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
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.
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.
Centre for Evaluation of Medicines, St. Joseph's Healthcare, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. levinem@mcmaster.ca
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.
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.
