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Market uptake of pegylated interferons for the treatment of hepatitis C in Europe : meeting abstract
(2008)
Introduction and Objectives Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease with life threatening sequelae such as end-stage liver cirrhosis and liver cancer. It is estimated that the infection annually causes about 86,000 deaths, 1.2 million disability adjusted life years (DALYs), and ¼ of the liver transplants in the WHO European region. Presently, only antiviral drugs can prevent the progression to severe liver disease. Pegylated interferons combined with ribavirin are considered as current state-of-the-art treatment. Objective of this investigation was to assess the market uptake of these drugs across Europe in order to find out whether there is unequal access to optimised therapy. Material and Methods We used IMS launch and sales data (April 2000 to December 2005) for peginterferons and ribavirin for 21 countries of the WHO European region. Market uptake was investigated by comparing the development of country-specific sales rates. For market access analysis, we converted sales figures into numbers of treated patients and related those to country-specific hepatitis C prevalence. To convert sales figures into patient figures, the amount of active pharmaceutical ingredients (API) sold was divided by average total patient doses (ATPD), derived by a probability tree-based calculation algorithm accounting for genotype distribution, early stopping rules, body weight, unscheduled treatment stops and dose reductions Ntotal=APIPegIFNalpha-2a/ATPDPegIFNalpha-2a+APIPegIFN&alpha-2b/ATPDPegIFNalpha-2b For more concise result presentation the 21 included countries were aggregated into four categories: 1. EU founding members (1957): Belgium, France, Germany, Italy and Netherlands; 2. Countries joining EU before 2000: Austria (1995), Denmark (1973), Finland (1995), Greece (1981), Republic of Ireland (1973), Spain (1986), Sweden and UK (1973) 3. Countries joining EU after 2000: Czech Republic (2004), Hungary (2004), Poland (2004) and Romania (2007); 4. EU non-member states: Norway, Russia, Switzerland and Turkey. Results Market launch and market uptake of the investigated drugs differed considerably across countries. The earliest, most rapid and highest increases in sales rates were observed in the EU founding member states, followed by countries that joined the EU before 2000, countries that joined the EU after 2000, and EU non-member states. Most new EU member states showed a noticeable increase in sales after joining the EU. Market access analysis yielded that until end of 2005, about 308 000 patients were treated with peginterferon in the 21 countries. Treatment rates differed across Europe. The number of patients ever treated with peginterferon per 100 prevalent cases ranged from 16 in France to less than one in Romania, Poland, Greece and Russia. Discussion Peginterferon market uptake and prevalence adjusted treatment rates were found to vary considerably across 21 countries in the WHO European region suggesting unequal access to optimised therapy. Poor market access was especially common in low-resource countries. Besides budget restrictions, national surveillance and prevention policy should be considered as explanations for market access variation. Although our results allowed for the ranking of countries in order of market access, no final conclusions on over- or undertreatment can be drawn, because the number of patients who really require antiviral treatment is unknown. Further research based on pan-European decision models is recommended to determine the fraction of not yet successfully treated but treatable patients among those ever diagnosed with HCV. ...
Friedrich Schlegel's lasting contribution to linguistics is usually seen in the impact that his book "Über die Sprache und Weisheit der Indier" from 1808 left on comparative linguistics and on the study of Sanskrit. Schlegel was one of the first European scholars to have studied Sanskrit extensively and he made a number of translations of Sanskrit literature into German which make up one third of "Über die Sprache und Weisheit der Indier". Schlegel's book is widely regarded as a founding document both of comparative linguistics and of indology, a fact which is quite remarkable in light of the development of Schlegel's thought after this text. His interest in Indian studies ceased more or less directly with the publication of this work, while his thoughts on language became more and more suffused by transcendental philosophy.
Freeze (1992) argued on the basis of data from several different languages that there is a close relationship between existential sentences (stating the existence of an entity) and locative sentences (stating the location of an entity). Freeze (1992) proposes that they are both derived from the same base structure and that the surface differences are rather due to the distinct information structures.This paper argues against this position with the data from Serbian existentials, which show clear syntactic differences from the locatives. Thus, the close relationship between existential and locative sentences that Freeze (1992) observes is conceptual, but not (necessarily) part of the syntax of the language. In order to account for the data, we propose that existential sentences originate from a different syntactic predication structure than the locative ones. The existential meaning arises, as we will show, from the interaction of this predication structure with the structure and meaning of the noun phrase.
The fear that with the existence of an unconditional basic income sufficient for living many people would cease to engage in a productive life, would only relax, consume and devote to having fun, can be addressed from different perspectives. One of these is the sociology of religion, which allows elaborating the argument that with such a way of life the question about the meaning of life cannot be answered. But this "meaning question", the whole research within the field of the sociology of religion speaks for this, compellingly must be answered by each life praxis. It cannot remain unanswered, as is said already in the Bible: "Man does not live on bread alone, [but on every word that comes from the mouth of God.]" (5. Moses 8.3, Matthew 4.4, Lukas 4.4) The paper examines the reasons of this fact and its consequences in regard to a life with an unconditional basic income sufficient for living.
Our study is concerned with the identification of ‘difficult’ structure s in the acquisition of a foreign language, which will shed light on theoretical considerations of L2 processing. We argue that – compared to simple vocabulary items or abstract syntactic patterns – structures that contain lexical material as well as categorial variables are especially difficult to acquire. The difficulty level for particular patterns is shown to depend on surface invariability but not on the syntactic categories within which target patterns are embedded. As an example we study the distribution of certain structures which are underused by L2 German learners.