Percutaneous absorption of non-steroidal anti-inflammatory drugs from in situ gelling xyloglucan formulations in rats.

The potential of gels formed in situ by dilute aqueous solutions of a xyloglucan polysaccharide derived from tamarind seed as sustained release vehicles for percutaneous administration of non-steroidal anti-inflammatory drugs has been assessed by in vitro and in vivo studies. Chilled aqueous solutions of xyloglucan that had been partially degraded by beta-galactosidase formed gels at concentrations of 1-2% w/w when warmed to 37 degrees C. The in vitro release of ibuprofen and ketoprofen at pH 7.4 from the enzyme degraded xyloglucan gels and the subsequent permeation of these fully ionized drugs through cellulose membranes followed root-time kinetics over a period of 12 h after an initial lag period. Diffusion coefficients were appreciably higher when the drugs were released from 1.5% w/w xyloglucan gels than when released from 25% w/w Pluronic F127 gels formed in situ under identical conditions. The difference in release rates was attributed to differences in the structure of the gels. The permeation rate of ibuprofen through excised skin was higher than that of ketoprofen when released from both gels, but of similar magnitude through cellulose membranes. Plasma concentrations of ibuprofen and ketoprofen from gels formed in situ following topical application of chilled aqueous solutions of xyloglucan and Pluronic F127 to the abdominal skin of rats were compared. The bioavailabilities of ibuprofen and ketoprofen were significantly higher when released from xyloglucan gels compared to Pluronic F127 gels. Occlusive dressing techniques had a greater enhancing effect on the bioavailability of ibuprofen when released from Pluronic gels.

Propentofylline treatment for Alzheimer disease and vascular dementia: an economic evaluation based on functional abilities.

A Canadian economic evaluation of propentofylline (a therapy shown to be effective for patients with mild to moderate Alzheimer disease and/or vascular dementia) versus standard care was conducted. Patients were categorized by functional abilities according to the Alberta Resident Classification System by translating measures that were originally captured through the Gottfries-Bråne-Steen scale. The Alberta Resident Classification System was then linked to a community dataset of home care costs for a population with dementia. Cost and cost-effectiveness analyses were performed from the perspective of the Ministry of Health, the caregiver, and society using an intent-to-treat analysis for propentofylline versus placebo. Results, limited to the 48-week clinical trial duration, indicated that propentofylline improved health outcomes of persons with dementia as statistically significant treatment effects were found. However, although an incremental cost for the propentofylline intervention was incurred from the Ministry of Health perspective, home care and, to a larger extent, caregiver costs were reduced. Savings in these areas may have partially offset annual treatment medication costs because a non-statistically significant cost difference was observed from a societal perspective.

Costing methods in the Canadian literature on the economic evaluation of health care. A survey and assessment.

We reviewed the Canadian literature on cost-effectiveness from 1980-95 with regard to costing methodologies. We abstracted each study using a list of data elements that describe costing methodology, and evaluated costing methodologies in the light of biases in costing methods, site, and case-mix selection.

A comparative review of pharmacoeconomic guidelines.

We have reviewed 4 international sets of guidelines for the economic evaluation of pharmaceutical products-those of the Australian Pharmaceutical Benefits Advisory Committee, the Canadian Coordinating Office for Health Technology Assessment, the Ontario Ministry of Health, and the England and Wales Department of Health. Comparison of these guidelines reveals that there are a number of differences between them, including disparities in outcome selection, costs and perspectives. These observations were attributed to differences in study purpose, conceptual approach, measurement techniques and value judgements. Uniformity can be achieved only in conceptual approach and measurement technique. Guidelines should be flexible to accommodate differences in the study purposes and value judgements of the analysts.

Concurrent utilization of chiropractic, prescription medicines, nonprescription medicines and alternative health care.

This study examines the use of chiropractic, prescription medicines, nonprescription medicines and alternative health care for two independent samples representative of the population of Edmonton, Alberta, Canada in 1979 (n = 439) and again in 1988 (n = 464). While the usage of prescription medicines was unchanged from 1979 to 1988, utilization of nonprescription medicines, chiropractic and alternative health care increased. Users of chiropractic tended to be concurrent users of the conventional health care system, although they were also more likely to utilize alternative health care. This study shows that Edmontonians tend to select their health care concurrently from various health care modalities including both prescription and nonprescription medicines and conventional and alternative health care.

Cost-benefit and cost-effectiveness in institutional pharmacy practice.

Patient care in health institutions has become more intensive, with greater use of drugs. Pharmacy departments have not been able to keep abreast of the demands placed on them by advances in clinical medicine. Medication errors occur too frequently and place the patient at risk. Use of the unit dose system would reduce these errors. Patient safety should be used as a measure of the effectiveness of pharmacy programs. Greater patient participation in the therapeutic process would improve the effectiveness of pharmacy services, as would therapeutic drug monitoring.

Hospital pharmacy in Canada.

The status of Canadian hospital pharmacy and the impact of national hospital insurance on its development are discussed. The provision of health care services for Canadians is shared by the federal and provincial governments. The federal government enacts protective and regulatory legislation, compiles health statistics, promotes research, and provides direct health care for those citizens for whom it is directly responsible. Each province is responsible for hospitals, the education and training of health care professionals, public health, and the financing and administration of health insurance for all its citizens. Largely because of line-item budget allocations and a bureaucratic tendency to equalize services for the whole population, funds for existing pharmaceutical services have been assured but the introduction of upgraded or innovative programs has been difficult to achieve. The result has been an even quality of health care services, including pharmacy, throughout the country and a deficiency in clinical pharmacy programs and the trained personnel to run them. The last decade has brought advances, however, as allocation methods have changed and both hospital and insurance administrators have recognized the patient benefits and cost effectiveness of many of the newer pharmacy programs. The main challenges facing Canadian hospital pharmacy are to upgrade clinical services and education and to improve managerial and bureaucratic competence among department directors.