Springer Science and Business Media LLC

In 1990, health care expenditures in the United States reached $666.2 billion, 12.2% of the gross domestic product (GDP). It is projected for the year 2000, the USA will spend $1.6 trillion for health care which will be comparable to 16.4% of that year's GDP. As a result of the rapid increase in costs of health care and limited resources available, patients/third-party payers and the government have initiated and implemented more rigid cost control measures. Economic analyses can help ensure the efficient use of health care dollars in areas such as drug therapy. The four methodologies available are cost-benefit analysis, cost-effectiveness analysis, cost-minimization analysis and cost-utility analysis. This article reviews methods and provides examples from the medical literature. These tools can assist care providers in determining which treatments are most cost-effective.

An overview is given of the different issues that have been discussed, with subsequent recommendation. Standardisation of measurement and reporting of eficacy parameter and side-effects is essential; not only the number of patients achieving complete seizure controlled or have a decrease in seizure frequency and severity should be mentioned but also the number who dropped out and the reasons therefore. More information is neede on the teratogeneticy of a drug, either by performing control trials or by registration of all pregnancies with new anti‐epileptic drugs. Appropriate bio‐marker for efficacy and toxicity should be developed. Health-related quality of life scales, collecting both subjective and objective information should be developed and used as complimentary tools in understanding more about the disease. A drug that improves the quality of life but is less effective in suppressing seizures should be marketed. Finally, pharmaco‐economic studies should be encuraged in the field of epilepsy.

The results of an inquiry among Dutch hospital pharmacists on the monitoring of aminoglycosides are presented and the relevance of monitoring is discussed. The vast majority of Dutch hospitals (47 out of 65) use aminoglycosides in a twice-daily dosage regimen, whereas 12 hospitals use a once-daily dose. The timing of peak level sampling is usually 30 min after the end of an intravenous infusion of 20–30 min. Mean ’therapeutic’ peak levels of gentamicin were 7–13 mg/l in the once-daily group, 6.4–9.6 mg/l in the twice-daily group and 5–9 mg/l in the small thricedaily group. Little or no evidence has been published to substantiate a real therapeutic range for aminoglycosides, concerning a relationship between peak or trough levels of aminoglycosides and clinical efficacy, ototoxicity and nephrotoxicity. All studies have been performed with the conventional thrice-daily regimen. No therapeutic range can be defined yet for once-daily or twice-daily aminoglycosides. The monitoring of aminoglycosides may be helpful to reduce the variability in serum levels after a standard dose.

Objective: To assess primary care physicians' prescribing patterns for musculoskeletal pain in different diagnostic categories.Methods: The data were collected in 25 randomly selected health centres, in which a total of 28 physicians took part in the four‐week study. Physicians recorded all the medicines they prescribed for patients visiting due to pain. Visits resulting in a diagnosis of musculoskeletal disease or injury were included in this study.Results: Analgesics, including non‐steroidal anti‐inflammatory drugs (NSAIDs), were prescribed for 61% of the patients. NSAIDs were prescribed for 46%, topical analgesics for 15% and opioids for 4% of the patients. In general, ibuprofen was the most frequently prescribed drug but back and neck pains were most commonly treated with naproxen. No difference between patients' genders was observed in analgesic prescriptions. Prescribing was associated with patient's age, physician's view on priority of visit, diagnosis and intensity of pain. There was a large variation in prescribing patterns between individual physicians and between different areas of the country.Conclusion: NSAIDs are the prevailing treatment for musculoskeletal pain in Finnish primary health care. Different drugs are favoured according to the diagnosis. The large variability in prescribing patterns cannot be explained solely by the characteristics of pain or patients.