No abstract

Patients in all countries showed a preference and WTP for Humalog Mix25 over Humulin 30/70. The main drivers of patient WTP may be of interest to pharmaceutical prescribers, manufacturers, and reimbursement agencies.

Pemetrexed/cisplatin demonstrated acceptable cost-effectiveness when compared with cisplatin monotherapy and alternative treatments commonly used in UK clinical practice.

This study aimed to provide information on the burden of illness and health-related quality of life (HRQoL) in children with epilepsy who experience prolonged acute convulsive seizures (PACS) in the community setting, and to investigate factors that may predict poor HRQoL in this population. Methods: Noninstitutionalized children (aged 3-16 years) who had experienced at least one PACS within the past year and had currently prescribed PACS rescue medication were enrolled in a cross-sectional study in Germany, Italy, Spain, and the United Kingdom (Practices in Emergency and Rescue medication For Epilepsy managed with Community-administered Therapy 3 [PERFECT-3]). Clinicians, parents/guardians, and patients completed webbased questionnaires regarding clinical characteristics, PACS frequency, and day-today impairment. Patients' HRQoL was rated by clinicians, parents/guardians, and patients themselves using the 5-dimension EuroQol questionnaire (EQ-5D) and summarized as a utility score. Potential predictors of poor HRQoL were tested in individual univariate generalized linear models and a global multivariable model. Results: Enrolled children (N = 286) had experienced 1-400 PACS (median: 4) in the past year. Clinicians reported that 216/281 patients (76.9%) had learning disabilities of varying severity. Mean EQ-5D utility scores rated by clinicians (n = 279), parents (n = 277), and patients (n = 85) were 0.52 (standard deviation: 0.41), 0.51 (0.39), and 0.74 (0.29), respectively. Increasing PACS frequency, increasing severity of learning disability, and specialist school attendance were significantly associated with decreasing EQ-5D utility score. In the multivariable model, having learning disabilities was the best predictor of poor HRQoL. Significance: Health-related quality of life was very poor in many children with epilepsy whose PACS were managed with rescue medication in the community, with learning disability being the most powerful predictor of patients' HRQoL. Mean EQ-5D utility scores were lower (worse) than published values for many other chronic disorders, indicating that optimal treatment should involve helping children and their families to manage learning disabilities and day-today impairments, in addition to preventing seizures.

Background:The prevalence of degenerative Aortic Stenosis (AS) is strongly linked to the phenomenon of population aging. While elderly patients form the majority of patients treated with AS, comorbidities place them at high for surgical aortic valve replacement (SAVR). With the new treatment option of transcatheter aortic valve implantation (TAVI), also patients formerly deemed inoperable can now be treated. Robust estimates in an elderly population remain unclear. The objective of this study is to perform a systematic review (SR) and meta-analysis (MA) to identify observational populationbased studies that report prevalence of severe AS in persons Ͼ 70yrs. Methods: A search of the published literature was conducted in Feb 2012 using Medical databases. General population observational studies, surveys, registries that reported the prevalence of degenerative severe AS in elderly persons (Ͼ70yrs) were included. Although the methods used to diagnose severe AS differed slightly between studies, the cut-off diagnostic criteria used in this analysis, where severe AS is defined as aortic valve area Ͻ1 cm 2 , was taken from the ESC AS guidelines. A MA of prevalence estimates was conducted in order to provide a point estimate (with confidence interval) of severe AS prevalence. Heterogeneity was quantified using the I2 measure and its significance was tested with the Q test. Results: A total of 1524 citations were retrieved for review and 7 observational studies reported severe AS in an elderly population. Five studies reported severe AS separately (from other forms of AS) and were included in the MA. The pooled prevalence of severe AS in persons Ͼ75yrs was 4.3% (95% CI 3.1%, 5.5%; heterogeneity, I2ϭ52.8%, chi-square p-valueϭ0.095). In persons Ͼ80yrs the pooled prevalence of severe AS was 4.8% (95% CI 3.4%, 6.3%; heterogeneity, I2ϭ48.2%, chi-square p-valueϭ0.122). Due to the moderate amount of heterogeneity in the estimates, which was deemed statistically non-significant, a fixed-effect approach was used. Conclusions: Our unique SR shows a prevalence of almost 5% in the octogenarians have severe AS. These figures reconfirm AS as a major disease and form a starting point in light of new less invasive TAV implantation.