It seems that more erythropoietin (EPO) is required when given intravenously (IV) than when given subcutaneously (SC). Estimates of the magnitude of this difference vary widely, impeding development of economic models in this area. Concerns about pure red cell aplasia led our program to switch from SC to IV EPO, so we studied the impact of this change on the cost of anemia therapy.
All in-center hemodialysis patients who had received EPO for at least 3 months prior to and following conversion to IV EPO were studied. Data was obtained retrospectively for 1 year prior to and prospectively for 1 year following conversion. The costs of anemia therapy (EPO, transfusions and iron) were calculated from the hospital's perspective.
158 patients were studied. One month after switching, the hemoglobin fell significantly, reaching a nadir at 3 months. This triggered more use of EPO, iron and transfusions. By month 7 hemoglobin levels had returned to initial levels, with a median rise in EPO dose of 1,250 units/week (p
High rates of antipsychotic drug prescribing in nursing homes can signal poor quality processes, but also raise concerns about drug safety due to the mortality risk of this therapy. Determining the extent to which variations in antipsychotic use are a symptom of facility-level quality problems as compared with a drug safety issue is important for selecting the correct interventions to effect change.
To determine whether nursing homes with higher rates of antipsychotic dispensing had higher rates of short-term mortality among their residents.
This population-based study examined 60,105 older adults newly admitted to nursing homes in Ontario between April 1, 2000 and March 31, 2004. Using adjusted Cox proportional hazard models, we explored the relationship between facility-level dispensing rates and mortality, controlling for resident characteristics. Facilities were grouped into quintiles according to mean antipsychotic rate. All-cause mortality at 30 and 120 days after admission was stratified by recent hospital discharge and analyzed by quintile.
Average antipsychotic dispensing ranged from 11.6% in the lowest quintile to 30.0% in the highest. Among residents with no recent hospitalization, all-cause mortality at 30 days was 2.5% in the lowest compared with 3.3% in the highest quintile (adjusted hazard ratio: 1.28, confidence interval: 1.06-1.56) and at 120 days was 9.3% compared with 11.7% (adjusted hazard ratio: 1.25, confidence interval: 1.13-1.39).
Residents were at increased risk of death simply by being admitted to a facility with a higher intensity of antipsychotic drug use, despite similar clinical characteristics at admission.
To evaluate the representation of frail older adults in randomized controlled trials (RCTs), and to assess consequences of under representation by analyzing drug discontinuation rates.
A cohort of older adults newly dispensed donepezil in Ontario between September 2001 and March 2002 was constructed using administrative data. A systematic review of the literature identified RCTs of donepezil. Patients dispensed donepezil were then compared to clinical trial subjects. Discontinuation rates were examined for patients with and without potential contraindications to this drug.
There were 6,424 older adults in the Ontario cohort with new claims for donepezil. Ten RCTs evaluating the use of donepezil were identified (n = 3,423). Between 51% and 78% of the Ontario cohort would have been ineligible for RCT enrollment. Patients dispensed donepezil were older (80.3 vs. 73.7 years, p