American Public Health Association. Making medicines affordable: the price factor (position paper)

The role of aromatase inhibitors in ameliorating deleterious effects of ovarian stimulation on outcome of infertility treatment

Clinical utilization of ovulation stimulation to facilitate the ability of a couple to conceive has not only provided a valuable therapeutic approach, but has also yielded extensive information on the physiology of ovarian follicular recruitment, endometrial receptivity and early embryo competency. One of the consequences of the use of fertility enhancing agents for ovarian stimulation has been the creation of a hyperestrogenic state, which may influence each of these parameters. Use of aromatase inhibitors reduces hyperestrogenism inevitably attained during ovarian stimulation. In addition, the adjunct use of aromatase inhibitors during ovarian stimulation reduces amount of gonadotropins required for optimum stimulation. The unique approach of reducing hyperestrogenism, as well as lowering amount of gonadotropins without affecting the number of mature ovarian follicles is an exciting strategy that could result in improvement in the treatment outcome by ameliorating the deleterious effects of the ovarian stimulation on follicular development, endometrial receptivity, as well as oocyte and embryo quality.

Cost analysis of glaucoma medications: a 3-year review

PURPOSE

To evaluate yearly cost of glaucoma medications at a university-affiliated teaching hospital with its own health maintenance organization from 1998 through 2000.

METHODS

We retrieved data from the Scott and White prescription claims file for 1,484 patients concerning Health Plan glaucoma-medication prescriptions for the years 1998 through 2000. Patient inclusion criteria were as follows: 1) use of a single or fixed-combination topical glaucoma medication during all four quarters of at least one full-year, 2) treatment of both eyes, 3) participation in the Health Plan prescription program, and 4) prescriptions filled at pharmacies participating in the Health Plan prescription program.

RESULTS

Over this 3-year period, the most costly medication per patient per year was dorzolamide hydrochloride-timolol maleate (Cosopt; Merck, West Point, PA [$470]), followed by betaxolol hydrochloride (Betoptic-S; Alcon, Fort Worth, TX [$370]), latanoprost (Xalatan; Pharmacia and Upjohn, Kalamazoo, MI [$352]), dorzolamide hydrochloride (Trusopt; Merck, West Point, PA [$288]), brimonidine tartrate (Alphagan; Allergan Pharmaceuticals, Irvine, CA [$273]), brinzolamide (Azopt; Alcon, Fort Worth, TX [$243]), timolol maleate 0.5% in a gel-forming solution (Timoptic-XE 0.5%; Merck, West Point, PA [$190]), carteolol hydrochloride (Ocupress; Otsuka Pharmaceutical, Rockville, MD [$183]), generic levobunolol hydrochloride 0.5% ($138), metipranolol (Optipranolol; Bausch and Lomb Pharmaceuticals, Tampa, FL [$135]), and generic timolol maleate 0.5% ($133).

CONCLUSION

Differences in yearly cost exist among topical glaucoma medications.

The conflict between effective and affordable health care--a perspective from the developing world

The recent introduction of recombinant FSH into the clinical management of patients suffering from infertility appears to be associated with several treatment benefits when compared with urinary human menopausal gonadotrophin. However, from the perspective of the developing world the associated increase in cost is a cause for concern--particularly if the "cheaper" urinary gonadotrophins are no longer marketed. The need for infertility care in Africa is significant, but health resources are very limited. The commonest cause of infertility in Africa is tubal disease, so that assisted reproductive techniques, and therefore exogenous gonadotrophins, are central to effective management. The conflict between affordable and effective health care is addressed.