Nationally, shortages of food-animal veterinary practitioners have been projected over the next several years. The purpose of this study was to ascertain livestock producers' perceptions on access to veterinary services and to measure opinions on potential solutions to access problems. Data for the study were from a 2006 survey of livestock producers in Tennessee. The study found that the majority of livestock producers had not perceived problems in obtaining veterinary services during the past year. Among those who had, the problems most commonly cited were a delay in obtaining services; that the veterinarian would treat the animal only if the producer transported it to the veterinary facility; and that the cost of the veterinary service was too high relative to the value of the animal. While it was hypothesized that producers who experienced a problem would have smaller farms on average and would reside in counties with lower numbers of large- or food-animal veterinarians, the results did not support this hypothesis. Among those who perceived a problem, scholarship programs to encourage veterinary students to specialize in large- or food-animal care and greater availability of veterinary technicians to perform health care services were viewed as effective ways to alleviate access problems. Financial incentives for veterinarians to locate in rural areas were also viewed as effective. While shortages have been predicted nationally, data from this survey do not suggest a perceived shortage in Tennessee. Problems in obtaining services appear to be more closely related to practice management and availability of large-animal practitioners in dairy and equine medicine.
The goal of this study was to determine the clinical and economic impact of using tulathromycin as first line treatment for bovine respiratory disease (BRD) compared with other commonly used antimicrobials. Two decision trees were developed simulating the consequences of treating cattle at high risk of developing BRD [control model (CM)] or cattle with first clinical BRD episode [treatment model (TM)]. As comparators florfenicol and tilmicosin were considered in both models whereas enrofloxacin was included in the TM because it was only labeled for treatment of BRD at the time of development of the calculators. A total of 5 (CM) and 10 (TM) comparative clinical studies that reported efficacy data for the selected drugs and indications were identified as suitable for model population. The following outcomes were considered: first treatment success, number of subsequent BRD treatments, chronics, and mortalities. Cost parameters were considered from the perspective of the producer and included treatment costs (first treatment and retreatments) and costs of chronics and deaths derived from published sources for 2010 (default). The models allowed the estimation of clinical and economic consequences according to each individual trial outcomes. Treatment with tulathromycin resulted in more first treatment successes and fewer removals (chronics and deaths) in all comparisons. The average total number of antimicrobial treatments required for the management of BRD was also least with tulathromycin as first treatment option. Because of better efficacy, total costs over the entire study periods were always lowest with tulathromycin. Depending on the study selected as the basis for the efficacy evaluation, cost savings with tulathromycin were calculated in the CM between US$21.00 and $47.86 (vs. florfenicol) and $11.37 and $72.64 (vs. tilmicosin); cost savings in the TM ranged between $28.47 and $143.87 (vs. florfenicol) and $7.75 and $84.91 (vs. tilmicosin) as well as between $23.22 and $47.82 (vs. enrofloxacin), with the ranges reflecting a variety of settings in different trials. Thus, the higher drug costs of tulathromycin were more than offset by reduced BRD treatments, chronics, and mortalities in the herd. Fewer BRD episodes in cattle treated with tulathromycin not only contributes to overall savings in BRD management but also reduces the necessity of repeated antibiotic treatment, supporting prudent use of antimicrobials in livestock.
Historically, bovine respiratory disease (BRD) has caused major challenges in the North American feedlot industry. Commonly, BRD is the leading cause of morbidity and mortality in feedyards. Current BRD detection practices involve visual appraisal of clinical signs, such as depression, nasal discharge, altered locomotion, lack of fill, and cough. A novel high-frequency active integrated electronics system (AIES) was utilized to collect and record eating behavior of newly received, southeastern, auction-market derived calves. Two studies evaluated the health performance of calves managed by a traditional health system (cowboy assessment) versus a technology system. Results demonstrated the AIES decreased total percentage of respiratory pulls from 38.3 to 19.6 (P = 0.0001), while BRD mortalities were numerically lower for the technology treatment group, but not significantly different from the traditional system.
OBJECTIVES: Psoriasis (PSO) is an immune-mediated systemic inflammatory disease. The therapeutic classes available to treat PSO include biologic drugs. Despite rising wholesale acquisition costs of biologics in recent years, little documented evidence is available on cost trends from the US managed care perspective. This analysis determines the change in healthcare costs for PSO patients to managed care organizations. METHODS: Continuously enrolled adult patients with ≥ 2 outpatient diagnoses for PSO (ICD-9: 696.1) were selected from the MarketScan Commercial and Medicare Supplemental databases if their first biologic prescription date (index date) occurred July 2008 through July 2013 and they were biologic naive ≥ 6 months preindex. Healthcare costs were based on annual reimbursements for 6 patient cohorts initiating biologic therapy from 2008 to 2013. Results were stratified by all-cause vs. PSO-related costs and further subdivided into medical inpatient, medical outpatient, emergency room, and pharmacy costs. RESULTS: 13,045 patients met the inclusion criteria and composed the 6 cohorts.
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