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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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Raina MacIntyre C, Kevin Yin J, Felter C, Menzies RI, Thommes E, Largeron N, Moa AM, Trent M, Costantino V, Choi S, Alvarez FP. Estimated health and economic impact of using high-dose influenza vaccine on respiratory and circulatory plus respiratory hospitalizations of older adults in Australia. Vaccine X 2023; 15:100365. [PMID: 37609557 PMCID: PMC10440578 DOI: 10.1016/j.jvacx.2023.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Background Standard dose influenza vaccine provides moderate protection from infection, but with lower effectiveness among the elderly. High dose and adjuvanted vaccines (HD-TIV and aTIV) were developed to address this. This study aims to estimate the incremental health and economic impact of using HD-TIV (high dose trivalent vaccine) instead of aTIV (adjuvanted trivalent vaccine) on respiratory and circulatory plus respiratory hospitalizations of older people (≥65 years) in Australia. Methods This is a modelling study comparing predicted hospitalization outcomes in people receiving HD-TIV or aTIV during an average influenza season in Australia. Hospitalization records of Australian adults ≥65 years of age from 01 April to 30 November during 15 influenza seasons (2002-2017 excluding 2009, which was a pandemic) were extracted from the Australian Institute of Health and Welfare [AIHW] and used to calculate hospitalisation rates during an average season. Relative vaccine effectiveness data for aTIV and HD-TIV were used to estimate morbidity burden related to influenza. Results Between 2002 and 2017, the average respiratory hospitalization rate among older people during influenza season (April-November) was 3,445/100,000 population-seasons, with an average cost of AU$ 7,175 per admission. The average circulatory plus respiratory hospitalization rate among older Australian people during that time was 10,393/100,000 population-seasons, with an average cost of AU$ 7829 per admission. For older Australians, HD-TIV may avert an additional 6,315-9,410 respiratory admissions each year, with an incremental healthcare cost saving of AU$ 15.9-38.2 million per year compared to aTIV. Similar results were also noted for circulatory plus respiratory hospitalizations. Conclusions From the modelled estimations, HD-TIV was associated with less economic burden and fewer respiratory, and circulatory plus respiratory hospitalizations than aTIV for older Australians.
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Affiliation(s)
| | - J. Kevin Yin
- Medical Department, Greater China, Sanofi Vaccines, Beijing, China
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Edward Thommes
- New Products and Innovation, Sanofi, Toronto, Ontario, Canada
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | | | - Aye M. Moa
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mallory Trent
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Seulki Choi
- Market Access, Sanofi, Sydney, NSW, Australia
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Association of low physical activity with higher respiratory tract infections frequency among pre-school children. Pediatr Res 2023:10.1038/s41390-022-02436-7. [PMID: 36690745 DOI: 10.1038/s41390-022-02436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND There is no consensus on the benefits of physical activity (PA) regarding upper respiratory tract infections (URTIs) among children. This study aimed to determine an association between the PA level and URTIs in preschoolers. METHODS In 4-7-year-old participants, URTI symptoms were monitored using the Polish version of the Wisconsin Upper Respiratory System Survey for Kids. The daily number of steps, PA intensity, and sleep duration were measured with a Garmin-vivofit pedometer. The lag effect between the initial level of daily PA and the frequency of infections was evaluated. RESULTS The average daily step count from healthy days was a significant determinant of the total number of days with the URTI symptoms, and it accounted for 44% (p < 0.001) of this variable variance. A low level of baseline PA (initial 14-day "run-in" observation period) was associated with an increased risk of URTI. In the non-sport group, the severity of the URTI symptoms depended on the number of daily steps. No significant correlation was found between sleep duration and the number of URTI days. CONCLUSION Low levels of PA in preschoolers result in increased susceptibility to respiratory infections. Parents should encourage children to engage in PA to prevent URTIs. IMPACT In pre-school children, higher physical activity (PA) is associated with fewer days of upper respiratory tract infection symptoms (URTIS). Children with a higher average daily step count have fewer days with URTIS over a long-term observation period. A change in the average number of steps per day by 1000 changed the number of days with symptoms of URTI by 4 days. The severity of URTIS was inversely related to the degree of PA. Children who participate in sports 3 or more hours per week have fewer URTIS than those who do not engage in sports regularly.
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Zhang S, Wahi-Singh P, Wahi-Singh B, Chisholm A, Keeling P, Nair H. Costs of management of acute respiratory infections in older adults: A systematic review and meta-analysis. J Glob Health 2022; 12:04096. [DOI: 10.7189/jogh.12.04096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shanshan Zhang
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Preventive Dentistry, Peking University, School and Hospital of Stomatology, Beijing, China
| | - Pia Wahi-Singh
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bhanu Wahi-Singh
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Alison Chisholm
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Polly Keeling
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- ReSViNET Foundation, Zeist, the Netherlands
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Woodall CA, McGeoch LJ, Hay AD, Hammond A. Respiratory tract infections and gut microbiome modifications: A systematic review. PLoS One 2022; 17:e0262057. [PMID: 35025938 PMCID: PMC8757905 DOI: 10.1371/journal.pone.0262057] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022] Open
Abstract
Respiratory tract infections (RTIs) are extremely common and can cause gastrointestinal tract symptoms and changes to the gut microbiota, yet these effects are poorly understood. We conducted a systematic review to evaluate the reported evidence of gut microbiome alterations in patients with a RTI compared to healthy controls (PROSPERO: CRD42019138853). We systematically searched Medline, Embase, Web of Science, Cochrane and the Clinical Trial Database for studies published between January 2015 and June 2021. Studies were eligible for inclusion if they were human cohorts describing the gut microbiome in patients with an RTI compared to healthy controls and the infection was caused by a viral or bacterial pathogen. Dual data screening and extraction with narrative synthesis was performed. We identified 1,593 articles and assessed 11 full texts for inclusion. Included studies (some nested) reported gut microbiome changes in the context of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (n = 5), influenza (H1N1 and H7N9) (n = 2), Tuberculosis (TB) (n = 4), Community-Acquired Pneumonia CAP (n = 2) and recurrent RTIs (rRTI) (n = 1) infections. We found studies of patients with an RTI compared to controls reported a decrease in gut microbiome diversity (Shannon) of 1.45 units (95% CI, 0.15-2.50 [p, <0.0001]) and a lower abundance of taxa (p, 0.0086). Meta-analysis of the Shannon value showed considerable heterogeneity between studies (I2, 94.42). Unbiased analysis displayed as a funnel plot revealed a depletion of Lachnospiraceae, Ruminococcaceae and Ruminococcus and enrichment of Enterococcus. There was an important absence in the lack of cohort studies reporting gut microbiome changes and high heterogeneity between studies may be explained by variations in microbiome methods and confounder effects. Further human cohort studies are needed to understand RTI-induced gut microbiome changes to better understand interplay between microbes and respiratory health.
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Affiliation(s)
- Claire A. Woodall
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Luke J. McGeoch
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Alastair D. Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Ashley Hammond
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Bhavsar A, Aris E, Harrington L, Simeone JC, Ramond A, Lambrelli D, Papi A, Boulet LP, Meszaros K, Jamet N, Sergerie Y, Mukherjee P. Burden of Pertussis in Individuals with a Diagnosis of Asthma: A Retrospective Database Study in England. J Asthma Allergy 2022; 15:35-51. [PMID: 35046668 PMCID: PMC8760990 DOI: 10.2147/jaa.s335960] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/20/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose The impact of pertussis in individuals with asthma is not fully understood. We estimated the incidence, health care resource utilization (HCRU), and direct medical costs (DMC) of pertussis in patients with asthma. Patients and Methods In this retrospective cohort study, the incidence rate of pertussis (identified using diagnostic codes) among individuals aged ≥50 years with an asthma diagnosis was assessed during 2009–2018 using Clinical Practice Research Datalink and Hospital Episode Statistics databases. HCRU and DMC were compared – between patients with diagnoses of asthma and pertussis (asthma+/pertussis+) and propensity score-matched patients with a diagnosis of asthma without pertussis (asthma+/pertussis–) – in the months around the pertussis diagnosis (–6 to +11). Results Among 687,105 individuals, 346 had a reported pertussis event (incidence rate: 9.6/100,000 person-years of follow-up; 95% confidence interval: 8.6–10.7). HCRU and DMC were assessed among 314 asthma+/pertussis+ patients and 1256 matched asthma+/pertussis– controls. Baseline HCRU was similar in both cohorts, but increases were observed in the asthma+/pertussis+ cohort from –6 to –1 month before to 2–5 months after diagnosis. Rates of accident and emergency visits, general practitioner (GP)/nurse visits, and GP prescriptions were 4.3-, 3.1-, and 1.3-fold, respectively, in the asthma+/pertussis+ vs asthma+/pertussis– cohorts during the month before diagnosis; GP/nurse visit rates were 2.0- and 1.2-fold during 0–2 and 2–5 months after diagnosis, respectively (all p<0.001). DMC was 1.9- and 1.6-fold during the month before and 2 months from diagnosis, respectively, in the asthma+/pertussis+ vs asthma+/pertussis– cohorts (both p<0.001). During months –1 to +11, DMC in the asthma+/pertussis+ cohort was £370 higher than in the asthma+/pertussis– controls. Conclusion A pertussis diagnosis among adults aged ≥50 years with asthma resulted in significant increases in HCRU and DMC across several months around diagnosis, suggesting lengthy diagnosis times and highlighting the need for prevention strategies.
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Affiliation(s)
- Amit Bhavsar
- Europe Medical Affairs, GSK, Wavre, Belgium
- Correspondence: Amit Bhavsar Tel +32 10 85 51 11 Email
| | | | | | | | - Anna Ramond
- Real-World Evidence, Evidera Ltd, London, UK
| | | | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
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Aris E, Harrington L, Bhavsar A, Simeone JC, Ramond A, Papi A, Vogelmeier CF, Meszaros K, Lambrelli D, Mukherjee P. Burden of Pertussis in COPD: A Retrospective Database Study in England. COPD 2021; 18:157-169. [PMID: 33866914 DOI: 10.1080/15412555.2021.1899155] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) may increase the risk and severity of pertussis infection. Health care resource utilization (HCRU) and direct medical costs (DMC) of treating pertussis among patients with COPD are unknown. Reported incidence of pertussis among individuals aged ≥ 50 years with COPD was assessed in Clinical Practice Research Datalink and Hospital Episode Statistics databases during 2009-2018 using a retrospective cohort design. HCRU and DMC from the National Health Service perspective were compared between patients with COPD and pertussis and propensity score-matched patients with COPD without pertussis. Seventy-eight new pertussis events were identified among 387 086 patients with COPD aged ≥ 50 years (incidence rate: 4.73; 95% confidence interval 3.74-5.91 per 100 000 person-years). HCRU and DMC were assessed among 67 patients with COPD and pertussis and 267 matched controls. During the month before the pertussis diagnosis, the rates of general practitioner (GP)/nurse visits (4289 vs. 1774 per 100 patient-years) and accident and emergency visits (182 vs. 18 per 100 patient-years) were higher in the pertussis cohort; GP/nurse visits (2935 vs. 1705 per 100 patient-years) were also higher during the following 2 months (all p < 0.001). During the month before the pertussis diagnosis, annualized per-patient total DMC were £2012 higher in the pertussis cohort (£3729 vs. £1717; p < 0.001); during the following 2 months, they were £2407 higher (£5498 vs. £3091; p < 0.001). In conclusion, a pertussis episode among individuals with COPD resulted in significant increases in HCRU and DMC around the pertussis event.
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Affiliation(s)
| | | | | | | | | | - Alberto Papi
- Respiratory Medicine & Research Centre on Asthma and COPD University of Ferrara, Respiratory Unit, Emergency Department, University Hospital S. Anna, Ferrara, Italy
| | - Claus F Vogelmeier
- Faculty of Medicine, Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University Marburg, Marburg, Germany.,German Center for Lung Research (DZL), Marburg, Germany
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