Obstetrics-Gynecology & Women's Health

The best approach is to combine clinical therapy with strong support from behavioral health professionals.

If you're going to choose a consultant to help you navigate today's ever-changing healthcare waters, you'd probably look for three key qualifications: experience, insight and diversity. While those characteristics might seem obvious, finding someone with those traits isn't always so apparent.

A pivotal phase 3 trial of a fully human monoclonal antibody, denosumab, that prevents bone destruction is under way and includes 7,800 postmenopausal, osteoporotic women aged 60 to 90 years. The primary endpoint is new vertebral fractures versus placebo and secondary end points are safety and tolerability of the new agent. Phase 2 clinical trials have demonstrated that denosumab is superior to aldendronate in preserving bone mineral density (BMD), reported researchers during the American College of Rheumatology Annual Scientific Meeting in San Diego, Calif.

Most cost estimates for infertility treatment, including IVF, range from $4 to $6 per member per year.

Eszopiclone (Lunesta, Sepracor), a novel, non-benzodiazepine sleep aid, shows significant value in the treatment of insomnia associated with menopause, said Claudio N. Soares, MD, PhD, at the North American Menopause Society's 16th annual meeting in San Diego, Calif.

Results from a phase 3 clinical study demonstrate that a novel transdermal estradiol gel (Bio-E-Gel, BioSante) represents a major improvement in low-dose estrogen therapy, significantly reducing the frequency and severity of hot flashes in menopausal women in a dose-dependent manner at all 3 doses studied, with the low dose being identified as the lowest effective approach, stated James A. Simon, MD, at the North American Menopause Society's 16th annual meeting in San Diego.

The growing trend for women to wait later in life before having their first child has placed many women at a higher risk for difficult conception. There are numerous classes of medications available to assist women who have been diagnosed with infertility.Agents that are used in the treatment of infertility include: clomiphene citrate, aromatase inhibitors, gonadotropins, chorionic gonadotropins, gonadotropin-releasing hormone, gonadotropin-releasing hormone agonists, gonadotropin-releasing hormone antagonists, follitropins, and other miscellaneous agents. Medications chosen for a patient will vary depending on the identified cause of the infertility. Additionally, economic factors will play a role. It is important for healthcare professionals to be aware of treatment options and have a basic understanding of the role these medications play in the treatment of infertility. (Formulary. 2005;40:329–341.)

In the september issue, Part I of this two-part series on episode grouping focused on how this method of statistical tracking enables healthcare organizations to more effectively deliver the most appropriate treatments in order to manage the associated costs.

One year of bisphosphonate therapy maintains the gains in bone mineral density (BMD) experienced after 1 year of full-length parathyroid hormone (1–84) in postmenopausal women at risk of osteoporotic fracture. The findings were published in the New England Journal of Medicine (2005;353:555–565).

The 2006 introduction of Part D under the Medicare Modernization Act will definitely affect medications targeting osteoporosis, the majority of which are prescribed to those 65 or older.

The biggest bang for the buck is treating the older population for which fractures are more prevalent.

While the overall cost of injectables is relatively consistent from health plan to health plan, regional differences exist in the total cost of individual therapy classes as a result of PMPM utilization, necessitating payers to develop injectable management programs that are customized for their geographical service area. Examples of these regional differences include the higher incidence of multiple sclerosis in northern states, higher prevalence of older Americans in states such as Florida and Arizona (and the associated higher oncology costs), and infertility costs in states where coverage is state-mandated.

April FDA Pipeline

Parkinson's Disease is a chronic, progressive neurological disorder that occurs when neurons in the part of the brain that controls movement start to degenerate. This leads to a shortage of the neurotransmitter dopamine, causing characteristic movement problems.

BREAST CANCER is the most common cancer found in women, and the second leading cause of cancer deaths in women. More than 200,000 new cases of invasive breast cancer are diagnosed in the United States each year, approximately 77% of them in women over 50 years of age.

DEAN F. NELSON, MD, was the first board-certified obstetrician and gynecologist in the state of Utah. Not only was he the first, he also was one of the best when it came to connecting with patients and really understanding them, recalls his son, American Medical Assn. (AMA) President John C. Nelson, MD, MPH.

Sexually Transmitted infections (STIs) such as syphilis, gonorrhea, herpes and chlamydia are a major health concern in the United States.

New molecular entities

When Common wisdom is debunked, it takes time for physicians and their patients to adjust to a new way of thinking. Hormone therapy (HT) is just beginning to emerge from that state of limbo.

In recent years, the looped, colored ribbon pinned to a lapel has come to symbolize awareness, support and advocacy.

Is it legal to ask health plan members their race and ethnicity? Accordingto the Civil Rights Act of 1964, it is; however, California, New Jersey,New Hampshire and Maryland restrict the use and collection of racial data.With the go-ahead from the federal government, health insurers are usingthe data to design strategies to improve care for specific populations.

According to a study published in the New England Journal of Medicine, short-term use of estrogen plus progestin significantly decreased the risk of colorectal cancer among postmenopausal women; however, for unknown reasons, the colorectal cancers that did develop in the hormone-treated group were diagnosed at a more advanced stage.

Findings from a newly released Women's Health Initiative (WHI) study suggest that conjugated equine estrogen (CEE) alone should not be used for chronic disease prevention, specifically coronary heart disease (CHD), in postmenopausal women. The study, published in the Journal of the American Medical Association, found that CEE increased the risk of stroke by 39% and offered no protection against heart disease.

More than half the women suffering from early-stage breast cancer (ESBC) are at increased risk of recurrence or death because of substantial reductions-planned or unplanned-in relative dose-intensity (RDI) when treated with adjuvant chemotherapy, according to a study published in the Journal of Clinical Oncology.

Disease-free survival in postmenopausal women with primary breast cancer significantly improved when tamoxifen monotherapy treatment was switched to exemestane therapy after 2-3 years, according to a study published in the New England Journal of Medicine. The existing treatment paradigm calls for tamoxifen, an estrogen-receptor modulator, to be taken alone for all 5 years, but some patients have experienced relapse.

A decision that backs ERISA could refuel interest in Congress to enact patients' rights legislation

Many arthritis sufferes are under 65 and need added support to maintain daily function

Authors Derek Van Amerongen, MD, MS Chief Medical Officer Humana Health Plan of Ohio Cincinnati, Ohio DonnaChiefari, RPH Director, Clinical Services NMHC Rx Latham, NY The views and opinions expressed in this supplement are those of the faculty and do not necessarily reflect the views of Advanstar Communications, Inc., publishers of Formulary, or Barr Laboratories Copyright 2004 Advanstar Communications, Inc., All rights reserved.

Extended use of combination monophasic oral contraceptives (OCs) used to treat women with menstrual disorders, such as endometriosis and dysmenorrhea, has been proven to be safe, effective, and acceptable to women. Even women without a medical indication for menstrual suppression may find that extending OC therapy may yield an improvement in their quality of life by diminishing menstrual symptoms associated with hormone withdrawal during the placebo interval. Most physicians and many women are aware of how to extend OC therapy, and commonly manipulate their cycles to avoid unwanted menstruation at inopportune times, such as during a honeymoon, vacation, or exams.

The oral contraceptive marketplace has undergone evolutionary changes over the years. Early oral contraceptive formulations contained higher doses of estrogen and progestin, which were associated with several safety concerns. Consequently, scientists returned to the laboratories to develop lower-dose formulations that would minimize risk without compromising efficacy. To date, numerous formulations have entered the marketplace that allow for tailored dosing to meet a woman?s clinical and individual needs. In order to provide additional treatment options and create more convenient oral contraceptive regimens, monophasic, multiphasic, extended-cycle, progestin-only, and chewable regimens have emerged. This article will review the main health risks and benefits of oral contraceptives, the concept of extended-cycle regimens, and the financial implications associated with oral contraceptive use.