ABSTRACT
Background: Lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) is a common problem among aging men. Several classes of drugs are efficacious and safe, but the first-line treatment is with alpha-1 adrenergic blockers. They provide symptomatic relief and have to be taken for a longer duration to sustain the effect. The preferred alpha-blockers among the stockpile should be efficacious, tolerable, and also cost-effective. Aim and Objective: This study focuses to compare the cost-effectiveness of various alpha blockers prescribed in patients with LUTS-BPH. Materials and Methods: An observational study of 78 patients who were newly diagnosed with LUTS-BPH from April 2014 to May 2015 was conducted. Patients were followed up at 4 weeks and at 12 weeks after the drugs had been prescribed. Efficacy assessment was done on basis of change in International Prostate Symptom Score (IPSS) score over 12 weeks. Average cost-effectiveness ratio of different alpha-blockers prescribed was evaluated and compared with Mann-Whitney U test in order to find the most cost-effective alpha-blocker in the study. Results: All patients were prescribed alpha-blockers either alone or in combination with other drugs. Tamsulosin was prescribed to n = 46, Silodosin to n = 16 and Alfuzosin to n = 16. The efficacy in terms of Mean change in IPSS after 12 weeks of study was 11.34 ± 5.23 for Tamsulosin, 11.70 ± 5.9 for Silodosin and 10.87 ± 4.77 for Alfuzosin and average cost-effectiveness ratio was 108.74, 183.07 and 127.50 for Tamsulosin, Silodosin, and Alfuzosin, respectively. Conclusion: Tamsulosin was the most cost-effective drug among the prescribed alpha-blockers. Since all the prescribed alpha-blockers had comparable efficacy so we concluded that the most cost-effective drug should be preferred for long-duration treatment.
ABSTRACT
Background & objectives: The effect of vitamin D supplementation on response to antiviral therapy in hepatitis C virus (HCV) genotype 1 and 4 infection still remains unclear, with studies yielding inconsistent results. The aim of the present study was to assess the effect of vitamin D supplementation on treatment outcome in patients with genotype 1/4 chronic hepatitis C (CHC) infection. Methods: Sixty consecutive, treatment-naïve, genotype 1 and 4 chronic HCV patients were included in the study. The patients were randomized into two groups: Vitamin D supplemented group received pegylated (PEG)-interferon ?-2a 180 ?g per week plus ribavirin (RBV) (1000-1200 mg/d) together with vitamin D3 (2000 IU/d) and control group received identical therapy without vitamin D (32 patients). Results: There were no significant differences between the two groups in terms of age, sex, body mass index and baseline laboratory values. Lower vitamin D levels were associated with higher grades of fibrosis in liver histology (vitamin D >20 ng/ml - 70% vs vitamin D <20 ng/ml - 37%, P<0.05). Vitamin D supplemented group had similar rapid viral response (40 vs 28%, P=0.36), complete early viral response (53.2 vs 40%, P=0.34), end of treatment response (64 vs 46%, P=0.17) and sustained virological response (SVR) (60 vs 44%, P=0.19) as compared to control group. Interleukin 28B polymorphism [odds ratio (OR)-15.37, 95% confidence interval (CI)-2.32-101.76, P=0.04] and baseline serum vitamin D levels (OR-6.36, 95% CI-1.36-29.61 P=0.02) were independent predictors of SVR in genotype 1/4 CHC. Vitamin D supplementation was not found to be predictor of response in genotype 1/4 CHC on multivariate analysis (OR-2.79, 95% CI- 0.63-12.34, P=0.74). Interpretation & conclusions: The present study showed that addition of vitamin D to PEG/RBV combination therapy in treatment-naïve patients who were infected with HCV genotype 1/4 had no effect on the rates of rapid, early and sustained viral responses.