriate therapy. In addition, a Danish trial found a cost advantage with early endoscopy. The UK investigators also point to the potential clinical advantage of early detection of premalignant lesions or early gastric cancer. However. the cost of the procedure and the risk of complications must be consider ed as well as any potential advantages, they add. AilOO ATR. e1 aI. Guidelines 011 appropriate indiclttions for upper JASU'Ointestinal endoscopy. British Modkai Journal 310: 853-8S6. I Apr 1995 ....... ,. Drugs & Therapy Perspectives For Rational Drug Selection and Use &1' . ....... PHAAMACORESOURCES 22 Apr , IiII5 5

Screening and TB prophylaxis are counterproductive

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Page 1: Screening and TB prophylaxis are counterproductive

C URR ENT I SS U ES

associated costs, patients are treated either at home or at a general practitioner's (GP) surgery.

Among 31 patients attending an outpatient clinic al the hospital, 29 receive IV therapy and I patient each receives SC and 1M therapy. or those patients receiving IV immunoglobulins. 7 are treated at home and II at a GP's surgery. The annual costs of immuno­globulin therapy are 5U55380 and SUS9530/palieni for SC and IV administration, respectively - thi s is based on an average of 18g of immunoglobulin every 4 weeks.

In contrast, Scandinavian researchers favour the use of SC immunoglobulin therapy.2 They report that use of the se. rather than the IV, route reduced annual treatment costs by $USIO I 28/0utpatient in Sweden.' • See PhannacoResources 23; 8. 25 Feb /995 I. Dams ETh\1. e\ aI. SuOCu\.aIlCO\lS immunoglobulin replacement in patients with prinwy antibody dcflCicocies. Unce\ 34S: 864. L Apr 1995 1. Ganlulf A . CI aI. Sub:.:u\Jll1eOUS immunoglobulin n:placement in patients with primary antibody dcflCicocics: safely and COSIS. Unce1 34S: 365-369. II Feb 1995

Screening and TB prophylaxis are counterproductive

School-based programmes of screening for tuberculosis and providing isoniazid prophy laxis are counterproductive when they divert key resources away from successful tuberculosis control programmes, says EM Taylor from Medical Emergency Relief International.

'False sense of security' The o rganisation is concerned about a screening

and prophylaxis strategy on the basis of poor efficacy, efficiency and, in particular. high opportunity costs. Such a programme could give health workers a 'false sense of security', as well as increase primary resistance. Also the Mantoux screening lest is not reproducible, and results can be confounded by a number of factors.

EM Taylor believes thai Madico et al. * are optimistic in suggesting that isoniazid prophylaxis would prevent active disease in 10-15% of cases. Furthermore, their analysis did not include the costs associated with investi gation and follow-up.

Different focus suggested EM Taylor suggests thai public health programmes

in developing countries should focus on ensuring that patients with a diagnosis of tuberculosis receive regular supplies of the necessary medication. This is in agreement with Dr J Mark Fitzgerald from the British Columbia Centre fo r Di sease Control in Vancouver, Canada, who believes that isoniazid prophylaxis s hould not be routinely recommended in developing countries. ** • See PhannocoResourr:es 24: 6, II Mar 1995 ** See PhannacoResourr:es 24: 6, 11 Mar 1995 1'Iylor EM. Mantou~ screening ror tuben:ulolSis. Lancet 345: 9)0.931. 8 Apr 1995 -'"

,------------------, Did you know •.. ?

Affective disorders impose a large burden on societal resources in the US, according to Drs DP Rice and lS Miller from the University of California, US. They suggest that substantial savings could be made if patients with affective disorders receive 'timely and appropriate treatment interventions'. This conclusion was based on the following cost estimates. "" The economic impact of affective disorders in the US

was estimated at SUS20.8 billion in 1985. d" Between 1985 and 1990, the estimated cost of

affective disorders rose by 48% to reach $US30.4 billion.

d" Direct treatment costs aa:ounted lor 58% of the 1985 total, morbidity costs comPI'ise:d 8%, mortality costs 29%, and other related costs (e.g. cost of crime and lost productivity due to imprisonment) 5%.

d" In 1985, around one-quarter of direct costs, or $US3.1 billion, was spent on short-stay hospital care, with another $32 binion spent on care in speciality institutions.

Q" In contrast, prescription drug costs were estimated at $US269 minion, or 2% of direct costs.

d" Overall, affective disorders ao::ounted for 21% of the cost of aU mental illnesses. Direct, indirect and other related costs of affective disorders comprised 29%, 13% and 22%, respectively, of the total cost of mental illness in the US.

Ria: OP, Milb !.S. The ~ burden of affective di$ordl:n. British Jwrnal of Psydtiatry 166 (Suppl. 27): 34-42. Apr 1995 -

News in brief ...

• Early endoscopy may prove more cost effective tha n delaying investigation, suggest UK-based investigators. An Australian trial found no difference in clinical and financial outcomes between patients who received empirical therapy with endoscopy when needed and those who received early endoscopy followed by appropriate therapy. In addition, a Danish trial found a cost advantage with early endoscopy. The UK investigators also point to the potential clinical advantage of early detection of premalignant lesions or early gastric cancer. However. the cost of the procedure and the risk of complications must be considered as well as any potential advantages, they add.

AilOO ATR. e1 aI. Guidelines 011 appropriate indiclttions for upper JASU'Ointestinal endoscopy. British Modkai Journal 310: 853-8S6. I Apr 1995 .......,.

Drugs & Therapy Perspectives For Rational Drug Selection and Use

&1' ........ ~

PHAAMACORESOURCES 22 Apr , IiII5

5