ABSTRACT
Background: Urinary tract infections are commonly seen in febrile children, high incidence of Vesico Ureteral Reflux (VUR) is frequently seen in paediatric patient which is of concern as it may lead to renal scarring. Despite presence of established clinical guidelines there is disparity amongst physician in the diagnosis and treatment of UTI, some physician prescribes taking into consideration the symptoms, some prescribe on the basis of smell and colour and some rely on urine culture and sensitivity report. There is dearth of studies in many tertiary health care centers regarding antimicrobial use. Authors conducted this study to evaluate antimicrobial sensitivity pattern, efficacy and cost effectiveness of antimicrobials used for UTI in children.Methods: Patients of urinary tract infection <13 years of age were included in the study. Symptoms of patient i.e. pain in abdomen, haematuria, increased frequency of urination and degree of fever were recorded. Efficacy was measured through calculating degree of defervescence per hour. Cost effective model was prepared by calculating cost effective ratio i.e. dividing cost of antimicrobial required to bring down the fever and degree through which fever came down.Results: E. coli was the most common pathogen isolated from urine positive culture (69.07%). Nitrofurantoin has shown highest sensitivity to all uropathogens (72.73%). Cotrimoxazole, ciprofloxacin and nitrofurantoin were found to be most cost effective.Conclusions: In this current study authors found E coli is the most common uropathogen isolated. Ceftriaxone, cefixime, cotrimoxazole and amikacin were found to be most efficacious. Cotrimoxazole, ciprofloxacin and nitrofurantoin were found to be most cost effective.
ABSTRACT
Background: Rheumatoid Arthritis (RA) is a chronic disabling disorder that lowers quality of life in the affected patients. Early treatment with disease-modifying anti-rheumatic drugs (DMARDs, provides better control of disease and minimize joint destruction. Long term therapy imparts considerable economic burden to the patients. Cost effective analysis was performed among the patients treated with methotrexate (MTX) alone, hydroxychloroquine (HCQ) alone, and both (MTX+HCQ).Methods: A prospective, observational study for six months to analyze the cost-effectiveness in RA patients with DMARDs-MTX, HCQ and MTX+HCQ. A total of 91 patients were included for analysis; 43 patients in MTX and HCQ group; 37 patients in MTX group and 11 patients in HCQ group. To assess the functional disability,” Stanford Health Assessment Questionnaire - Disability Index” (HAQ-DI) was administered. The patients were followed up for four months. The HAQ-DI at the baseline was compared with that of final follow up. The change in HAQ-DI and the total costs were used to find out the average cost- effective ratio (ACER).Results: The least ACER was obtained for Hydroxychloroquine and highest was for Methotrexate. But there was no statistically significant difference in ACER between various treatment groups. There was no significant difference in the disease activity improvement between the three groups.Conclusions: MTX, HCQ and MTX+HCQ showed improvement in disease activity without any significant difference. MTX is superior considering direct cost but there is no difference in the total cost between three groups.
ABSTRACT
Although medical nutrition therapy (MNT) is considered as a cornerstone of medical treatment for hypercholesterolemia, few studies have evaluated medical and economical outcome of MNT. This study was conducted to identify whether MNT administered by registered dieticians could lead to a beneficial clinical and cost outcome in persons with hypercholesterolemia. A prospective clinical trial was carried out at outpatient clinics, which involved an initial visit with a dietitian followed by another visit at first 4 weeks during the 6 weeks study periods. Thirty-nine subjects took part in a 6 weeks nutrition intervention program. Clinical and economical outcomes were compared before and after MNT. Medical nutrition therapy lowered total serum cholesterol level 6.1% (P<0.05), low-density lipoprotein cholesterol (LDL-C) 9.4% (P<0.05) and high-density lipoprotein cholesterol (HDL-C) 3.0% (P<0.05). The cost-effective ratio was 1,520 won/cholesterol mg/dl and 1,441 won/LDL-cholesterol mg/dl, respectively. After dietitian's intervention, lipid drug eligibility was obviated in 16 of 39(41%) subjects. The cost savings from the avoidance of lipid medications was 151,107 won per patient annually. In conclusion, it is suggested that provision of systemic intensive nutritional care for persons with hypercholesterolemia has significant effects on serum cholesterol reduction and clinical cost savings.