By R. Sivert. University of South Carolina, Aiken. 2018.

Philadelphia: Lippincott- m odel of acute renal failure and sepsis in rats discount sumatriptan 25mg visa. Drum l W buy 50 mg sumatriptan mastercard, M itch W E: M etabolism in acute renal failure generic sumatriptan 25 mg on-line. Bergström J: Factors causing catabolism in m aintenance hem odialysis 1996, 9:484–490. O m P, H ohenegger M : Energy m etabolism in acute urem ic rats. Soop M , Forsberg E, Thˆrne A, Alvestrand A: Energy expenditure in 18. M itch W E, Chesney RW : Am ino acid m etabolism by the kidney. Laidlaw SA, Kopple JD: N ewer concepts of indispensable am ino 6. Spreiter SC, M yers BD, Swenson RS: Protein-energy requirem ents in acids. N aschitz JE, Barak C, Yeshurun D: Reversible dim inished insulin Am J Clin N utr 1980, 33:1433–1437. M itch W E: Am ino acid release from the hindquarter and urea appear- 21. Salusky IB, Flügel-Link RM , Jones M R, Kopple JD: Effect of acute 1991, 260:E280–E285. Clark AS, M itch W E: M uscle protein turnover and glucose uptake in 23. Stehle P: The potential use of dipeptides in clinical nutrition. M aroni BJ, Karapanos G, M itch W E: System A am ino acid transport 24. H übl W , Drum l W , Roth E, Lochs H : Im portance of liver and kidney in incubated m uscle: Effects of insulin and acute urem ia. Am J Physiol for the utilization of glutam ine-containing dipeptides in m an. Drum l W , Kelly RA, M itch W E, M ay RC: Abnorm al cation transport 25. H asik J, H ryniewiecki L, Baczyk K, Grala T: An attem pt to evaluate in urem ia. Lopez-M artinez J, Caparros T, Perez-Picouto F: N utrition parenteral nesis in isolated perfused rat liver. M ay RC, Kelly RA, M itch W E: M echanism s for defects in m uscle Clin Esp 1980, 157:171–178. Kierdorf H : Continuous versus interm ittent treatm ent: Clinical results m etabolic acidosis. Drum l W : Im pact of continuous renal replacem ent therapies on patients with acute renal failure on continuous arteriovenous hem ofil- m etabolism. Frankenfeld DC, Badellino M M , Reynolds H N , et al. Toback FG: Regeneration after acute tubular necrosis. Ikizler TA, Greene JH , W ingard RL, H akim RM : N itrogen balance in 50. Toback FG, Dodd RC, M aier ER, H avener LJ: Am ino acid adm inis- acute renal failure patients. M ay RC, Clark AS, Goheer M A, M itch W E: Specific defects in sis. N Engl J of glucose, lactate and am ino acids in acutely urem ic dogs. O ken DE, Sprinkel M , Kirschbaum BB, Landwehr DM : Am ino acid 33. Zager RA, Venkatachalam M A: Potentiation of ischem ic renal injury 34. Dobyan DC, Bulger RE, Eknoyan G: The role of phosphate in the M etab 1996, 22:168–177. W akabayashi Y, Kikawada R: Effect of L-arginine on m yoglobin- M etab 1991, 17:112–115. Ding H , Kopple JD, Cohen A, H irschberg R: Recom binant hum an 39.

Kozma: Strategic Outcomes Service of Care Sciences generic sumatriptan 50 mg otc, Inc buy discount sumatriptan 50 mg on line. Reeder and Brian Meissner: College of Pharmacy purchase 25mg sumatriptan free shipping, University of most efficient outcome. In a resource-constrained environ- South Carolina, Columbia, South Carolina. For example, it is esti- more efficient if devoted to another alternative? One useful mated that $44 billion is spent annually on the treatment way to address this question is with data on patient and of depression and $100 billion is spent annually on the cost outcomes. The cost to treat There is an inextricable but sometimes complex relation- schizophrenia has been estimated at $33 billion per year, ship between quality of care and outcomes. Outcomes data accounting for 22% of dollars spent to treat all categories are one way of evaluating quality. Increasing competition for scarce resources encour- ment. What is acceptable quality to one person may be ages decision makers to use outcomes data to evaluate the unacceptable to another at any given level of cost. On a macro level, an analysis using These issues are not new to health care providers, but the measures of quality and cost will not define the percentage development of drug formularies as mechanisms to control of gross domestic product (GDP) that a nation should spend costs has generated a need for outcomes studies to evaluate to achieve a certain level of quality in health care, but rather the benefits obtained from new pharmacologic agents. On a micro level, arose regarding whether health care outcomes were better there is no specific quality of life score on an instrument for patients treated with SSRIs than for patients treated with that indicates if or when a drug product should be reim- traditional TCA therapy (5–7). There is no single clinical measure that indicates ceuticals was more costly than prior standard therapy (the that a patient is in perfect health. All outcomes data require TCAs), prescribed for a wide variety of patients, and had the interpretation and evaluation of a medical decision (in clinical trials) fewer side effects. Outcomes data provide one more, albeit in many were shown to be superior in some domains in clinical trials, cases relevant, piece of information on which to base deci- there was a practical question regarding whether these bene- sions. Is the total cost per acute improve outcomes, for outcomes to be documented and depressive episode (successfully treated case) therefore lower improved, this terminology must be defined in more con- with the newer products despite higher drug acquisition crete terms. One conceptualization of health care outcomes costs? Does treatment with SSRIs cost more, but provide is the economic, clinical, humanistic outcomes model better humanistic outcomes such as quality of life or quality- (ECHO) (13). This conceptualization portrays health out- adjusted life years? These are the types of questions that comes along three dimensions. Clinical outcomes are out- outcomes research and pharmacoeconomic evaluations at- comes related to the effects of medical treatments or disease tempt to answer. This chapter does not specifically address on medical events such as hospitalization or death (i. Economic outcomes are usually expressed as costs issues in outcomes research. Humanistic out- from an evaluation of a body of literature. In addition to these outcomes, there are cal aspects of the treatment of mental health diseases. Given many intermediate variables that are important when mea- the substantial clinical information in the remainder of this suring the effects of a disease or treatment. These variables text, this chapter focuses on evaluation of the economic and are referred to in the published literature by many names humanistic outcomes related to pharmaceutical use. Specifi- including process variables, surrogate outcomes, or interme- cally, the techniques of pharmacoeconomics will be re- diate variables. In many cases making a clear distinction viewed as well as the instruments for evaluating humanistic between these consequences of pharmaceutical use is proba- outcomes in mental health care populations. For example, a score PHARMACOECONOMICS on a depression inventory is probably closer to an intermedi- ate variable, whereas events such as rehospitalization or sui- In the current health care environment, many decisions are cide reflect the 'end results' or outcomes one would like driven by costs. Although Chapter 39: The Role of Pharmaceuticals in Mental Health Care Outcomes 527 the fraction of the health care dollar spent on pharmaceuti- tion, then the decision is based entirely on the costs of the cals is low, it is clear that as both the pressure to reduce inputs. The classic example of a cost minimization analysis costs and the percentage of health care dollars spent on is the use of generic versus branded products. If the chemical pharmaceuticals grow, so does interest in the costs of medi- entities and formulations are identical, then there is no rea- cations. Economists, however, are quick to point out that son to suspect that the outcomes associated with the use of the acquisition cost of the pharmaceutical is not the most either product would be different. In this case, the decision appropriate unit of analysis. It is possible that the acquisition is based solely on the costs of the inputs. The difficulty with cost of many pharmaceuticals may be offset by reductions cost-minimization analysis is establishing that outcomes are in other more expensive forms of care.

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