Bernhard Schwarz

Self-reported organic and nonorganic sleep problems in schoolchildren aged 11 to 15 years in vienna

PURPOSE To estimate the prevalence of self-reported sleep problems, to examine associations among demographic characteristics, familial factors, and sleep problems, and to investigate the association between the symptoms of obstructive sleep apnea (OSA) and nonorganic sleep disorders. METHODS An anonymous questionnaire with 22 questions was designed. 332 schoolchildren (aged 11-15 years, mean age 12 years and 9 months; median, 12 years; 56% female, 44% male) from two high schools in Vienna were investigated with regard to self-reported symptoms characteristic for obstructive sleep apnea and for parasomnia/insomnia. Data were analyzed by definition of three groups (problem, occasional problem, and nonproblem sleepers, and by calculation of an insomnia/parasomnia sum score). Statistical analysis included nonparametric tests (Mann Whitney-U and Kruskal), Pearson correlation test, and multiple regression analysis. RESULTS Twelve percent reported at least one sleep problem every night, 76% reported occasional sleep problems, and 12% had no sleep problems. Girls were affected more frequently than boys (p <.01). Children with sleep problems suffered more often from concentration difficulties (p <.05), daytime fatigue (p <.001), and daytime naps (p <.05). Children who snored had nightmares (10% vs. 2%, p <.01), night terrors (4% vs. 1.5%, p <.001), sleepwalking (1.4% vs. 1%, p <.05), and nocturnal awakening (16% vs. 5%, p <.01) more frequently. On multiple regression analysis, 23% of the variability of a defined parasomnia/insomnia sum score had the characteristic OSA symptoms of nocturnal sweating, dryness of the mouth, snoring, hyperactivity, and daytime fatigue. CONCLUSION 12% of schoolchildren aged 11-15 years reported sleep problems almost every night. The children suffer from daytime fatigue, naps, and concentration difficulties. Nearly one-fourth of the symptoms of parasomnia/insomnia were associated with characteristic signs of OSA, suggesting the importance of a routine clinical investigation in children with so-called nonorganic sleep disorders.

Die Langzeit-Kosteneffektivität von Clopidogrel zusätzlich zu Azetylsalizylsäure bei Patienten mit akutem Koronarsyndrom ohne ST-Streckenhebung im österreichischen Gesundheitssystem

BackgroundThe CURE trial showed a 20 % risk reduction of suffering from stroke, myocardial infarction or cardiovascular death in patients with acute coronary syndrome without ST-segment elevation treated with clopidogrel on top of standard therapy including acetylsalicylic acid (ASA) compared to standard therapy alone. We thought to evaluate the incremental cost-effectiveness of this therapeutic strategy in Austria.MethodsA Markov model with six states (at risk, first year with stroke, following years with stroke, first year with new MI, following years with new MI and death) was used. Intervention, i.e. treatment with clopidogrel, was studied for a period of 12 months (maximum follow-up in the trial). Costs and effects of the intervention were annualized based on the 9-month average follow-up in the CURE trial. Resource use for different health states was estimated by Austrian experts, associated costs were based on published data for Austrian fees. Annual costs for clopidogrel treatment and savings due to initial hospitalisation were taken from a former short-term cost-effectiveness analysis. In the base case, simulations were performed for a cohort consisting of 61.3 % men (similar to that of the trial, average age 64 years). LYS (life-year saved) was used as the measure of effectiveness. Costs and effects were discounted at 3 %.ResultsThe model predicts an incremental survival of 0.12 years, when treating patients with acute coronary syndrome for 12 months with clopidogrel on top of standard therapy. If both direct and indirect costs are evaluated the costs per life-year saved are € 4,146. Using the upper bound of the 95 % CI of the relative risk in the CURE trial, the ratios are € 2,566/LYS and € 9,676/LYS.ConclusionA 12-month therapy with clopidogrel on top of standard therapy including ASA in patients with acute coronary syndrome can be regarded as cost-effective from a societal perspective in Austria.

Schnarchen als Leithinweis für schlafstörungen bei Schulkindern 11 und 15 Jahren — Die ersten Ergebnisse der wiener epidemiologischen Studie

SummaryIntroductionThe prevalence of snoring was evaluated in school children between 11 and 15 years of age. In addition to items reported by parents, children were asked to answer a questionnaire in order to receive information about the children’s potential complaints, life style and school performance.MethodThe study was performed in 21 randomly selected schools the Vienna area. 1434 school children were interviewed by a questionnaire (mean age 12.5 years, median 13 years, 676 girls vs. 699 boys). The questionnaire consisted of 45 multiple-choice questions about the socioeconomic status, possible sleep disorders and signs or symptoms of obstructive sleep apneas (OSA). The questionnaire completed by parents was also used to calculate the Brouillette-Score from the items snoring, obstructed breaths and apneas.Results5.2% (74/1434) of children and 6.9% (86/1259) of parents or caregivers reported about snoring (frequently or very frequently). There were no sex differences for the children’s and the parents’ questionnaire. None of the children had a clearly positive result (hint of OSA) from the Brouillette-Score whereas “suspicious OSA” was observed in 3.2% (40/1259). When frequent and very frequent snorers were compared with the other children, more mouth breathing during sleep (p<0.00001), mouth dryness (p<0.00005), headache (p<0.0005), cigarette exposition at home (p<0.001), smoking (p<0.005), daytime naps (p<0.005), crying out of sleep (p<0.01), daytime tiredness (p<0.05) und a higher body mass index (p<0.05) could be observed in this group, in addition to the items reported by the parents.ConclusionThe prevalence of snoring is lower in our study than in other studies. No statistically significant sex differences were observed, both in the parents’ and the children’s questionnaire. In our study snoring seems to be a sign or symptom of different sleep disorders, and not only of OSA. A statistically significant correlation between snoring and anamnestic hints of sleep disorders underlines the need to ask concerned children themselves for observations potentially associated with sleep disorders. Results of the Brouillette-Score could not be used to identify sleep disorders in our study.ZusammenfassungEinleitungBei Schulkindern zwischen 11–15 Jahren wurde die Häufigkeit des Schnarchens untersucht. Ergänzend zu Elternangaben wurden mit einem Fragebogen von den Schulkindern selbst Daten zu subjektiver Befindlichkeit. Lebensumständen und Schulleistung erfragt.MethodikDie Umfrage erfolgte in 21 randomisiert ausgesuchten Haupt-/allgemeinbildenden höheren Schulen im Großraum Wien. Befragt wurden 1434 Schüler (Alter: Mittel 12,5 Jahre, Median 13 Jahre, 676, Mädchen vs, 699 Buben). Der Schülerfragebogen enthielt 45 multiple-choice Fragen zu anamnestischen Hinweisen bzw. Leitsymptomen des obstruktiven Schlafapnoe Syndroms (OSA), typischen In- oder Parasomnien und zu soziodemographischen Daten. Ergänzend wurde aus den Elternangaben über Schnarchen, erschwerte Atmung und beobachtete Atempausen der Brouillette-Score berechnet.Ergebnis5.2% (74/1434) aller befragten Kinder und 6.9% (86/1259) der Eltern bzw. Erziehungsberechtigten gaben Schnarchen (last immer oder häufig) an. Eine geschlechtsspezifische Kumulierung gab es weder in Schüler- noch Elternangaben. Im Brouillette-Score ergab sich kein einziges Mal die Aussage „OSA ja”, die Aussage „Verdacht auf OSA” traf bei 3,2% (40/1259) zu. Die Gruppe der regelmäßigen Schnarcher unterscheidet sich von den übrigen Probanden neben den von Eltern angegebenen Auffälligkeiten im Schlaf durch vermehrtes Auftreten von Mundatmung (p<0.00001), Mundtrockenheit (p<0.0005), Kopfschmerzen (p<0.0005), Zigaretten im Haushalt (p<0.001), Rauchen (p<0.005), Mittagsschlaf (p <0.005), Aufschrein (p<0.01), Tagesmüdigkeit (p<0.05) und body mass index (p<0.05).SchlussfolgerungDie Prävalenz des regelmäßigen nächtlichen Schnarchens ist in unserer Studie geringer als in anderen Studien und zeigt weder im Schüler- noch Elternfragebogen eine signifikant unterschiedliche Geschlechtsverteilung. In unserer Studie ist Schnarchen auch ein wichtiges Leitsymptom für nicht OSA bedingte bzw. nicht organische Schlafstörungen. Der statistisch signifikante Zusammenhang zwischen Schnarchen und den klinisch-anamnestischen Hinweisen unterstreicht die Notwendigkeit einer spezifischen Schlafanamnese mit den Betroffenen selbst. Der aus den Elternangaben berechnete Brouillette-Score war in unserer Studie nicht aussagekräftig.

HYPERGLYCEMIA AND CORONARY RISK FACTORS RESULTS FROM WESTERN AUSTRIA

We investigated mean levels and prevalences of total cholesterol, HDL cholesterol, triglycerides, fasting blood glucose, systolic blood pressure and body mass index in adults aged 25 to 64 years participating in the WHO Country-wide Integrated Noncommunicable. Diseases Intervention (CINDI) Programme in Vorarlberg, western Austria. According to the Austrian expert panel and based upon the above age standardized risk factors 50.9% of the male and 29.3% of the female population were at high risk for developing coronary heart disease. Risk factor levels were further compared between euglycemic and hyperglycemic participants. After adjusting for age hyperglycemia was associated with higher body mass index in men (p=0.026) and women (p<0.001), higher systolic blood pressure in men (p<0.001) and women (p=0.003), and higher levels of triglycerides in women (p=0.008). No significant differences were observed in total and HDL cholesterol in either sex. When controlling for age and body mass index, fasting blood glucose levels had significant associations only with systolic blood pressure in men (p=0.001). But, with respect to all risk factors, hyperglycemic participants had an age-adjusted adverse coronary risk profile both in men (p=0.002) and in women (p<0.001).

Die Langzeit-Kosteneffektivität von Clopidogrel zusätzlich zu Azetylsalizylsäure bei Patienten mit akutem Koronarsyndrom ohne ST-Streckenhebung im österreichischen Gesundheitssystem@@@Long-term cost-effectiveness of Clopidogrel plus acetylsalicylic acid in patients with acute coronary syndrome without ST-segment elevation in Austria

ObjectivesThe purpose of this study was to perform a cost-effectiveness analysis for clopidogrel plus aspirin (ASA) vs. aspirin alone, both on top of standard therapy, for patients with acute coronary syndrome without ST-segment elevation in Austria, based on the randomized CURE trial.MethodsThe cost-effectiveness analysis was performed on the basis of the results from the CURE trial using “within trial” data obtained during a mean follow-up period of 9 months. The primary outcome of this analysis is the incremental cost per event avoided (incremental cost effectiveness ratio, ICER). The events used for this analysis are clinically severe outcomes (vascular death, myocardial infarction, stroke). The costs assessed in this model relate to initial hospitalisation and re-hospitalisations and to medication costs. The number of events avoided and incidence of inpatient care are based on the clinical outcome of the CURE trial. The model was calculated for 4 different szenarios with either high or low hospitalisation and medication costs. The primary results of this cost effectiveness analysis are based on the “standard szenario”, assuming low costs both for hospitalisation and medication.ResultsPatients in the clopidogrel arm have on average higher costs than patients treated with ASA alone, € 4,616 versus € 4,189. This results in incremental costs of € 427 for every patient receiving clopidogrel. These higher costs are primarily due to the higher medication costs. Due to its superior efficacy the treatment with clopidogrel resulted in 0.0201 avoided events per patient based on the CURE trial. This leads to an incremental cost effectiveness ratio of € 21,249. As the hospitalisation costs are the most important cost factor in this model and as these costs are lower in the clopidogrel arm, any increase in these costs will lead to a more favourable ICER for clopidogrel, i.e. € 20,267. Higher medication costs would lead to a minor increase of the ICER to € 21,488.ConclusionThis cost effectiveness analysis for Clopidogrel results in an incremental cost effectiveness ratio of € 21,249 per event avoided based on data derived from the CURE study. As the events taken into account are medically serious ones, this amount seems to be socially acceptable and reasonable. Overall clopidogrel can be regarded as a cost-effective option when used for 9 months on top of standard care including ASA for patients with acute coronary syndrome without ST-segment elevation.

An Economic Analysis Using Ribosomal Immunotherapy to Treat Children with Recurrent Upper Respiratory Tract Infections

SummaryOtitis media and rhinopharyngitis are common childhood illnesses, and are mostly treated with antibiotics. Antibiotics do not, however, prevent recurrences and can result in high treatment costs. This study analyses the cost of two treatment options for children with otitis media and rhinopharyngitis: immunoprophylaxis using a ribosomal immunostimulant (Ribomunyl®, Pierre Fabre Medicament, France) versus no immunoprophylaxis. The per-patient cost of Ribomunyl® in Austrian schillings [ÖS728 (

Eine Kostenanalyse von Telithromycin im Vergleich zu Clarithromycin und Amoxicillin/Clavulansäure in der Behandlung von Patienten mit ambulant erworbener Pneumonie oder akuter Exazerbation einer chronischen Bronchitis in ÖsterreichCost analysis of telithromycin versus clarithromycin and amoxicillin/clavulanic acid in the treatment of patients with community-acquired pneumonia or acute exacerbations of chronic bronchitis

US1 = ÖS 12.80 at August 1997)] was found to be offset by direct savings through the prevention of acute infectious episodes. Ribosomal immunotherapy was found to be cost effective in the core analysis, in which costs of concomitant medication and out- and inpatient ENT-specialist services were not included. Based on a restricted core analysis, taking into account physician visits, antibiotics and Ribomunyl®, the net savings per patient on 6 months ranged from 7.0 to 12.0% in this most conservative estimate. The absolute savings per patient on 6 months were estimated to be between ÖS 162 and 315. Additional substantial savings could be expected from lower prescription frequencies of concomitant medication, and conservative surgical ENT-physician services, especially in cases requiring inpatient care. These savings have been evaluated and reinforce the results.

Eine Kostenanalyse von Telithromycin im Vergleich zu Clarithromycin und Amoxicillin/Clavulansäure in der Behandlung von Patienten mit ambulant erworbener Pneumonie oder akuter Exazerbation einer chronischen Bronchitis in Österreich

BackgroundLower respiratory tract infections (LRTI) such as community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) are frequent diseases associated with high morbidity and mortality. The use of antibiotics faces growing challenges due to resistance problems. Telithromycin is a new antibacterial agent of the ketolide class designed to provide optimal treatment against common bacterial respiratory tract pathogens. The aim of this study was to compare telithromycin with clarithromycin and amoxicillin/clavulanic acid, the standard antibacterial treatments for CAP or AECB in Austria, with regard to costs and treatment outcomes.MethodsThe pharmacoeconomic model is based on the results of four randomised clinical trials (1,895 patients). We compared a 5 day treatment with telithromycin to a 10 day treatment with clarithromycin or amoxicillin/clavulanic acid in adult patients with AECB as well as a 5 to 10 day treatment with telithromycin to a 10 day treatment with clarithromycin in patients with CAP. The frequency of additional medical resource use (e.g. CAP- or AECB-related hospitalisations), physician visits, tests or procedures, additional antibacterial use and LRTI-related length of hospital stay were compared by treatment group for 31–36 days. Associated costs were calculated using the public health insurance fees for Austria. Basic assumptions (perspective, cost-data, sensitivity analyses) were made according to recent Austrian sick fund guidelines.ResultsEven though the clinical efficacy of telithromycin is equivalent to that of clarithromycin or amoxicillin/clavulanic acid in the clinically evaluable perprotocol populations, telithromycin treatment was associated with fewer CAP-or AECB-related hospitalisations and shorter hospital stays. The hospitalisation cost constitutes the biggest portion of the cost associated with unsuccessful antibacterial treatment in LRTI; accordingly, the estimated overall cost, including both the cost of the antibacterial treatment itself and the cost associated with additional use of healthcare resources, was always lower for patients treated with telithromycin than for patients receiving standard antibacterial treatment. The total treatment cost per patient for telithromycin ranged from € 98 to € 119 versus € 159 to € 207 for the comparators. Telithromycin could thus save between € 46 and € 96 per patient in the treatment of CAP and AECB. The validity of the results was proven in several sensitivity analyses.ConclusionAccording to this pharmacoeconomic model telithromycin could be a valuable and cost-saving treatment option compared with standard antibacterial treatment for Austrian patients with lower respiratory tract infections such as CAP and AECB within a five week observation period.

Eine Kostenanalyse von Telithromycin im Vergleich zu Clarithromycin und Amoxicillin/Clavulansäure in der Behandlung von Patienten mit ambulant erworbener Pneumonie oder akuter Exazerbation einer chronischen Bronchitis in Österreich@@@Cost analysis of telithromycin versus clarithromycin and amoxicillin/clavulanic acid in the treatment of patients with community-acquired pneumonia or acute exacerbations of chronic bronchitis

BackgroundLower respiratory tract infections (LRTI) such as community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) are frequent diseases associated with high morbidity and mortality. The use of antibiotics faces growing challenges due to resistance problems. Telithromycin is a new antibacterial agent of the ketolide class designed to provide optimal treatment against common bacterial respiratory tract pathogens. The aim of this study was to compare telithromycin with clarithromycin and amoxicillin/clavulanic acid, the standard antibacterial treatments for CAP or AECB in Austria, with regard to costs and treatment outcomes.MethodsThe pharmacoeconomic model is based on the results of four randomised clinical trials (1,895 patients). We compared a 5 day treatment with telithromycin to a 10 day treatment with clarithromycin or amoxicillin/clavulanic acid in adult patients with AECB as well as a 5 to 10 day treatment with telithromycin to a 10 day treatment with clarithromycin in patients with CAP. The frequency of additional medical resource use (e.g. CAP- or AECB-related hospitalisations), physician visits, tests or procedures, additional antibacterial use and LRTI-related length of hospital stay were compared by treatment group for 31–36 days. Associated costs were calculated using the public health insurance fees for Austria. Basic assumptions (perspective, cost-data, sensitivity analyses) were made according to recent Austrian sick fund guidelines.ResultsEven though the clinical efficacy of telithromycin is equivalent to that of clarithromycin or amoxicillin/clavulanic acid in the clinically evaluable perprotocol populations, telithromycin treatment was associated with fewer CAP-or AECB-related hospitalisations and shorter hospital stays. The hospitalisation cost constitutes the biggest portion of the cost associated with unsuccessful antibacterial treatment in LRTI; accordingly, the estimated overall cost, including both the cost of the antibacterial treatment itself and the cost associated with additional use of healthcare resources, was always lower for patients treated with telithromycin than for patients receiving standard antibacterial treatment. The total treatment cost per patient for telithromycin ranged from € 98 to € 119 versus € 159 to € 207 for the comparators. Telithromycin could thus save between € 46 and € 96 per patient in the treatment of CAP and AECB. The validity of the results was proven in several sensitivity analyses.ConclusionAccording to this pharmacoeconomic model telithromycin could be a valuable and cost-saving treatment option compared with standard antibacterial treatment for Austrian patients with lower respiratory tract infections such as CAP and AECB within a five week observation period.

Die Kosteneffektivität von Clopidogrel bei Patienten mit Atherosklerose-assoziierten Erkrankungen

BackgroundLower respiratory tract infections (LRTI) such as community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) are frequent diseases associated with high morbidity and mortality. The use of antibiotics faces growing challenges due to resistance problems. Telithromycin is a new antibacterial agent of the ketolide class designed to provide optimal treatment against common bacterial respiratory tract pathogens. The aim of this study was to compare telithromycin with clarithromycin and amoxicillin/clavulanic acid, the standard antibacterial treatments for CAP or AECB in Austria, with regard to costs and treatment outcomes.MethodsThe pharmacoeconomic model is based on the results of four randomised clinical trials (1,895 patients). We compared a 5 day treatment with telithromycin to a 10 day treatment with clarithromycin or amoxicillin/clavulanic acid in adult patients with AECB as well as a 5 to 10 day treatment with telithromycin to a 10 day treatment with clarithromycin in patients with CAP. The frequency of additional medical resource use (e.g. CAP- or AECB-related hospitalisations), physician visits, tests or procedures, additional antibacterial use and LRTI-related length of hospital stay were compared by treatment group for 31–36 days. Associated costs were calculated using the public health insurance fees for Austria. Basic assumptions (perspective, cost-data, sensitivity analyses) were made according to recent Austrian sick fund guidelines.ResultsEven though the clinical efficacy of telithromycin is equivalent to that of clarithromycin or amoxicillin/clavulanic acid in the clinically evaluable perprotocol populations, telithromycin treatment was associated with fewer CAP-or AECB-related hospitalisations and shorter hospital stays. The hospitalisation cost constitutes the biggest portion of the cost associated with unsuccessful antibacterial treatment in LRTI; accordingly, the estimated overall cost, including both the cost of the antibacterial treatment itself and the cost associated with additional use of healthcare resources, was always lower for patients treated with telithromycin than for patients receiving standard antibacterial treatment. The total treatment cost per patient for telithromycin ranged from € 98 to € 119 versus € 159 to € 207 for the comparators. Telithromycin could thus save between € 46 and € 96 per patient in the treatment of CAP and AECB. The validity of the results was proven in several sensitivity analyses.ConclusionAccording to this pharmacoeconomic model telithromycin could be a valuable and cost-saving treatment option compared with standard antibacterial treatment for Austrian patients with lower respiratory tract infections such as CAP and AECB within a five week observation period.