Acid-related disorders are common, chronic conditions that have considerable impact on a patient's quality of life. In a study conducted by Majumdar et al. (2003:2411) the prevalence of chronic acid-related disorders was 2.3%. Acid-related disorders represent a major financial consideration with respect to the costs of drug prescribing (Whitaker, 1998:6). Health care cost increases each year. This leads to an increased interest in economic evaluation of health care and medical technologies (Anell & Svarvar, 2000:175). Health care providers no longer make treatment decisions independent of the consideration of the resultant cost. The treatment provided must not only provide value but the value must be documented to justify spending money. Economic evaluation research has emerged to offer guidance to policy makers, practitioners, health plans and institutions facing difficult treatment and coverage decisions (Ellis era/., 2002:271). The main objectives of this study were to investigate the prescribing patterns and cost of acid reducing medicine with special reference to proton pump inhibitors and histamine-2 receptor antagonists in a section of the private health care sector of South Africa from 2001 to 2006. A longitudinal retrospective drug utilisation study was done on acid reducing medicine items claimed through a national medicine claims database. The five study years were 2001, 2002, 2004, 2005 and 2006. All the study years stretched from 1 January to 31 December. It was determined that acid reducing medicine items prescribed decreased from 2.74% during 2001 to 2.50% during 2006 of all medicine items claimed. The same decreasing trend was observed regarding the cost of acid reducing medicine items. The cost percentage decreased from 4.89% (2001) to 3.72% (2006). However, the average cost per medicine item for the acid reducers increased by 5.35% from 2001 (R230.04 ± 176.29) to 2002 (R243.72 ± 184.18) and then decreased by 15.23% from 2002 to 2004. It again decreased with 15.05% from 2004 (R206.19 ± 179.42) to 2006 (R175.70 ± 172.55). The changes in the average cost of acid reducers were of no practical significance. Proton pump inhibitors represented about half of the acid reducing medicine items prescribed and more than 70% of the total cost of acid reducing medicine items during the study years. The average cost of PPIs revealed a practical significant decrease (d > 0.8) from 2002 (R372.42 ± 156.62) to 2006 (R241.56 ± 177.21). H2RAs contributed between 15.00% and 18.26% of all acid reducing medicine items while contributing to between 9.68% and 16.85% of the total cost of all acid reducers. The active ingredient most often prescribed was lansoprazole during 2001 and 2002, esomeprazole during 2004 and omeprazole during 2005 and 2006. Lanzor® 30mg was the acid reducer with the highest cost from 2001 to 2005, while Pariet® 20mg took the lead in 2006. Zantac® 150mg effervescent tablets were the H2RA, with the highest cost, during the five study years. The percentage innovator items decreased by 4.50% from 2001 to 2002, increased by 1.01% from 2002 to 2004 and decreased again by 31.06% from 2004 to 2006. The slight increase in the percentage innovator medicine items claimed from 2002 to 2004 may be explained by the introduction of Nexiam® (esomeprazole) into the market in 2002. The total number of generic medicine items claimed contributed between 9.62% (n = R1 788 242.25) in 2001 and 30.75% (n = R3 196 163.34) in 2006 of the total cost of acid reducing medicine items. The average cost per day of innovator medicine items was higher than the average cost per day of generic medicine items. This might be explained by a lower average cost for generic medicine items. It was also determined that the prevalence of the two-drug regimens was the highest during the five study years. The Helicobacter pylori (H.pylori) eradication treatments, which included different antibiotics, increased from 2.72% in 2001 to 5.05% in 2006. The PDD for most of the active ingredients of H2RAs and PPIs remained stable during the study years. However, it appears that the PDDs, of the PPIs, active ingredients were more constant than the PDDs, or the H2RAs, active ingredients. The median of the different PPI active ingredients was reasonably more constant than the median of the different H2RA active ingredients. Thus the changes between the PPIs' and H2RAs' active ingredients might be explained by the variation in the median (the number of days the relevant medicine item was claimed for). It is then also recommended that the aspects of generic substitution as well as the usage of H2RAs as prescribed vs. self medication should be further investigated to increase possible cost savings. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.

Die arbuskuläre Mykorrhiza (AM) ist eine mutualistische Symbiose, die die Phosphataufnahme und Pathogenresistenz von Pflanzen verbessern kann. In der vorliegenden Doktorarbeit wurde die Rolle der Protonen-pumpenden ATPase MtHA1 für die AM Symbiose in Medicago truncatula untersucht. In MtHA1 Mutanten konnten AM Pilze nur noch verkürzte Arbuskel ohne typische Verzweigungen ausbilden. Dies zeigte sich auch in Expressionsmustern von Genen, die für Proteine in verschiedenen Bereichen der periarbuskulären Membran kodieren. Außerdem waren AM Pilzbesiedelung, die verbesserte Nährstoffaufnahme und die Wachstumsförderung in MtHA1 mutierten Pflanzen reduziert. Die Mykorrhiza-induzierte Resistenz (MIR) wurde näher in M. truncatula Pflanzen untersucht, die von Aphanomyces euteiches infiziert waren, dem Erreger einer Wurzelfäule in Leguminosen. In einem geteilten Wurzelsystem, das eine hohe Expression von Verteidigungsgenen aufwies, unterdrückte ein AM Pilz diese Expression und erhöhte in Folge die Empfindlichkeit für das Pathogen. In Wurzeln von Topfkulturen dagegen konnte eine typische MIR beobachtet werden, die wahrscheinlich auf erhöhter Aktivität der Jasmonat/Ethylen-regulierten Verteidigungsantwort beruht, verursacht durch eine Unterdrückung der Salizylsäuresynthese. Im Ergebnis zeigt diese Arbeit die bedeutende Rolle des Gens MtHA1 für die Bildung und Funktion der arbuskelhaltigen Zellen. Die Mutation des Gens führt zur verminderten Arbuskelverzweigung, reduzierter Phosphataufnahme und Wachstumsförderung in der Mykorrhiza und schließlich zu einer geringeren Gesamtbesiedelung durch den AM Pilz. Genexpressionsanalysen weisen darauf hin, dass unterschiedliche Mechanismen den lokalen und systemischen Wechselwirkungen zwischen AM Pilzen und Pathogenen in der Wurzel zu Grunde liegen. Verschieden physiologische Zustände von geteilten Wurzelsystemen und Wurzeln in Topfkulturen erschweren allerdings einen direkten Vergleich der beiden experimentellen Ansätze. / Arbuscular mycorrhiza (AM) is a wide spread mutualistic symbiosis, which can improve phosphate acquisition and pathogen resistance of plants. In the current Ph.D. thesis the role of a proton pumping ATPase (MtHA1) for the AM symbiosis in Medicago truncatula was investigated. In MtHA1 mutant plants, different AM fungi only developed truncated arbuscules without forming typical hyphal branches, and this phenotype was mirrored by expression patterns of genes for proteins located in different areas of the periarbuscular membrane. AM fungal colonization, improved phosphate uptake and plant growth promotion were reduced in MtHA1 mutant plants. Mycorrhiza-induced resistance (MIR) and the nodule symbiosis were, however, not affected. MIR was further analyzed in the M. truncatula infected with Aphanomyces euteiches which causes a root-rot disease in legumes. In a split root system showing high levels of defense-gene expression, colonization of an AM fungus reduced this expression and in consequence increased susceptibility of the roots for the pathogen. In roots of pot cultures, however, a typical MIR was observed and could be based on the higher activity of jasmonate/ethylene-regulated defense responses due to suppression of salicylic acid biosynthesis. In conclusion, this work shows that the gene MtHA1 encoding a proton pumping-ATPase plays a critical role in the formation and function of arbuscule-containing cells. Expression of the mutated gene results in reduced formation of arbuscule branches. This in turn negatively influences mycorrhizal phosphate uptake, plant growth promotion and overall mycorrhizal colonization of the roots. Gene expression analyses indicate that different mechanisms underlay local and systemic interactions between the mycorrhizal fungus and the root pathogen. The different physiological stages of pot culture and split root system make a comparison of the two experimental approaches, however, difficult.