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Canadian cost- utility analysis of intravenous immunoglobulin for acute childhood idiopathic thrombocytopenic purpura.

https://arctichealth.org/en/permalink/ahliterature124449
Source
J Popul Ther Clin Pharmacol. 2012;19(2):e166-78
Publication Type
Article
Date
2012
Author
Gord Blackhouse
Feng Xie
Mitchell A H Levine
Kaitryn Campbell
Nazila Assasi
Kathryn Gaebel
Daria O'Reilly
Jean- Eric Tarride
Ron Goeree
Author Affiliation
Programs for Assessment of Technology in Health (PATH) Research Institute, McMaster University, Hamilton, Ontario, Canada. blackhou@mcmaster.ca
Source
J Popul Ther Clin Pharmacol. 2012;19(2):e166-78
Date
2012
Language
English
Publication Type
Article
Keywords
Acute Disease
Adrenal Cortex Hormones - economics - therapeutic use
Age Factors
Body Weight
Canada
Child
Cost-Benefit Analysis
Drug Costs
Hospital Costs
Hospitalization - economics
Humans
Immunoglobulins, Intravenous - economics - therapeutic use
Immunologic Factors - economics - therapeutic use
Intracranial Hemorrhages - economics - etiology - prevention & control
Markov Chains
Models, Economic
Platelet Count
Purpura, Thrombocytopenic, Idiopathic - blood - complications - drug therapy - economics
Quality-Adjusted Life Years
Time Factors
Treatment Outcome
Abstract
Idiopathic thrombocytopenic purpura (ITP) is a hematological disorder and can be classified as acute or chronic. The main goal of treatment for acute childhood ITP is the prevention of potentially fatal bleeding complications, the most serious of which is intracranial hemorrhage (ICH). Treatment options for acute childhood ITP include splenectomy, corticosteroids, and blood products such as intravenous immunoglobulin.
The objective was to evaluate, from a Canadian perspective, the cost-effectiveness of intravenous immunoglobulin (IVIG) compared to alternative inpatient treatments for acute childhood idiopathic thrombocytopenic purpura (ITP).
A Markov model with a lifelong time horizon was used to evaluate the costs and quality-adjusted life years (QALYs) for 5 treatments for children hospitalized for ITP: 1) no treatment; 2) IVIG; 3) Anti-D; 4) prednisone; and 5) methylprednisolone. The model predicted the probability of intracranial hemorrhage for each treatment strategy based on the time children spent with platelet counts
PubMed ID
22580389 View in PubMed
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Natural health product use in Canada: analysis of the National Population Health Survey.

https://arctichealth.org/en/permalink/ahliterature167846
Source
Can J Clin Pharmacol. 2006;13(2):e240-50
Publication Type
Article
Date
2006
Author
Sumeet R Singh
Mitchell A H Levine
Author Affiliation
Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, Canada.
Source
Can J Clin Pharmacol. 2006;13(2):e240-50
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Biological Products - administration & dosage
Canada
Female
Humans
Male
Middle Aged
Multivariate Analysis
Population Surveillance - methods
Abstract
The use of natural health products (NHPs) in Western countries has increased dramatically over the past two decades. Although prevalence estimates have been published in the U.S. and elsewhere, little is known about the characteristics of persons who use NHPs.
To measure the prevalence of NHP use among adults in Canada, identify the most commonly used agents, and determine the socioeconomic, demographic, and health-related correlates of use.
NHP use by adults was assessed using the 2000-2001 National Population Health Survey (NPHS), a biennial general health survey conducted by Statistics Canada. A total of 11,424 adults completed the survey in 2000-2001. NHPs were defined as botanical and naturally-derived non-botanical products, excluding essential vitamins and minerals. Prevalence of use estimates were calculated nationally, and by age, gender, socioeconomic status, disease states, and health care practices. Multivariate logistic regression modeling was used to simultaneously assess the correlations of these variables with NHP use.
The prevalence of past 2-day NHP use in Canada was 9.3% in 2000-2001. Fifty-seven percent of users also reported taking a conventional medicine in the same period. Glucosamine, echinacea, and garlic were the most frequently used products. Women reported NHP use more frequently than men (11.5% vs. 7.1%). As compared to young adults, NHP use was about 50% higher in middle-aged and older Canadians. There were no associations with either income or education level. Several disease states were associated with a high prevalence of NHP use: respondents with fibromyalgia (23.3%), inflammatory bowel disease (17.4%), and urinary incontinence (16.8%) were most likely to be NHP users. However, in the multivariate analysis, age and the use of vitamins or minerals were most predictive of NHP use, while health status variables were of less importance.
NHP use is an important health phenomenon in Canada. Although respondents in poor health were more likely to use NHPs, a significant proportion of healthy Canadians also reported NHP use. The use of NHPs also cut across different socioeconomic groups. Concurrent use of conventional medications was common and suggests a need for health professionals to monitor for potential interactions.
PubMed ID
16921199 View in PubMed
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Potential interactions between pharmaceuticals and natural health products in Canada.

https://arctichealth.org/en/permalink/ahliterature165503
Source
J Clin Pharmacol. 2007 Feb;47(2):249-58
Publication Type
Article
Date
Feb-2007
Author
Sumeet R Singh
Mitchell A H Levine
Author Affiliation
Centre for Evaluation of Medicines, 105 Main St. East, Level One, Hamilton, ON, Canada L8N 1G6.
Source
J Clin Pharmacol. 2007 Feb;47(2):249-58
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Biological Products - adverse effects
Canada
Data Collection
Drug Interactions
Female
Humans
Male
Middle Aged
Abstract
This study sought to measure the extent to which potentially interacting combinations of natural health products (NHPs) and drugs are used in the Canadian adult population. Data were obtained from the Statistics Canada 2000-2001 National Population Health Survey. A total of 11 424 adults completed the survey. Of the survey participants, 9.3% reported the use of at least 1 natural health product in the prior 2 days. Among natural health product users, 57% also used a conventional medicine with systemic exposure in the same time period. A minimum of 1 potential drug-NHP interaction was identified in 28.4% of such combination users. Most interactions (90%) were of unknown clinical significance. Female gender, older age, lower education, and the presence of diabetes and high blood pressure were associated with a higher risk of having at least 1 potential interaction. Health professionals need to maintain a working knowledge of common potential drug-NHP interactions, to dialogue with all patients regarding the use of natural health products, and to remain vigilant in reporting all suspected interactions and adverse events involving natural health products. Regulatory agencies should also capture and assess reports of drug-NHP interactions more effectively.
PubMed ID
17244776 View in PubMed
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Self-reported use of natural health products: a cross-sectional telephone survey in older Ontarians.

https://arctichealth.org/en/permalink/ahliterature145641
Source
Am J Geriatr Pharmacother. 2009 Dec;7(6):383-92
Publication Type
Article
Date
Dec-2009
Author
Mitchell A H Levine
Shuang Xu
Katherine Gaebel
Nicole Brazier
Michel Bédard
Kevin Brazil
Lynne Lohfeld
Stuart M MacLeod
Author Affiliation
Centre for Evaluation of Medicines, St. Joseph's Healthcare, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. levinem@mcmaster.ca
Source
Am J Geriatr Pharmacother. 2009 Dec;7(6):383-92
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Biological Products - administration & dosage
Communication
Cross-Sectional Studies
Dietary Supplements
Female
Health status
Herb-Drug Interactions
Humans
Male
Minerals - administration & dosage
Ontario
Telephone
Vitamins - administration & dosage
Abstract
The self-reported use of natural health products (NHPs) (herbal products and vitamin and mineral supplements) has increased over the past decade in Canada. Because the elderly population might have comorbidities and concurrently administered medications, there is a need to explore the perceptions and behaviors associated with NHPs in this age group.
The goal of this study was to assess the use of NHPs in a cohort of older Canadian residents and the characteristics, perceptions, and behaviors associated with NHP use.
Survey participants aged > or = 60 years were randomly selected from telephone listings in the area of greater Hamilton, Ontario, Canada. Data were collected using a standardized computer-assisted telephone interview system. Self-reported data covering 7 domains were collected: (1) demographics; (2) self-reported 12-month NHP use; (3) reasons for NHP use; (4) self-reported 12-month prescription medication use; (5) expenditures on NHPs; (6) patient-reported adverse events and drug-NHP interactions; and (7) perceptions of physicians' attitudes regarding NHPs. Descriptive statistics were used to compare the characteristics of NHP users with those of nonusers and to assess the characteristics of NHP users across these 7 domains. Multivariate regression analysis was conducted to determine the demographic variables that might be associated with NHP user status.
Of 2528 persons identified as age > or = 60 years, 1206 (48%) completed the telephone interview. Six hundred sixteen of these respondents (51%) reported the use of > or = 1 NHP during the previous 12 months. On the initial univariate analysis, younger age and higher income were significantly associated with reporting NHP use (mean age, users vs nonusers, 71.1 vs 72.7 years, respectively; 95% CI, 1.02-1.06; P or = 60 years reported NHP use, and there is a need for greater communication with physicians to avoid potential drug-NHP interactions.
PubMed ID
20129259 View in PubMed
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Validity of self-reported prescription drug insurance coverage.

https://arctichealth.org/en/permalink/ahliterature186126
Source
Health Rep. 2003 Feb;14(2):35-46
Publication Type
Article
Date
Feb-2003
Author
Paul Grootendorst
Edward C Newman
Mitchell A H Levine
Author Affiliation
Faculty of Pharmacy, University of Toronto, Toronto, Ontario, M5S 2S2. paul.grootendorst@utoronto.ca
Source
Health Rep. 2003 Feb;14(2):35-46
Date
Feb-2003
Language
English
Publication Type
Article
Keywords
Aged
Awareness
Canada
Cross-Sectional Studies
Drug Prescriptions - economics
Family Characteristics
Health Services Research
Humans
Insurance Coverage - statistics & numerical data
Insurance, Pharmaceutical Services - statistics & numerical data
Probability
Self Disclosure
Abstract
This article assesses the validity of prescription drug insurance coverage as self-reported in the 1996/97 National Population Health Survey (NPHS).
The data are from the cross-sectional household component of Statistics Canada's 1996/97 NPHS.
Most seniors and all social assistance recipients are entitled to prescription drug benefits from their provincial governments. For NPHS respondents eligible for such benefits, the percentage reporting coverage in 1996/97 was calculated. Logit regression was used to assess the determinants of self-reported coverage.
Only 51% of seniors and 46% of social assistance recipients who were eligible for provincial benefits reported drug insurance coverage in 1996/97. The probability of reporting coverage was generally higher in provinces with drug programs that did not impose deductibles.
PubMed ID
12658863 View in PubMed
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