Prescribing Patterns of Antiretroviral Drugs in a Section of Private Health Care Sector of South

The general objective of this study was to investigate the prescribing patterns and cost of antiretroviral (ARV) drugs in the private health care sector in South Africa by using a medicine claims database. A quantitative; retrospective drug utilisation review was performed on data retrieved from 2001; 2002 and 2004 records. Antiretroviral drugs repre- sented 0.38 (n = 1 475 380) for 2001; 0.72 (n = 2 076 236) for 2002; and 1.68 (n = 2 595 254) for 2004 of all studied prescriptions. The total cost of the ARV drugs represen-ted 1.31 (R379 708 489) for 2001; 3.03 (R601 350 325) for 2002; and increased to 5.25 (R661 223 146) for 2004 of all drugs claimed. All ARV medicine items claimed during 2001 (n = 9 796) and 2002 (n = 35 271) were innovator products. Only 5.23 (n=5 329) of all the ARV medicine items (n = 101 938) claimed during 2004 were generic products. The average cost per ARV medicine item for 2004 increased from R317.93 (SD = R190.80) for the period January to April to R369.20 (SD = R219.50) for the period May to August; and decreased to R324.79 (SD = R212.48) for the period September to December and resulted in a cost saving of R41 044.35 for the period May to August versus September to December. Both the prevalence and cost of ARV drug therapy increased from 2001 to 2002. The prevalence increased from 2002 to 2004; but the cost decreased during 2004. The decrease in the cost of ARV drug therapy is probably a result of the implementation of the new pricing regulations in May 2004

Low-power radiofrequency application and intracardiac echocardiography for creation of continuous left atrial linear lesions.

INTRODUCTION: Continuity of radiofrequency (RF) lesions for a catheter-based cure of atrial fibrillation is essential in order to avoid reentrant tachycardias. In the present study, we assessed the value of intracardiac echocardiography and preablation electrode-tissue interface parameters for creation of left atrial linear lesions. METHODS AND RESULTS: In six healthy dogs, two left atrial linear lesions (lesion 1, along the inferior posterior left atrium; lesion 2, from the appendage to the left atrial roof) were attempted via a transseptal approach using a deflectable catheter with six 7-mm coil electrodes. In a randomized fashion, one lesion was performed under echocardiographic guidance and one with blinded echocardiographic monitoring. The following preablation parameters were assessed for every coil electrode: (1) mean atrial electrogram amplitude of six consecutive sinus beats; (2) diastolic pacing threshold; and (3) temperature response to application of 5 W for 10 seconds. After ablation (target temperature 70 degrees C, maximum power 50 W, duration 60 sec), the excised left atrium was examined macroscopically and histologically for lesion length, continuity, and presence or absence of lesions associated with each coil. Out of 12 attempted RF lesions, 7 were continuous (length, 47+/-5 mm, lesion 2, n = 6) and 5 were discontinuous (lesion 1, n = 5). Fifty-two of 70 coil electrodes (74%) had pathologic evidence of lesion creation. Intracardiac echocardiography was superior to fluoroscopy with respect to the actual number of coil electrodes creating lesions, and lesion continuity was correctly predicted in 9 of 12 lesions. Intracardiac echocardiography was 85% sensitive and 54% specific in predicting lesions created by individual coils. The correlation between the mean 60-second ablation temperature and the preablation parameters was 0.45 for the electrogram amplitude, -0.67 for the pacing threshold, and 0.81 for the temperature response to low-power application. Sensitivity and specificity for prediction of lesions created by individual coils, respectively, were 84% and 48% for the electrogram amplitude, 90% and 68% for the pacing threshold, and 96% and 76% for the low-power RF application. CONCLUSION: Long linear lesions can be safely and effectively performed in the canine left atrium, using a tip-deflectable multielectrode catheter. Intracardiac echocardiography may be helpful for positioning the ablation catheter in some parts of the left atrium, and preablation parameters, especially a nontraumatic low-power RF application, are able to predict ultimate lesion creation with high accuracy.