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Julian F. Guest - One of the best experts on this subject based on the ideXlab platform.
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the cost effectiveness of Macrogol 3350 compared to lactulose in the treatment of adults suffering from chronic constipation in the uk
Alimentary Pharmacology & Therapeutics, 2009Co-Authors: R R Taylor, Julian F. GuestAbstract:Background It is unknown whether Macrogol 3350 (Movicol) affords the UK’s National Health Service (NHS) a cost-effective addition to the current range of laxatives. Aim To estimate the cost-effectiveness of Macrogol 3350 compared with lactulose in the treatment of chronic constipation, from the perspective of the UK’s NHS. Methods A decision model depicting the management of chronic constipation was constructed using clinical outcomes and resource use values derived from patients suffering from chronic constipation in The Health Independent Network (THIN) database. The model was used to estimate the cost-effectiveness of a GP prescribing Macrogol 3350 instead of lactulose to treat adults ≥18 years of age suffering from chronic constipation. Results Sixty-eight percent of patients given Macrogol 3350 were successfully treated within 6 months after starting treatment compared to 60% of patients given lactulose.Patients’ health status at 6 months was estimated to be 0.458 and 0.454 quality-adjusted life years (QALYs) in the Macrogol 3350 and lactulose groups respectively. The total 6-monthly NHS cost of initially treating patients with Macrogol 3350 or lactulose was estimated to be £420 (US $688) and £419 (US $686) respectively. Hence, the cost per QALY gained with Macrogol 3350 was estimated to be £250 (US $410). Conclusion Macrogol 3350 affords the NHS a cost-effective addition to the range of laxatives available for this potentially resource-intensive condition. Aliment Pharmacol Ther 31, 302–312
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Cost-effectiveness of Macrogol 4000 compared to lactulose in the treatment of chronic functional constipation in the UK.
Current medical research and opinion, 2008Co-Authors: Julian F. Guest, John P. Clegg, Marianne T HelterAbstract:ABSTRACTObjective: To estimate the cost-effectiveness of Macrogol 4000 compared to lactulose in the treatment of chronic functional constipation, from the perspective of the National Health Service (NHS) in the UK.Methods: A decision model depicting the management of chronic functional constipation was constructed using clinical outcomes and resource use values derived from patients suffering from chronic functional constipation in The Health Improvement Network (THIN) Database. The model was used to estimate the cost-effectiveness of a general practitioner (GP) prescribing Macrogol 4000 relative to lactulose to treat adults ≥18 years of age suffering from chronic functional constipation.Results: Forty-two per cent (95% confidence interval [CI]: 38%; 46%) of Macrogol 4000-treated patients are expected to be successfully treated within 3 months after starting treatment, compared to 31% (95% CI: 27%; 37%) of lactulose-treated patients. Patients' health status at 3 months was estimated to be 0.213 (95% CI: 0...
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clinical and economic impact of using Macrogol 3350 plus electrolytes in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction based on actual clinical practice in england and wales
Current Medical Research and Opinion, 2007Co-Authors: Julian F. Guest, John P. Clegg, Marianne T Helter, David C A Candy, Di Edwards, Anne K Dale, John Fell, Michael Cosgrove, G DebelleAbstract:ABSTRACTObjective: To estimate the clinical and economic impact of using Macrogol 3350 plus electrolytes (Macrogol 3350; Movicol; Movicol Paediatric Plain) in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction.Methods: A chart review was undertaken to extract clinical outcomes and resource use from the case notes of a cohort of children aged 2–11 years with faecal impaction who initially received either Macrogol 3350 (in an outpatient setting) or enemas and suppositories or manual evacuation for initial disimpaction. Five centres across England and Wales participated in the study. These data were used to inform a decision model which depicted the management of children during the disimpaction phase and for a period of 12 weeks following initial disimpaction. Unit resource costs at 2005/2006 prices were applied to the resource utilisation estimates within the model, enabling the incremental costs and consequences of using Macrogol 3350 in a...
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pharmacoeconomic impact of low dose Macrogol 3350 plus electrolytes compared with lactulose in the management of chronic idiopathic constipation among ambulant patients in belgium
Clinical Drug Investigation, 2004Co-Authors: Julian F. Guest, Susan J VarneyAbstract:To estimate the economic impact of using low-dose Macrogol 3350 plus electrolytes (Macrogol 3350; Movicol®) compared with lactulose in the treatment of chronic idiopathic constipation among ambulant patients in Belgium, from the perspectives of the Sick Fund and patients. The analysis considered separately the economic impact of (a) a specialist and (b) a general practitioner (GP) initiating treatment. This was a modelling study performed from the perspective of Belgium’s Sick Fund and patients. Estimates of healthcare resource utilisation in a previously reported UK model depicting the management of chronic idiopathic constipation with either Macrogol 3350 and lactulose over 3 months were replaced with Belgian estimates derived from a panel of 11 gastroenterologists and 11 GPs. The model was used to estimate the expected 3-monthly Sick Fund cost and direct cost to patients of using either laxative to manage chronic idiopathic constipation in Belgium. According to our model, 53% and 24% of patients are expected to be successfully treated with Macrogol 3350 and lactulose, respectively. Additionally, using Macrogol 3350 instead of lactulose is expected to reduce the 3-monthly Sick Fund cost in approximately 55% of patients and afford a cost-effective treatment in the remaining patients. Furthermore, the 3-monthly Sick Fund cost of managing chronic idiopathic constipation among ambulant patients is expected to be reduced by approximately 50% if patients were initially treated by a GP instead of a specialist. In Belgium, laxatives are paid for by patients. Despite the difference in their acquisition cost, treating chronic idiopathic constipation with either Macrogol 3350 or lactulose was found to be cost neutral from a patient’s perspective. The true cost of managing chronic idiopathic constipation is impacted on by a broad range of resources and not only laxative acquisition costs. This study indicated that managing ambulant patients with chronic idiopathic constipation with Macrogol 3350 instead of lactulose is a cost-effective treatment from the Sick Fund’s perspective and cost neutral from a patient’s perspective.
Yu.v. Zhyhal - One of the best experts on this subject based on the ideXlab platform.
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Functional constipation at a young age. Place of Macrogol 4000 (Forlax) in the treatment
GASTROENTEROLOGY, 2009Co-Authors: A.e. Dorofeiev, M.m. Rudenko, Yu.v. ZhyhalAbstract:Background. Considering the wide prevalence of functional constipation (FC) at a young age, we set ourselves the task of comparing the effectiveness of osmotic laxative Macrogol 4000 (Forlax) in the treatment of FC in adolescents and young adults in the Ukrainian population. Materials and methods. We have examined 35 young adults aged 19 to 25 years (average age 24.10 ± 0.33 years) and 28 children in late adolescence aged 15 to 19 years (average age 15.90 ± 0.21 years). In the group of young adults, female patients slightly dominated (20/15), and among adolescents, both sexes were equally represented (14/14). It was an open-label, multi-center study. Patients with FC were monitored at the Kyiv gastrocenter and Kramatorsk Children’s Territorial Medical Association. The diagnosis of FC in the adult and adolescent groups was made based on the well-known Rome IV criteria. The frequency of bowel movements during the week was evaluated, as well as the shape of the stool according to the Bristol stool scale. The general state of health and severity of abdominal distention were evaluated on a 10-centimeter Visual analogue scale. Macrogol Forlax was administered as 10 g of powder dissolved in a glass of water once a day in the morning. With insufficient effect after 7 days of treatment, the dose was doubled. The duration of the drug use was 14 days. Results. After two weeks of treatment, the following results were obtained. The frequency of bowel movements was 4.36 ± 0.21 (p < 0.001) once a week, the shape of the stool according to the Bristol stool scale was 3.48 ± 0.22 (p
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functional constipation at a young age place of Macrogol 4000 forlax in the treatment
Gastroenterology, 2009Co-Authors: A.e. Dorofeiev, M.m. Rudenko, Yu.v. ZhyhalAbstract:Background. Considering the wide prevalence of functional constipation (FC) at a young age, we set ourselves the task of comparing the effectiveness of osmotic laxative Macrogol 4000 (Forlax) in the treatment of FC in adolescents and young adults in the Ukrainian population. Materials and methods. We have examined 35 young adults aged 19 to 25 years (average age 24.10 ± 0.33 years) and 28 children in late adolescence aged 15 to 19 years (average age 15.90 ± 0.21 years). In the group of young adults, female patients slightly dominated (20/15), and among adolescents, both sexes were equally represented (14/14). It was an open-label, multi-center study. Patients with FC were monitored at the Kyiv gastrocenter and Kramatorsk Children’s Territorial Medical Association. The diagnosis of FC in the adult and adolescent groups was made based on the well-known Rome IV criteria. The frequency of bowel movements during the week was evaluated, as well as the shape of the stool according to the Bristol stool scale. The general state of health and severity of abdominal distention were evaluated on a 10-centimeter Visual analogue scale. Macrogol Forlax was administered as 10 g of powder dissolved in a glass of water once a day in the morning. With insufficient effect after 7 days of treatment, the dose was doubled. The duration of the drug use was 14 days. Results. After two weeks of treatment, the following results were obtained. The frequency of bowel movements was 4.36 ± 0.21 (p < 0.001) once a week, the shape of the stool according to the Bristol stool scale was 3.48 ± 0.22 (p < 0.001), the need for excessive straining was observed in 6 (17.1 %) patients, a feeling of incomplete defecation persisted in 4 (11.4 %) persons. The general state of health according the Visual analogue scale was 5.41 ± 0.30 cm (p = 0.008), the feeling of bloating — 2.07 ± 0.22 cm (p = 0.08). Conclusions. In the Ukrainian population, Macrogol (Forlax) has a significant laxative effect in both young adults and adolescents suffering from functional constipation. According to our data, the efficiency reached 85.7 % in adults, and 89.3 % in adolescents.
Asbjorn Mohr Drewes - One of the best experts on this subject based on the ideXlab platform.
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colorectal transit and volume during treatment with prolonged release oxycodone naloxone versus oxycodone plus Macrogol 3350
Journal of Neurogastroenterology and Motility, 2018Co-Authors: Jakob Lykke Poulsen, Christina Brock, Klaus Krogh, Esben Bolvig Mark, Jens Brondum Frokjaer, Asbjorn Mohr DrewesAbstract:Background/Aims Opioid-induced constipation (OIC) is the most common gastrointestinal (GI) side effect to opioid treatment. Opioid receptor antagonists against OIC have been introduced, but their efficacy has not been directly compared to conventional laxatives. Our aim was to compare symptoms and objective parameters of gut function in an experimental model of OIC during treatment with the opioid antagonist naloxone and oxycodone in prolonged-release (PR) formulation versus oxycodone plus Macrogol 3350. Methods In this randomized, double-blind, crossover trial 20 healthy men received a 5-day treatment of combined PR oxycodone/naloxone or PR oxycodone plus Macrogol 3350. Regional GI transit times and segmental colorectal transit were assessed with the Motilis 3D-Transit electromagnetic capsule system. Colorectal volumes were determined by MRI. OIC symptoms were assessed with validated questionnaires, along with stool frequency and consistency. Results Total colorectal volume did not change after 5 days' treatment with PR oxycodone/naloxone (941 vs 1036 mL; P = 0.091), but increased significantly after PR oxycodone plus Macrogol treatment (912 vs 1123 mL; P 0.05). The Patient Assessment of Constipation Symptom Questionnaire abdominal symptoms score was lower during PR oxycodone/naloxone compared to PR oxycodone plus Macrogol (0.2 vs 3.2; P = 0.002). Stool frequency was lower during PR oxycodone/naloxone compared to PR oxycodone plus Macrogol (4.2 vs 5.4; P = 0.035). Conclusions PR oxycodone plus Macrogol increases colorectal volume, but does not improve GI transit compared to PR oxycodone/naloxone. However, PR oxycodone/naloxone results in a lower abdominal symptom burden, despite higher stool frequency during Macrogol treatment.
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prolonged release oxycodone naloxone improves anal sphincter relaxation compared to oxycodone plus Macrogol 3350
Neurogastroenterology and Motility, 2017Co-Authors: Jakob Lykke Poulsen, Christina Brock, Debbie Gronlund, Donghua Liao, Hans Gregersen, Klaus Krogh, Asbjorn Mohr DrewesAbstract:Opioid analgesics inhibit anal sphincter function and contribute to opioid-induced bowel dysfunction (OIBD). However, it is unknown whether the inhibition can be reduced by opioid antagonism with prolonged-release (PR) naloxone and how this compares to laxative treatment. To compare the effects of combined PR oxycodone/naloxone or PR oxycodone plus Macrogol 3350 on anal sphincter function and gastrointestinal symptoms. A randomized, double-blind, crossover trial was conducted in 20 healthy men. Participants were treated for 5 days with combined PR oxycodone/naloxone or PR oxycodone plus Macrogol 3350. Resting anal pressure, anal canal distensibility, and relaxation of the internal sphincter to rectal distension were evaluated before treatment (baseline) and on day 5. The Patient Assessment of Constipation Symptom (PAC-SYM) questionnaire, stool frequency, and stool consistency were assessed daily. Both PR oxycodone/naloxone and PR oxycodone plus Macrogol treatment decreased sphincter relaxation compared to baseline (− 27.5%; P < 0.001 and − 14.7%; P = 0.01). However, sphincter relaxation was increased after PR naloxone/oxycodone treatment compared to Macrogol (difference = + 17.6%; P < 0.001). Resting anal pressure and anal canal distensibility did not differ between treatments. PAC-SYM abdominal symptoms score was lower during PR naloxone compared to Macrogol (0.2 vs. 3.2; P = 0.002). The number of bowel movements was lower during PR naloxone versus Macrogol (4.2 vs. 5.4; P = 0.035). Relaxation of the internal anal sphincter was significantly better after PR oxycodone/naloxone treatment compared to PR oxycodone plus Macrogol 3350. These findings highlight that OIBD may require specific therapy against the complex, pan-intestinal effects of opioids.
Enrico Stefano Corazziari - One of the best experts on this subject based on the ideXlab platform.
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comparative outcome of stapled trans anal rectal resection and Macrogol in the treatment of defecation disorders
World Journal of Gastroenterology, 2011Co-Authors: Ivano Biviano, Danilo Badiali, Laura Candeloro, F.i. Habib, Massimo Mongardini, A. Caviglia, Fiorella Anzini, Enrico Stefano CorazziariAbstract:AIM: To prospectively assess the efficacy and safety of stapled trans-anal rectal resection (STARR) compared to standard conservative treatment, and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR. METHODS: Thirty patients (Female, 28; age: 51 ± 9 years) with rectocele or rectal intussusception, a defecation disorder, and functional constipation were submitted for STARR. Thirty comparable patients (Female, 30; age 53 ± 13 years), who presented with symptoms of rectocele or rectal intussusception and were treated with Macrogol, were assessed. Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during Macrogol treatment. A responder was defined as an absence of the Rome III diagnostic criteria for functional constipation. Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients, respectively. RESULTS: After STARR, 53% of patients were responders; during conservative treatment, 75% were responders. After STARR, 30% of the patients reported the use of laxatives, 17% had intermittent anal pain, 13% had anal leakage, 13% required digital facilitation, 6% experienced defecatory urgency, 6% experienced fecal incontinence, and 6% required re-intervention. During Macrogol therapy, 23% of the patients complained of abdominal bloating and 13% of borborygmi, and 3% required digital facilitation.No preoperative symptom, defecographic, or manometric finding predicted the outcome of STARR. Post-operative defecography showed a statistically significant reduction (P < 0.05) of the rectal diameter and rectocele. The post-operative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified, and that rectal compliance was reduced (P = 0.01). CONCLUSION: STARR is not better and is less safe than Macrogol in the treatment of defecation disorders. It could be considered as an alternative therapy in patients unresponsive to Macrogol.
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Comparative outcome of stapled trans-anal rectal resection and Macrogol in the treatment of defecation disorders
'Baishideng Publishing Group Inc.', 2011Co-Authors: Ivano Biviano, Danilo Badiali, Laura Candeloro, F.i. Habib, Massimo Mongardini, A. Caviglia, Fiorella Anzini, Enrico Stefano CorazziariAbstract:AIM: To prospectively assess the efficacy and safety of stapled trans-anal rectal resection (STARR) compared to standard conservative treatment, and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR. METHODS: Thirty patients (Female, 28; age: 51 +/- 9 years) with rectocele or rectal intussusception, a defecation disorder, and functional constipation were submitted for STARR. Thirty comparable patients (Female, 30; age 53 +/- 13 years), who presented with symptoms of rectocele or rectal intussusception and were treated with Macrogol, were assessed. Patients were interviewed with a standardized questionnaire at study enrollment and 38 +/- 18 mo after the STARR procedure or during Macrogol treatment. A responder was defined as an absence of the Rome. diagnostic criteria for functional constipation. Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients, respectively. RESULTS: After STARR, 53% of patients were responders; during conservative treatment, 75% were responders. After STARR, 30% of the patients reported the use of laxatives, 17% had intermittent anal pain, 13% had anal leakage, 13% required digital facilitation, 6% experienced defecatory urgency, 6% experienced fecal incontinence, and 6% required re-intervention. During Macrogol therapy, 23% of the patients complained of abdominal bloating and 13% of borborygmi, and 3% required digital facilitation. No preoperative symptom, defecographic, or manometric finding predicted the outcome of STARR. Post-operative defecography showed a statistically significant reduction (P < 0.05) of the rectal diameter and rectocele. The postoperative anorectal manometry showed that anal pressurere and rectal sensitivity were not significantly modified, and that rectal compliance was as reduced (P = 0.01). CONCLUSION: STARR is not better and is less safe than Macrogol in the treatment of defecation disorders. It could be considered as an alternative therapy in patients unresponsive to Macrogol. (C) 2011 Baishideng. All rights reserved
A.e. Dorofeiev - One of the best experts on this subject based on the ideXlab platform.
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Functional constipation at a young age. Place of Macrogol 4000 (Forlax) in the treatment
GASTROENTEROLOGY, 2009Co-Authors: A.e. Dorofeiev, M.m. Rudenko, Yu.v. ZhyhalAbstract:Background. Considering the wide prevalence of functional constipation (FC) at a young age, we set ourselves the task of comparing the effectiveness of osmotic laxative Macrogol 4000 (Forlax) in the treatment of FC in adolescents and young adults in the Ukrainian population. Materials and methods. We have examined 35 young adults aged 19 to 25 years (average age 24.10 ± 0.33 years) and 28 children in late adolescence aged 15 to 19 years (average age 15.90 ± 0.21 years). In the group of young adults, female patients slightly dominated (20/15), and among adolescents, both sexes were equally represented (14/14). It was an open-label, multi-center study. Patients with FC were monitored at the Kyiv gastrocenter and Kramatorsk Children’s Territorial Medical Association. The diagnosis of FC in the adult and adolescent groups was made based on the well-known Rome IV criteria. The frequency of bowel movements during the week was evaluated, as well as the shape of the stool according to the Bristol stool scale. The general state of health and severity of abdominal distention were evaluated on a 10-centimeter Visual analogue scale. Macrogol Forlax was administered as 10 g of powder dissolved in a glass of water once a day in the morning. With insufficient effect after 7 days of treatment, the dose was doubled. The duration of the drug use was 14 days. Results. After two weeks of treatment, the following results were obtained. The frequency of bowel movements was 4.36 ± 0.21 (p < 0.001) once a week, the shape of the stool according to the Bristol stool scale was 3.48 ± 0.22 (p
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functional constipation at a young age place of Macrogol 4000 forlax in the treatment
Gastroenterology, 2009Co-Authors: A.e. Dorofeiev, M.m. Rudenko, Yu.v. ZhyhalAbstract:Background. Considering the wide prevalence of functional constipation (FC) at a young age, we set ourselves the task of comparing the effectiveness of osmotic laxative Macrogol 4000 (Forlax) in the treatment of FC in adolescents and young adults in the Ukrainian population. Materials and methods. We have examined 35 young adults aged 19 to 25 years (average age 24.10 ± 0.33 years) and 28 children in late adolescence aged 15 to 19 years (average age 15.90 ± 0.21 years). In the group of young adults, female patients slightly dominated (20/15), and among adolescents, both sexes were equally represented (14/14). It was an open-label, multi-center study. Patients with FC were monitored at the Kyiv gastrocenter and Kramatorsk Children’s Territorial Medical Association. The diagnosis of FC in the adult and adolescent groups was made based on the well-known Rome IV criteria. The frequency of bowel movements during the week was evaluated, as well as the shape of the stool according to the Bristol stool scale. The general state of health and severity of abdominal distention were evaluated on a 10-centimeter Visual analogue scale. Macrogol Forlax was administered as 10 g of powder dissolved in a glass of water once a day in the morning. With insufficient effect after 7 days of treatment, the dose was doubled. The duration of the drug use was 14 days. Results. After two weeks of treatment, the following results were obtained. The frequency of bowel movements was 4.36 ± 0.21 (p < 0.001) once a week, the shape of the stool according to the Bristol stool scale was 3.48 ± 0.22 (p < 0.001), the need for excessive straining was observed in 6 (17.1 %) patients, a feeling of incomplete defecation persisted in 4 (11.4 %) persons. The general state of health according the Visual analogue scale was 5.41 ± 0.30 cm (p = 0.008), the feeling of bloating — 2.07 ± 0.22 cm (p = 0.08). Conclusions. In the Ukrainian population, Macrogol (Forlax) has a significant laxative effect in both young adults and adolescents suffering from functional constipation. According to our data, the efficiency reached 85.7 % in adults, and 89.3 % in adolescents.
