Community drug expenditure and recent cost containment measures

The annual cost of medicines under the community drugs schemes increased from Euro 564 m in 2000 to Euro 1,961 m in 2009 before falling an estimated 8% by 2011. Escalating public health costs, fiscal stress and the unsustainability of the previous growth in expenditure has led to the increased use of pharmaceutical cost containment measures in Ireland. Collectively, these measures are estimated to have reduced public expenditure on community drugs by Euro 380 m in 2011 and involve addressing; (1) the ex-factory price of drugs including price cuts of up to 40% on off-patent and generic drugs leading to an estimated Euro 200 m saving (53%); (2) pharmacy dispensing fees and mark-ups via a new dispensing fee structure and reducing both retail and wholesale mark-ups with a Euro 100 m saving (26%); and (3) scheme coverage and patient co-payments including restricting scheme coverage for persons over 70 years and increasing the level of co-payments with savings of Euro 80 m (21%).

Mullerian inhibiting substance inhibits breast cancer cell growth through an NFkappa B-mediated pathway

Müllerian inhibiting substance (MIS), a member of the transforming growth factor-beta superfamily, induces regression of the Müllerian duct in male embryos. In this report, we demonstrate MIS type II receptor expression in normal breast tissue and in human breast cancer cell lines, breast fibroadenoma, and ductal adenocarcinomas. MIS inhibited the growth of both estrogen receptor (ER)-positive T47D and ER-negative MDA-MB-231 breast cancer cell lines, suggesting a broader range of target tissues for MIS action. Inhibition of growth was manifested by an increase in the fraction of cells in the G(1) phase of the cell cycle and induction of apoptosis. Treatment of breast cancer cells with MIS activated the NFkappaB pathway and selectively up-regulated the immediate early gene IEX-1S, which, when overexpressed, inhibited breast cancer cell growth. Dominant negative IkappaBalpha expression ablated both MIS-mediated induction of IEX-1S and inhibition of growth, indicating that activation of the NFkappaB signaling pathway was required for these processes. These results identify the NFkappaB-mediated signaling pathway and a target gene for MIS action and suggest a putative role for the MIS ligand and its downstream interactors in the treatment of ER-positive as well as negative breast cancers.