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Box 15.2.a: Background commentary highlighting economics aspects of interventions

“Faecal incontinence…can be a debilitating problem with medical, social and economic implications... In the United States more than $400 million is spent each year on a range of both urinary and faecal incontinence products... During 1991 the direct costs of pads, appliances and other prescription items throughout hospitals and long term care settings in the UK for incontinence in general was estimated at £68 million... With the rise in numbers of elderly people in the world, this condition will be an increasing challenge to both healthcare services and home carers.” (Brown 2007).


“If such a new and relatively expensive treatment [Lamotrigine] is to be available for routine use, a clear understanding as to how it compares with a standard antiepileptic drug (AED) such as carbamazepine is needed. The potential cost implications are highlighted by a survey of epilepsy services in the North West, UK, which showed that almost 40% of drug costs (the largest single contributor of the direct costs of epilepsy) was accounted for by the new AEDs lamotrigine and vigabatrin, despite the fact they were only taken by seven per cent of patients.” (Gamble 2006).


“The cost of palliative chemotherapy treatment for advanced colorectal cancer includes not only the costs associated with the administration of chemotherapy, but also the provision of support to manage chemotherapy related complications. If palliative chemotherapy improves symptom control and quality of life this may reduce patient dependency and need for other symptomatic/ supportive care measures offsetting the cost of this treatment. On the other hand, if the incidence of chemotherapy related toxicity is high and there is a decrease in quality of life as a result of treatment, then the cost of palliative chemotherapy will become much greater than that of supportive care alone.” (Best 2000).