A 69-year-old man who had been taking digoxin for 2.5 years developed an elevated serum concentration of digoxin in association with digoxin toxicity (characterized by nausea and vomiting) 9 days after the addition of itraconazole to his regimen for the treatment of sternal osteomyelitis. Coadministration of itraconazole resulted in a statistically significant increase in the half-life of digoxin that necessitated a reduction of the digoxin dose by almost 60%. We thus recommend that patients receiving itraconazole and digoxin concomitantly have serum levels of digoxin monitored frequently. In addition, these patients should be carefully questioned about nonspecific gastrointestinal symptoms, which may indicate early digoxin toxicity.
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technologyA pharmacy-based filgrastim protocol in oncology patients. A pharmacy sub-committee of the cancer committee at the study institution developed the protocol.The costing was undertaken retrospectively and on the same patient sample as that used in the effectiveness analysis. Study sampleTwenty-one patient charts were reviewed before the protocol was implemented and 34 charts were reviewed after implementation. Patients were selected on a one in four basis in both periods. Nine patients after implementation were excluded because they did not reach their nadir or an ANC of 1500 cells/cubic millimetre for two days or because they received one-time doses only. No power calculations were reported.No sensitivity analysis was conducted. Estimated benefits used in the economic analysisA pharmacy-based protocol for discontinuing filgrastim therapy in oncology patients did not delay subsequent chemotherapy cycles or increase the infection rate. Due to the cost-minimisation approach adopted the reader is referred to the effectiveness results reported above for specific details.Cost and benefits were not combined. The results showed that a pharmacy-based protocol for discontinuing filgrastim therapy in oncology patients saved the study institution more than $22,000 in the first six months without delaying subsequent chemotherapy cycles or significantly increasing the infection rate. This suggests that the intervention is a weakly dominant strategy. Validity of estimate of measure of benefitThe analysis of benefits was based on the therapeutic equivalence of treatment alternatives. The economic analysis therefore included only costs. The authors did not consider improved quality of life resulting from fewer injections and, perhaps, more comprehensive patient monitoring.The authors only considered drug costs, but did not include professional fees. Moreover, quantities and costs were not reported separately. The price year was not reported which would make reflation exercises in other settings problematic. No sensitivity or statistical analyses on costs were reported, which makes it difficult to assess the validity of the cost estimates.PubMedID 10683131
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