Secondary prophylaxis treatment versus on-demand treatment for patients with severe haemophilia A: comparisons of cost and outcomes in Taiwan.

This study compared secondary prophylaxis treatment with on-demand treatment for severe haemophilia A in Taiwan. Fifty patients from one medical centre were evaluated over a 5-year period. Differences in annual bleed rates and factor VIII (FVIII) utilization were assessed between patients receiving secondary prophylaxis and patients receiving FVIII concentrates on-demand. Results were then used as inputs in a pharmacoeconomic model to predict outcomes of future haemophilia therapy strategies in Taiwan. The median annual number of total bleeding episodes was significantly lower in the 13 (26%) patients who received secondary prophylaxis than in the 37 patients who received FVIII on-demand (7.76 vs. 31.91, P < 0.0001). The between-group difference in median annual factor VIII utilization was statistically significant (1824.41 IU kg(-1) for the prophylaxis group and 1324.81 IU kg(-1) for the on-demand group, P < 0.01). It was estimated that approximately $2 million (USD) per year would be added to the cost of treatment by having all severe haemophilia A patients in Taiwan receive secondary prophylaxis instead of on-demand therapy while 12,566 bleeding will be prevented. It is recommended that National Health Insurance officials utilize these data to evaluate the benefits of enhanced treatment strategies and before making substantial policy changes to haemophilia care in Taiwan.

Using the pharmacoepidemiology approach to evaluate the first-year posttransplantation ambulatory health care cost from the Longitudinal Health Insurance Database (2001 to 2006) in Taiwan.

This research evaluated the total first-year posttransplantation ambulatory health care cost using a countrywide health claims database. We searched all health reimbursement claims of posttransplantation patients from 2001 to 2006 using the ICD-9-CM codes (V42.0, V42.1, V42.6, V42.7, V42.8) for kidney, heart, lung, liver, and other specified organ transplantations. We excluded patients undergoing transplantation surgery>12 months before 2001 or with <1 year of or irregular follow-up visits. All of the studied ambulatory care expenditures by visit files were based on the Taiwan Longitudinal Health Insurance Database (2005), which contained the claims of 1,000,000 beneficiaries who were randomly sampled from the Registry for Beneficiaries of the National Health Insurance Research Database. During this 6-year period we identified 336 transplant patients with 145 new cases having consecutive and >12 months of follow-up ambulatory visits to calculate the first-year posttransplantation cost. Among them, the first-year posttransplantation drug costs and total health care costs of the kidney, heart, lung, liver, and other organ transplantations were (m NTs) 346,396.6+/-170,806.9 and 404,241.9+/-182,499.1, 242,878.5+/-128,772.7 and 302,325+/-129,609.9, 345,792+/-185,940.8 and 387,840.5+/-184,244.5, 404,441.8+/-299,311.7 and 471,631.5+/-306,936.3 and 40,718.2+/-50,740.2 and 67,469.8+/-70,765.7, respectively. Drug expenditures were approximately 80% of the total health care cost except for the other specified organ transplant, i.e., bone marrow, wherein they were 60%. The mean differences between drug expenditures and total costs of various organ transplants were significant (P<.01; ANOVA). Despite the first-year health care cost a the posttransplantation patient being less than dialysis costs in Taiwan, most end-stage renal disease patients are still a waiting organ donation; therefore, some candidates are seeking a transplants outside Taiwan.

A retrospective study on the utilization of and expenditure for immunosuppressants for organ transplant recipients in Taiwan--updated to 2006.

We sought to examine the utilization of and expenditure for immunosuppressants among transplant recipients under the Taiwan global budget system updated from 2004 to 2006, as provided by the Taiwan Longitudinal Health Insurance Database (2005). By using all ambulatory care orders (OO) of files from 2002 to 2006, we identified immunosuppressive agents by the Anatomic Therapeutic Chemical (ATC) code. We selected and analyzed all immunosuppressants classified into the L04 group. For the analytic work, a generalized linear model was developed to examine the effect of time and different ATC subgroup immunosuppressants on drug expenditures. Compared with the previous report covering 1999-2003, wherein the most frequently prescribed immunosuppressive agents were cyclosporine (43%), mycophenolate (30.8%), and tacrolimus (21.3%), the updated information showed cyclosporine 36.8%, tacrolimus 30.17%, and mycophenolate 21.46%. In 2005, the total drug expenditure for tacrolimus was higher than for cyclosporine which was the major immunosuppressive agent used previously. Wald chi-square tests on the effect of time from 2001 to 2006 with different immunosuppressive drug classes showed a significant result (P<.01), namely, increased drug expenditures over time owing to different ATC classes of immunosuppressants. Projecting drug expenditure using a pharmacoepidemiology approach could show the overall picture of cost utilization, including the complex determinants of price inflation, utilization, and physician behavior.

Preparation and pharmacological evaluation of physostigmine-loaded polyisobutylcyanoacrylate nanoparticles in rats.

The nanoparticles of physostigmine were prepared by an emulsion polymerization of polyisobutylcyanoacrylate. The drug content, release and particle size distribution of the nanoparticles were characterized. In vitro drug release profiles displayed a retardation by the nanoparticles in comparison to the aqueous solution. Pharmacological evaluation of physostigmine nanoparticles in vivo were carried out with Sprague-Dawley rats. The endogenous acetylcholine was sampled by on-line microdialysis and determined by a sensitive microbore HPLC/ED system in the striatum of rats. The choline oxidase and catalase immobilized enzyme reactors were used as the pre-column to erase choline. Accordingly, this chromatographic flow sequence could be utilized for the quantitative assay of acetylcholine without interference. The results indicate that the increase of acetylcholine (%) in the rats striatum by the nanoparticle was 2.3 times (AUC) higher than that of aqueous solution.

Determination of acetylcholine by on-line microdialysis coupled with pre- and post-microbore column enzyme reactors with electrochemical detection.

A sensitive procedure consisting of a pre- and post-microbore column reactor sequence of a LC-electrochemical detection system coupled with on-line microdialysis system is described in the present study to measure endogenous acetylcholine concentration in freely moving rats. The pre-column packed, with immobilized choline oxidase and catalase, was used to remove choline, whereas the post-column, packed with immobilized acetylcholine oxidase and choline oxidase, was used to measure acetylcholine selectively. The detection limit of acetylcholine oxidase and choline oxidase, was used to measure acetylcholine selectively. The detection limit of acetylcholine was found to be 5 fmol/microliter (50 fmol/10 microliters). The usefulness of the described methodology was evaluated by examining the change in the striatal acetylcholine concentration of freely moving rats after physostigmine (0.5 mg/kg, s.c.) administration.

A relationship between foaming and H.L.B. value.

Synopsis The foaming properties of solutions of purified samples of the C(10) to C(18) even-numbered sodium alkyl sulphates in water have been studied using three methods of foam generation. Foam volumes increased with increase in surfactant concentration, and reached a limiting value at the C.M.C. At post-C.M.C. concentrations, foam volumes increased to a maximum with temperature, and then decreased. The point at which the maximum occurred, the maximum foam temperature (M.F.T.), varied from one surfactant to another, but was independent of the experimental method. M.F.T. was inversely proportional to the hydrophile-lipophile balance (H.L.B.) value. The corresponding triethanolamine salts behaved in the same way. Similar results were observed with non-ionics, but the plots of H.L.B. value against M.F.T. were positive.