Budgetary Impact of Medicinal Therapies for Rare Diseases in Bulgaria

Effectiveness of buccal infiltration anaesthesia compared to inferior alveolar nerve block anaesthesia in primary mandibular molar extractions: a randomised controlled study

Aim The current study assessed the efficiency of buccal infiltration (BI) and inferior alveolar nerve block (IANB) during the extraction of deciduous mandibular molars.Subjects and method A total of 112 children aged between 5-8 years with mandibular molar indicated for extraction were divided into two groups at random. The BI group was injected with 4% articaine using BI, while the IANB group was injected with 2% lidocaine using IANB. The effectiveness of both techniques was examined using the Wong-Baker FACES Pain Rating Scale (W-BFPRS); Faces, Legs, Activity, Cry, and Consolability (FLACC) scale; and pulse oximetry.Results Using the W-BFPRS scale, success rates were 83.9% and 75.0% for the BI group and 82.1% and 71.4% for the IANB group during the injection and extraction, respectively, while using the FLACC scale, success rates were 83.9% and 92.9% for the BI group and 78.6% and 89.3% for the IANB group. In terms of pulse rate and oxygen saturation, there was no significant difference between the two groups.Conclusions BI with articaine is as efficient as IANB with lidocaine in the extraction of deciduous mandibular molars.

Effects of low level laser therapy on injection pain and anesthesia efficacy during local anesthesia in children: A randomized clinical trial

BACKGROUND

The use of low level laser therapy (LLLT) to reduce injection pain associated with dental local anesthesia is reported in a limited number of studies in adults, but research on the effects of LLLT in children is needed.

AIM

This study aimed to evaluate the effects of topical anesthesia + LLLT on injection pain, anesthesia efficacy, and duration in local anesthesia of children who are undergoing pulpotomy treatment.

DESIGN

The study was conducted as a randomized, controlled-crossover, double-blind clinical trial with 60 children aged 6-9 years. Before local infiltration anesthesia was administered, only topical anesthesia was applied in one side (control group/CG), and topical anesthesia plus LLLT (a diode laser: 810 nm; continuous mode; 0.3W; 20 s; 69 J/cm² ) was applied in the contralateral side (LG) as pre-anesthesia. The injection pain and anesthesia efficacy were evaluated subjectively and objectively using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale respectively. Data were analyzed for statistical significance (p < .05).

RESULTS

The "no pain" and "severe pain" rates in the PRS were 41.7% and 3.3% for the LG and 21.7% and 11.7% for the CG, respectively, during injection. Similarly, in the FLACC data, the number of "no pain" responses was higher for the LG than the CG (40%, 33.3%) and no "severe pain" rate was observed in both groups. The only statistically significant difference found for the PRS was p < .05. The median pain score was "0" for the LG and the CG in the FLACC data for the evaluation of anesthesia efficacy, and there was no statistically significant difference between the groups in terms of pain and anesthesia duration (p > .05). Also, most of the children preferred injection with topical anesthesia + LLLT (66.7%).

CONCLUSIONS

It has been determined that the application of topical anesthesia + LLLT with an 810-nm diode laser before local infiltration anesthesia reduced injection pain and did not have an effect on anesthesia efficacy and duration in children.

Public spending on orphan medicines: a review of the literature

Background and objective

Little is known about how much public payers spend on orphan medicines. This study aimed at identifying information on orphan medicine expenditure incurred by public payers that was published in literature globally and at possibly synthesising their shares as portion of the total pharmaceutical expenditure.

Methods

A literature review was undertaken using Medline, the Orphanet Journal of Rare Diseases and Google Scholar. Titles and abstracts were screened, and full texts of potentially qualifying studies were reviewed for inclusion. Included articles were analysed, and bibliometric parameters as well as public expenditure data on orphan medicines were retrieved.

Results

Six hundred forty three articles excluding duplicates were identified. After screening of the abstracts and a review of the full texts, 13 articles qualified for in-depth analysis.The 13 selected articles on orphan pharmaceutical expenditure were published between 2010 and 2018. Survey periods varied between 1 year and 12 years. One publication included 22 countries but the majority of the studies were related to a single country. Expenditure data was available in five of the 13 articles, and eight articles used 'expenditure proxies' such as sales data. Spending data had been sourced from public institutions (4 studies), private providers (5 studies) and a combination of both (3 studies, no information on data source in 1 study). In all included studies, secondary data were analysed. Reported expenditure shares for orphan medicines in relation to total pharmaceutical spend was frequently below 3%. Countries with higher shares included the USA, Canada, the Netherlands and Bulgaria-the latter reporting spending on orphan medicines as high as 9%.

Conclusions

A low number of studies that informed about pharmaceutical spending on orphan medicines was published, thereof only a few explicitly analysed expenditure data of public payers. A conclusive synthesis of public spending on orphan medicines is a challenge given to the diversity in methodologies to measure expenditure. There is a need for further research to survey primary data of public spending for orphan medicines, based on a sound methodology to measure these data and to compare them internationally.