Resource utilisation and costs of treatment with doxazosin versus tamsulosin
in men with benign prostatic hyperplasia
G Oster, J Edelsberg, A Pozniak, D Thompson
Pages 31-40 ¦ Abstract ¦
Tooley PJH, Cookson RH, Jones M, Nuyts GD
Medical events and resource utilisation in cancer-pain patients treated with
strong opioids: an analysis of the UK General Practice Research Database
J Outcomes Res 2000; 4: 1-14
We studied the medical events and use of healthcare resources during general
practitioner (GP) management of severe cancer pain. A total of 2,323 anonymised
patient records were allocated to three cohorts depending on their initially prescribed
strong opioid: TTS-fentanyl (TTS, n=270); immediate-release strong opioids (IRO,
n=1909); and other sustained-release strong opioids (SRO, n=144). The groups were
comparable for age. TTS tended to be used more in women. Median duration of cancer
prior to strong opioid treatment was 7.1, 6.0, and 5.3 months in TTS, IRO and
SRO, respectively. Mean duration of strong opioid treatment was 68 days (TTS),
97 days (IRO) and 92 days (SRO). TTS had a similar medical events profile to SRO,
but a lower risk of important medical events than IRO. Compared to TTS, patients
on IRO had more constipation (relative risk [RR] 1.49; 95% confidence interval
[CI] 1.14-1.94), more nausea or vomiting (RR 1.43; 95% CI 1.09-1.88) and more
cardiac events (RR 1.95; 95% CI 1.15-3.29); SRO patients had a greater incidence
of cardiac events (RR 2.79; 95% CI 1.49-5.22).
Compared to IRO and SRO, fewer TTS patients consumed additional pain medication,
laxatives, antibiotics and central nervous system medication. Compared to TTS,
IRO patients had a higher rate of hospitalisations (RR 1.95;
95% CI 1.14-3.31) and GP visits (RR 1.21; 95% CI 0.98-1.49).
The use of TTS is associated with improved patient tolerability and a reduction
in the use of healthcare resources when compared to other strong opioids.
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Osborne RH, Hawthorne G, Papanicolaou M, Wegmueller Y
Measurement of rapid changes in health outcomes in people with influenza symptoms
J Outcomes Res 2000; 4: 15-30
Clinical trials' outcomes assessment requires symptoms and health status tracking,
particularly where symptoms come and go rapidly. We report indicators assessing
health in people suffering influenza symptoms where changes occur daily.
Thirty-six people with influenza symptoms completed self-report questionnaires
daily for 8 days: including the Influenza Impact Wellbeing Scale (IIWS) probing
health, sleep quality and ability to perform usual activities; and the Assessment
of Quality of Life (AQoL), a health-related quality of life instrument. An 11-item
checklist, the Influenza Symptom Severity (ISS) scale, assessed influenza symptoms
severity. Psychometric properties of the IIWS and ISS are reported.
Over the 8 days, ISS scores decreased by 75%, IIWS scores increased by 58% and
AQoL scores improved by 10% (all p <0.01). Influenza symptoms recorded by the
ISS scale predicted 50% of the variation in the IIWS.
All three instruments were sufficiently sensitive to track rapid health status
changes and may be useful outcomes measures in clinical trials involving influenza
patients. These are promising results that require confirmation in larger studies.
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Oster G, Edelsberg J, Pozniak A, Thompson D
Resource utilisation and costs of treatment with doxazosin versus tamsulosin
in men with benign prostatic hyperplasia
J Outcomes Res 2000; 4: 31-40
We used claims data (spanning August 1996 through December 1998) from a large
New England health insurer to examine differences in utilisation and costs of
care among men with benign prostatic hyperplasia (BPH) who received doxazosin
versus tamsulosin. All male plan members who had a diagnosis of BPH and started
therapy with doxazosin (n=394) or tamsulosin (n=167) were included. Measures of
interest included all BPH-related prescription drug therapy, office-based physician
services, tests and procedures, and hospital inpatient and outpatient services
over a 90-day period of follow-up. Subjects in the doxazosin group had fewer physician
visits (-0.13; 95% CI: -0.25, -0.01), lower mean costs of BPH-related drug therapy
(-$12; 95% CI: -$18, -$6) and physician services (-$11; 95% CI: $-23, $0), and
nominally lower mean total costs of BPH-related treatment (-$67; 95% CI: -$219,
$85) than those in the tamsulosin group.
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