BACKGROUND: The prevalence of irritable bowel syndrome with constipation (IBS-C) is estimated to be between 4.3% and 5.2% among adults in the United States. Little is known about the health care resource utilization and costs associated with IBS-C.

Ritonavir therapy, combined with other antiretroviral treatments, significantly contributes to maintenance of functioning and well-being over at least 6 months in patients with advanced HIV disease.

CC imposes a substantial burden in direct healthcare costs in a commercially insured population, mainly attributable to greater use of medical services.

Summary Aims To estimate Adult ADHD Self‐Report Scale ( ASRS ‐v1.1) Symptom Checklist normative total scores among the US adult general population and to evaluate overall attention‐deficit hyperactivity disorder ( ADHD ) symptom burden among US adults with ADHD . Methods Prior 2012 and 2013 US National Health and Wellness Survey respondents were re‐contacted. Demographics, comorbidities, and ASRS ‐v1.1 data were collected. ASRS ‐v1.1 scores were compared by sex, age, ADHD diagnosis, and ADHD medication use. Group differences were evaluated using chi‐square tests and independent samples t‐ tests for categorical and continuous variables, respectively. Results Of 22 397 respondents, 465 self‐reported being diagnosed with ADHD by a physician; of these, 174 self‐reported using ADHD medication. The mean ASRS ‐v1.1 total score was 2.0 ( SD = 3.2); scores differed by age and sex (all, P < 0.001). ADHD (vs no ADHD ) was associated with depression (58.1% vs 18.0%), anxiety (53.1% vs 16.0%), and sleep difficulties (37.0% vs 14.0%) (all, P < 0.001). ADHD medication use (vs no use) was associated with depression (68.4% vs 51.9%), anxiety (67.2% vs 44.7%), panic disorder (25.9% vs 17.2%), and insomnia (27.6% vs 19.6%) (all, P < 0.05). ADHD (vs no ADHD ) respondents scored higher on all 18 ASRS ‐v1.1 items (all, P < 0.05). Medication users (vs non‐users) scored higher on six items (all, P < 0.05). Discussion Adult ADHD may be undertreated or sub‐optimally treated, despite a high symptom burden. Normative data will allow comparisons with individuals’ scores to support the assessment of ADHD symptom burden among adults. Conclusion Findings highlight the importance of assessing ADHD symptom burden, especially among adults presenting with comorbidities.

Linaclotide was found to be a less costly option vs lubiprostone for the treatment of adult patients with IBS-C.

Background Contemporary trials of patients with heart failure with reduced ejection fraction (HFrEF) required a recent worsening heart failure (WHF) event for inclusion. We aimed to describe characteristics and outcomes of patients with HFrEF and a recent WHF event at a large tertiary referral center. Methods and Results We identified adult patients with chronic symptomatic HFrEF (ejection fraction ≤35%) treated at Duke University between January 1, 2009, and December 31, 2018, and applied a set of exclusion criteria to generate a cohort similar to those enrolled in contemporary heart failure trials. Patients were stratified by presence or absence of a recent WHF event, defined as an emergency department visit for heart failure or hospitalization for heart failure in the prior 12 months. Characteristics and outcomes including death and hospitalization were assessed. Of 3867 patients with HFrEF meeting study criteria, 2823 (73.0%) had a WHF event in the prior 12 months. Compared with patients without a WHF event, those with a WHF event were more likely to be under‐represented racial and ethnic groups and had lower ejection fraction, a greater burden of comorbidities, and more echocardiographic evidence of cardiac dysfunction. Despite higher use of guideline‐directed therapies, patients with a WHF event had higher rates of death (hazard ratio, 2.30; 95% CI, 2.01–2.63), all‐cause hospitalization (hazard ratio, 1.56; 95% CI, 1.42–1.71), and heart failure hospitalization (hazard ratio, 1.59; 95% CI, 1.44–1.75) through 5 years compared with those without a recent WHF event. Conclusions WHF events are common in patients with HFrEF and are associated with more advanced disease. Patients with recent WHF have high rates of death and hospitalization, underscoring the need for novel therapies in this large subgroup of patients with HFrEF.

Reported macrolide resistance of S. pneumoniae varies substantially and may be a significant issue in certain regions. Use of meta-analysis to aggregate individual studies enabled determination of robust values for macrolide resistance. This information is useful for clinical and policy decision makers in developing appropriate antibiotic strategies.

OBJECTIVES: Infliximab is indicated in Crohn's disease (CD) resistant to standard treatment (ST), but its impact on health care costs and quality-adjusted life-expectancy is incompletely understood. We assessed the cost-effectiveness of episodic (ET) and maintenance (MT) infliximab treatment in CD patients with 10-years follow-up. METHODS: A total of 212 incident adult CD patients (age at onset 34.4Ϯ14.5 years, 49.4% male) were treated with antibiotics, mesalazine, corticosteroids, thiopurines, surgery (comprising ST) over 10-years to 2004. Eight health states were defined by intensity of therapy in these patients. We determined Markov transition probabilities between these states, health care costs and QALYs in 3 month-cycles. This cohort was modeled to allow drug-refractory or pre-surgery patients to receive infliximab: either ET in one cycle, or MT in responders for a period of 1-year (MT-1yr) or for 10-years (MT-10 yrs). Transition probabilities of ST were applied to patients getting IFX; the probability of continuing infliximab in MT was set to correct for decay. Health care costs and QALYs in ET and MT were estimated for 10-years (discounted at 3%) and compared with those of ST patients. RESULTS:The average cost (QALYs gained) per patient over 10-years was €23,169 (6.7014) for ST; €21,691 (7.0403) for ET, €29,012 (7.0553) for MT-1yr, and €50,416 (7.2603) for MT-10 yrs. ST was associated with higher costs and lower outcomes and was thus dominated by ET. The incremental cost-effectiveness ratios (ICERs) of MT-1yr and MT-10 yrs over ST were €16,510/QALY gained, and €48,751/QALY gained, respectively. When compared with ET, the ICERs of MT-1yr and MT-10 yrs were €488,066/QALY gained, and €130,568/QALY gained, respectively. When the infliximab price was halved these ICERs remained very high. CONCLUSIONS: ET or MT with infliximab are either cost-saving or cost-effective when compared with ST. However, at current drug prices, MT does not provide good value for money when compared with ET. OBJECTIVES:To evaluate direct medical costs, health outcomes, and cost-effectiveness of 48-week Peginterferon alpha-2a with 2nd line 2-years Entecavir treatment versus 3 years Entecavir treatment for HBeAg-positive chronic hepatitis B according to the Response Guided Treatment (RGT) strategy in China. METHODS: A Markov model was designed to evaluate the direct medical costs and outcomes (life years and QALYs gained) of treating HBeAg-positive chronic hepatitis B in China, with a maximum analysis time horizon of 80 years. The model included 10 health states -Chronic hepatitis B (CHB), HBeAg seroconversion, HBsAg loss, CHB with resistance, Compensated cirrhosis, Decompensated cirrhosis, Hepatocellular carcinoma, Liver transplant, Post-liver transplant and death. Based on the analysis of published literature, a two-round expert panel survey was conducted among 22 hepatitis B specialists nationally to identify clinical and utility data. From the perspective of China's health insurance system, cost data was calculated based on the publ...