Glaucoma is a term used for a group of diseases; associated with optic nerve damage which leads to loss of retinal ganglionic cells. The changes stimulated in the optic nerve head cause visual field restriction which may ultimately result in blindness. Conventionally, the drugs used in treatment are ocular anti-hypertensives and are available as eye drops. Challenges faced in ocular delivery of a drug reduce the efficacy of such formulations. In a disease like glaucoma which is a leading cause of irreversible blindness, effective delivery of drug to the site of absorption is paramount in order to prevent disease progression. The novel drug delivery systems have shown great promise in this regard. They have been developed with a viewpoint to improve ocular retention of therapeutic agents. Niosomes have been exploited well and have elicited a positive response. The review is aimed at bringing out facts about the disease including worldwide prevalence, types, treatment, its impact and also constraints in ocular drug delivery, drug delivery alternatives, and niosomes in particular with their composition, advantages and their potential in management of ocular hypertension.
RESULTS: Sixty-eight patients were included (38 ACS; 30 stroke; 87% men; 87% urban; mean age:53 years). Average Left Ventricular Ejection Fraction was 50.8% in ACS patients and 97% had no or mild stroke symptoms at discharge. There were on average 90.9(standard deviation¼122.7) work-days lost after ACS and 88.3(100.3) after stroke. Patient's index hospitalization followed by initial sick leave accounted for 28. 5(26.8) and 38.1(39.4) work-days in ACS and stroke patients respectively. The ACS and stroke patients lost 37.0(65.8) and 23.6(76.6) work-days respectively due to absenteeism, and another 9.7(25.5) and 8.1(18.4) days due to presenteeism. Caregivers lost 15.8(44.0) and 18.5(42.0) days helping ACS and stroke patients respectively. Thus, in ACS patients, the average total indirect costs in the year post-CVE was PLN29,131 (39,314)/V6,526 (8,808). For stroke the total indirect cost per patient was PLN28,280 (PLN32,111)/ V6,335 (V7,194). CONCLUSIONS: The results suggest that, in this population of relatively young patients, indirect costs of CVE in Poland are substantial in the first year following this CVE and, based on literature, are comparable or exceed direct costs. Indirect costs for ACS and stroke are similar. About 20% of lost time and associated indirect costs fall on caregivers helping the CVE patients.
revascularisation: 9; angina: 3) and North America (N¼6; revascularisation: 3; angina: 3). In general, utility values as per type of revascularisation (either percutaneous coronary intervention [PCI] or coronary artery bypass graft [CABG]) did not show significant differences, particularly within same studies. However, the mean values widely varied across the included studies (overall [N¼17]: 0.33-0.90; PCI [N¼10]: 0.33-0.86; CABG [N¼9]: 0.69-0.90). Majority of the studies reported improvement in utility values over time (6/8 studies). Utility values for angina, irrespective of geographical location, ranged from 0.51 to 0.81 (EQ-5D [N¼6]: 0.51-0.81; SF-6D [N¼2]: 0.62-0.78; other scales [N¼2]: 0.66-0.74). Severity of angina was associated with lower utility values. CONCLUSIONS: Overall, angina and revascularisation have a negative impact on the reported health utilities. Careful interpretation of published values is advised, given the heterogeneity of methodologies, patient populations and timing of utilities assessment reported in the available literature. Nevertheless, our results can be a valuable resource for future cost-utility analyses.
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