Standard cost lists for healthcare in Canada. Issues in validity and inter-provincial consolidation.

A standard cost list is a listing of recommended costs for a selected group of services. Standard costs are used in economic evaluation studies to eliminate that proportion of cost differences between interventions that are due to cost differences between providers. In this article we provide a summary of cost lists for pharmaceutical economic evaluation purposes which have been developed in 2 provinces in Canada-Alberta and Manitoba. We then assess these 2 lists from 2 different viewpoints. First, we developed criteria for the internal and external validity of costs and, in light of these validity criteria, we assessed how the 2 standard cost lists compared with the 'ideal' measure of long run marginal costs. Second, we identified the criteria for the inter-provincial consolidation of standard cost measures (in order to develop a single, consolidated cost list); in light of these criteria, we assessed whether the degree to which the 2 separate lists could be consolidated. The lists achieved a considerable degree of external validity, but fared less well in terms of internal validity. However, these results depend on the 'ideal' measure of cost which is used. The lists, in the forms which were developed, are not easily consolidated into a single list. Further refined cost data would be needed in order to achieve consolidation.     

Bacteriologic and clinical efficacy of high dose amoxicillin/clavulanate in children with acute otitis media.

OBJECTIVES: To determine the bacteriologic and clinical efficacy of high dose amoxicillin/clavulanate (90/6.4 mg/kg/day) against common bacterial pathogens causing acute otitis media (AOM), including penicillin-resistant Streptococcus pneumoniae (PRSP). METHODS: In this open label multicenter study, 521 infants and children with AOM [mean age, 18.6 months; age < 24 months, n = 375 (72%)] were treated with amoxicillin/clavulanate 90/6.4 mg/kg/day in two divided doses for 10 days. Bilateral otitis media, previous episodes of AOM, antibiotic treatment within 3 months and day-care attendance were recorded in 60.1, 35.7, 50.2 and 38.2% of the children, respectively. Tympanocentesis was performed before the first dose and repeated on Days 4 to 6 for all children with S. pneumoniae at 22 centers and for all children with any pathogen at 3 centers. Clinical response was assessed at end of therapy. RESULTS: Pathogens were isolated from 355 (68%) of 521 enrolled children; 180 children underwent repeat tympanocentesis and were bacteriologically evaluable. Baseline pathogens were S. pneumoniae (n = 122 enrolled/93 bacteriologically evaluable), Haemophilus influenzae (n = 160/51), both (n = 37/32) and others (n = 36/4). Pathogens were eradicated from 172 (96%) of 180 bacteriologically evaluable children. Overall 122 (98%) of 125 isolates of S. pneumoniae were eradicated, including 31 (91%) of 34 PRSP isolates (penicillin MICs 2 to 4 micrograms/ml). Seventy-eight (94%) of 83 isolates of H. influenzae were eradicated. Symptoms and otoscopic signs of acute inflammation were completely resolved or improved on Days 12 to 15 in 263 (89%) of 295 clinically evaluable children with bacteriologically documented AOM. CONCLUSIONS: On the basis of bacteriologic outcome on Days 4 to 6 and clinical outcome on Days 12 to 15, we found that high dose amoxicillin/clavulanate (90/6.4 mg/kg/day) was highly efficacious in children with AOM, including those most likely to fail treatment, namely children < 24 months of age and those with infectious caused by PRSP.     

STUDIES ON THE SENSITIZATION OF ANIMALS WITH SIMPLE CHEMICAL COMPOUNDS : III. ANAPHYLAXIS INDUCED BY ARSPHENAMINE

Experiments are described which show that with a given treatment guinea pigs can be sensitized to arsphenamine, so that a considerable percentage die in anaphylactic shock on intravenous administration of the substance.     

Wachstumshormone und BMP

BMP (bone morphogenetic proteins) belong to the TGFβ superfamily and appear to play a central role in fracture healing. Two growth factors have been in use since 2001 as an approved therapy option for the delayed healing of fractures or open lower leg fractures: BMP-7 for delayed fracture healing and BMP-2 for open lower leg fractures. The aim of the present study was to examine the effectiveness of the BMP in fracture healing and compare fracture healing without the use of bone growth factors. Patients who were treated with BMP-7 following repeated attempts to treat atrophic pseudoarthrosis of the tibia were compared with a large standardized collective of patients with first-time spongiosa plastic. Patients receiving BMP-7 showed significantly better bone fusion in the fracture area at radiological examination at four months. In order to prove the advantages of this procedure, as well as to be able to recommend it as a treatment modality, further studies on larger patient collectives and prospective control groups are needed.     

Receptor-mediated ingestion responses by lung macrophages from a canine model of ARDS

Receptor-mediated ingestion was examined in macrophages derived from a canine model of the adult respiratory distress syndrome (ARDS). The results showed that Fc-mediated ingestion by alveolar macrophages (AM) and macrophages from lung parenchyma (PM) was significantly diminished when compared with their respective controls. Pulsing all the experimental groups with lipopolysaccharide (LPS) for 1 hr in vitro failed to either enhance the response or return the activity to levels achieved by control cells. In parallel studies, an analysis of C3b-mediated ingestion showed that both the experimental AM and PM performed this function only at a magnitude equal to the control cells. Similar responses were observed when an LPS pulse was performed. Although there was a reduction in Fc-mediated ingestion and an apparent restraint of the C3b-mediated ingestion, both AM and PM expressed a significantly enhanced ability to spread. These results suggested that the canine model of ARDS alters at least one select macrophage function that may be important to subsequently protect the host. Such disturbances in the cellular immune response may contribute to the progression of infection and lung pathology associated with this disease process.