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221. Savings in direct medical costs produced by an inhaled solution of tobramycin (Tobi) in children with cystic fibrosis
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Supplement / The Netherlands Journal of Medicine 54 (1999) S3 –S84
Among 270 cf children 2 patients died, 2 were out of observation. 266 of our patients are still under observation. In 1998 the mortality reduced to 0.74%. Survival time was performed using Kaplan-Meier method. 87% of our cf patients were expected to be alive at the age of 25 years. There was analysed influence of the age of diagnosis for survival time (Cox’s method). There is a significant correlation between age of diagnosis and survival time. The age of diagnosis is a risk factor for survival time.
221. Savings in direct medical costs produced by an inhaled solution of tobramycin (Tobi) in children with cystic fibrosis. Jacques LeLorier 1,2 , Sylvie Perreault 1 , Howard Birnbaum 2 , Paul Greenberg 2 . 1 Centre de Recherche, Centre hospitalier de ˆ l’ Universite´ de Montreal, Campus Hotel-Dieu , Canada, 2 Analysis Group /Economics, Cambridge, Mass., USA. Background: Ramsey et al. (NEJM 340:1;23–30, 1999) have shown that TOBI produces a 26% (95% CI 2% to 43%) decrease in the probability of being hospitalized. Methods: Individual patient-data from the trial were used to calculate the number of days in hospital, on home iv and on home antibiotic therapy on average and for the sub-groups of patients with FEV1 , 50 and FEV1 . 50. The direct medical costs for these parameters were obtained from the Ontario Ministry of Health. Results: Pertinent pharmaco-economic results reported in days and 95% CI were as follows. In hospital: T 5 5.2, P 5 8.2; Dif 5 2 3 (20.97 to 2 5.02). Home iv therapy: T 5 5.9, P 5 9.3; Dif. 5 2 3.4 (20.79 to 2 6.02). Home oral therapy: T 5 15.4, P 5 18.1; Dif 5 2 2.7 (1.07 to 2 6.52). The average savings in direct medical costs that could be produced by the use of Tobramycin during a 20 week treatment period in Ontario would amount to 13,256 CAN$. The maximal savings would be obtained in children with FEV1 less than 50%: 22,735 CAN$. Conclusions: Substantial savings in direct medical costs could be obtained with the utilization of TOBI in patients with cystic fibrosis.
222. Hypoplasia of the sphenoid sinuses in cystic fibrosis; a diagnostic tool? H.B. Eggesbø 1 , T. Eken 2 , K. Eiklid 3 , F. Kolmannskog 4 . Depts. of 1 Radiology and 2 Anaesthesiology, ˚ Hospital, Aker Hospital, 3 Dept. of Medical Genetics, Ulleval 4 Sentrum Røntgeninstitutt, Oslo, Norway. The size of the sphenoid sinuses from 96 patients with cystic fibrosis was measured from coronal computed tomography (CT) images and compared to sinuses from 130 patients with inflammatory sinonasal disease. Area and circumference were automatically measured from the image with the largest coronal area of the sphenoid sinuses, and antero-posterior extension was calculated from lateral scanograms. CF patients generally had small sphenoid sinuses with pneumatization only of the presphenoid. When CF patients were grouped according to number of confirmed mutations (CF-0, CF-1, or CF-2), the largest differences for all parameters were observed between the CF-2 and the control groups (ANOVA: p , 0.0001). The CF-0 and CF-1 groups
consisted of two populations, one overlapping the CF-2 group and another overlapping the control group.
223. Sino-nasal polyposis in children with cystic fibrosis. K. ´ Hospital for Children, Holics, R. Ujhelyi, G. Katona. Heim Pal CF Center and ENT Department, Budapest, Hungary. The incidence of nasal polyps in cystic fibrosis (CF) patients has been reported to be 6% to 48%. There is a general agreement that functional endoscopic surgery (FESS) is a method of choice in the operative therapy even in children in this disease. Methods and results: 32 children (aged 3.5–19) with cystic fibrosis underwent functional endoscopic sinus surgery because of severe nasal and paranasal polyposis. There were no adverse events or side effects observed. The rate of recidive during the two years follow-up period was 65%. Detailed evaluation (including spiral CT scan) and unsuccessful medical treatment always preceded the operation. Even in recidive cases a significant improvement could be observed in nasal obstruction, nasal discharge, snoring and physical activity (unpaired t-test: p , 0.05). Bacterial evaluation revealed Staphylococci colonization in 58%. Haemophylus influenzae in 25%. Pseudomonas aeruginosa in 18.7% of patients (nose and sinus respectively). Histology showed certain changes in patients to patients – this needs further investigation to explore the connection with clinical status. Conclusion: FESS is an effective, good method for the therapy of polyposis in patients with CF. Still remains the problem of high recurrence rate and the unsolved method of postoperative care.
224. Assessment of severity of symptoms of sinus disease in adult CF patients. C.M. Smyth, R. Convery, L. Lukehurst, M.J. Walshaw. Adult CF Unit, Cardiothoracic Centre, Liverpool, UK. Although the abnormalities of CF mucus are expressed in the upper airway and childhood sinus development is abnormal, little attention has been paid to the degree of symptoms that sinus disease causes in adult patients. Therefore, as part of a survey of sinus symptoms in this patient group, we assessed the effect of 9 specific sinus related symptoms on well-being on a large cohort of adult CF patients. The degree of severity of symptoms was ranked using a 0 to 3 point scale, and the picture of morbidity for each patient obtained by aggregation to give their individual ‘‘combined sinus score’’ (maximum attainable score 27). Forty-nine of 88 patients (56%) questioned had mild sinus related symptoms (score 8 or less), whilst 28 (32%) had moderate symptoms (score 9 to 17). However, 11 patients (12%) had severe symptoms (score 18 or greater), with the highest score attained being 22. There was no difference in combined sinus score between the sexes, nor was the degree of severity related to age. However, those patients who had previously sought ENT attention were more likely to still have more severe symptoms (combined sinus score: treated mean 11.25 [range 1–20] versus untreated 8.32 [0–22], P , 0.05). This survey confirms that a significant proportion of adult CF patients have considerable morbidity from chronic sinus disease.
225. Visual deficits in cystic fibrosis. T.J. Buckingham, S.
Supplement / The Netherlands Journal of Medicine 54 (1999) S3 –S84
Among 270 cf children 2 patients died, 2 were out of observation. 266 of our patients are still under observation. In 1998 the mortality reduced to 0.74%. Survival time was performed using Kaplan-Meier method. 87% of our cf patients were expected to be alive at the age of 25 years. There was analysed influence of the age of diagnosis for survival time (Cox’s method). There is a significant correlation between age of diagnosis and survival time. The age of diagnosis is a risk factor for survival time.
221. Savings in direct medical costs produced by an inhaled solution of tobramycin (Tobi) in children with cystic fibrosis. Jacques LeLorier 1,2 , Sylvie Perreault 1 , Howard Birnbaum 2 , Paul Greenberg 2 . 1 Centre de Recherche, Centre hospitalier de ˆ l’ Universite´ de Montreal, Campus Hotel-Dieu , Canada, 2 Analysis Group /Economics, Cambridge, Mass., USA. Background: Ramsey et al. (NEJM 340:1;23–30, 1999) have shown that TOBI produces a 26% (95% CI 2% to 43%) decrease in the probability of being hospitalized. Methods: Individual patient-data from the trial were used to calculate the number of days in hospital, on home iv and on home antibiotic therapy on average and for the sub-groups of patients with FEV1 , 50 and FEV1 . 50. The direct medical costs for these parameters were obtained from the Ontario Ministry of Health. Results: Pertinent pharmaco-economic results reported in days and 95% CI were as follows. In hospital: T 5 5.2, P 5 8.2; Dif 5 2 3 (20.97 to 2 5.02). Home iv therapy: T 5 5.9, P 5 9.3; Dif. 5 2 3.4 (20.79 to 2 6.02). Home oral therapy: T 5 15.4, P 5 18.1; Dif 5 2 2.7 (1.07 to 2 6.52). The average savings in direct medical costs that could be produced by the use of Tobramycin during a 20 week treatment period in Ontario would amount to 13,256 CAN$. The maximal savings would be obtained in children with FEV1 less than 50%: 22,735 CAN$. Conclusions: Substantial savings in direct medical costs could be obtained with the utilization of TOBI in patients with cystic fibrosis.
222. Hypoplasia of the sphenoid sinuses in cystic fibrosis; a diagnostic tool? H.B. Eggesbø 1 , T. Eken 2 , K. Eiklid 3 , F. Kolmannskog 4 . Depts. of 1 Radiology and 2 Anaesthesiology, ˚ Hospital, Aker Hospital, 3 Dept. of Medical Genetics, Ulleval 4 Sentrum Røntgeninstitutt, Oslo, Norway. The size of the sphenoid sinuses from 96 patients with cystic fibrosis was measured from coronal computed tomography (CT) images and compared to sinuses from 130 patients with inflammatory sinonasal disease. Area and circumference were automatically measured from the image with the largest coronal area of the sphenoid sinuses, and antero-posterior extension was calculated from lateral scanograms. CF patients generally had small sphenoid sinuses with pneumatization only of the presphenoid. When CF patients were grouped according to number of confirmed mutations (CF-0, CF-1, or CF-2), the largest differences for all parameters were observed between the CF-2 and the control groups (ANOVA: p , 0.0001). The CF-0 and CF-1 groups
consisted of two populations, one overlapping the CF-2 group and another overlapping the control group.
223. Sino-nasal polyposis in children with cystic fibrosis. K. ´ Hospital for Children, Holics, R. Ujhelyi, G. Katona. Heim Pal CF Center and ENT Department, Budapest, Hungary. The incidence of nasal polyps in cystic fibrosis (CF) patients has been reported to be 6% to 48%. There is a general agreement that functional endoscopic surgery (FESS) is a method of choice in the operative therapy even in children in this disease. Methods and results: 32 children (aged 3.5–19) with cystic fibrosis underwent functional endoscopic sinus surgery because of severe nasal and paranasal polyposis. There were no adverse events or side effects observed. The rate of recidive during the two years follow-up period was 65%. Detailed evaluation (including spiral CT scan) and unsuccessful medical treatment always preceded the operation. Even in recidive cases a significant improvement could be observed in nasal obstruction, nasal discharge, snoring and physical activity (unpaired t-test: p , 0.05). Bacterial evaluation revealed Staphylococci colonization in 58%. Haemophylus influenzae in 25%. Pseudomonas aeruginosa in 18.7% of patients (nose and sinus respectively). Histology showed certain changes in patients to patients – this needs further investigation to explore the connection with clinical status. Conclusion: FESS is an effective, good method for the therapy of polyposis in patients with CF. Still remains the problem of high recurrence rate and the unsolved method of postoperative care.
224. Assessment of severity of symptoms of sinus disease in adult CF patients. C.M. Smyth, R. Convery, L. Lukehurst, M.J. Walshaw. Adult CF Unit, Cardiothoracic Centre, Liverpool, UK. Although the abnormalities of CF mucus are expressed in the upper airway and childhood sinus development is abnormal, little attention has been paid to the degree of symptoms that sinus disease causes in adult patients. Therefore, as part of a survey of sinus symptoms in this patient group, we assessed the effect of 9 specific sinus related symptoms on well-being on a large cohort of adult CF patients. The degree of severity of symptoms was ranked using a 0 to 3 point scale, and the picture of morbidity for each patient obtained by aggregation to give their individual ‘‘combined sinus score’’ (maximum attainable score 27). Forty-nine of 88 patients (56%) questioned had mild sinus related symptoms (score 8 or less), whilst 28 (32%) had moderate symptoms (score 9 to 17). However, 11 patients (12%) had severe symptoms (score 18 or greater), with the highest score attained being 22. There was no difference in combined sinus score between the sexes, nor was the degree of severity related to age. However, those patients who had previously sought ENT attention were more likely to still have more severe symptoms (combined sinus score: treated mean 11.25 [range 1–20] versus untreated 8.32 [0–22], P , 0.05). This survey confirms that a significant proportion of adult CF patients have considerable morbidity from chronic sinus disease.
225. Visual deficits in cystic fibrosis. T.J. Buckingham, S.