Nicole Mittmann

Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people

BACKGROUND Tricyclic antidepressants (TCAs) are associated with an increased risk of falls and hip fractures in elderly people. Selective serotonin-reuptake inhibitors (SSRIs) are reported to be better tolerated than TCAs. We investigated the risk of hip fractures associated with SSRIs and TCAs. METHODS This case-control study used administrative healthcare data from the province of Ontario, Canada. 8239 cases-patients aged 66 years or older, treated in hospital between April, 1994, and March, 1995, for hip fracture-were each matched for age and sex to five controls. Logistic regression was used to calculate the odds ratio for hip fracture with adjustment for potential confounding effects produced by concomitant drug use and comorbidity. FINDINGS With participants who had no exposure to antidepressants as the reference category, the adjusted odds ratio for hip fracture was 2.4 (95% CI 2.0-2.7) for exposure to SSRIs, 2.2 (1.8-2.8) for exposure to secondary-amine TCAs, and 1.5 (1.3-1.7) for exposure to tertiary-amine TCAs. For all types of antidepressants, current use was associated with a higher risk of hip fracture than former use. The odds ratios for hip fracture were higher for new current users than for continuous current users in all three drug classes. The proportion of current use in the low-dose range was 22% for SSRIs, 50% for secondary-amine TCAs, and 58% for tertiary-amine TCAs. INTERPRETATION Exposure to any of the three classes of antidepressants is associated with a significant increase in the risk of hip fracture. Despite differences in dose distribution, this analysis suggests that SSRIs do not offer an advantage over TCAs in terms of risk of hip fracture.

Utility Scores for Chronic Conditions in a Community-Dwelling Population

AbstractObjective: The objective of this study was to determine utility scores for various chronic conditions. Design and setting: This study is a descriptive analysis. Health Utilities Index (HUI) scores for 20 chronic conditions were examined from the National Population Health Survey (NPHS) from 1994 to 1995. Patients and participants: 17 626 individuals were surveyed (54.3% women). Chronic conditions included: acne (requiring medication), Alzheimer’s disease, arthritis/rheumatism, asthma, back problems excluding arthritis, chronic bronchitis or emphysema, cancer, cataracts, diabetes, epilepsy, food allergies, glaucoma, heart disease, high blood pressure, migraine headaches, other allergies, sinusitis, stroke, stomach/intestinal ulcers and urinary incontinence. Interventions: Health Utilities Index-Mark III (HUI-Mark III) scores for patients with and without a NPHS-defined chronic condition were collected. Utility scores were examined according to age, gender and comorbidity. Main outcome measures and results: 42.6% of individuals reported having no NPHS-defined chronic condition. The most commonly reported health conditions were allergies other than food (17.6%) and rheumatism/arthritis (16.5%). The mean HUI-Mark III scores for patients without a health state was 0.933 ± 0.079. Individuals with Alzheimer’s disease (0.580 ± 0.263), stroke (0.676 ± 0.230) and urinary incontinence (0.698 ± 0.230) had the lowest overall HUI-Mark III scores. Utility scores decreased as age and as the number of comorbid conditions increased. Conclusions: This study provides health economists, researchers and policymakers with a reference for health utilities of various chronic conditions, different age groups, gender and comorbidities.

A validation study of The Geriatric Depression Scale short form

The validity of the Geriatric Depression Scale (GDS) short form was assessed in a geriatric affective disorders outpatient clinic (N = 116). The GDS was highly correlated with the Montgomery Asberg Depression Rating Scale (MADRS), and with optimal cutoff scores of 5/6, demonstrated a sensitivity of 85% and a specificity of 74.0%. The GDS appears to be a useful, valid screening instrument in this population.

The efficacy, safety and tolerability of antidepressants in late life depression : a meta-analysis

BACKGROUND To determine the efficacy, safety and tolerability of antidepressants in depressed elderly patients. METHODS Search for randomized controlled double-blind studies evaluating atypical antidepressants (ATYPs), reversible inhibitors of monoamine oxidase-A, selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants in moderate/severe depressed patients > or = 60 years for > or = four weeks. The random effects model (single-arm; comparative) was used to aggregate efficacy, safety and dropout. RESULTS No difference in single-arm aggregation of outcomes for four antidepressant classes. Comparative analyses showed no statistical difference between outcomes, except SSRIs had a higher response rate than ATYPs. CONCLUSION Elderly show no differences in antidepressant class outcomes. LIMITATIONS Heterogeneity and lack of power. CLINICAL RELEVANCE There is little advantage for antidepressant classes over another in the aged.

Prospective Cost-Effectiveness Analysis of Cetuximab in Metastatic Colorectal Cancer: Evaluation of National Cancer Institute of Canada Clinical Trials Group CO.17 Trial

BACKGROUND The National Cancer Institute of Canada Clinical Trials Group CO.17 study showed that patients with advanced colorectal cancer had improved overall survival when cetuximab, an epidermal growth factor receptor-targeting antibody, was given in addition to best supportive care. We conducted a cost-effectiveness analysis using prospectively collected resource utilization and health utility data for patients in the CO.17 study who received cetuximab plus best supportive care (N = 283) or best supportive care alone (N = 274). METHODS Direct medical resource utilization data were collected, including medications, physician visits, toxicity management, blood products, emergency department visits, and hospitalizations. Mean survival times for the study arms were calculated for the entire population and for the subset of patients with wild-type KRAS tumors over an 18- to 19-month period. All costs were presented in 2007 Canadian dollars. One-way and probabilistic sensitivity analysis was used to determine the robustness of the results. Cost-effectiveness acceptability curves were determined. The 95% confidence intervals (CIs) for the incremental cost-effectiveness ratios and the incremental cost-utility ratios were estimated by use of a nonparametric bootstrapping method (with 1000 iterations). RESULTS For the entire study population, the mean improvement in overall and quality-adjusted survival with cetuximab was 0.12 years and 0.08 quality-adjusted life-years (QALYs), respectively. The incremental cost with cetuximab compared with best supportive care was

Evaluation of the Extent of Under-Reporting of Serious Adverse Drug Reactions The Case of Toxic Epidermal Necrolysis

23,969. The incremental cost-effectiveness ratio was

Economic Analysis: Randomized Placebo-Controlled Clinical Trial of Erlotinib in Advanced Non–Small Cell Lung Cancer

199,742 per life-year gained (95% CI =

Intravenous Immunoglobulin Use in Patients with Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome

125,973 to

Evaluation of direct medical costs of hospitalization for febrile neutropenia

652,492 per life-year gained) and the incremental cost-utility ratio was

The Economic Impact of Clostridium difficile Infection: A Systematic Review

299,613 per QALY gained (95% CI =