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Kirmizi Sonmez NI, Aydin V, Atac O, Akici A. Association of arbitrary prescribing behavior to costly drug expenditures: a pharmacoeconomic study in primary care. Postgrad Med J 2023; 100:36-41. [PMID: 37827534 DOI: 10.1093/postmj/qgad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/15/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND We aimed to examine the cost-related prescribing performance of primary care physicians who had a higher versus lower tendency of arbitrary prescribing. METHODS In this cross-sectional study, we evaluated the prescriptions of primary care physicians in Istanbul, collected with 3:1 systematic sampling. We determined higher versus lower arbitrary prescribing by the physician's degree of writing the solo diagnosis of "Z00- General examination without diagnosis/complaint": those for whom such prescriptions constituted >5% were classified as Group A and those with them at <0.5% as Group B. We compared these two groups by the total and disease-specific drug costs per prescription they produced for 10 frequently encountered indications. RESULTS The median cost of disease-specific medication for all diagnoses in Group A and Group B, except anemia, was equal. In upper respiratory tract infections (URTIs), hypertension, anemia, diabetes, and conjunctivitis, the mean prescription costs of Group A were significantly higher than those of Group B (P < .001, P < .001, P = .009, P = .007, and P < .001, respectively), whereas disease-specific drug costs per prescription were similar (P > .05 in all diagnoses). In myalgia, Group A had lower cost per prescription (P < .001) and higher analgesic costs per prescription (P < .001) compared to those in Group B. We found significantly higher disease-specific drug cost share in Group B for URTIs (antibiotic), gastroesophageal reflux disease (gastric acid-suppressant), hypertension (antihypertensive), anemia (iron preparations), diabetes (antidiabetic), depression (antidepressant), and conjunctivitis (corticosteroid) than those in Group A (P < .001 for each). CONCLUSIONS Our study showed that physicians who had a higher tendency of prescribing for no clear indication are also more likely to produce costly prescriptions.
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Affiliation(s)
- N Ipek Kirmizi Sonmez
- Department of Pharmacology, School of Pharmacy, Bahcesehir University, Istanbul 34353, Turkey
| | - Volkan Aydin
- Department of Medical Pharmacology, International School of Medicine, Istanbul Medipol University, Istanbul 34815, Turkey
| | - Omer Atac
- Department of Public Health, International School of Medicine, Istanbul Medipol University, Istanbul 34815, Turkey
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY 40506, United States
| | - Ahmet Akici
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul 34854, Turkey
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Althomali A, Altowairqi A, Alghamdi A, Alotaibi M, Althubaiti A, Alqurashi A, Harbi AA, Algarni MA, Haseeb A, Elnaem MH, Alsenani F, Elrggal ME. Impact of Clinical Pharmacist Intervention on Clinical Outcomes in the Critical Care Unit, Taif City, Saudi Arabia: A Retrospective Study. PHARMACY 2022; 10:pharmacy10050108. [PMID: 36136841 PMCID: PMC9498917 DOI: 10.3390/pharmacy10050108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Objectives: Clinical pharmacists are now playing a significant role in hospitals aiming to reduce medication errors, adverse drug reactions, and healthcare costs. Therefore, the main objective of this study was to assess the interventions provided by a clinical pharmacist in the intensive care unit at the King Faisal Hospital in Taif city. (2) Methods: For this single-center retrospective study, patients were included from December 2021 to May 2022. In the present study, all the interventions of clinical pharmacists made over six months were included. The Intensive care unit (ICU) ward was covered by three clinical pharmacists, and the interventions made were categorized into four groups: (1) interventions related to indications; (2) interventions regarding safety; (3) interventions regarding dosing, and (4) miscellaneous. Descriptive statistics was applied to evaluate the results in the form of frequencies and percentages. Analysis was performed using the statistical package SPSS 20.0. (3) Results: Overall, a total of 404 interventions were recommended for 165 patients during the six- month period of study. Among them, 370 interventions (91.5%) were accepted by physicians. Among all the interventions, the majority were suggested regarding ‘indication’ (45.7%), including the addition of drugs, drugs with no indications, and duplication. The acceptance rate of clinical pharmacist intervention was 98.5%. (4) Conclusions: This retrospective study shows that clinical pharmacists played a critical role in optimizing drug therapy which could subsequently help to prevent drug-related issues and lower drug costs. More research is needed to do a thorough cost-benefit analysis.
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Affiliation(s)
- Abdullah Althomali
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Ahmed Altowairqi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Afnan Alghamdi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Musim Alotaibi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | | | | | - Adnan Al Harbi
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Majed Ahmed Algarni
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Abdul Haseeb
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University, Kuantan 53100, Pahang, Malaysia
| | - Faisal Alsenani
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Mahmoud E. Elrggal
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
- Correspondence: or
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Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2017; 6:37-46. [PMID: 29354549 PMCID: PMC5774321 DOI: 10.2147/iprp.s108047] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Global healthcare expenditure is escalating at an unsustainable rate. Money spent on medicines and managing medication-related problems continues to grow. The high prevalence of medication errors and inappropriate prescribing is a major issue within healthcare systems, and can often contribute to adverse drug events, many of which are preventable. As a result, there is a huge opportunity for pharmacists to have a significant impact on reducing healthcare costs, as they have the expertise to detect, resolve, and prevent medication errors and medication-related problems. The development of clinical pharmacy practice in recent decades has resulted in an increased number of pharmacists working in clinically advanced roles worldwide. Pharmacist-provided services and clinical interventions have been shown to reduce the risk of potential adverse drug events and improve patient outcomes, and the majority of published studies show that these pharmacist activities are cost-effective or have a good cost:benefit ratio. This review demonstrates that pharmacists can contribute to substantial healthcare savings across a variety of settings. However, there is a paucity of evidence in the literature highlighting the specific aspects of pharmacists' work which are the most effective and cost-effective. Future high-quality economic evaluations with robust methodologies and study design are required to investigate what pharmacist services have significant clinical benefits to patients and substantiate the greatest cost savings for healthcare budgets.
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Affiliation(s)
- Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Kontoghiorghe CN, Andreou N, Constantinou K, Kontoghiorghes GJ. World health dilemmas: Orphan and rare diseases, orphan drugs and orphan patients. World J Methodol 2014; 4:163-188. [PMID: 25332915 PMCID: PMC4202455 DOI: 10.5662/wjm.v4.i3.163] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/05/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023] Open
Abstract
According to global annual estimates hunger/malnutrition is the major cause of death (36 of 62 million). Cardiovascular diseases and cancer (5.44 of 13.43 million) are the major causes of death in developed countries, while lower respiratory tract infections, human immunodeficiency virus infection/acquired immunodeficiency syndrome, diarrhoeal disease, malaria and tuberculosis (10.88 of 27.12 million) are the major causes of death in developing countries with more than 70% of deaths occurring in children. The majority of approximately 800 million people with other rare diseases, including 100000 children born with thalassaemia annually receive no treatment. There are major ethical dilemmas in dealing with global health issues such as poverty and the treatment of orphan and rare diseases. Of approximately 50000 drugs about 10% are orphan drugs, with annual sales of the latter approaching 100 billion USD. In comparison, the annual revenue in 2009 from the top 12 pharmaceutical companies in Western countries was 445 billion USD and the top drug, atorvastatin, reached 100 billion USD. In the same year, the total government expenditure for health in the developing countries was 410 billion USD with only 6%-7% having been received as aid from developed countries. Drugs cost the National Health Service in the United Kingdom more than 20 billion USD or 10% of the annual health budget. Uncontrollable drug prices and marketing policies affect global health budgets, clinical practice, patient safety and survival. Fines of 5.3 billion USD were imposed on two pharmaceutical companies in the United States, the regulatory authority in France was replaced and clinicians were charged with bribery in order to overcome recent illegal practises affecting patient care. High expenditure for drug development is mainly related to marketing costs. However, only 2 million USD was spent developing the drug deferiprone (L1) for thalassaemia up to the stage of multicentre clinical trials. The criteria for drug development, price levels and use needs to be readdressed to improve drug safety and minimise costs. New global health policies based on cheaper drugs can help the treatment of many categories of orphan and rare diseases and millions of orphan patients in developing and developed countries.
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Gallagher J, Byrne S, Woods N, Lynch D, McCarthy S. Cost-outcome description of clinical pharmacist interventions in a university teaching hospital. BMC Health Serv Res 2014; 14:177. [PMID: 24742158 PMCID: PMC4020601 DOI: 10.1186/1472-6963-14-177] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pharmacist interventions are one of the pivotal parts of a clinical pharmacy service within a hospital. This study estimates the cost avoidance generated by pharmacist interventions due to the prevention of adverse drug events (ADE). The types of interventions identified are also analysed. METHODS Interventions recorded by a team of hospital pharmacists over a one year time period were included in the study. Interventions were assigned a rating score, determined by the probability that an ADE would have occurred in the absence of an intervention. These scores were then used to calculate cost avoidance. Net cost benefit and cost benefit ratio were the primary outcomes. Categories of interventions were also analysed. RESULTS A total cost avoidance of €708,221 was generated. Input costs were calculated at €81,942. This resulted in a net cost benefit of €626,279 and a cost benefit ratio of 8.64: 1. The most common type of intervention was the identification of medication omissions, followed by dosage adjustments and requests to review therapies. CONCLUSION This study provides further evidence that pharmacist interventions provide substantial cost avoidance to the healthcare payer. There is a serious issue of patient's regular medication being omitted on transfer to an inpatient setting in Irish hospitals.
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Affiliation(s)
- James Gallagher
- Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
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Abstract
Pharmacoeconomics is an essential component of health technology assessment and the appraisal of medicines for use by UK National Health Service (NHS) patients. As a comparatively young discipline, its methods continue to evolve. Priority research areas for development include methods for synthesizing indirect comparisons when head-to-head trials have not been performed, synthesizing qualitative evidence (for example, stakeholder views), addressing the limitations of the EQ-5D tool for assessing quality of life, including benefits not captured in quality-adjusted life years (QALYs), ways of assessing valuation methods (for determining utility scores), extrapolation of costs and benefits beyond those observed in trials, early estimation of cost-effectiveness (including mechanism-based economic evaluation), methods for incorporating the impact of non-adherence and the role of behavioural economics in influencing patients and prescribers.
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Affiliation(s)
- Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Institute of Medical and Social Care Research, Bangor University, Dean Street, Bangor, Gwynedd LL57 1UT, UK.
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Pink J, Lane S, Hughes DA. Mechanism-based approach to the economic evaluation of pharmaceuticals: pharmacokinetic/pharmacodynamic/pharmacoeconomic analysis of rituximab for follicular lymphoma. PHARMACOECONOMICS 2012; 30:413-29. [PMID: 22428718 DOI: 10.2165/11591540-000000000-00000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Economic value is an important consideration during all phases of the drug development process. We previously published an article in PharmacoEconomics in which we described a mechanism-based economic modelling approach that incorporates data obtained during phase II clinical studies on the relationships between dose, exposure and response. We now describe case studies of rituximab for the treatment of follicular non-Hodgkin's lymphoma based on this methodology. METHODS We utilized a population pharmacokinetic and pharmacodynamic model linking serum rituximab concentration to progression-free survival, to simulate the effectiveness of rituximab in various clinical contexts. These served as inputs to economic models of follicular lymphoma, based on National Institute for Health and Clinical Excellence (NICE) appraisals, to assess the cost effectiveness of rituximab. Our results were compared with trial-based estimates from the NICE appraisals. In a further analysis, we simulated the results of an ongoing trial to generate predictions of cost effectiveness. RESULTS Our analyses suggest an acceptable degree of concordance between simulation- and trial-based estimates of cost effectiveness. For first-line and maintenance therapy, deviations of £2,099 and £1,355 per QALY, respectively, from trial-based incremental cost-effectiveness ratio estimates of £8,290 and £7,721 per QALY gained would not affect reimbursement decisions. The probability of rituximab-containing regimens being cost effective at £20,000 and £30,000 per QALY thresholds was 1 for both first-line and maintenance therapy in both simulated and trial-based analyses. CONCLUSIONS Our analyses demonstrate the feasibility of mechanism-based economic analyses, which may have applications during drug development to the following: (i) directing future research based on the cost of reducing uncertainty; (ii) assessing subgroups, dosing schedules and protocol deviations; and (iii) informing strategic research and development and pricing decisions.
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Affiliation(s)
- Joshua Pink
- Centre for Health Economics and Medicines Evaluation, Institute of Medical and Social Care Research, Bangor University, Bangor, Wales
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Abstract
The National Health System in the UK has evolved to become one of the largest healthcare systems in the world. At the time of writing of this review (August 2010) the UK government in its 2010 White Paper “Equity and excellence: Liberating the NHS” has announced a strategy on how it will “create a more responsive, patient-centred NHS which achieves outcomes that are among the best in the world”. This review article presents an overview of the UK healthcare system as it currently stands, with emphasis on Predictive, Preventive and Personalised Medicine elements. It aims to serve as the basis for future EPMA articles to expand on and present the changes that will be implemented within the NHS in the forthcoming months.
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