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Background. Amphotericin B is a widely used broad-spectrum antifungal agent, despite being associated with significant adverse events, including nephrotoxicity. Methods. The present prospective study collected data on outcomes for 418 adult patients treated consecutively with polyenes in hematology and oncology wards in 20 hospitals in Europe. Results. Patients initially received amphotericin B deoxycholate (62% of patients), liposomal amphotericin B (27%), or other lipid formulations of amphotericin B (11%). Of the patients initially treated with amphotericin B deoxycholate, 36% had therapy switched to lipid formulations of amphotericin B, primarily because of increased serum creatinine levels (in 45.7% of patients) or other amphotericin B-attributable adverse events (in 41.3% of patients). Nephrotoxicity, which was defined as a ⩾50% increase in the serum creatinine level, developed in 57% of patients with normal kidney function at baseline. Predictors of nephrotoxicity included formulation type and duration of treatment. Compared with patients without nephrotoxicity, patients with nephrotoxicity had a higher mortality rate (24%), and their mean length of stay in the hospital was prolonged by 8.6 days. Slight increases in the serum creatinine level (i.e., ⩾50%) were associated with a significantly longer stay in the hospital. Severe nephrotoxicity (i.e., a ⩾200% increase in the serum creatinine level) was a significant predictor of death, as were severe underlying medical conditions and documented fungal infection. Conclusion. This prospective study confirmed that, in European hospitals, amphotericin B formulations have a major influence on the length of stay in the hospital and nephrotoxicity-associated mortality. [ABSTRACT FROM AUTHOR]

Background: The Reduction of Endpoints in NIDDM [non-insulin-dependent diabetes mellitus] with the Angiotensin II Antagonist Losartan (RENAAL) study demonstrated the renoprotective effects of losartan in patients with nephropathy from type 2 diabetes., Objective: To perform an economic evaluation of the costs associated with end-stage renal disease (ESRD) from a Canadian public health perspective, based on the clinical outcomes reported in the RENAAL study., Methods: ESRD-related costs were determined by estimating the mean number of days with ESRD multiplied by the daily cost of ESRD (140 dollars); mean days with ESRD were calculated by subtracting the area under the Kaplan-Meier survival curve for time to the first event of ESRD or all-cause mortality from the area under the curve for all-cause mortality. Daily ESRD cost was determined using Canadian specific data sources. ESRD-related cost savings with losartan were obtained by subtracting the ESRD-related costs of the losartan group from those of the placebo group. Net cost savings were ESRD-related cost savings with losartan minus the drug cost of losartan., Results: Losartan reduced the number of ESRD days by 33.6 per patient over 3.5 years (95% CI 10.9 to 56.3) compared with placebo. Losartan reduced ESRD-related costs by 4,695 dollars per randomized patient over 3.5 years (95% CI 1,523 dollars to 7,868 dollars). After accounting for the drug cost of losartan, net cost savings with losartan were 3,675 dollars per randomized patient over 3.5 years., Conclusion: Losartan therapy for patients with nephropathy from type 2 diabetes reduces the clinical incidence of ESRD and can result in considerable cost savings for the Canadian public health system.

Background: Migraine is prevalent and associated with substantial direct and indirect costs that may vary across geographic and national boundaries. The effects of migraine, self-reported by Canadians, on health care resource use as well as paid and unpaid work loss were examined., Patients and Methods: The Migraine Background Questionnaire (MBQ) was self-administered during the screening visit of a phase III clinical trial of rizatriptan (a potent, selective 5-hydroxytryptamine(1B/1D)-receptor agonist or 'triptan'). Patients suffering from moderate to severe migraine in the previous six months were offered the opportunity to participate. Migraine frequency was determined and costs were estimated and assigned based on known direct costs of health care resource utilization, and indirect costs of paid and unpaid work and productivity loss., Results: One hundred thirty-four patients completed the MBQ. In the previous year, 89% of those patients reported visiting a clinic, 23% reported visiting an emergency room and 5% reported being hospitalized for migraine. Patients reported an average of 6.5 days absent from work, 44 days working with migraine headache and 10.4 reduced workday equivalents due to ineffectiveness at work with migraine. Based on data obtained from the Ontario, the average overall annual cost due to migraine was estimated to be 3,025 dollars/patient; most of this (87%) due to indirect costs., Conclusion: In Canada, patients with moderate to severe migraine, as identified in a phase III clinical trial, reported lost work days and reduced effectiveness while at work, as well as increased health care resource utilization due to migraine. The associated cost was estimated to be substantial.

Background: Noncompliance with antihypertensive therapy is a major problem that hinders successful hypertension management., Objective: To study antihypertensive drug persistence for hypertensive patients in routine clinical settings., Methods: Hypertensive patients were retrospectively studied (1994 through 1998) using databases managed by Saskatchewan Health. The study population (46,458 people) included all patients with an International Classification of Diseases-9 code of 401, 402, 403 or 404, or any four-digit code included in these categories, who received at least one antihypertensive therapy prescription during the first 4.5 years of the study and received no antihypertensive therapy 12 months before the dispensing of the first therapy. Prescriptions were placed into the following drug classes: angiotensin II antagonists, angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers and diuretics. Persistence was determined for four intervals in the patient's therapy at 180, 360, 540 and 720 days., Results: Drug class had a statistically significant (P<0.001) effect on persistence. Angiotensin II antagonists had the highest persistence followed by angiotensin-converting enzyme inhibitors, calcium channel blockers, beta-blockers and diuretics. Persistence decreased as the time interval increased. Females were significantly more persistent than males (P<0.005), and elderly patients were significantly more persistent than younger patients (P<0.001) at each of the four time intervals. For angiotensin II antagonists, age and sex did not affect persistence., Conclusions: The consistently higher persistence associated with the use of angiotensin II antagonists may improve the management of hypertension.