Systematic review of pharmacoeconomic studies of pharmacogenomic tests.

There is currently a lack of consensus on the components that should be included in the pharmacoeconomic evaluation of pharmacogenomic tests. We conducted a systematic review focusing on pharmacogenomic tests to identify and comment on key parameters. The articles selected as economic analyses were classified using a framework including components related to testing, model, health outcomes, costs and incremental cost-effectiveness ratio. We found 15 studies that met our inclusion and exclusion criteria. A high degree of heterogeneity between evaluations was observed even within studies evaluating the same pharmacogenomic test. Components specific to pharmacogenomic tests were identified as marker prevalence, population ethnicity, pharmacogenomic treatment effect and cost of genomic data collection and analysis. In order to fully assess all aspects of pharmacogenomic testing, future pharmacoeconomic assessments should include every specific component that has an impact on the incremental cost-effectiveness ratio.

Do proton-pump inhibitors increase the risk for nosocomial pneumonia in a medical intensive care unit?

PURPOSE: The aim of this study was to determine whether the use of gastric acid-suppressive agents increases the risk of nosocomial pneumonia (NP) in a medical intensive care unit population. MATERIALS AND METHODS: Retrospective cohort study in a medical intensive care unit of a 554-bed, university-affiliated, academic medical center. RESULTS: A total of 924 medical records were included in the database during the study period of which 787 patients were included in the study. Out of this cohort,104 patients (13.2%) eventually developed a NP. The risk for patients who received proton-pump inhibitors (adjusted hazard ratio [AHR] 0.63; 95% CI 0.39-1.01) was not significantly different than in non exposed patients. Variables most strongly associated with NP were the administration of sedatives or neuromuscular blockers for at least 2 consecutive days (AHR 3.39;95% CI 1.99-5.75), an Acute Physiology and Chronic Health Evaluation II (APACHE II) severity score greater than 15 (AHR, 3.34; 95% CI 1.82-6.50), and presence of a central venous catheter (AHR, 1.76; 95% CI 1.12-2.76). CONCLUSIONS: Prior use of a proton-pump inhibitor did not correlate with a significant increase in the risk of developing NP. This risk was higher with the administration of sedatives or neuromuscular blockers, increased disease severity, and placement of a central venous catheter.

Risk of Clostridium difficile-associated disease among patients receiving proton-pump inhibitors in a Quebec medical intensive care unit.

Our study was conducted to determine whether use of gastric acid-suppressive agents increased the risk of Clostridium difficile-associated disease (CDAD) in a medical intensive care unit of one of the first hospitals to be threatened by the current CDAD epidemic in Quebec, Canada. Our findings suggest that efforts to determine risk factors for CDAD should focus on other areas, such as older age and antibiotic use.