Infliximab use in Crohn's disease: impact on health care resources in the UK.

OBJECTIVE: To quantify the impact of infliximab therapy on health care resource utilization in the UK. METHODS: A retrospective audit was undertaken at seven centres in the UK, which reviewed patient notes for a period of 6 months before and 6 months after an initial infliximab infusion. Details of hospital admissions, outpatient visits, operations, diagnostic procedures, drug usage, and overall efficacy were collected. Results were compared for the two 6 month study periods. RESULTS: A total of 205 patients (62% female, median age 33 years) with moderate/severe Crohn's disease were audited. The majority of patients had chronic active disease (62%) and most received one infusion initially (72%). Clinicians rated 74% of responses as good to excellent and patients 72%. Most patients had concomitant immunosuppression (pre: 75%, post: 75%). Approximately half of the patients (45%) stopped taking steroids, with a further 34% having a dosage reduction. A fall of 1093 inpatient days was seen (1435 vs. 342) in the 6 months following infliximab administration. There were seven fewer operations, 33 fewer examinations under anaesthetic, and 99 fewer diagnostic procedures. Outpatient visits were similar pre- versus post- (555 vs. 534). The total reduction in direct costs amounted to an estimated pounds 591,006. Three hundred and fifty-three infliximab infusions were administered at an estimated cost of pounds 562,719. Thus, there was a net reduction of pounds 28,287 or pounds 137.98 per patient. CONCLUSIONS: Infliximab appears to be a potentially cost effective treatment for selected patients based on the reduced number of inpatient stays, examinations under anaesthetic, and diagnostic procedures over a 6 month period.

Motivators for change and barriers to help-seeking in Australian problem gamblers.

Although prevalence studies consistently indicate that many thousands of Australians experience gambling-related problems, only a relatively small proportion of these people seek professional help. This study examines the principal motivations for, and impediments to, help-seeking in a sample of 77 problem gamblers recruited from agencies and the general community. The results indicated that profession help-seeking is predominantly crisis-driven rather than being motived by a gradual recognition of problematic behaviour. Shame, denial and social factors were identified as the most significant barriers to change rather than a lack of knowledge, or dislike of, treatment agencies. The value of early interventions including the screening of gamblers in routine medical consultations and partner support strategies is discussed.