Ondansetron: costs and resource utilisation in a US teaching hospital setting

A retrospective pharmacoeconomic analysis was conducted to compare lengths of hospital stay for, and usage of hospital resources by, patients (850 admissions) who received either ondansetron or standard antiemetic therapy during hospital admissions for cancer chemotherapy. Average hospital costs for patients admitted to a 720 bed academic medical centre for maintenance chemotherapy between October 1990 and September 1991 were analysed using the hospital's online computerised clinical financial management system. A separate prospective time-and-motion study was used to evaluate specific costs of nursing care associated with episodes of severe nausea and vomiting. In addition, patient perception of quality of life and satisfaction with therapy were evaluated for 27 chemotherapy patients using quality-of-life measurements on the Functional Living Index-Cancer (FLIC) scale. The results of these studies showed that the average length of hospital stay was shorter for patients who received ondansetron rather than standard antiemetic therapy, but that average hospital costs were not significantly different. The reduced hospitalisation costs offset the higher acquisition cost of ondansetron. Mean quality-of-life scores decreased significantly after chemotherapy for patients receiving either ondansetron or standard therapy, but the changes in scores were not strongly associated with the antiemetic agents used or with any of the clinical or demographic variables measured in this study.

Adjuvant corticosteroid therapy for Pneumocystis carinii pneumonia in AIDS patients

OBJECTIVE

To review published abstracts, case reports, and journal articles and evaluate data examining the use of systemic corticosteroids as adjuvant treatment for Pneumocystis carinii pneumonia (PCP) in patients with AIDS.

DATA SOURCES

Computerized online databases, peer-reviewed journals from January 1986 through September 1991, and personal communication with a National Institutes of Health correspondent.

STUDY SELECTION

The authors identified 13 reports pertinent to this review. By author consensus, five studies were selected for analysis based on sample size, controlled study design, and clinical outcome measures. Recommendations of an expert panel from the National Institutes of Health and the University of California also are discussed.

DATA EXTRACTION

Data are presented based on the methodologic strength of the studies reviewed. Studies are assessed on sample size, inclusion criteria, comparative cohort populations, specific patient outcome measures, and statistical analysis.

DATA SYNTHESIS

Results of the study analysis support the use of systemic corticosteroids as early adjunctive therapy for AIDS patients with moderate-to-severe PCP who have an initial arterial oxygen partial pressure of less than 70 mm Hg or an alveolar-arterial gradient greater than 35 mm Hg on room air. Improved outcomes included decreased mortality, respiratory failure, and deterioration of oxygenation. Data evaluated have shown that adjuvant corticosteroid therapy is most effective when initiated within 72 hours of beginning specific antipneumocystis therapy. A small, but sometimes significant, increased rate of infection in steroid-treated patients was noted.

CONCLUSIONS

Based on the literature reviewed, early systemic adjuvant corticosteroid therapy can benefit patients with moderate-to-severe AIDS-related PCP. The steroid regimen used in the largest controlled trial and recommended by the expert panel is prednisone 40 mg bid (days 1-5), then 40 mg/d (days 6-10), then 20 mg/d (days 1-21).