RESUMEN
BACKGROUND: Previous estimates of the national economic burden of allergic rhinoconjunctivitis (AR/AC) have relied on data analyses in which AR/AC was the primary International Classification of Diseases-ninth revision-Clinical Modification (ICD-9-CM)-coded diagnosis. These studies ignore the costs when AR/AC was a secondary diagnosis to other disorders such as asthma and sinusitis. OBJECTIVE: We sought to determine the national direct cost of illness for AR/AC. METHODS: An expert panel used the Delphi technique to estimate the proportion of visits coded by other primary ICD-9-CM diagnoses in which AR/AC was a significant secondary comorbid condition. The costs of this proportion were deemed to be "attributable" to AR/AC and were added to the costs when allergic rhinitis and allergic conjunctivitis were the primary diagnoses. RESULTS: The cost when AR/AC was the primary diagnosis was $1.9 billion (in 1996 dollars). The cost when AR/AC was a secondary diagnosis was estimated at $4.0 billion, giving an estimate of $5.9 billion for the overall direct medical expenditures attributable to AR/AC. Outpatient services (63%, $3.7 billion), medications (25%, $1.5 billion), and inpatient services (12%, $0.7 billion) accounted for the expenditures. Children 12 years and younger accounted for $2.3 billion (38.0%). CONCLUSION: Upper airway allergy is an expensive disease process because of its readily apparent manifestations as AR/AC and its contribution to other airway disorders.
Asunto(s)
Conjuntivitis Alérgica/economía , Costo de Enfermedad , Rinitis Alérgica Perenne/economía , Adulto , Niño , Comorbilidad , Conjuntivitis Alérgica/epidemiología , Conjuntivitis Alérgica/inmunología , Conjuntivitis Alérgica/terapia , Técnica Delphi , Costos de los Medicamentos , Femenino , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Humanos , Pacientes Internos , Masculino , Pacientes Ambulatorios , Rinitis Alérgica Perenne/epidemiología , Rinitis Alérgica Perenne/inmunología , Rinitis Alérgica Perenne/terapia , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: There have been no recent assessments of the economic burden of sinusitis in the peer-reviewed literature. OBJECTIVE: We sought to estimate the 1996 total direct health care expenditures for the treatment of sinusitis. METHODS: This study determined (1) direct expenditures of medical and surgical encounters in which sinusitis was the primary diagnosis and (2) attributable expenditures when related airway diseases were the primary diagnosis and sinusitis was a comorbid condition. An expert panel used the Delphi consensus-building technique to determine the proportions for the latter. RESULTS: Overall health care expenditures attributable to sinusitis in 1996 were estimated at $5.8 billion, of which $1.8 billion (30.6%) was for children 12 years or younger. A primary diagnosis of acute or chronic sinusitis accounted for 58.7% of all expenditures ($3.5 billion). About 12% each of the costs for asthma and chronic otitis media and eustachian tube disorders were attributed to diagnosis and treatment of comorbid sinusitis. Nearly 90% of all expenditures ($5.1 billion) were associated with ambulatory or emergency department services. CONCLUSION: The economic burden of sinusitis in the United States is significant. However, the limitations of this type of evaluation suggest the $5.8 billion amount may be an underestimate of the true direct costs.
Asunto(s)
Costo de Enfermedad , Sinusitis/economía , Adulto , Asma/economía , Asma/epidemiología , Niño , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Humanos , Pólipos Nasales/economía , Pólipos Nasales/epidemiología , Otitis Media/economía , Otitis Media/epidemiología , Trastornos Respiratorios/economía , Trastornos Respiratorios/epidemiología , Rinitis/economía , Rinitis/epidemiología , Sinusitis/epidemiología , Estados Unidos/epidemiologíaRESUMEN
The purpose of the present study was to evaluate the possible therapeutic effects of interferon alpha and gamma in the management of atopic dermatitis (AD) and hyperimmunoglobulin E syndrome (HIES). A total of three patients with severe AD/HIES were studied. Two patients with AD (patients no. 1 and 2) were treated initially with IFN-gamma (0.05 mg/m2, thrice weekly). Although initial improvement was observed in both patients, due to the incomplete resolution of the disease in patient no. 1 (severity score decreased from 14 to 6), IFN-gamma was replaced by IFN-alpha (3 x 10(6) U/m2, thrice weekly) which offered further improvement (severity score decreased to 3). Patient no. 2 had a recurrence of the disease activity at the fourth week, which did not respond to an increased dose of IFN-gamma (0.1 mg/m2), hence the medication was changed to IFN-alpha (0.5 x 10(6) U/m2, thrice weekly). Following an additional 20 weeks therapy with IFN-alpha, the lesions improved dramatically and reached complete remission (severity score decreased from 12 to 0). A third patient with HIES was treated with IFN-gamma (0.05 mg/m2, thrice weekly), following which the disease severity score improved from 11 to 3 in 20 weeks. This preliminary study supports the therapeutic effect of IFNs in patients with atopic diseases. The sequential or combined usage of IFN-alpha and IFN-gamma may offer additional therapeutic benefit. The data further suggest that non-IgE-related mechanism(s) may also play an important role in this treatment modality.
Asunto(s)
Dermatitis Atópica/terapia , Interferón-alfa/uso terapéutico , Interferón gamma/uso terapéutico , Síndrome de Job/terapia , Adulto , Preescolar , Relación Dosis-Respuesta a Droga , Humanos , Interferón-alfa/efectos adversos , Interferón gamma/efectos adversos , MasculinoRESUMEN
This report describes the results of a phase 1 study evaluating the safety, infectivity, and immunogenicity of a new live oral Salmonella typhi temperature-sensitive (ts) 51-1 typhoid fever vaccine in the human. Three normal male subjects aged 23-32 years received three oral doses of S. typhi ts 51-1, each dose containing 10(9) organisms. Prior to and following immunization each subject was carefully monitored by clinical and laboratory parameters over a 2 week period during which serial specimens of blood and stool were analysed for the presence of the organism. Blood specimens were also obtained for the determination of serum antibody and cell-mediated immune responses and stool filtrates were analysed for the development of coproantibody. The results of these studies indicate that: (1) the vaccine is well tolerated with no clinical or laboratory evidence of adverse reactions; (2) ts 51-1 was detected in only one stool specimen from one volunteer; the organism recovered displayed characteristics of the ts 51-1 vaccine strain; and (3) although no significant humoral or cell-mediated lymphocytotoxic immune responses were detected in the blood, coproantibody was detected in stool specimens from all of the three immunized subjects and IgA-armed ADCC activity was detected in two of three subjects. These studies indicate that S. typhi ts 51-1 may be a suitable strain for the development of an improved oral typhoid fever vaccine. Studies are in progress to determine optimal methods of vaccine delivery preparatory to large phase 2 studies of efficacy.