RESUMEN
BACKGROUND: Little is known about the proportion of oral contraceptive pill (OCP) users that use progestin-only pills (POPs), factors associated with POP use, and whether out-of-pocket expenditures and dispensing patterns are similar to combined oral contraceptives (COCs). STUDY DESIGN: Observational cohort using 1996-2008 Medical Expenditure Panel Surveys. RESULTS: Among all OCP users, 4% used POPs and changed little between 1996 and 2008. Women were more likely to use POPs if they received postpartum care (p<.001), had a diagnosis of hypertension (p<.001) or resided in the West (p<.01). POP users, compared to COC users, were more likely to pay $15 and more (p<.01) and less likely to obtain more than one pack per purchase (p<.001), controlling for age, race/ethnicity and insurance coverage. CONCLUSION: POP use is very low in the United States. POP users obtained fewer packs per purchase compared with COC users, suggesting that POP may be used as transitional OCPs, particularly during the postpartum period.
Asunto(s)
Conducta Anticonceptiva , Anticonceptivos Orales Combinados/administración & dosificación , Anticonceptivos Hormonales Orales/administración & dosificación , Congéneres del Estradiol/administración & dosificación , Honorarios por Prescripción de Medicamentos , Congéneres de la Progesterona/administración & dosificación , Adolescente , Adulto , Estudios de Cohortes , Conducta Anticonceptiva/tendencias , Anticonceptivos Orales Combinados/economía , Anticonceptivos Hormonales Orales/economía , Prescripciones de Medicamentos/economía , Congéneres del Estradiol/economía , Femenino , Encuestas Epidemiológicas , Humanos , Hipertensión/fisiopatología , Seguro de Servicios Farmacéuticos , Persona de Mediana Edad , Periodo Posparto , Congéneres de la Progesterona/economía , Análisis Espacio-Temporal , Estados Unidos , Adulto JovenAsunto(s)
Composición de Medicamentos , Hidroxiprogesteronas/economía , Producción de Medicamentos sin Interés Comercial/economía , Nacimiento Prematuro/prevención & control , Congéneres de la Progesterona/economía , Caproato de 17 alfa-Hidroxiprogesterona , Composición de Medicamentos/economía , Industria Farmacéutica/economía , Humanos , Hidroxiprogesteronas/uso terapéutico , Congéneres de la Progesterona/uso terapéutico , Terminología como AsuntoRESUMEN
Drospirenone is a synthetic progestogen contained, with estradiol, in the hormone replacement therapy (HRT) product black triangle downAngeliq (Bayer Schering Pharma). This combination is licensed for the relief of oestrogen-deficiency symptoms in women who are at least 1 year postmenopausal.1 It is also licensed for prevention of osteoporosis in women at high risk of future fractures who are intolerant of, or have contraindications to, other medicinal products approved for the prevention of osteoporosis.1 It has also been suggested that drospirenone may have an antihypertensive effect.2 Here we discuss the place of this drug for women following a natural menopause.
Asunto(s)
Androstenos/uso terapéutico , Congéneres de la Progesterona/uso terapéutico , Anciano , Androstenos/economía , Presión Sanguínea/efectos de los fármacos , Peso Corporal/efectos de los fármacos , Densidad Ósea/efectos de los fármacos , Contraindicaciones , Costos de los Medicamentos , Femenino , Terapia de Reemplazo de Hormonas/economía , Terapia de Reemplazo de Hormonas/métodos , Humanos , Persona de Mediana Edad , Posmenopausia/efectos de los fármacos , Guías de Práctica Clínica como Asunto , Congéneres de la Progesterona/economíaAsunto(s)
Anticonceptivos Sintéticos Orales , Desogestrel , Ovulación/efectos de los fármacos , Congéneres de la Progesterona , Anticoncepción/métodos , Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Orales Combinados/economía , Anticonceptivos Orales Combinados/farmacología , Anticonceptivos Sintéticos Orales/efectos adversos , Anticonceptivos Sintéticos Orales/economía , Anticonceptivos Sintéticos Orales/farmacología , Desogestrel/efectos adversos , Desogestrel/economía , Desogestrel/farmacología , Prescripciones de Medicamentos , Femenino , Humanos , Dispositivos Intrauterinos/efectos adversos , Dispositivos Intrauterinos/economía , Educación del Paciente como Asunto/normas , Pautas de la Práctica en Medicina , Congéneres de la Progesterona/efectos adversos , Congéneres de la Progesterona/economía , Congéneres de la Progesterona/farmacología , Reino Unido , Salud de la MujerRESUMEN
The experience of 6 million Norplant users has led to several more advanced implants. Implanon is a single-rod implant system containing a low androgenic progestin and requires 1 to 2 minutes for insertion and removal. Like other implants, Implanon prevents pregnancy by changing the character of the cervical mucus and interfering with luteal function. Unlike Norplant, though, Implanon is designed to prevent ovulation for the full duration of use. Implant contraception has several advantages over other types of contraception including high efficacy, minimal required maintenance, absence of estrogen, and rapid return of fertility after discontinuation. Implants can be a good choice for adolescents; women with hypertension, diabetes, anemia, endometriosis, or other medical problems; and women who are breast-feeding. Irregular bleeding is the most common adverse effect of implants and can be treated with several medication regimens. Preinsertion counseling, however, is the most important factor in ensuring satisfaction with implants. Unfortunately, no implant system is currently available in the United States since August 2000, but Implanon is expected to reach the U.S. market within the next 2 years.
Asunto(s)
Anticonceptivos Femeninos/administración & dosificación , Desogestrel , Implantes de Medicamentos/administración & dosificación , Megestrol/análogos & derivados , Congéneres de la Progesterona/administración & dosificación , Moco del Cuello Uterino/efectos de los fármacos , Ensayos Clínicos como Asunto , Anticonceptivos Femeninos/economía , Anticonceptivos Femeninos/farmacología , Consejo , Endometrio/efectos de los fármacos , Femenino , Humanos , Levonorgestrel/administración & dosificación , Levonorgestrel/farmacología , Megestrol/administración & dosificación , Megestrol/farmacología , Norprogesteronas/administración & dosificación , Norprogesteronas/farmacología , Ovulación/efectos de los fármacos , Satisfacción del Paciente , Embarazo , Congéneres de la Progesterona/economía , Congéneres de la Progesterona/farmacología , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Compuestos de Vinilo/administración & dosificación , Compuestos de Vinilo/farmacologíaRESUMEN
BACKGROUND: Because natural progesterone is poorly absorbed and rapidly metabolized, synthetic derivatives of progesterone, such as medroxyprogesterone acetate (MPA), are used in combination with estrogen in hormone replacement therapy. A micronized form of natural progesterone is available that is readily absorbed and reaches peak serum concentrations from 1 to 4 hours after administration. OBJECTIVE: The purpose of this study was to compare the quality of life (QOL), menopausal symptoms, and costs associated with a natural micronized progesterone (MP) formulation versus MPA as add-on therapy to estrogen in hormone replacement for post-menopausal women. METHODS: This prospective, multicenter, randomized, fixed-dose, open-label, parallel-group study enrolled postmenopausal, otherwise healthy, nonhysterectomized women 45 to 65 years of age who had been amenorrheic for > or =6 months and exhibited symptoms of estrogen deficiency. All women received 0.625 mg conjugated equine estrogens on days 1 to 25 of a 30-day cycle; on days 12 to 25, women were randomized to receive either MP 200 mg or MPA 5 mg; patients were followed for 9 months. QOL, the primary end point, was measured at baseline and months 3, 6, and 9 using the 36-Item Short-Form Health Survey (SF-36), the Nottingham Health Profile (NHP), and the condition-specific Women's Health Questionnaire (WHQ). Bleeding pattern, compliance, menopausal symptoms, and cost were evaluated as secondary end points. Costs (in 1997 Canadian dollars) were assessed from the societal perspective and included costs of study medication, hormone therapy monitoring, concomitant medication, outpatient resources, out-of-pocket expenses, and patient and caregiver time loss. RESULTS: A total of 182 women were enrolled; 89 received MP and 93 received MPA. Improvements in climacteric symptoms were observed from baseline to month 9 for both treatments. Mean scores on all domains of the SF-36 at month 9 were greater than scores at baseline in both treatment groups but the increases were not statistically significant. All domains within the NHP and WHQ improved significantly over this period for both groups (P < or = 0.008). Only patients receiving MP showed specific improvements in the menstrual problems and cognitive domains of the WHQ. The difference in average 9-month cost per patient was not statistically significant, at Can 367 dollars +/- 120 dollars and Can 360 dollars +/- 369 dollars for patients receiving MP and MPA, respectively. CONCLUSIONS: MP is a clinically effective, well-tolerated, and cost-comparable alternative to MPA.
Asunto(s)
Economía Farmacéutica , Terapia de Reemplazo de Hormonas/economía , Acetato de Medroxiprogesterona/uso terapéutico , Posmenopausia/efectos de los fármacos , Congéneres de la Progesterona/uso terapéutico , Progesterona/uso terapéutico , Calidad de Vida , Anciano , Femenino , Humanos , Acetato de Medroxiprogesterona/economía , Persona de Mediana Edad , Progesterona/economía , Congéneres de la Progesterona/economía , Clase SocialRESUMEN
The efficacy of depot medroxyprogesterone acetate in the treatment of endometriosis was assessed in 19 patients with severe diseases. Assessment was based on changes in subjective symptoms and signs at 4 weekly interval during treatment and after 52 weeks follow up, and changes in visible deposits and adhesions at laparoscopy before and after treatment. There were significant reductions in mean total subjective and symptoms scores, mean total R-AFS adhesions and implants scores, and mean additive diameter of implant scores at the end of treatment and follow up. Treatment success occurred in 75% of the patients, majority (66%) of whom had complete resolution of deposits. Side effects encountered include menorrhagia, break through bleeding, excessive weight gain, myalgia, breast pain, acne and delay in return of menses. It was concluded that DMPA an effective, cheap and readily available medication which is worth using in patients who can not afford the expensive alternatives.
Asunto(s)
Endometriosis/tratamiento farmacológico , Acetato de Medroxiprogesterona/uso terapéutico , Congéneres de la Progesterona/uso terapéutico , Acné Vulgar/inducido químicamente , Adulto , Preparaciones de Acción Retardada , Costos de los Medicamentos , Endometriosis/clasificación , Endometriosis/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Acetato de Medroxiprogesterona/economía , Menorragia/inducido químicamente , Trastornos de la Menstruación/inducido químicamente , Dolor/inducido químicamente , Congéneres de la Progesterona/economía , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
As the first real contraceptive innovation in over 20 years, and as a long-acting method requiring clinical intervention for insertion and removal, Norplant raised an especially wide range of issues. It also encountered a number of difficulties. In April 1997, an Institute of Medicine (IOM) workshop on implant contraceptives reviewed newly available data on Norplant's efficacy, safety, and use; considered lessons learned from the method's development, introduction, and market experience; and explored approaches based on those lessons that could improve the environment for contraceptive research and development and make market entry for new contraceptive technologies less troubled. In addition to presenting the IOM workshop findings, the present article calls attention to the rich scientific prospects available for development of the next generation of contraceptives, and notes signs of an evolving new paradigm, essential if those prospects are to be realized to any significant extent.
PIP: An April 1997 workshop, convened by the US Institute of Medicine, reviewed data on Norplant's efficacy, safety, and use; considered lessons learned from the method's development, introduction, and market experience; and explored approaches based on these lessons that could improve the environment for contraceptive research and development and facilitate market entry for new contraceptive technologies. A review of clinical experience with Norplant suggested the importance of delivery in a medically controlled environment, provider training in insertion and removal techniques, intensive client counseling, and free choice. Negative mass media coverage and litigation have had an adverse impact on Norplant use patterns. Nine areas were identified for consideration or action: clinical research on hormonal effects, market research and regularized interactions with industry, a preintroductory phase permitting various assessments in advance of full-scale product introduction, mechanisms to ensure informed decision making, postmarketing surveillance, provider credentialing, core guidelines for long-acting contraceptives, cost analyses, and product liability legislation. Dialogue at the workshop provided evidence of a paradigm shift toward a woman-centered contraceptive research agenda.