Management of chronic urinary retention in glanular penile calciphylaxis.

Urinary retention in penile calciphylaxis is a rare phenomenon due to its association with end-stage renal failure. A 48 year-old male was noted to have a lesion with necrotic appearances overlying his urethral meatus with increasing bladder volumes. He is on haemodialysis for end-stage renal failure and was being treated for infected calciphylaxis ulcers on his thigh. The current literature provides little guidance on managing urinary retention in this cohort of patients. We recommend that ultrasound-guided aspiration of the bladder should be performed in patients with glanular penile calciphylaxis who develop urinary retention as it offers a high safety profile.

At what cost is collagenase clostridium histolyticum viable for treating Peyronie's disease in a public healthcare system?

BACKGROUND: Collagenase clostridium histolyticum is a recognized non-surgical management for Peyronie's disease, licenced for use in the UK for patients with a palpable plaque and a curvature deformity of at least 30°. However, it is not currently funded for use within the National Health Service. Collagenase clostridium histolyticum has also recently been withdrawn from the European and other markets worldwide, but there is potential for this to be produced off-patent in the future. OBJECTIVES: To determine whether collagenase clostridium histolyticum is cost-neutral when compared to surgical management within a public health care system, using the National Health Service as an example. MATERIALS AND METHODS: Two published protocols for the administration of collagenase in Peyronie's disease were identified-the 'IMPRESS protocol' and the 'London protocol'. Costs were taken from published NHS literature. Surgical intervention rates after collagenase clostridium histolyticum administration and primary penile plication were taken from published literature. The costs of the two published protocols were calculated with costs of any repeat surgical intervention were included within each protocol per patient cost. RESULTS: At the current cost per vial of collagenase to the National Health Service, the IMPRESS protocol per patient costs £3,832.77 (143.7%) more than primary surgery, whilst the London protocol costs £70.77 (2.7%) more than primary surgery. DISCUSSION: At a cost of £548.41 per vial, collagenase administered under the London protocol would be a management option for Peyronie's disease cost neutral to primary corrective surgery. CONCLUSION: Central funding of collagenase in a public healthcare system would enable the management of Peyronie's disease to be moved to the outpatient setting. For this to be done at no additional cost to the NHS, it would require a cost reduction per vial of collagenase of £23.59 (4.1%), to a cost of £548.41.

Decision-making for foot-and-mouth disease control: Objectives matter.

Formal decision-analytic methods can be used to frame disease control problems, the first step of which is to define a clear and specific objective. We demonstrate the imperative of framing clearly-defined management objectives in finding optimal control actions for control of disease outbreaks. We illustrate an analysis that can be applied rapidly at the start of an outbreak when there are multiple stakeholders involved with potentially multiple objectives, and when there are also multiple disease models upon which to compare control actions. The output of our analysis frames subsequent discourse between policy-makers, modellers and other stakeholders, by highlighting areas of discord among different management objectives and also among different models used in the analysis. We illustrate this approach in the context of a hypothetical foot-and-mouth disease (FMD) outbreak in Cumbria, UK using outputs from five rigorously-studied simulation models of FMD spread. We present both relative rankings and relative performance of controls within each model and across a range of objectives. Results illustrate how control actions change across both the base metric used to measure management success and across the statistic used to rank control actions according to said metric. This work represents a first step towards reconciling the extensive modelling work on disease control problems with frameworks for structured decision making.

The North American Animal Disease Spread Model: a simulation model to assist decision making in evaluating animal disease incursions.

The North American Animal Disease Spread Model is a stochastic, spatial, state-transition simulation model for the spread of highly contagious diseases of animals. It was developed with broad international support to assist policy development and decision making involving disease incursions. User-established parameters define model behavior in terms of disease progression; disease spread by animal-to-animal contact, contact with contaminated personnel or equipment, and airborne dissemination; and the implementation of control measures such as destruction and vaccination. Resources available to implement disease control strategies, as well as the direct costs associated with these strategies, are taken into consideration. The model records a wide variety of measures of the extent of simulated outbreaks and other characteristics. The graphical interface and output visualization features also make it a useful tool for training and preparedness exercises. This model is now being used to evaluate outbreak scenarios and potential control strategies for several economically important exotic animal diseases in the United States, Canada, and elsewhere. NAADSM is freely available via the Internet at http://www.naadsm.org.