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Refoios Camejo R.,Pfizer | Refoios Camejo R.,Erasmus University Rotterdam | McGrath C.,Pfizer | Herings R.,Erasmus University Rotterdam | And 3 more authors.
Value in Health

Objective: When comparators' prices decrease due to market competition and loss of exclusivity, the incremental clinical effectiveness required for a new technology to be cost-effective is expected to increase; and/or the minimum price at which it will be funded will tend to decrease. This may be, however, either unattainable physiologically or financially unviable for drug development. The objective of this study is to provide an empirical basis for this discussion by estimating the potential for price decreases to impact on the cost-effectiveness of new therapies in hypertension. Methods: Cost-effectiveness at launch was estimated for all antihypertensive drugs launched between 1998 and 2008 in the United Kingdom using hypothetical degrees of incremental clinical effectiveness within the methodologic framework applied by the UK National Institute for Health and Clinical Excellence. Incremental cost-effectiveness ratios were computed and compared with funding thresholds. In addition, the levels of incremental clinical effectiveness required to achieve specific cost-effectiveness thresholds at given prices were estimated. Results: Significant price decreases were observed for existing drugs. This was shown to markedly affect cost-effectiveness of technologies entering the market. The required incremental clinical effectiveness was in many cases greater than physiologically possible so, as a consequence, a number of products might not be available today if current methods of economic appraisal had been applied. Conclusions: We conclude that the definition of cost-effectiveness thresholds is fundamental in promoting efficient innovation. Our findings demonstrate that comparator price attrition has the potential to put pressure in the pharmaceutical research model and presents a challenge to new therapies being accepted for funding. Copyright © 2012, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. Source

Savini H.,Laveran Military Teaching Hospital | Gautret P.,Institut Universitaire de France | Gaudart J.,Aix - Marseille University | Gaudart J.,University College London | And 9 more authors.
Emerging Infectious Diseases

Data collected by the GeoSentinel Surveillance Network for 1,415 ill travelers returning from Indian Ocean islands during 1997-2010 were analyzed. Malaria (from Comoros and Madagascar), acute nonparasitic diarrhea, and parasitoses were the most frequently diagnosed infectious diseases. An increase in arboviral diseases reflected the 2005 outbreak of chikungunya fever. Source

Mendelson M.,G16 68 Groote Schuur Hospital | Davis X.M.,Centers for Disease Control and Prevention | Jensenius M.,University of Oslo | Keystone J.S.,Tropical Disease Unit | And 6 more authors.
American Journal of Tropical Medicine and Hygiene

Using the GeoSentinel database, an analysis of ill patients returning from throughout sub-Saharan Africa over a 13-year period was performed. Systemic febrile illness, dermatologic, and acute diarrheal illness were the most common syndromic groupings, whereas spotted fever group rickettsiosis was the most common individual diagnosis for travelers to South Africa. In contrast to the rest of sub-Saharan Africa, only six cases of malaria were documented in South Africa travelers. Vaccine-preventable diseases, typhoid, hepatitis A, and potential rabies exposures were uncommon in South Africa travelers. Pre-travel advice for the travelers to the 2010 World Cup should be individualized according to these findings. Copyright © 2010 by The American Society of Tropical Medicine and Hygiene. Source

Wyler N.,InterHealth | Green S.,InterHealth | Boddington N.,InterHealth | Davies C.,InterHealth | And 2 more authors.
Travel Medicine and Infectious Disease

People of all ages volunteer in developing countries, but little is known about the health risks they face. InterHealth, a travel clinic, provides a health screening service for short-term overseas volunteers. A cross-sectional study design was used to analyse 413 post-travel health questionnaires completed between February and November 2009. The sample consisted of volunteers who worked on short-term projects in developing countries for a variety of non-governmental organisations. At least one sick day was taken by 137 (33.2%) participants. Medical care was accessed by 39 (9.6%) participants, and standby medication was used by 87 (21.6%) participants. Diarrhoea, especially amongst those aged under 20 or who visited Latin America, was the most commonly reported health problem (95; 23.9%). Possible exposure to schistosomiasis was reported by 56 (13.8%) participants, mostly from East Africa. Upon return, the majority of participants (371; 91.2%) reported feeling well. The findings of this study show the importance of tailored post-travel health screening for short-term overseas volunteers. This study may help to tailor pre-departure travel health consultations for this group, particularly around food hygiene, hand washing and potential exposure to infection, but further research is needed to assess the impact of pre-travel health advice. © 2012 Elsevier Ltd. All rights reserved. Source

Esposito D.H.,Centers for Disease Control and Prevention | Han P.V.,Centers for Disease Control and Prevention | Kozarsky P.E.,Emory University | Walker P.F.,University of Minnesota | And 43 more authors.
American Journal of Tropical Medicine and Hygiene

To describe patient characteristics and disease spectrum among foreign visitors to Haiti before and after the 2010 earthquake, we used GeoSentinel Global Surveillance Network data and compared 1 year post-earthquake versus 3 years pre-earthquake. Post-earthquake travelers were younger, predominantly from the United States, more frequently international assistance workers, and more often medically counseled before their trip than pre-earthquake travelers. Work-related stress and upper respiratory tract infections were more frequent post-earthquake; acute diarrhea, dengue, and Plasmodium falciparum malaria were important contributors of morbidity both pre- and post-earthquake. These data highlight the importance of providing destination- and disaster-specific pre-travel counseling and post-travel evaluation and medical management to persons traveling to or returning from a disaster location, and evaluations should include attention to the psychological wellbeing of these travelers. For travel to Haiti, focus should be on mosquito-borne illnesses (dengue and P. falciparum malaria) and travelers' diarrhea. Copyright © 2012 by The American Society of Tropical Medicine and Hygiene. Source

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