Consideration of these factors is vital when measuring the extent of both absenteeism and presenteeism, and will allow for more accurate estimation of the impact of RA on work productivity. This information may also guide interventions aiming to prevent or postpone work disability and job loss.

ABSTRACT.Purpose: To assess resource utilization and costs associated with glaucoma management in France and Sweden. Methods: A total of 267 patient records (121 in France, 146 in Sweden) with diagnoses of primary open-angle glaucoma (POAG) and ocular hypertension (OH), treated medically, were reviewed for a 2-year period (beginning during 1997-99) for relevant clinical and resource utilization data. Economic data were applied to estimate treatment costs. Results: The annual cost of treating glaucoma was estimated at SEK5305 (E531)/patient in Sweden and E390/patient in France. In both countries, medication costs comprised about half of the total costs. Surgical procedures and hospitalizations represented greater proportions of total cost in France (7.0% and 9.6%, respectively) than in Sweden (3.7% and 0.6%, respectively). Conclusion: Medication costs represent a high proportion of total treatment costs. These findings highlight the relative importance of medical therapy and of assessing the cost-effectiveness of medications in glaucoma.

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Introduction Intestinal strictures are a known complication of Crohn's disease (CD) and may be inflammatory (in part), fibrostenotic or post-operative (anastomotic). Treatment options include a combination of medical, endoscopic or surgical interventions. We performed a retrospective analysis of our radiological assessment and endoscopic management of CD related strictures. Methods A retrospective review of adult patients who underwent balloon dilatation of CD related strictures by a single endoscopist at our institution. All patients underwent MR enterography prior to endoscopic assessment. Where necessary strictures were dilated under fluoroscopic screening. Endoscopic success was defined as the ability to traverse the stricture endoscopically after dilatation. Clinical success was defined as improvement in patients symptoms at follow-up. Complications, need for escalation of medical therapy, further dilatation or surgical intervention were recorded. Results A total of 56 dilatations were performed in 30 patients (range 1e5). Mean age was 47.5 years. 16 were females. Mean duration of disease was 209 months (range 14e444). Mean follow-up was 29.5 months (range 1e135). 27/30 (90%) had at least one previous CD surgical resection (range 0e6, mean 1.96 per patient). The site of the strictures were ileo-colonic in 21/30 (70%), colonic 3/30 (10%), gastro-duodenal 3/30 (10%), ileo-rectal 2/30 (7%) and ileal pouch stricture in 1/30 (3%). Stricture lengths at MRE were 6 cm, a length deemed significant as this is the length of the colonoscopic balloons. At MRE 17 (57%) of strictures were deemed to have an inflammatory component and 13 (43%) fibrostenotic. There was correlation between MRE and endoscopic findings of the nature of the stricturing (inflammatory vs fibrostenotic) in 26/30 (87%) of cases. Fluoroscopic screening was used in 21/30 (70%) of cases. Dilatation endoscopically successful in 27/30 (90%) cases and clinically successful in 26/30 (87%) of cases. No dilatation was performed in one case due to technical difficulties and this patient ultimately required surgical resection. Fourteen patients (47%) required repeated dilatations for symptom recurrence (range 2e5 dilatations). 17 patients (57%) had an escalation of their medical therapy after dilatation. A total of 5/30 (17%) ultimately required elective surgery for symptom recurrence. Conclusion MRE enterographic assessment of CD related strictures correlates well with endoscopic findings. Fluoroscopic screening facilitates safe and effective dilatation of CD related strictures which, together with optimising medical therapy, can reduce the need for surgical intervention.

This analysis indicates that adalimumab, when used according to UK treatment guidelines, is cost-effective vs conventional therapy for treating AS patients.

this model showed that the favourable clinical benefit of paricalcitol results in positive short- and long-term health economic benefits. This study suggests that the use of paricalcitol in patients with early CKD may be cost effective from the UK NHS perspective versus non-selective VDR activator medication.

ObjectivesGastrointestinal (GI) intolerance is associated with adverse outcomes in critically ill patients receiving enteral nutrition (EN). The objective of this analysis is to quantify the cost of GI intolerance and the cost implications of starting with semi-elemental EN in intensive care units (ICUs).Study designA US-based cost–consequence model was developed to compare the costs for patients with and without GI intolerance and the costs with semi-elemental or standard EN while varying the proportion of GI intolerance cases avoided.Materials and methodsICU data on GI intolerance prevalence and outcomes in patients receiving EN were derived from an observational study. ICU stay costs were obtained from literature and the costs of EN from US customers’ price lists. The model was used to conduct a threshold analysis, which calculated the minimum number of cases of GI intolerance that would have to be avoided to make the initial use of semi-elemental formula cost saving for the cohort.ResultsOut of 100 patients receiving EN, 31 had GI intolerance requiring a median ICU stay of 14.4 days versus 11.3 days for each patient without GI intolerance. The model calculated that semi-elemental formula was cost saving versus standard formula when only three cases of GI intolerance were prevented per 100 patients (7% of GI intolerance cases avoided).ConclusionIn the US setting, the model predicts that initial use of semi-elemental instead of standard EN can result in cost savings through the reduction in length of ICU stay if >7% of GI intolerance cases are avoided.

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