Although acromegaly is a rare disease, the clinical, economic and health-related quality of life (HRQoL) burden is considerable due to the broad spectrum of comorbidities as well as the need for lifelong management. We performed a comprehensive literature review of the past 12 years (1998–2010) to determine the benefit of disease control (defined as a growth hormone [GH] concentration <2.5 μg/l and insulin-like growth factor [IGF]-1 normal for age) on clinical, HRQoL, and economic outcomes. Increased GH and IGF-1 levels and low frequency of somatostatin analogue use directly predicted increased mortality risk. Clinical outcome measures that may improve with disease control include joint articular cartilage thickness, vertebral fractures, left ventricular function, exercise capacity and endurance, lipid profile, and obstructive apnea events. Some evidence suggests an association between controlled disease and improved HRQoL. Total direct treatment costs were higher for patients with uncontrolled compared to controlled disease. Costs incurred for management of comorbidities, and indirect cost could further add to treatment costs. Optimizing disease control in patients with acromegaly appears to improve outcomes. Future studies need to evaluate clinical outcomes, as well as HRQoL and comprehensive economic outcomes achieved with controlled disease.

The purpose of this literature review was to identify and summarize published studies describing the epidemiology and management of chronic lymphocytic leukaemia (CLL). Chronic lymphocytic leukaemia represents 22-30% of all leukaemia cases with a worldwide incidence projected to be between < 1 and 5.5 per 100,000 people. Australia, the USA, Ireland and Italy have the highest CLL incidence rates. Chronic lymphocytic leukaemia presents in adults, at higher rates in males than in females and in whites than in blacks. Median age at diagnosis is 64-70 years. Five-year survival rate in the USA is 83% for those < 65 years old and 68% for those 65 + years old. Hereditary and genetic links have been noted. Persons with close relatives who have CLL have an increased risk of developing it themselves. No single environmental risk factor has been found to be predictive for CLL. Patients are usually diagnosed at routine health care visits because of elevated lymphocyte counts. The most common presenting symptom of CLL is lymphadenopathy, while difficulty exercising and fatigue are common complaints. Most patients do not receive treatment after initial diagnosis unless presenting with clear pathologic conditions. Pharmacological therapy may consist of monotherapy or combination therapy involving glucocorticoids, alkylating agents, and purine analogs. Fludarabine may be the most effective single drug treatment currently available. Combination therapy protocols have not been shown to be more effective than fludarabine alone. As no cure is yet available, a strong unmet medical need exists for innovative new therapies. Experimental treatments under development include allogeneic stem cell transplant, mini-allogeneic transplants, and monoclonal antibodies (e.g. alemtuzumab against CD52; rituximab against CD20).

A573was inadequate response from traditional disease-modifying anti-rheumatic drugs (DMARDs) alone (54.9%), followed by symptom control (13.4%). Among the remaining responses, clinical data (e.g., results from clinical trials) was cited most frequently in the UK (17.1%) compared to Germany/Spain (9.0%/4.7%), while personal experience was cited most in Germany (15.3%) vs. UK/Spain (2.7%/0.9%). Inadequate response to DMARDs was most frequently reported for adalimumab (61.5%) vs. etanercept (46.9%) or other biologics (40.2%); inadequate DMARD symptom control was more cited for etanercept (18.8%) vs. adalimumab (11.1%) or other biologics (9.8%). Among the 23 patients who switched to a second biologic agent, 72.7% were switched due to inadequate response to the first biologic agent. ConClusions: Across the three study countries, prescribers most frequently initiated biologic therapy due to inadequate response or lack of symptom control on traditional DMARDs. Other reasons varied by country, however differences across biologic agents prescribed were minimal.

Objectives: To evaluate economic impact of linezolid (LZD) versus vancomycin (VAN) for treatment of confirmed methicillin-resistant Staphylococcus aureus(MRSA) nosocomial pneumonia (NP) in German health care system. MethOds: A 4 week decision model was developed capturing 1 st and 2 nd line therapy. Published literature (primarily Wunderink 2012, reported 54.8% clinical efficacy for LZD vs. 44.9% for VAN in modified Intent-to-Treat population at End of Study for treatment of MRSA NP) and expert opinion provided clinical and resource use data, such as efficacy, mortality, adverse events (AEs), treatment duration, and length of hospital/ICU stay. German cost data was obtained from published literature. Base-case analysis used 10-day treatment duration. In event of treatment failure/ severe AEs on 1st-line therapy, drug was switched after 7 days. Costs were reported in 2012 Euros. Results: LZD was associated with minimally lower costs (€ 16,119 vs. € 16,144), and greater overall treatment success compared to VAN, resulting in LZD 'dominating' VAN. About 80% of treatment costs were related to hospital stay, primarily ICU (72%). Drug therapy, physician visits, laboratory tests and AEs/ treatment failure each account for ≤ 5% of total costs. Several scenarios were tested by varying treatment duration (7 or 14 days), and varying discontinuation/ switch of therapy (at 5 or 10 days). In cases of shorter treatment duration (7 day) or delayed switch of therapy (at 10 day), linezolid continues to 'dominate'. However, with 14 day treatment duration or early switch (at 5 day) linezolid becomes more costly, but still has greater effectiveness resulting in a relatively low Incremental Cost Effectiveness Ratio (ICER) of € 8,207 and € 2,343 per successfully treated patient. cOnclusiOns: LZD is a cost-effective alternative to VAN for treatment of MRSA-confirmed NP, owing primarily to its higher clinical response rate. Future analyses should use other country costs/resource use data to test result generalizability and assess empiric treatment phase.