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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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Matei E, Șăulean AA, Râpă M, Constandache A, Predescu AM, Coman G, Berbecaru AC, Predescu C. ZnO nanostructured matrix as nexus catalysts for the removal of emerging pollutants. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:114779-114821. [PMID: 37919505 PMCID: PMC10682326 DOI: 10.1007/s11356-023-30713-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Water pollution stands as a pressing global environmental concern, elevating the significance of innovative, dependable, and sustainable solutions. This study represents an extensive review of the use of photocatalytic zinc oxide nanoparticles (ZnO NPs) for the removal of emerging pollutants from water and wastewater. The study examines ZnO NPs' different preparation methods, including physical, chemical, and green synthesis, and emphasizes on advantages, disadvantages, preparation factors, and investigation methods for the structural and morphological properties. ZnO NPs demonstrate remarkable properties as photocatalysts; however, their small dimensions pose an issue, leading to potential post-use environmental losses. A strategy to overcome this challenge is scaling up ZnO NP matrices for enhanced stability and efficiency. The paper introduces novel ZnO NP composites, by incorporating supports like carbon and clay that serve as photocatalysts in the removal of emerging pollutants from water and wastewater. In essence, this research underscores the urgency of finding innovative, efficient, and eco-friendly solutions for the removal of emerging pollutants from wastewater and highlights the high removal efficiencies obtained when using ZnO NPs obtained from green synthesis as a photocatalyst. Future research should be developed on the cost-benefit analysis regarding the preparation methods, treatment processes, and value-added product regeneration efficiency.
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Affiliation(s)
- Ecaterina Matei
- Faculty of Materials Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 313 Splaiul Independentei, 060042, Bucharest, Romania
| | - Anca Andreea Șăulean
- Faculty of Materials Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 313 Splaiul Independentei, 060042, Bucharest, Romania.
| | - Maria Râpă
- Faculty of Materials Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 313 Splaiul Independentei, 060042, Bucharest, Romania
| | - Alexandra Constandache
- Faculty of Biotechnical Systems Engineering, National University of Science and Technology POLITEHNICA Bucharest, 313 Splaiul Independentei, 060042, Bucharest, Romania
| | - Andra Mihaela Predescu
- Faculty of Materials Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 313 Splaiul Independentei, 060042, Bucharest, Romania
| | - George Coman
- Faculty of Materials Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 313 Splaiul Independentei, 060042, Bucharest, Romania
| | - Andrei Constantin Berbecaru
- Faculty of Materials Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 313 Splaiul Independentei, 060042, Bucharest, Romania
| | - Cristian Predescu
- Faculty of Materials Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 313 Splaiul Independentei, 060042, Bucharest, Romania
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Kakkar M, Caetano de Souza Valentim E, Barmak AB, Arany S. Potential association of anticholinergic medication intake and caries experience in young adults with xerostomia. J Dent Sci 2023; 18:1693-1698. [PMID: 37799860 PMCID: PMC10548045 DOI: 10.1016/j.jds.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Background/purpose Growing prescription of anticholinergic medications has a critical effect on oral health. A link between anticholinergic medication-induced xerostomia (subjective feeling of oral dryness) and a high Decayed, Missing, and Filled teeth (DMFT) index has been reported in the older population. The purpose of this retrospective study is to determine anticholinergic exposure and prevalence of the most frequently used anticholinergic medications in adults 18-44 years of age, as well as to explore xerostomia and its association with caries status. Materials and methods We performed a retrospective study of adults between the age of 18 and 44 years who received a dental examination between January 2019 and April 2010, at Eastman Institute for Oral Health (EIOH), Rochester, NY. We reviewed the electronic dental charts and medical records of 236 adults with xerostomia. Results 71% of young adults with xerostomia were prescribed at least five or more medications (polypharmacy), and 85% took at least one anticholinergic drug. The average anticholinergic drug scale (ADS) was 2.93. We found systemic conditions such as cardiac, neurological, and sleep apnea affecting the DMFT index by predicting the caries status (P < 0.001). Conclusion Anticholinergic exposure and medication-induced xerostomia in younger adults are associated with dental caries and require complex interdisciplinary therapy.
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Affiliation(s)
- Mayank Kakkar
- Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, NY, USA
| | | | - Abdul Basir Barmak
- Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, NY, USA
| | - Szilvia Arany
- Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, NY, USA
- Specialty Care Clinic, Eastman Institute of Oral Health, University of Rochester, NY, USA
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Akbarpour Z, Zarei L, Varahrami V, Peiravian F, Yousefi N. Main drivers of diabetes pharmaceuticals expenditures: evidence from OECD countries and Iran. J Diabetes Metab Disord 2023; 22:431-442. [PMID: 37255794 PMCID: PMC10225425 DOI: 10.1007/s40200-022-01161-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 06/01/2023]
Abstract
Purpose This study aimed to identify the impact of prominent drivers on drug expenditure for diabetes. Method Following the examination of previous studies, this study identified possible factors contributing to diabetes pharmaceutical expenditures. The explanatory variables for the study were the median population age, access to innovative drugs, GDP per capita, prevalence, price, and consumption of diabetes drugs. Then, to estimate the per capita expenditure among diabetic patients, this study developed the panel data model and two time-series regression models for OECD countries and Iran, respectively. Results In the panel data regression model, R2 was 0.43. The influence of the age, prevalence, consumption volume and GDP per capita coefficients were + 1.79, + 0.704, + 3.86057, + 0.00054, respectively. Also, the probability level of all variables was less than 0.05. In Iran's comparative time-series regression model, R2 was 0.9, and the only significant influence coefficient was the age (β=+0.91). In the another model for Iran, R2 was 0.99, the influence coefficient of age was + 0.249, the prevalence was + 0.131, innovation was + 0.029, and the price was + 0.00054; all the probability levels were less than 0.05. Conclusion Pharmaceutical per capita expenditure is affected by several factors. These factors are not the same in various counties. Passing a judgment on drug utilization only based on pharmaceutical per capita expenditure cannot be perfect. Also, judging whether the per capita drug expenditure in one country is desirable without attention to the affecting factors and only relying on the value of utilized medicines is defective.
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Affiliation(s)
- Zahra Akbarpour
- Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Zarei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vida Varahrami
- Department of Economics, Shahid Beheshti University, Tehran, Iran
| | - Farzad Peiravian
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazila Yousefi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Létinier L, Bezin J, Jarne A, Pariente A. Drug-Drug Interactions and the Risk of Emergency Hospitalizations: A Nationwide Population-Based Study. Drug Saf 2023; 46:449-456. [PMID: 37046156 DOI: 10.1007/s40264-023-01283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Several studies suggest a significant risk of hospitalization because of drug-drug interactions in the general population. However, to our knowledge, this risk has never been measured precisely in a large population. OBJECTIVE We aimed to estimate the risk of emergency hospitalization associated with exposure to the contraindicated concomitant use of interacting drugs in the general population. METHODS A self-controlled case-series analysis was carried out on a cohort of 150,000 subjects randomly selected from the French national health insurance database, between 01/01/2016 and 31/12/2016. Exposure to the contraindicated concomitant use of interacting drugs was defined as the overlapping period of dispensings of drugs contraindicated because of clinically meaningful drug-drug interactions. The main outcome, incidence rate ratios, comparing the incidence rate of emergency hospitalizations during each category of exposure time periods with that during the reference period, was estimated using the conditional Poisson regression model. RESULTS Over the study period, 967 subjects were exposed to at least one contraindicated concomitant use of interacting drug and 177 had been exposed and presented at least one emergency hospitalization. Compared to the unexposed follow-up time, the risk of emergency hospitalization increased during exposure to contraindicated concomitant use of interacting drug periods (incidence rate ratio: 2.41; 95% confidence interval 1.55-3.76). This could translate into 7200 (4500-8900) potentially preventable emergency hospitalizations yearly in France. CONCLUSIONS We evidenced an almost 2.5-fold increase in the risk of emergency hospitalizations during periods of exposure to contraindicated concomitant use of interacting drugs, with a potential public health impact exceeding 7000 preventable hospitalizations yearly in France. These results confirm the need to reinforce training in prescription practices and tools for prevention concerning contraindicated concomitant use of interacting drugs. These would especially concern drugs involved in an increase in long QT syndrome when associated such as citalopram, and highly prescribed drugs with a risk of overdose if co-prescribed with cytochrome P450 inhibitors, such as antigout and lipid-lowering drugs.
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Affiliation(s)
- Louis Létinier
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Inserm UMR 1219, University of Bordeaux, Bordeaux, France.
- Service de Pharmacologie Médicale, CHU Bordeaux, Université de Bordeaux, 146, rue Léo Saignat, BP36, 33076, Bordeaux Cedex, France.
| | - Julien Bezin
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Inserm UMR 1219, University of Bordeaux, Bordeaux, France
- Service de Pharmacologie Médicale, CHU Bordeaux, Université de Bordeaux, 146, rue Léo Saignat, BP36, 33076, Bordeaux Cedex, France
| | - Ana Jarne
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Inserm UMR 1219, University of Bordeaux, Bordeaux, France
| | - Antoine Pariente
- Service de Pharmacologie Médicale, CHU Bordeaux, Université de Bordeaux, 146, rue Léo Saignat, BP36, 33076, Bordeaux Cedex, France
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Medication Use and Storage, and Their Potential Risks in US Households. PHARMACY 2022; 10:pharmacy10010027. [PMID: 35202076 PMCID: PMC8879450 DOI: 10.3390/pharmacy10010027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/16/2022] [Accepted: 02/02/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Medications stored in US households may pose risks to vulnerable populations and the environment, potentially increasing societal costs. Research regarding these aspects is scant, and interventions like medication reuse may alleviate negative consequences. The purpose of this study was to describe medications stored in US households, gauge their potential risk to minors (under 18 years of age), pets, and the environment, and estimate potential costs of unused medications. Methods: A survey of 220 US Qualtrics panel members was completed regarding medications stored at home. Published literature guided data coding for risks to minors, pets, and the environment and for estimating potential costs of unused medications. Results: Of the 192 households who provided usable and complete data, 154 (80%) reported storing a medication at home. Most medications were taken daily for chronic diseases. The majority of households with residents or guests who are minors and those with pets reported storing medications with a high risk of poisoning in easily accessible areas such as counters. Regarding risk to the aquatic environment, 46% of the medications had published data regarding this risk. For those with published data, 42% presented a level of significant risk to the aquatic environment. Unused medications stored at home had an estimated potential cost of $98 million at a national level. Implications/Conclusions: Medications stored at home may pose risks to vulnerable populations and the environment. More research regarding medications stored in households and their risks is required to develop innovative interventions such as medication reuse to prevent any potential harm.
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Asif AH, Rafique N, Hirani RAK, Wu H, Shi L, Sun H. Heterogeneous activation of peroxymonosulfate by Co-doped Fe 2O 3 nanospheres for degradation of p-hydroxybenzoic acid. J Colloid Interface Sci 2021; 604:390-401. [PMID: 34271491 DOI: 10.1016/j.jcis.2021.06.161] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 02/06/2023]
Abstract
Environmental remediation has become more effective when using nanotechnologies. In this study, iron oxide (α-Fe2O3) nanospheres with different cobalt doping levels (xCo-Fe2O3) were synthesised and applied in the heterogeneous activation of peroxymonosulfate (PMS) for the degradation of p-hydroxybenzoic acid (p-HBA). The catalyst (3Co-Fe2O3) with 3% Co doping exhibits the best performance for PMS activation, possibly because of the larger specific surface area and the tailored catalyst surface as confirmed by X-ray photoelectron spectroscopy (XPS). Reaction parameters were investigated to optimise the degradation efficiency. The metal ions leaching tests confirmed the higher stability of the catalyst, thanks to the leaching suppression by the doping of Co2+. The main contribution of free radicals (SO4•- and •OH) was confirmed by electron paramagnetic resonance (EPR) spectra, whereas partial contribution of oxygen anions and singlet oxygen (O2•-, 1O2) was observed during the quenching tests. Finally, a radical based degradation mechanism was proposed for the removal of p-HBA. It is expected to open up a novel perspective for the application of iron oxide as a potential catalyst for the removal of emerging contaminants.
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Affiliation(s)
- Abdul Hannan Asif
- School of Engineering, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Nasir Rafique
- School of Engineering, Edith Cowan University, Joondalup, WA 6027, Australia
| | | | - Hong Wu
- School of Engineering, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Lei Shi
- College of Materials Science and Engineering, Nanjing Forestry University, Nanjing 210037, China
| | - Hongqi Sun
- School of Engineering, Edith Cowan University, Joondalup, WA 6027, Australia.
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Tatar M, Jalali MS, Tak HJ, Chen LW, Araz OM, Wilson FA. Impact of Florida's prescription drug monitoring program on drug- related fatal vehicle crashes: a difference-in-differences approach. Inj Prev 2021; 28:105-109. [PMID: 34162702 DOI: 10.1136/injuryprev-2020-044113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prescription drug use has soared in the USA within the last two decades. Prescription drugs can impair motor skills essential for the safe operation of a motor vehicle, and therefore can affect traffic safety. As one of the epicentres of the opioid epidemic, Florida has been struck by high opioid misuse and overdose rates, and has concurrently suffered major threats to traffic disruptions safety caused by driving under the influence of drugs. To prevent prescription opioid misuse in Florida, Prescription Drug Monitoring Programs (PDMPs) were implemented in September 2011. OBJECTIVE To examine the impact of Florida's implementation of a mandatory PDMP on drug-related MVCs occurring on public roads. METHODS We employed a difference-in-differences approach to estimate the difference in prescription drug-related fatal crashes in Florida associated with its 2011 PDMP implementation relative to those in Georgia, which did not use PDMPs during the same period (2009-2013). The analyses were conducted in 2020. RESULTS In Florida, there was a significant decline in drug-related vehicle crashes during the 22 months post-PDMP. PDMP implementation was associated with approximately two (-2.21; 95% CI -4.04 to -0.37; p<0.05) fewer prescribed opioid-related fatal crashes every month, indicating 25% reduction in the number of monthly crashes. We conducted sensitivity analyses to investigate the impact of PDMP implementation on central nervous system depressants and stimulants as well as cocaine and marijuana-related fatal crashes but found no robust significant reductions. CONCLUSIONS The implementation of PDMPs in Florida provided important benefits for traffic safety, reducing the rates of prescription opioid-related vehicle crashes.
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Affiliation(s)
- Moosa Tatar
- Matheson Center for Health Care Studies, University of Utah Health, Salt Lake City, Utah, USA .,Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Mohammad S Jalali
- Harvard Medical School, MGH Institute for Technology Assessment, Boston, Massachusetts, USA.,Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Li-Wu Chen
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, Missouri, USA
| | - Ozgur M Araz
- College of Business, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Fernando A Wilson
- Matheson Center for Health Care Studies, University of Utah Health, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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Borrelli EP, McGladrigan CG. Five Year Analysis Assessing the Trend in Prescribing and Expenditures of Oral Oncolytics for Medicare Part D: 2013-2017. J Pharm Pract 2021; 35:580-586. [PMID: 33722080 DOI: 10.1177/08971900211000208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Oral oncolytics are becoming a mainstay in oncology, representing first-line therapies for numerous different malignancies. In addition, the cost of oncology drugs has increased dramatically in recent years. Given the increasing number of oral oncolytics available, as well as the increase in medication costs in recent years, it is important to assess the trend in prescriptions and expenditures of these agents. METHODS A descriptive retrospective analysis of the Medicare Part D Provider Utilization and Payment Data Public Use File (PUF) was conducted for the years 2013 through 2017. Outcomes of interest included total aggregate prescriptions per year, total aggregate expenditures per year, mean expenditure per prescription per year, and mean expenditure per standardized 30-day prescription per year. Chi-square tests were conducted to assess statistical significance of differences in proportions of prescriptions as well as expenditures between 2013 and 2017. RESULTS The number of prescriptions for oral oncolytics dispensed to Medicare Part D beneficiaries increased from 7,017,902 in 2013 to 8,164,883 in 2017. Medicare Part D expenditures for oral oncolytics increased greater than 2.5-fold from $5,631,224,307 in 2013 to $14,422,681,331 in 2017 after adjusting for inflation. The mean expenditure per prescription for oral oncolytics increased from $802 in 2013 to $1,766 in 2017. CONCLUSIONS This study found oral oncolytic utilization has been increasing in recent years with a slight, but statistically significant increase in the proportion of oncolytics for all Medicare prescriptions from 2013 through 2017.
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Affiliation(s)
- Eric P Borrelli
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
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McCormick N, Wallace ZS, Sacks CA, Hsu J, Choi HK. Decomposition Analysis of Spending and Price Trends for Biologic Antirheumatic Drugs in Medicare and Medicaid. Arthritis Rheumatol 2020; 72:234-241. [PMID: 31609057 DOI: 10.1002/art.41138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/08/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Billions of public dollars are spent each year on biologic disease-modifying antirheumatic drugs (DMARDs), but the drivers of recent increases in biologic DMARD spending are unclear. This study was undertaken to characterize changes in total spending and unit prices for biologic DMARDs in Medicare and Medicaid programs and quantified the major sources of these spending increases. METHODS We accessed drug spending data from years 2012-2016, covering all Medicare Part B (fee-for-service), Medicare Part D, and Medicaid enrollees. After calculating 5-year changes in total spending and unit prices for each biologic DMARD as well as in aggregate, we performed standard decomposition analyses to isolate 4 sources of spending growth: drug prices, uptake (number of recipients), treatment intensity (mean number of doses per claim), and treatment duration (annual number of claims per recipient), both excluding and including time-varying rebates. RESULTS From 2012 to 2016, annual spending on public-payer claims for the 10 biologic DMARDs included in this study more than doubled ($3.8 billion to $8.6 billion), with median drug price increases of 51% in Medicare Part D (mean 54%) and 8% in Medicare Part B (mean 21%). With adjustment for general inflation, unit price increases alone accounted for 57% of the 5-year, $3.0 billion spending increase in Part D, while 37% of the spending increase was from increased uptake. Accounting for time-varying rebates, prices were still responsible for 54% of increased spending. Unit prices and spending were lower under Medicaid than under Medicare Part D, though temporal trends and contributors were similar. CONCLUSION Postmarket drug price changes alone account for the majority of the recent spending growth in biologic DMARDs. Policy interventions targeting price increases, particularly those under Medicare Part D plans, may help mitigate financial burdens for public payers and biologic DMARD recipients.
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Affiliation(s)
- Natalie McCormick
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Zachary S Wallace
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Chana A Sacks
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John Hsu
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hyon K Choi
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, and Arthritis Research Canada, Richmond, British Columbia, Canada
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Patel PM, Vaidya V, Osundina F, Comoe DA. Determining patient preferences of community pharmacy attributes: A systematic review. J Am Pharm Assoc (2003) 2019; 60:397-404. [PMID: 31780193 DOI: 10.1016/j.japh.2019.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Patient selection of community pharmacy is based on a multitude of factors. With increasing competition and rapidly changing face of pharmacy, identification of these factors is critical for patient satisfaction and financial success. This systematic review summarizes patient preferences for different attributes of community pharmacy. DATA SOURCES Systematic review of peer-reviewed studies conducted on U.S. population, published from 2005 to 2018 in EBSCO, PubMed, and EMBASE, was conducted to identify attributes of community pharmacy that determine patient patronage. STUDY SELECTION Studies conducted between 2005 and 2018 on U.S. population that examined attributes in choosing a pharmacy were eligible for this systematic review. DATA EXTRACTION Data were independently extracted, assessed, and evaluated by 2 reviewers. Any disagreements were resolved by the third reviewer. Data obtained included year, setting, number of patients, data collection and evaluation methods, and relevant results and outcomes. RESULTS Of the 713 papers identified, 10 articles met the inclusion criteria and were included in this systematic review. Majority of the studies used surveys to examine key attributes that influence patients' selection of a pharmacy. Pharmacist traits like friendly, helpful, trustworthy, professional, competent, caring, knowledgeable, responsive, and approachable are critical attributes that influence a patient's selection of pharmacy. Convenience (i.e., location, hours of operation, wait time, stock availability) also influenced patients' selection of pharmacy. Cost and contract with insurance were other important factors. Availability of auto-refills appeared consistently in the studies. Medication safety (detecting drug interactions) quality metrics also appeared high among patients' preferences. CONCLUSION The results of this review found that a relationship with a respectful, friendly, competent pharmacist represents important pharmacist-related attributes in the process of pharmacy selection. Important pharmacy-related attributes include cost, convenience, and wait times. Availability of auto-refill service was also a frequently reported attribute in this review.
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Revisiting John Snow to Meet the Challenge of Nontuberculous Mycobacterial Lung Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214250. [PMID: 31683836 PMCID: PMC6862550 DOI: 10.3390/ijerph16214250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/09/2023]
Abstract
Nontuberculous mycobacteria (NTM) are ubiquitous components of the soil and surface water microbiome. Disparities by sex, age, and geography demonstrate that both host and environmental factors are key determinants of NTM disease in populations, which predominates in the form of chronic pulmonary disease. As the incidence of NTM pulmonary disease rises across the United States, it becomes increasingly evident that addressing this emerging human health issue requires a bold, multi-disciplinary research framework that incorporates host risk factors for NTM pulmonary disease alongside the determinants of NTM residence in the environment. Such a framework should include the assessment of environmental characteristics promoting NTM growth in soil and surface water, detailed evaluations of water distribution systems, direct sampling of water sources for NTM contamination and species diversity, and studies of host and bacterial factors involved in NTM pathogenesis. This comprehensive approach can identify intervention points to interrupt the transmission of pathogenic NTM species from the environment to the susceptible host and to reduce NTM pulmonary disease incidence.
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Pompei CME, Campos LC, da Silva BF, Fogo JC, Vieira EM. Occurrence of PPCPs in a Brazilian water reservoir and their removal efficiency by ecological filtration. CHEMOSPHERE 2019; 226:210-219. [PMID: 30927673 DOI: 10.1016/j.chemosphere.2019.03.122] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 05/20/2023]
Abstract
The presence of PPCPs (Pharmaceuticals and Personal Care Products) in water sources and drinking water has concerned researchers in recent times. This study was carried out to evaluate the occurrence of 6 PPCPs (namely paracetamol, diclofenac, naproxen, ibuprofen, benzophenone-3 and methylparaben) in the Lobo reservoir, their degradation products, and how efficiently they were removed by 22 ecological filters, considering individual and mixture of compounds. There were 3 spiking events of PPCPs (2 μg L-1) in the ecological filter influents conducted with a lag period of 15 days between spikes. Water samples were collected from the influent and effluent of the filters at 3, 6 and 24 h after each spiking event. All target PPCPs were identified in the Lobo reservoir water in the range of μg L-1. The personal care products were detected with 100% frequency in the samples, and in higher concentrations compared to the pharmaceuticals. Degradation products of diclofenac and benzophenone-3 were identified in the water samples. Results of this investigation show that ecological filtration was an effective process (70-99%) to remove 2 μg L-1 of the selected PPCPs, and demonstrated that the filters were resilient to individual compounds and to their mixtures.
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Affiliation(s)
- Caroline Moço Erba Pompei
- Water Resources and Applied Ecology Center, São Carlos School of Engineering, University of São Paulo, São Carlos, SP, Brazil.
| | - Luiza Cintra Campos
- Department of Civil, Environmental and Geomatic Engineering, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Bianca Ferreira da Silva
- Institute of Chemistry, State University "Julio de Mesquita Filho"-UNESP, Araraquara, SP, Brazil.
| | - José Carlos Fogo
- Department of Statistics, Federal University of São Carlos, SP, Brazil.
| | - Eny Maria Vieira
- Department of Chemistry and Molecular Physics, São Carlos Institute of Chemistry, University of São Paulo, São Carlos, SP, Brazil.
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Abstract
Opioid analgesics and antibiotics prescribed by dentists is a useful and cost-effective measure when prescribed appropriately. Common dental conditions are best managed by extracting the offending tooth, restoring the tooth with an appropriate filling material, performing root canal therapy, and/or fabricating a prosthesis for the edentulous space. Unnecessary prescription of opioid analgesics and antibiotics to treat dental pain and bacterial infection is a growing public health concern. This article highlights the state of the literature on opioid analgesic and antibiotic prescribing practices in dentistry, the impact of opioid analgesic overdose, and prevention strategies to reduce opioid analgesics and antibiotic overprescription.
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Hong SJ, Li EC, Matusiak LM, Schumock GT. Spending on Antineoplastic Agents in the United States, 2011 to 2016. J Oncol Pract 2018; 14:JOP1800069. [PMID: 30226791 DOI: 10.1200/jop.18.00069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Recent cancer drug approvals are lauded as being more effective with relatively fewer adverse effects, but these treatments come with a great cost to the US health care system. There is little information on recent trends in actual antineoplastic expenditures representative of the whole US health care system or by sector. Therefore, the objective of this study was to describe antineoplastic expenditures in the United States by year and sector. METHODS: This was a retrospective, cross-sectional study of IQVIA (formerly QuintilesIMS) National Sales Perspective data for the period of January 1, 2011, to December 31, 2016. Actual expenditures were totaled by health care sector and calendar year, then adjusted for medical-cost inflation to 2016 dollars. Growth was calculated as the percentage increase from the previous year. RESULTS: Total expenditures of antineoplastic agents across all channels grew from $26.8 billion in 2011 to $42.1 billion in 2016. Antineoplastic spending increased 12.2% in 2016 (compared with the previous year), followed by 15.6% in 2015, 13.4% in 2014, 6.3% in 2013, and 0.4% in 2012. Throughout the study period, 96.5% of total antineoplastic expenditures occurred within clinics, mail-order pharmacies, nonfederal hospitals, and retail pharmacies. CONCLUSION: Antineoplastic expenditures are expected to increase because of continuing development and approval of costly targeted cancer therapies. Cost containment and utilization management strategies must be balanced so as not to restrict access or disrupt innovation. Future policies should focus on ensuring safe and appropriate use of antineoplastics while balancing long-term drug costs.
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Affiliation(s)
- Samuel J Hong
- University of Illinois at Chicago, Chicago, IL; Sandoz, Princeton, NJ; and Plymouth Meeting, PA
| | - Edward C Li
- University of Illinois at Chicago, Chicago, IL; Sandoz, Princeton, NJ; and Plymouth Meeting, PA
| | - Linda M Matusiak
- University of Illinois at Chicago, Chicago, IL; Sandoz, Princeton, NJ; and Plymouth Meeting, PA
| | - Glen T Schumock
- University of Illinois at Chicago, Chicago, IL; Sandoz, Princeton, NJ; and Plymouth Meeting, PA
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16
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Lee MJ, Khan MM, Salloum RG. Recent Trends in Cost-Related Medication Nonadherence Among Cancer Survivors in the United States. J Manag Care Spec Pharm 2018; 24:56-64. [PMID: 29290172 PMCID: PMC10398090 DOI: 10.18553/jmcp.2018.24.1.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cancer survivors avoid necessary medications due to costs. OBJECTIVE To estimate the prevalence of cost-related medication non-adherence (CRN) by age and insurance status over a number of years in a national sample of U.S. cancer survivors. METHODS Using the 1999-2012 National Health Interview Survey, we examined the prevalence and correlates of self-reported CRN, that is, patient-reported inability to afford prescribed medications within the past 12 months, resulting in nonadherence among cancer survivors. Descriptive statistics and multivariate logistic regression models were used to identify time trends in CRN among cancer survivors. RESULTS In a nationally representative sample of 20,517 cancer survivors from 1999 to 2012, 1,788 (8.7%) survivors reported CRN, representing approximately 436,498 individuals nationally. CRN increased significantly from 11.8% (1999-2005) to 16.9% (2006-2012) among younger cancer survivors (P < 0.001). Among young cancer survivors (aged 45-64 years), the uninsurance rate was higher for those reporting CRN in the years 2006-2012 (48.5%) than in the earlier period (42.5%; P = 0.043). Among older cancer survivors, insurance coverage through Medicare only was lower for individuals reporting CRN in the years 2006-2012 (5.8%) than in the earlier period (7.8%; P = 0.0210). In adjusted models, younger cancer survivors without health insurance were more likely to report CRN than those with supplemental private insurance with Medicare, and older cancer survivors with Medicare only were more likely to report CRN than those with supplemental private insurance with Medicare. CONCLUSIONS Increasing trends in CRN were evident among younger cancer survivors. DISCLOSURES No external funding was received for this work. The authors have no conflicts of interest to report. Study concept and design were contributed by Lee, along with Khan and Salloum. Lee collected the data, and data interpretation was performed by Lee, Khan, and Salloum. The manuscript was written primarily by Lee, with assistance from Khan and Salloum, and revised by Lee, Khan, and Salloum.
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Affiliation(s)
- Min Jee Lee
- 1 Arnold School of Public Health, University of South Carolina, Columbia
| | - M Mahmud Khan
- 1 Arnold School of Public Health, University of South Carolina, Columbia
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Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System. Antimicrob Agents Chemother 2018; 62:AAC.00337-18. [PMID: 29967028 DOI: 10.1128/aac.00337-18] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 06/05/2018] [Indexed: 01/12/2023] Open
Abstract
Data are needed from outpatient settings to better inform antimicrobial stewardship. In this study, a random sample of outpatient antibiotic prescriptions by primary care providers (PCPs) at our health care system was reviewed and compared to consensus guidelines. Over 12 months, 3,880 acute antibiotic prescriptions were written by 76 PCPs caring for 40,734 patients (median panel, 600 patients; range, 33 to 1,547). PCPs ordered a median of 84 antibiotic prescriptions per 1,000 patients per year. Azithromycin (25.8%), amoxicillin-clavulanate (13.3%), doxycycline (12.4%), amoxicillin (11%), fluoroquinolones (11%), and trimethoprim-sulfamethoxazole (10.6%) were prescribed most commonly. Medical records corresponding to 300 prescriptions from 59 PCPs were analyzed in depth. The most common indications for these prescriptions were acute respiratory tract infection (28.3%), urinary tract infection (23%), skin and soft tissue infection (15.7%), and chronic obstructive pulmonary disease (COPD) exacerbation (6.3%). In 5.7% of cases, no reason for the prescription was listed. No antibiotic was indicated in 49.7% of cases. In 12.3% of cases, an antibiotic was indicated, but the prescribed agent was guideline discordant. In another 14% of cases, a guideline-concordant antibiotic was given for a guideline-discordant duration. Therefore, 76% of reviewed prescriptions were inappropriate. Ciprofloxacin and azithromycin were most likely to be prescribed inappropriately. A non-face-to-face encounter prompted 34% of prescriptions. The condition for which an antibiotic was prescribed was not listed in primary or secondary diagnosis codes in 54.5% of clinic visits. In conclusion, there is an enormous opportunity to reduce inappropriate outpatient antibiotic prescriptions.
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18
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Schumock GT, Stubbings J, Wiest MD, Li EC, Suda KJ, Matusiak LM, Hunkler RJ, Vermeulen LC. National trends in prescription drug expenditures and projections for 2018. Am J Health Syst Pharm 2018; 75:1023-1038. [PMID: 29748254 DOI: 10.2146/ajhp180138] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2018 in nonfederal hospitals, clinics, and overall (all sectors). METHODS Drug expenditure data through calendar year 2017 were obtained from the IQVIA (formerly QuintilesIMS) National Sales Perspectives database and analyzed. New drug approvals, patent expirations, and other factors that may influence drug spending in hospitals and clinics in 2018 were also reviewed. Expenditure projections for 2018 for nonfederal hospitals, clinics, and overall (all sectors) were made based on a combination of quantitative analyses and expert opinion. RESULTS Total U.S. prescription sales in the 2017 calendar year were $455.9 billion, a 1.7% increase compared with 2016. The top drug based on expenditures was adalimumab ($17.1 billion), followed by insulin glargine and etanercept. Prescription expenditures in nonfederal hospitals totaled $34.2 billion, a 0.7% decrease in 2017 compared with 2016. Expenditures in clinics increased 10.9%, to a total of $70.8 billion. The decrease in spending in nonfederal hospitals was driven by lower utilization. The top 25 drugs by expenditures in nonfederal hospitals and clinics were dominated by specialty drugs. CONCLUSION We project a 3.0-5.0% increase in total drug expenditures across all settings, a 11.0-13.0% increase in clinics, and a 0.0-2.0% increase in hospital drug spending in 2018. Health-system pharmacy leaders should carefully examine their own local drug utilization patterns to determine their own organization's anticipated spending in 2018.
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Affiliation(s)
- Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL.
| | - JoAnn Stubbings
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Michelle D Wiest
- UC Health, Cincinnati, OH, and James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
| | - Edward C Li
- Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME
| | - Katie J Suda
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | | | | | - Lee C Vermeulen
- University of Kentucky College of Medicine, Lexington, KY, and UK HealthCare, Lexington, KY
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Pennington MJ, Rothman JA, Jones MB, McFrederick QS, Gan J, Trumble JT. Effects of contaminants of emerging concern on Myzus persicae (Sulzer, Hemiptera: Aphididae) biology and on their host plant, Capsicum annuum. ENVIRONMENTAL MONITORING AND ASSESSMENT 2018; 190:125. [PMID: 29423658 DOI: 10.1007/s10661-018-6503-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/22/2018] [Indexed: 06/08/2023]
Abstract
Many countries are utilizing reclaimed wastewater for agriculture as water demands due to drought, rising temperatures, and expanding human populations. Unfortunately, wastewater often contains biologically active, pseudopersistant pharmaceuticals, even after treatment. Runoff from agriculture and effluent from wastewater treatment plants also contribute high concentrations of pharmaceuticals to the environment. This study assessed the effects of common pharmaceuticals on an agricultural pest, the aphid Myzus persicae (Sulzer, Hemiptera: Aphididae). Second instar nymphs were transferred to bell peppers (Capsicum annuum) that were grown hydroponically. Treatment plants were spiked with contaminants of emerging concern (CECs) at environmentally relevant concentrations found in reclaimed wastewater. M. persicae displayed no differences in population growth or microbial community differences due to chemical treatments. Plants, however, displayed significant growth reduction in antibiotic and mixture treatments, specifically in wet root masses. Antibiotic treatment masses were significantly reduced in the total and root wet masses. Mixture treatments displayed an overall reduction in plant root wet mass. Our results suggest that the use of reclaimed wastewater for crop irrigation would not affect aphid populations, but could hinder or delay crop production.
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Affiliation(s)
- Marcus John Pennington
- Graduate Program in Environmental Toxicology, University of California, Riverside, CA, 92521, USA.
- Department of Entomology, University of California, 417 Entomology Building, Riverside, CA, 92521, USA.
| | - Jason A Rothman
- Department of Entomology, University of California, 417 Entomology Building, Riverside, CA, 92521, USA
- Graduate Program in Microbiology, University of California, Riverside, CA, 92521, USA
| | - Michael Bellinger Jones
- Department of Entomology, University of California, 417 Entomology Building, Riverside, CA, 92521, USA
| | - Quinn S McFrederick
- Department of Entomology, University of California, 417 Entomology Building, Riverside, CA, 92521, USA
- Graduate Program in Microbiology, University of California, Riverside, CA, 92521, USA
| | - Jay Gan
- Graduate Program in Environmental Toxicology, University of California, Riverside, CA, 92521, USA
- Department of Environmental Science, University of California, Riverside, CA, 92521, USA
| | - John T Trumble
- Graduate Program in Environmental Toxicology, University of California, Riverside, CA, 92521, USA
- Department of Entomology, University of California, 417 Entomology Building, Riverside, CA, 92521, USA
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20
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Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Matusiak LM, Schumock GT. Antibiotic Expenditures by Medication, Class, and Healthcare Setting in the United States, 2010-2015. Clin Infect Dis 2018; 66:185-190. [PMID: 29020276 PMCID: PMC9454312 DOI: 10.1093/cid/cix773] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/23/2017] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Improving antibiotic use has the potential to decrease healthcare costs by reducing the incidence of antibiotic-resistant infections, antibiotic-associated adverse events, and expenditures due to unnecessary prescriptions. Antibiotic expenditures in 2009 totaled $10.7 billion in the United States. Since then, national and local antibiotic stewardship initiatives have grown. The purpose of this study was to assess trends in antibiotic expenditures by healthcare setting in the United States between 2010 and 2015. METHODS Systemic (nontopical) antibiotic expenditures from January 2010 to December 2015 were extracted from the QuintilesIMS National Sales Perspectives database. These data represent a statistically valid projection of US medication purchases. Regression analyses evaluated trends in expenditures over the study period. RESULTS Antibiotic expenditures totaled $56.0 billion over the 6-year period; the majority (59.1%) of expenditures were associated with the outpatient setting. Overall antibiotic expenditures in 2015 ($8.8 billion) were 16.6% lower than in 2010 ($10.6 billion). Antibiotic expenditures similarly decreased in the community by 25.5% (P = .05), but outpatient clinics and mail service pharmacy expenditures experienced significant growth (148% and 67% increase, respectively; P < .01 for both). In 2015, 16.5% of antibiotic expenditures in the community were for parenteral formulations, an increase of 25%. CONCLUSIONS From 2010 to 2015, antibiotic expenditures decreased. The majority of antibiotic expenditures were in the outpatient setting, specifically community pharmacies. Expenditures for intravenous agents in the community are increasing and may represent increased use. These results reinforce the importance of antibiotic stewardship efforts across the spectrum of healthcare.
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Affiliation(s)
- Katie J Suda
- Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Hines Jr. Veterans Affairs Hospital, Illinois
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago
| | - Lauri A Hicks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca M Roberts
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert J Hunkler
- Professional Relations, QuintilesIMS, Plymouth Meeting, Pennsylvania
| | - Linda M Matusiak
- Professional Relations, QuintilesIMS, Plymouth Meeting, Pennsylvania
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago
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21
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Pennington MJ, Rothman JA, Dudley SL, Jones MB, McFrederick QS, Gan J, Trumble JT. Contaminants of emerging concern affect Trichoplusia ni growth and development on artificial diets and a key host plant. Proc Natl Acad Sci U S A 2017; 114:E9923-E9931. [PMID: 29087336 PMCID: PMC5699077 DOI: 10.1073/pnas.1713385114] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Many countries are utilizing reclaimed wastewater for agriculture because drought, rising temperatures, and expanding human populations are increasing water demands. Unfortunately, wastewater often contains biologically active, pseudopersistent pharmaceuticals, even after treatment. Runoff from farms and output from wastewater treatment plants also contribute high concentrations of pharmaceuticals to the environment. This study assessed the effects of common pharmaceuticals on an agricultural pest, Trichoplusia ni (Lepidoptera: Noctuidae). Larvae were reared on artificial diets spiked with contaminants of emerging concern (CECs) at environmentally relevant concentrations. Trichoplusia ni showed increased developmental time and mortality when reared on artificial diets containing antibiotics, hormones, or a mixture of contaminants. Mortality was also increased when T. ni were reared on tomatoes grown hydroponically with the same concentrations of antibiotics. The antibiotic-treated plants translocated ciprofloxacin through their tissues to roots, shoots, and leaves. Microbial communities of T. ni changed substantially between developmental stages and when exposed to CECs in their diets. Our results suggest that use of reclaimed wastewater for irrigation of crops can affect the developmental biology and microbial communities of an insect of agricultural importance.
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Affiliation(s)
- Marcus J Pennington
- Department of Entomology, University of California, Riverside, CA 92521
- Graduate Program in Environmental Toxicology, University of California, Riverside, CA 92521
| | - Jason A Rothman
- Department of Entomology, University of California, Riverside, CA 92521
- Graduate Program in Microbiology, University of California, Riverside, CA 92521
| | - Stacia L Dudley
- Graduate Program in Environmental Toxicology, University of California, Riverside, CA 92521
- Department of Environmental Science, University of California, Riverside, CA 92521
| | - Michael B Jones
- Department of Entomology, University of California, Riverside, CA 92521
| | - Quinn S McFrederick
- Department of Entomology, University of California, Riverside, CA 92521
- Graduate Program in Microbiology, University of California, Riverside, CA 92521
| | - Jay Gan
- Graduate Program in Environmental Toxicology, University of California, Riverside, CA 92521
- Department of Environmental Science, University of California, Riverside, CA 92521
| | - John T Trumble
- Department of Entomology, University of California, Riverside, CA 92521;
- Graduate Program in Environmental Toxicology, University of California, Riverside, CA 92521
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22
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Park T, Griggs SK, Chung PD. Characteristics of patients using specialty medications. Res Social Adm Pharm 2017; 14:901-908. [PMID: 29050932 DOI: 10.1016/j.sapharm.2017.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/15/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Specialty medications include innovative drugs and biologic agents requiring special handling and close monitoring. Although specialty medications have been widely used for various chronic conditions, increased use of these medications has contributed a growing share of total health care expenditures. OBJECTIVE The aim of this study was to examine patient characteristics related to specialty medication use. METHODS Using Medical Expenditure Panel Survey (MEPS) data from 2000 through 2013, this study identified U.S. adults using specialty medications. Andersen's Health Services Utilization model was used to identify potential factors related to specialty medication use. Associations between the variables identified by Andersen's model and specialty medication use were analyzed using logistic multilevel modelling. Sampling weights were considered and standard errors were adjusted to account for the complex survey design. RESULTS A fully adjusted model suggested that older adults, individuals with prescription drug insurance, or those using mail order services were more likely to use specialty medications regardless of whether they used traditional medications concurrently. Behaviors of using specialty medications were positively associated with married and active working status and negatively associated with middle or high income and having a usual source of care (visiting a doctor's office, clinic, or health center when sick) when comparing individuals using traditional medications and those using specialty medications. In addition, when comparing individuals using traditional medications with those using both specialty medications and traditional medications, behaviors of using specialty medications were positively associated with female gender, worse health state, and more comorbidities. CONCLUSION This study identified characteristics of patients using specialty medications. Some sociodemographic, economic, and clinical factors were related to specialty medication use among U.S. adults.
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Affiliation(s)
- Taehwan Park
- Pharmacy Administration, St. Louis College of Pharmacy, St. Louis, MO, 63110, USA; Center for Health Outcomes Research and Education, St. Louis College of Pharmacy, St. Louis, MO, 63110, USA.
| | - Scott K Griggs
- Pharmacy Administration, St. Louis College of Pharmacy, St. Louis, MO, 63110, USA; Center for Health Outcomes Research and Education, St. Louis College of Pharmacy, St. Louis, MO, 63110, USA
| | - Paul D Chung
- Anesthesiology and Perioperative Care Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA
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Altawalbeh SM, Saul MI, Seybert AL, Thorpe JM, Kane-Gill SL. Intensive care unit drug costs in the context of total hospital drug expenditures with suggestions for targeted cost containment efforts. J Crit Care 2017; 44:77-81. [PMID: 29073536 DOI: 10.1016/j.jcrc.2017.10.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/13/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess costs of intensive care unit (ICU) related pharmacotherapy relative to hospital drug expenditures, and to identify potential targets for cost-effectiveness investigations. We offer the unique advantage of comparing ICU drug costs with previously published data a decade earlier to describe changes over time. MATERIALS AND METHODS Financial transactions for all ICU patients during fiscal years (FY) 2009-2012 were retrieved from the hospital's data repository. ICU drug costs were evaluated for each FY. ICU departments' charges were also retrieved and calculated as percentages of total ICU charges. RESULTS Albumin, prismasate (dialysate), voriconazole, factor VII and alteplase denoted the highest percentages of ICU drug costs. ICU drug costs contributed to an average of 31% (SD 1.0%) of the hospital's total drug costs. ICU drug costs per patient day increased by 5.8% yearly versus 7.8% yearly for non-ICU drugs. This rate was higher for ICU drugs costs at 12% a decade previous. Pharmacy charges contributed to 17.7% of the total ICU charges. CONCLUSIONS Growth rates of costs per year have declined but still drug expenditures in the ICU are consistently a significant driver in this resource intensive environment with a high impact on hospital drug expenditures.
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Affiliation(s)
- Shoroq M Altawalbeh
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; Department of Clinical Pharmacy, School of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Melissa I Saul
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Amy L Seybert
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; UPMC, Department of Pharmacy, Pittsburgh, PA, United States
| | - Joshua M Thorpe
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; UPMC, Department of Pharmacy, Pittsburgh, PA, United States.
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24
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Yang Y, Ok YS, Kim KH, Kwon EE, Tsang YF. Occurrences and removal of pharmaceuticals and personal care products (PPCPs) in drinking water and water/sewage treatment plants: A review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 596-597:303-320. [PMID: 28437649 DOI: 10.1016/j.scitotenv.2017.04.102] [Citation(s) in RCA: 653] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/05/2017] [Accepted: 04/13/2017] [Indexed: 05/17/2023]
Abstract
In recent years, many of micropollutants have been widely detected because of continuous input of pharmaceuticals and personal care products (PPCPs) into the environment and newly developed state-of-the-art analytical methods. PPCP residues are frequently detected in drinking water sources, sewage treatment plants (STPs), and water treatment plants (WTPs) due to their universal consumption, low human metabolic capability, and improper disposal. When partially metabolized PPCPs are transferred into STPs, they elicit negative effects on biological treatment processes; therefore, conventional STPs are insufficient when it comes to PPCP removal. Furthermore, the excreted metabolites may become secondary pollutants and can be further modified in receiving water bodies. Several advanced treatment systems, including membrane filtration, granular activated carbon, and advanced oxidation processes, have been used for the effective removal of individual PPCPs. This review covers the occurrence patterns of PPCPs in water environments and the techniques adopted for their treatment in STP/WTP unit processes operating in various countries. The aim of this review is to provide a comprehensive summary of the removal and fate of PPCPs in different treatment facilities as well as the optimum methods for their elimination in STP and WTP systems.
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Affiliation(s)
- Yi Yang
- Department of Science and Environmental Studies, The Education University of Hong Kong, Tai Po, New Territories, Hong Kong
| | - Yong Sik Ok
- O-Jeong Eco-Resilience Institute (OJERI), Division of Environmental Science and Ecological Engineering, Korea University, Seoul, Republic of Korea
| | - Ki-Hyun Kim
- Department of Civil and Environmental Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Eilhann E Kwon
- Department of Environment and Energy, Sejong University, Seoul 05006, Republic of Korea
| | - Yiu Fai Tsang
- Department of Science and Environmental Studies, The Education University of Hong Kong, Tai Po, New Territories, Hong Kong.
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25
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Pennington MJ, Rothman JA, Jones MB, McFrederick QS, Gan J, Trumble JT. Effects of contaminants of emerging concern on Megaselia scalaris (Lowe, Diptera: Phoridae) and its microbial community. Sci Rep 2017; 7:8165. [PMID: 28811598 PMCID: PMC5557979 DOI: 10.1038/s41598-017-08683-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/17/2017] [Indexed: 11/09/2022] Open
Abstract
Drought, rising temperatures, and expanding human populations are increasing water demands. Many countries are extending potable water supplies by irrigating crops with wastewater. Unfortunately, wastewater contains biologically active, long-lived pharmaceuticals, even after treatment. Run-off from farms and wastewater treatment plant overflows contribute high concentrations of pharmaceuticals to the environment. This study assessed the effects of common pharmaceuticals on a cosmopolitan saprophagous insect, Megaselia scalaris (Diptera: Phoridae). Larvae were reared on artificial diets spiked with contaminants of emerging concern (CECs) at environmentally relevant concentrations. Female flies showed no oviposition preference for treated or untreated diets. Larvae exposed to caffeine in diets showed increased mortality, and larvae fed antibiotics and hormones showed signs of slowed development, especially in females. The normal sex ratio observed in M. scalaris from control diets was affected by exposure to caffeine and pharmaceutical mixture treatments. There was an overall effect of treatment on the flies' microbial communities; notably, caffeine fed insects displayed higher microbial variability. Eight bacterial families accounted for approximately 95% of the total microbes in diet and insects. Our results suggest that CECs at environmentally relevant concentrations can affect the biology and microbial communities of an insect of ecological and medical importance.
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Affiliation(s)
- Marcus J Pennington
- Department of Entomology, University of California, Riverside, CA, 92521, USA.
- Graduate Program in Environmental Toxicology, University of California, Riverside, CA, 92521, USA.
| | - Jason A Rothman
- Department of Entomology, University of California, Riverside, CA, 92521, USA
- Graduate Program in Microbiology, University of California, Riverside, CA, 92521, USA
| | - Michael B Jones
- Department of Entomology, University of California, Riverside, CA, 92521, USA
| | - Quinn S McFrederick
- Department of Entomology, University of California, Riverside, CA, 92521, USA
- Graduate Program in Microbiology, University of California, Riverside, CA, 92521, USA
| | - Jay Gan
- Graduate Program in Environmental Toxicology, University of California, Riverside, CA, 92521, USA
- Department of Environmental Chemistry, University of California, Riverside, CA, 92521, USA
| | - John T Trumble
- Department of Entomology, University of California, Riverside, CA, 92521, USA
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Schumock GT, Li EC, Wiest MD, Suda KJ, Stubbings J, Matusiak LM, Hunkler RJ, Vermeulen LC. National trends in prescription drug expenditures and projections for 2017. Am J Health Syst Pharm 2017; 74:1158-1173. [PMID: 28533252 DOI: 10.2146/ajhp170164] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2017 in nonfederal hospitals, clinics, and overall (all sectors). METHODS Drug expenditure data through calendar year 2016 were obtained from the QuintilesIMS National Sales Perspectives database and analyzed. Other factors that may influence drug spending in hospitals and clinics in 2017, including new drug approvals and patent expirations, were also reviewed. Expenditure projections for 2017 for nonfederal hospitals, clinics, and overall (all sectors) were made based on a combination of quantitative analyses and expert opinion. RESULTS Total U.S. prescription sales in the 2016 calendar year were $448.2 billion, a 5.8% increase compared with 2015. More than half of the increase resulted from price hikes of existing drugs. Adalimumab was the top drug overall in 2016 expenditures ($13.6 billion); in clinics and nonfederal hospitals, infliximab was the top drug. Prescription expenditures in clinics and nonfederal hospitals totaled $63.7 billion (an 11.9% increase from 2015) and $34.5 billion (a 3.3% increase from 2015), respectively. In nonfederal hospitals and clinics, growth in spending was driven primarily by price increases of existing drugs and increased volume, respectively. CONCLUSION We project a 6.0-8.0% increase in total drug expenditures across all settings, an 11.0-13.0% increase in clinics, and a 3.0-5.0% increase in hospital drug spending in 2017. Health-system pharmacy leaders should carefully examine their own local drug utilization patterns to determine their own organization's anticipated spending in 2017.
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Affiliation(s)
- Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Edward C Li
- Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME
| | - Michelle D Wiest
- UC Health, Cincinnati, OH, and James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
| | - Katie J Suda
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - JoAnn Stubbings
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | | | | | - Lee C Vermeulen
- University of Kentucky College of Medicine, Center for Health Services Research, Lexington, KY
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Fitzpatrick MA, Suda KJ, Evans CT, Hunkler RJ, Weaver F, Schumock GT. Influence of drug class and healthcare setting on systemic antifungal expenditures in the United States, 2005-15. Am J Health Syst Pharm 2017; 74:1076-1083. [PMID: 28522642 DOI: 10.2146/ajhp160943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Overall and specific class trends in systemic antifungal expenditures in various U.S. healthcare settings from 2005 through 2015 were evaluated. METHODS Systemic antifungal expenditures from January 1, 2005, through December 31, 2015, were obtained from the QuintilesIMS National Sales Perspective database, which provides a statistically valid projection of medication purchases from multiple markets throughout the United States. Summary data for total antifungal expenditures over the entire period are reported, as are growth and the percentage change in expenditures from one year to the next. Expenditures were also assessed specifically by year, class, and healthcare setting. Expenditure trends over the study period were assessed using simple linear trend regression models. RESULTS Overall expenditures for the 11-year period were $9.37 billion. The greatest proportion of expenditures occurred in nonfederal hospitals (47.2%) and for triazoles (57.6%). From 2005 through 2015, total expenditures decreased from $1.1 billion to $894 million (-18.8%, p = 0.09); however, expenditures in clinics and retail pharmacies increased (202%, p < 0.01, and 13.8%, p = 0.04, respectively), a trend most pronounced after 2012. Expenditures for flucytosine also increased (968.1%, p < 0.01), particularly in clinics where there was a dramatic 6,640.9% increase (p < 0.01). CONCLUSION From 2005 through 2015, an increase in systemic antifungal expenditures was observed in community settings, despite an overall decrease in total antifungal expenditures in the United States. Large increases in flucytosine expenditures were observed, particularly in the community.
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Affiliation(s)
- Margaret A Fitzpatrick
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Medicine, Division of Infectious Diseases, Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Katie J Suda
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | - Charlesnika T Evans
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Preventive Medicine, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Frances Weaver
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Glen T Schumock
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL
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Suda KJ, Hunkler RJ, Matusiak LM, Schumock GT. Influenza Antiviral Expenditures and Outpatient Prescriptions in the United States, 2003-2012. Pharmacotherapy 2017; 35:991-7. [PMID: 26598091 DOI: 10.1002/phar.1656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
STUDY OBJECTIVES The clinical efficacy and cost-effectiveness of influenza antiviral use are controversial, with recent analyses suggesting potentially limited value. Thus, the objectives of this study were to describe influenza antiviral expenditures overall and by health care setting over a 10-year period (2003-2012) and to assess the correlation between outpatient influenza antiviral prescription use and influenza-like illness (ILI) outpatient visits. DESIGN Retrospective, cross-sectional study. DATA SOURCES IMS Health National Sales Perspectives and Xponent databases and Centers for Disease Control and Prevention ILINet national influenza surveillance system database. PATIENTS All prescriptions for oseltamivir, rimantadine, or zanamivir from community pharmacies, mail order pharmacies, clinics, nonfederal hospitals, and other health care settings (federal hospitals, military facilities, jails and prisons, universities, staff-model health maintenance organizations, veterinary hospitals and clinics, and long-term care facilities) between January 1, 2003, and December 31, 2012. MEASUREMENTS AND MAIN RESULTS Prescribing rates were calculated (prescriptions/1000 persons) for each year from 2003 to 2012 by using U.S. Census Bureau data. Influenza season was defined as July 1-June 30 of each calendar year. Linear regression assessed the correlation between influenza antiviral expenditures, prescription use, and ILI diagnoses. From 2003 to 2012, influenza antiviral drug expenditures accounted for $3.74 billion, with the majority from community pharmacies. After adjusting for inflation, no growth was observed for expenditures. A total of 32.8 million influenza antiviral prescriptions were dispensed from community pharmacies during the study period, and these prescriptions experienced 133.2% growth from 2003 to 2012. One third of expenditures and one quarter of dispensed prescriptions were in 2009. Influenza seasons were correlated with ILI and antiviral prescriptions. Annual community pharmacy expenditures were also associated with influenza antiviral prescriptions dispensed over the 10-year period. CONCLUSION Influenza antivirals totaled $3.74 billion in the United States from 2003 to 2012, with the majority in 2009 and from community pharmacies. Influenza antivirals constituted a small proportion of total medication expenditures, but unforeseen pandemics resulted in unusually high use and expenditures. Influenza antiviral prescriptions dispensed from community pharmacies were associated with ILI and drug expenditures.
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Affiliation(s)
- Katie J Suda
- Center of Innovation of Complex Chronic Healthcare, Department of Veterans Affairs and Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago, Hines, Illinois
| | | | | | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago, Chicago, Illinois
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Alahabadi A, Hosseini-Bandegharaei A, Moussavi G, Amin B, Rastegar A, Karimi-Sani H, Fattahi M, Miri M. Comparing adsorption properties of NH 4 Cl-modified activated carbon towards chlortetracycline antibiotic with those of commercial activated carbon. J Mol Liq 2017. [DOI: 10.1016/j.molliq.2017.02.077] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Suda KJ, Halbur DJ, Hunkler RJ, Matusiak LM, Schumock GT. Spending on Hepatitis C Antivirals in the United States, 2009-2015. Pharmacotherapy 2016; 37:65-70. [DOI: 10.1002/phar.1865] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 08/24/2016] [Accepted: 09/28/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Katie J. Suda
- Department of Veterans Affairs; Center of Innovation for Complex Chronic Healthcare; Edward Hines, Jr. VA Hospital Chicago Illinois
- Department of Pharmacy Systems, Outcomes and Policy; University of Illinois at Chicago; Chicago Illinois
| | - Drew J. Halbur
- Department of Pharmacy Practice; University of Illinois at Chicago; Chicago Illinois
| | | | | | - Glen T. Schumock
- Department of Pharmacy Systems, Outcomes and Policy; University of Illinois at Chicago; Chicago Illinois
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Top 1% of Inpatients Administered Antimicrobial Agents Comprising 50% of Expenditures: A Descriptive Study and Opportunities for Stewardship Intervention. Infect Control Hosp Epidemiol 2016; 38:259-265. [PMID: 27917735 DOI: 10.1017/ice.2016.261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To characterize the top 1% of inpatients who contributed to the 6-month antimicrobial budget in a tertiary, academic medical center and identify cost-effective intervention opportunities targeting high-cost antimicrobial utilization. DESIGN Retrospective cohort study. PATIENTS Top 1% of the antimicrobial budget from July 1 through December 31, 2014. METHODS Patients were identified through a pharmacy billing database. Baseline characteristics were collected through a retrospective medical chart review. Patients were presented to the antimicrobial stewardship team to determine appropriate utilization of high-cost antimicrobials and potential intervention opportunities. Appropriate use was defined as antimicrobial therapy that was effective, safe, and most cost-effective compared with alternative agents. RESULTS A total of 10,460 patients received antimicrobials in 6 months; 106 patients accounted for $889,543 (47.2%) of the antimicrobial budget with an antimicrobial cost per day of $219±$192 and antimicrobial cost per admission of $4,733±$7,614. Most patients were immunocompromised (75%) and were followed by the infectious disease consult service (80%). The most commonly prescribed antimicrobials for treatment were daptomycin, micafungin, liposomal amphotericin B, and meropenem. Posaconazole and valganciclovir accounted for most of the prophylactic therapy. Cost-effective opportunities (n=71) were present in 57 (54%) of 106 patients, which included dose optimization, de-escalation, dosage form conversion, and improvement in transitions of care. CONCLUSION Antimicrobial stewardship oversight is important in implementing cost-effective strategies, especially in complex and immunocompromised patients who require the use of high-cost antimicrobials. Infect Control Hosp Epidemiol 2017;38:259-265.
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Hirsch BR, Balu S, Schulman KA. The impact of specialty pharmaceuticals as drivers of health care costs. Health Aff (Millwood) 2016; 33:1714-20. [PMID: 25288414 DOI: 10.1377/hlthaff.2014.0558] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The pharmaceutical industry is shifting its focus from blockbuster small molecules to specialty pharmaceuticals. Specialty pharmaceuticals are novel drugs and biologic agents that require special handling and ongoing monitoring, are administered by injection or infusion, and are sold in the marketplace by a small number of distributors. They are frequently identified by having a cost to payers and patients of $600 or more per treatment. The total costs of the new agents are likely to have a substantial impact on overall health care costs and on patients during the next decade, unless steps are taken to align competing interests. We examine the economic and policy issues related to specialty pharmaceuticals, taking care to consider the impact on patients. We assess the role of cost-sharing provisions, legislation that is promoting realignment within the market, the role of biosimilars in price competition, and the potential for novel drug development paradigms to help bend the cost curve. The economic aspects of this analysis highlight the need for a far-reaching discussion of potential novel approaches to innovation pathways in our quest for both affordability and new technology.
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Affiliation(s)
- Bradford R Hirsch
- Bradford R. Hirsch is an assistant professor of medicine at Duke University, in Durham, North Carolina
| | - Suresh Balu
- Suresh Balu is a manager of strategy and innovation at the Duke Translational Medicine Institute, Duke University
| | - Kevin A Schulman
- Kevin A. Schulman is a professor of medicine and the Gregory Mario and Jeremy Mario Professor of Business Administration at Duke University
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Borah BJ, Qiu Y, Shah ND, Gleason PP. Impact of provider mailings on medication adherence by Medicare Part D members. Healthcare (Basel) 2016; 4:207-16. [DOI: 10.1016/j.hjdsi.2016.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/08/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022] Open
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Malhotra S, Cheriff AD, Gossey JT, Cole CL, Kaushal R, Ancker JS. Effects of an e-Prescribing interface redesign on rates of generic drug prescribing: exploiting default options. J Am Med Inform Assoc 2016; 23:891-898. [DOI: 10.1093/jamia/ocv192] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Objective Increasing the use of generic medications could help control medical costs. However, educational interventions have limited impact on prescriber behavior, and e-prescribing alerts are associated with high override rates and alert fatigue. Our objective was to evaluate the effect of a less intrusive intervention, a redesign of an e-prescribing interface that provides default options intended to “nudge” prescribers towards prescribing generic drugs.
Methods This retrospective cohort study in an academic ambulatory multispecialty practice assessed the effects of customizing an e-prescribing interface to substitute generic equivalents for brand-name medications during order entry and allow a one-click override to order the brand-name medication.
Results Among drugs with generic equivalents, the proportion of generic drugs prescribed more than doubled after the interface redesign, rising abruptly from 39.7% to 95.9% (a 56.2% increase; 95% confidence interval, 56.0–56.4%; P < .001). Before the redesign, generic drug prescribing rates varied by therapeutic class, with rates as low as 8.6% for genitourinary products and 15.7% for neuromuscular drugs. After the redesign, generic drug prescribing rates for all but four therapeutic classes were above 90%: endocrine drugs, neuromuscular drugs, nutritional products, and miscellaneous products.
Discussion Changing the default option in an e-prescribing interface in an ambulatory care setting was followed by large and sustained increases in the proportion of generic drugs prescribed at the practice.
Conclusions Default options in health information technology exert a powerful effect on user behavior, an effect that can be leveraged to optimize decision making.
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Affiliation(s)
- Sameer Malhotra
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- Physician Organization, Weill Cornell Medical College, New York, NY, USA
| | - Adam D Cheriff
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- Physician Organization, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - J Travis Gossey
- Physician Organization, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Curtis L Cole
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- Physician Organization, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Rainu Kaushal
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Jessica S Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
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35
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Schumock GT, Li EC, Suda KJ, Wiest MD, Stubbings J, Matusiak LM, Hunkler RJ, Vermeulen LC. National trends in prescription drug expenditures and projections for 2016. Am J Health Syst Pharm 2016; 73:1058-75. [PMID: 27170624 DOI: 10.2146/ajhp160205] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2016 in nonfederal hospitals, clinics, and overall (all sectors). METHODS Drug expenditure data through calendar year 2015 were obtained from the IMS Health National Sales Perspectives database and analyzed. Other factors that may influence drug spending in hospitals and clinics in 2016, including new drug approvals and patent expirations, were also reviewed. Expenditure projections for 2016 were based on a combination of quantitative analyses and expert opinion. RESULTS Total U.S. prescription sales in the 2015 calendar year were $419.4 billion, which was 11.7% higher than sales in 2014. Prescription expenditures in clinics and nonfederal hospitals totaled $56.7 billion (a 15.9% increase) and $33.6 billion (a 10.7% increase), respectively, in 2015. In nonfederal hospitals, growth in spending was driven primarily by increased prices for existing drugs. The hepatitis C combination drug ledipasvir-sofosbuvir was the top drug overall in terms of 2015 expenditures ($14.3 billion); in both clinics and nonfederal hospitals, infliximab was the top drug. Individual drugs with the greatest increases in expenditures in 2015 were specialty agents and older generics; these agents are likely to continue to influence total spending in 2016. CONCLUSION We project an 11-13% increase in total drug expenditures overall in 2016, with a 15-17% increase in clinic spending and a 10-12% increase in hospital spending. Health-system pharmacy leaders should carefully examine local drug utilization patterns in projecting their own organization's drug spending in 2016.
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Affiliation(s)
- Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL.
| | - Edward C Li
- Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME
| | - Katie J Suda
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edwards Hines Jr. VA Hospital, Hines, ILDepartment of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Michelle D Wiest
- UC Health, Cincinnati, OHJames L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
| | - JoAnn Stubbings
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | | | | | - Lee C Vermeulen
- Center for Clinical Knowledge Management, UW Health, Madison, WISchool of Pharmacy, University of Wisconsin, Madison, WI
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Hartke PL, Vermeulen LC, Hoffman JM, Shah ND, Doloresco F, Suda KJ, Li EC, Matusiak LM, Hunkler RJ, Schumock GT. Accuracy of annual prescription drug expenditure forecasts in AJHP. Am J Health Syst Pharm 2016; 72:1642-8. [PMID: 26386105 DOI: 10.2146/ajhp140850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The accuracy of the forecasts of drug expenditures in nonfederal hospitals and clinics published annually in the American Journal of Health-System Pharmacy (AJHP) relative to the accuracy of forecasts produced by the Centers for Medicare and Medicaid Services (CMS) was evaluated. METHODS AJHP-published forecasts of drug expenditure growth for nonfederal hospitals (for the years 2003 through 2013) and clinics (for the years 2004 through 2013) were compared with data on actual growth. Data on actual and projected growth published by CMS were analyzed for the years 2003 through 2012. The mean absolute error and directional accuracy of the forecasts published in AJHP for nonfederal hospitals and clinics and the CMS forecasts were determined and compared. RESULTS Actual spending growth was within the range of the forecast published in AJHP for 2 of 11 years for nonfederal hospitals and for 3 of 10 years for clinics; the forecasts for nonfederal hospitals and clinics were directionally accurate 27.3% and 60.0% of the time, respectively. The mean absolute errors of the AJHP-published drug expenditure forecasts for the nonfederal hospital and clinic sectors were 2.0 and 4.7 percentage points, respectively. The CMS forecasts of overall drug spending were directionally accurate 70% of the time, and the mean absolute error (2.2 percentage points) was not statistically different from that of either sector forecast published in AJHP. CONCLUSION The annual drug expenditure forecasts published in AJHP have been reasonably accurate for predicting growth in prescription expenditures when compared with other available drug expenditure forecasts.
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Affiliation(s)
- Patricia L Hartke
- Patricia L. Hartke, Pharm.D., is Postgraduate Year 2 Resident, University of Illinois at Chicago (UIC) and Takeda Pharmaceuticals, Chicago, IL; at the time of writing she was Postgraduate Year 1 Resident, Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, is Director, Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison. James M. Hoffman, Pharm.D., M.S., BCPS, is Associate Member, Pharmaceutical Sciences, Medication Outcomes and Safety Officer, St. Jude Children's Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis. Nilay D. Shah, Ph.D., is Associate Professor of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. Fred Doloresco, Pharm.D., M.S., is Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo. Katie J. Suda, Pharm.D., M.S., is Research Health Scientist, Department of VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC. Edward C. Li, Pharm.D., BCOP, is Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME. Linda M. Matusiak, B.A., is Senior Manager, Research Support; and Robert J. Hunkler, M.B.A., is Director, Professional Relations, IMS Health, Plymouth Meeting, PA. Glen T. Schumock, Pharm.D., M.B.A., Ph.D., FCCP, is Professor and Head, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC
| | - Lee C Vermeulen
- Patricia L. Hartke, Pharm.D., is Postgraduate Year 2 Resident, University of Illinois at Chicago (UIC) and Takeda Pharmaceuticals, Chicago, IL; at the time of writing she was Postgraduate Year 1 Resident, Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, is Director, Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison. James M. Hoffman, Pharm.D., M.S., BCPS, is Associate Member, Pharmaceutical Sciences, Medication Outcomes and Safety Officer, St. Jude Children's Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis. Nilay D. Shah, Ph.D., is Associate Professor of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. Fred Doloresco, Pharm.D., M.S., is Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo. Katie J. Suda, Pharm.D., M.S., is Research Health Scientist, Department of VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC. Edward C. Li, Pharm.D., BCOP, is Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME. Linda M. Matusiak, B.A., is Senior Manager, Research Support; and Robert J. Hunkler, M.B.A., is Director, Professional Relations, IMS Health, Plymouth Meeting, PA. Glen T. Schumock, Pharm.D., M.B.A., Ph.D., FCCP, is Professor and Head, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC
| | - James M Hoffman
- Patricia L. Hartke, Pharm.D., is Postgraduate Year 2 Resident, University of Illinois at Chicago (UIC) and Takeda Pharmaceuticals, Chicago, IL; at the time of writing she was Postgraduate Year 1 Resident, Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, is Director, Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison. James M. Hoffman, Pharm.D., M.S., BCPS, is Associate Member, Pharmaceutical Sciences, Medication Outcomes and Safety Officer, St. Jude Children's Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis. Nilay D. Shah, Ph.D., is Associate Professor of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. Fred Doloresco, Pharm.D., M.S., is Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo. Katie J. Suda, Pharm.D., M.S., is Research Health Scientist, Department of VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC. Edward C. Li, Pharm.D., BCOP, is Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME. Linda M. Matusiak, B.A., is Senior Manager, Research Support; and Robert J. Hunkler, M.B.A., is Director, Professional Relations, IMS Health, Plymouth Meeting, PA. Glen T. Schumock, Pharm.D., M.B.A., Ph.D., FCCP, is Professor and Head, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC
| | - Nilay D Shah
- Patricia L. Hartke, Pharm.D., is Postgraduate Year 2 Resident, University of Illinois at Chicago (UIC) and Takeda Pharmaceuticals, Chicago, IL; at the time of writing she was Postgraduate Year 1 Resident, Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, is Director, Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison. James M. Hoffman, Pharm.D., M.S., BCPS, is Associate Member, Pharmaceutical Sciences, Medication Outcomes and Safety Officer, St. Jude Children's Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis. Nilay D. Shah, Ph.D., is Associate Professor of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. Fred Doloresco, Pharm.D., M.S., is Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo. Katie J. Suda, Pharm.D., M.S., is Research Health Scientist, Department of VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC. Edward C. Li, Pharm.D., BCOP, is Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME. Linda M. Matusiak, B.A., is Senior Manager, Research Support; and Robert J. Hunkler, M.B.A., is Director, Professional Relations, IMS Health, Plymouth Meeting, PA. Glen T. Schumock, Pharm.D., M.B.A., Ph.D., FCCP, is Professor and Head, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC
| | - Fred Doloresco
- Patricia L. Hartke, Pharm.D., is Postgraduate Year 2 Resident, University of Illinois at Chicago (UIC) and Takeda Pharmaceuticals, Chicago, IL; at the time of writing she was Postgraduate Year 1 Resident, Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, is Director, Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison. James M. Hoffman, Pharm.D., M.S., BCPS, is Associate Member, Pharmaceutical Sciences, Medication Outcomes and Safety Officer, St. Jude Children's Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis. Nilay D. Shah, Ph.D., is Associate Professor of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. Fred Doloresco, Pharm.D., M.S., is Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo. Katie J. Suda, Pharm.D., M.S., is Research Health Scientist, Department of VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC. Edward C. Li, Pharm.D., BCOP, is Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME. Linda M. Matusiak, B.A., is Senior Manager, Research Support; and Robert J. Hunkler, M.B.A., is Director, Professional Relations, IMS Health, Plymouth Meeting, PA. Glen T. Schumock, Pharm.D., M.B.A., Ph.D., FCCP, is Professor and Head, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC
| | - Katie J Suda
- Patricia L. Hartke, Pharm.D., is Postgraduate Year 2 Resident, University of Illinois at Chicago (UIC) and Takeda Pharmaceuticals, Chicago, IL; at the time of writing she was Postgraduate Year 1 Resident, Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, is Director, Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison. James M. Hoffman, Pharm.D., M.S., BCPS, is Associate Member, Pharmaceutical Sciences, Medication Outcomes and Safety Officer, St. Jude Children's Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis. Nilay D. Shah, Ph.D., is Associate Professor of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. Fred Doloresco, Pharm.D., M.S., is Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo. Katie J. Suda, Pharm.D., M.S., is Research Health Scientist, Department of VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC. Edward C. Li, Pharm.D., BCOP, is Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME. Linda M. Matusiak, B.A., is Senior Manager, Research Support; and Robert J. Hunkler, M.B.A., is Director, Professional Relations, IMS Health, Plymouth Meeting, PA. Glen T. Schumock, Pharm.D., M.B.A., Ph.D., FCCP, is Professor and Head, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC
| | - Edward C Li
- Patricia L. Hartke, Pharm.D., is Postgraduate Year 2 Resident, University of Illinois at Chicago (UIC) and Takeda Pharmaceuticals, Chicago, IL; at the time of writing she was Postgraduate Year 1 Resident, Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, is Director, Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison. James M. Hoffman, Pharm.D., M.S., BCPS, is Associate Member, Pharmaceutical Sciences, Medication Outcomes and Safety Officer, St. Jude Children's Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis. Nilay D. Shah, Ph.D., is Associate Professor of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. Fred Doloresco, Pharm.D., M.S., is Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo. Katie J. Suda, Pharm.D., M.S., is Research Health Scientist, Department of VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC. Edward C. Li, Pharm.D., BCOP, is Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME. Linda M. Matusiak, B.A., is Senior Manager, Research Support; and Robert J. Hunkler, M.B.A., is Director, Professional Relations, IMS Health, Plymouth Meeting, PA. Glen T. Schumock, Pharm.D., M.B.A., Ph.D., FCCP, is Professor and Head, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC
| | - Linda M Matusiak
- Patricia L. Hartke, Pharm.D., is Postgraduate Year 2 Resident, University of Illinois at Chicago (UIC) and Takeda Pharmaceuticals, Chicago, IL; at the time of writing she was Postgraduate Year 1 Resident, Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, is Director, Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison. James M. Hoffman, Pharm.D., M.S., BCPS, is Associate Member, Pharmaceutical Sciences, Medication Outcomes and Safety Officer, St. Jude Children's Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis. Nilay D. Shah, Ph.D., is Associate Professor of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. Fred Doloresco, Pharm.D., M.S., is Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo. Katie J. Suda, Pharm.D., M.S., is Research Health Scientist, Department of VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC. Edward C. Li, Pharm.D., BCOP, is Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME. Linda M. Matusiak, B.A., is Senior Manager, Research Support; and Robert J. Hunkler, M.B.A., is Director, Professional Relations, IMS Health, Plymouth Meeting, PA. Glen T. Schumock, Pharm.D., M.B.A., Ph.D., FCCP, is Professor and Head, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC
| | - Robert J Hunkler
- Patricia L. Hartke, Pharm.D., is Postgraduate Year 2 Resident, University of Illinois at Chicago (UIC) and Takeda Pharmaceuticals, Chicago, IL; at the time of writing she was Postgraduate Year 1 Resident, Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, is Director, Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison. James M. Hoffman, Pharm.D., M.S., BCPS, is Associate Member, Pharmaceutical Sciences, Medication Outcomes and Safety Officer, St. Jude Children's Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis. Nilay D. Shah, Ph.D., is Associate Professor of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. Fred Doloresco, Pharm.D., M.S., is Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo. Katie J. Suda, Pharm.D., M.S., is Research Health Scientist, Department of VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC. Edward C. Li, Pharm.D., BCOP, is Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME. Linda M. Matusiak, B.A., is Senior Manager, Research Support; and Robert J. Hunkler, M.B.A., is Director, Professional Relations, IMS Health, Plymouth Meeting, PA. Glen T. Schumock, Pharm.D., M.B.A., Ph.D., FCCP, is Professor and Head, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC
| | - Glen T Schumock
- Patricia L. Hartke, Pharm.D., is Postgraduate Year 2 Resident, University of Illinois at Chicago (UIC) and Takeda Pharmaceuticals, Chicago, IL; at the time of writing she was Postgraduate Year 1 Resident, Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, is Director, Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison. James M. Hoffman, Pharm.D., M.S., BCPS, is Associate Member, Pharmaceutical Sciences, Medication Outcomes and Safety Officer, St. Jude Children's Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis. Nilay D. Shah, Ph.D., is Associate Professor of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. Fred Doloresco, Pharm.D., M.S., is Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo. Katie J. Suda, Pharm.D., M.S., is Research Health Scientist, Department of VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC. Edward C. Li, Pharm.D., BCOP, is Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME. Linda M. Matusiak, B.A., is Senior Manager, Research Support; and Robert J. Hunkler, M.B.A., is Director, Professional Relations, IMS Health, Plymouth Meeting, PA. Glen T. Schumock, Pharm.D., M.B.A., Ph.D., FCCP, is Professor and Head, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, UIC.
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Selmanovic K, Zec SL, Vanis N, Zecevic L, Setkic M, Rasic A, Zerem E. UTILISATION ANALYSIS OF ANTIHYPERTENSIVE DRUGS IN BOSNIA AND HERZEGOVINA FOR THE TIME-PERIOD 2013-2015. Mater Sociomed 2016; 28:116-20. [PMID: 27147917 PMCID: PMC4851497 DOI: 10.5455/msm.2016.28.116-120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/06/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Expenditures for drugs are increasingly burdening already insufficient funds for health protection. This is especially evident in less developed European countries such as Bosnia and Herzegovina. The question is whether such analyses can help save funds for financing treatment for diseases, with an emphasis on a more rational choice of drug for appropriate indication, whereby clinical complications of hypertension would be prevented and patients would have quality of their lives improved. AIM Focus of research has been set on analysis of use of antihypertensive drugs in Bosnia and Herzegovina in the time-period January 2013-March 2015. Use of all drugs for treatment of hypertension in that time-period in the country has been shown in an unbiased manner. METHODS The study is designed as retrospective-prospective comparative research of use of antihypertensive drugs in BiH in a certain time-period. Data are collected from relevant drug utilisation database which has been established in Bosnia and Herzegovina since 2013. RESULTS We have calculated financial expenditure for prescribed antihypertensives in the time- period of 2013, 2014 and Q1 2015. Use of antihypertensives at the country level for this time-period is BAM 200,242,218. At the country level, physicians are most often opting for combination therapy: ACE inhibitors + diuretics (20.2%) and ACE inhibitors + Ca channel antagonists (18.0%). CONCLUSION In this research, it has been shown that modern drugs are used for treatment of hypertension in Bosnia and Herzegovina. These drugs are used in the same order as they are prescribed in developed countries.
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Affiliation(s)
- Kenan Selmanovic
- Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Svjetlana Loga Zec
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nenad Vanis
- Department of Gastroenterology and Hepatology, Clinical Centre of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Lamija Zecevic
- Institute of Clinical Immunology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Manja Setkic
- Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Azra Rasic
- Institute of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Enver Zerem
- Department of Gastroenterology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Kyzas GZ, Koltsakidou A, Nanaki SG, Bikiaris DN, Lambropoulou DA. Removal of beta-blockers from aqueous media by adsorption onto graphene oxide. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 537:411-20. [PMID: 26282775 DOI: 10.1016/j.scitotenv.2015.07.144] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 05/28/2023]
Abstract
The aim of the present study is the evaluation of graphene oxide (GhO) as adsorbent material for the removal of beta-blockers (pharmaceutical compounds) in aqueous solutions. The composition and morphology of prepared materials were characterized by scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FT-IR). Atenolol (ATL) and propranolol (PRO) were used as model drug molecules and their behavior were investigated in terms of GhO dosage, contact time, temperature and pH. Adsorption mechanisms were proposed and the pH-effect curves after adsorption were discussed. The kinetic behavior of GhO-drugs system was analyzed after fitting to pseudo-first and -second order equations. The adsorption equilibrium data were fitted to Langmuir, Freundlich and Langmuir-Freundlich model calculating the maximum adsorption capacity (67 and 116 mg/g for PRO and ATL (25 °C), respectively). The temperature effect on adsorption was tested carrying out the equilibrium adsorption experiments at three different temperatures (25, 45, 65 °C). Then, the thermodynamic parameters of enthalpy, free energy and entropy were calculated. Finally, the desorption of drugs from GhO was evaluated by using both aqueous eluants (pH2-10) and organic solvents.
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Affiliation(s)
- George Z Kyzas
- Laboratory of Polymer Chemistry and Technology, Department of Chemistry, Aristotle University of Thessaloniki, GR-541 24 Thessaloniki, Greece
| | - Anastasia Koltsakidou
- Laboratory of Environmental Pollution Control, Department of Chemistry, Aristotle University of Thessaloniki, GR-541 24 Thessaloniki, Greece
| | - Stavroula G Nanaki
- Laboratory of Polymer Chemistry and Technology, Department of Chemistry, Aristotle University of Thessaloniki, GR-541 24 Thessaloniki, Greece
| | - Dimitrios N Bikiaris
- Laboratory of Polymer Chemistry and Technology, Department of Chemistry, Aristotle University of Thessaloniki, GR-541 24 Thessaloniki, Greece
| | - Dimitra A Lambropoulou
- Laboratory of Environmental Pollution Control, Department of Chemistry, Aristotle University of Thessaloniki, GR-541 24 Thessaloniki, Greece.
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Yariv H. The case of pharmacist prescribing policy in Israel. Isr J Health Policy Res 2015; 4:49. [PMID: 26664669 PMCID: PMC4675054 DOI: 10.1186/s13584-015-0045-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 08/29/2015] [Indexed: 11/10/2022] Open
Abstract
Pharmacy prescribing policy in Israel has been negotiated and changed in recent years in order to improve patient treatment and access to medicines, and reduce national health insurance costs by allowing pharmacists to prescribe medications. Various stakeholders and institutions were involved in the formulation process, affecting the process while representing different motives. The complexity of pharmacy prescribing policy formulation is universal - any policy project needs, for strategic and tactical reasons, to acquire an inventory of institutions involved, identify the key players and explore potential support or opposition among them. This article uses the field (theory) of new institutional economics to explain the process of pharmaceutical institutional change and identifies the stakeholders who are involved in the reform. In the framework of pharmaceutical policies, seven models of prescribing practices are outlined, and the Canadian and British prescribing models are presented. The paper then focuses on the Israeli case and the main issues that concern decision-makers in the Israeli health system, such as inequality in access to health services and the erosion of the notion of universal health services. These concerns and the involvement of different stakeholders, such as The Israeli Medical Association (IMA) and health funds, influenced and directed the final Pharmacist Prescribing Law. After several rejections and amendments the law was passed, enabling experienced pharmacists to prescribe only to patients with a previous prescription given by a physician in the hope it would improve services to patients and reduce physicians’ workloads. Here, the topic of the new prescribing policy is introduced, using tools from the new institutional school in political economy.
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Affiliation(s)
- Hila Yariv
- Poznań School of Economics, aleja Niepodległości 10, Poznań, Poland
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40
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Lee M, Salloum RG. Racial and ethnic disparities in cost-related medication non-adherence among cancer survivors. J Cancer Surviv 2015; 10:534-44. [PMID: 26620816 DOI: 10.1007/s11764-015-0499-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/17/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer survivors are delaying or avoiding necessary care due to costs, and medication non-adherence is an important aspect of deferred treatment. This study estimates the prevalence of cost-related medication non-adherence (CRN) by race and ethnicity and examines factors associated with CRN among cancer survivors. METHODS Using the 2006-2013 National Health Interview Survey, we examine self-reported CRN among cancer survivors compared with cancer-free controls. Descriptive statistics and multiple logistic regression models were used to identify factors associated with CRN among cancer survivors. RESULTS In a nationally representative sample of 472,542 adults, 10,998 participants reported a history of cancer and 461,544 did not. Among 10,998 cancer survivors, 1397 (12.70 %) reported CRN. Among older cancer survivors, African-Americans were 2.64 times more likely (95 % confidence interval (CI), 1.73 to 4.01) and Hispanics 2.07 times more likely (95 % CI, 1.32 to 3.24) than whites to report CRN. Among younger cancer survivors, Hispanics were 1.61 times more likely (95 % CI, 1.23 to 2.10) than whites to report CRN. CONCLUSIONS Significant racial and ethnic disparities in CRN were evident among cancer survivors. Older African-American and Hispanic overall survivors were more likely to report CRN in the past year compared with non-Hispanic whites. IMPLICATIONS FOR CANCER SURVIVORS Given increasing prescription drug expenditure, it is important to closely monitor CRN in high-risk subgroups. Racial and ethnic minority groups at high risk for CRN should be counseled on the importance of medication adherence and offered support services to promote medication adherence. Further studies are warranted to establish effective policies and interventions in vulnerable populations.
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Affiliation(s)
- Minjee Lee
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
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Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in Prescription Drug Use Among Adults in the United States From 1999-2012. JAMA 2015; 314:1818-31. [PMID: 26529160 PMCID: PMC4752169 DOI: 10.1001/jama.2015.13766] [Citation(s) in RCA: 843] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE It is important to document patterns of prescription drug use to inform both clinical practice and research. OBJECTIVE To evaluate trends in prescription drug use among adults living in the United States. DESIGN, SETTING, AND PARTICIPANTS Temporal trends in prescription drug use were evaluated using nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Participants included 37,959 noninstitutionalized US adults, aged 20 years and older. Seven NHANES cycles were included (1999-2000 to 2011-2012), and the sample size per cycle ranged from 4861 to 6212. EXPOSURES Calendar year, as represented by continuous NHANES cycle. MAIN OUTCOMES AND MEASURES Within each NHANES cycle, use of prescription drugs in the prior 30 days was assessed overall and by drug class. Temporal trends across cycles were evaluated. Analyses were weighted to represent the US adult population. RESULTS Results indicate an increase in overall use of prescription drugs among US adults between 1999-2000 and 2011-2012 with an estimated 51% of US adults reporting use of any prescription drugs in 1999-2000 and an estimated 59% reporting use of any prescription drugs in 2011-2012 (difference, 8% [95% CI, 3.8%-12%]; P for trend <.001). The prevalence of polypharmacy (use of ≥5 prescription drugs) increased from an estimated 8.2% in 1999-2000 to 15% in 2011-2012 (difference, 6.6% [95% CI, 4.4%-8.2%]; P for trend <.001). These trends remained statistically significant with age adjustment. Among the 18 drug classes used by more than 2.5% of the population at any point over the study period, the prevalence of use increased in 11 drug classes including antihyperlipidemic agents, antidepressants, prescription proton-pump inhibitors, and muscle relaxants. CONCLUSIONS AND RELEVANCE In this nationally representative survey, significant increases in overall prescription drug use and polypharmacy were observed. These increases persisted after accounting for changes in the age distribution of the population. The prevalence of prescription drug use increased in the majority of, but not all, drug classes.
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Affiliation(s)
- Elizabeth D. Kantor
- Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan
Kettering Cancer Center, New York, NY, USA
| | - Colin D. Rehm
- Friedman School of Nutrition Science and Policy, Tufts University,
Boston, MA, USA
- Office of Community & Population Health, Montefiore Medical
Center, Bronx, NY, USA
| | - Jennifer S. Haas
- Division of General Internal Medicine and Primary Care, Brigham and
Women’s Hospital, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan
School of Public Health, Boston, MA, USA
| | - Andrew T. Chan
- Channing Division of Network Medicine, Brigham and Women’s
Hospital, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital,
Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General
Hospital, Boston, MA, USA
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women’s
Hospital, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health,
Boston, MA, USA
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Calip GS, Malmgren JA, Lee WJ, Schwartz SM, Kaplan HG. Myelodysplastic syndrome and acute myeloid leukemia following adjuvant chemotherapy with and without granulocyte colony-stimulating factors for breast cancer. Breast Cancer Res Treat 2015; 154:133-43. [PMID: 26450505 PMCID: PMC4718738 DOI: 10.1007/s10549-015-3590-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/03/2015] [Indexed: 10/23/2022]
Abstract
Risk of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) post-breast cancer treatment with adjuvant chemotherapy and granulocyte colony-stimulating factors (G-CSF) is not fully characterized. Our objective was to estimate MDS/AML risk associated with specific breast cancer treatments. We conducted a retrospective cohort study of women aged ≥66 years with stage I-III breast cancer between 2001 and 2009 using the Surveillance, Epidemiology, and End Results-Medicare database. Women were classified as receiving treatment with radiation, chemotherapy, and/or G-CSF. We used multivariable Cox proportional hazards models to estimate adjusted hazard ratios (HR) and 95 % confidence intervals (CI) for MDS/AML risk. Among 56,251 breast cancer cases, 1.2 % developed MDS/AML during median follow-up of 3.2 years. 47.1 % of women received radiation and 14.3 % received chemotherapy. Compared to breast cancer cases treated with surgery alone, those treated with chemotherapy (HR = 1.38, 95 %-CI 0.98-1.93) and chemotherapy/radiation (HR = 1.77, 95 %-CI 1.25-2.51) had increased risk of MDS/AML, but not radiation alone (HR = 1.08, 95 % CI 0.86-1.36). Among chemotherapy regimens and G-CSF, MDS/AML risk was differentially associated with anthracycline/cyclophosphamide-containing regimens (HR = 1.86, 95 %-CI 1.33-2.61) and filgrastim (HR = 1.47, 95 %-CI 1.05-2.06), but not pegfilgrastim (HR = 1.10, 95 %-CI 0.73-1.66). We observed increased MDS/AML risk among older breast cancer survivors treated with anthracycline/cyclophosphamide chemotherapy that was enhanced by G-CSF. Although small, this risk warrants consideration when determining adjuvant chemotherapy and neutropenia prophylaxis for breast cancer patients.
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Affiliation(s)
- Gregory S Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 South Wood Street M/C 871, Chicago, IL, 60612-7230, USA.
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Judith A Malmgren
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- HealthStat Consulting, Inc., Seattle, WA, USA
| | - Wan-Ju Lee
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 South Wood Street M/C 871, Chicago, IL, 60612-7230, USA
| | - Stephen M Schwartz
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Pennington MJ, Rivas NG, Prager SM, Walton WE, Trumble JT. Pharmaceuticals and personal care products alter the holobiome and development of a medically important mosquito. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2015; 203:199-207. [PMID: 25913146 DOI: 10.1016/j.envpol.2015.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/30/2015] [Accepted: 04/08/2015] [Indexed: 06/04/2023]
Abstract
The increasing demand for fresh water has forced many countries to use reclaimed wastewater for agricultural purposes. This water contains pharmaceuticals and personal care products (PPCPs) that remain biologically active following passage through wastewater treatment plants. Run-off from farms and contaminated water from treatment facilities exposes aquatic ecosystems to PPCPs. This study examined the effects of PPCPs on a lower trophic organism. Culex quinquefasciatus larvae were reared in water contaminated with environmentally relevant concentrations of common PPCPs. Acetaminophen alone and a mixture of contaminants were found to increase developmental time of larvae. Susceptibility to Bti increased in larvae exposed to antibiotics, acetaminophen, or a mixture of PPCPs. Antibiotics, hormones, and the mixture altered the mosquito bacterial microbiome. Overall, the results indicate that at environmentally relevant concentrations, PPCPs in reclaimed water can have biologically important effects on an ecologically and medically important lower trophic level insect.
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Affiliation(s)
- Marcus J Pennington
- Department of Entomology, University of California, Riverside, CA 92521, USA; Graduate Program in Environmental Toxicology, University of California, Riverside, CA 92521, USA.
| | - Nicholas G Rivas
- Department of Entomology, University of California, Riverside, CA 92521, USA
| | - Sean M Prager
- Department of Entomology, University of California, Riverside, CA 92521, USA
| | - William E Walton
- Department of Entomology, University of California, Riverside, CA 92521, USA
| | - John T Trumble
- Department of Entomology, University of California, Riverside, CA 92521, USA; Graduate Program in Environmental Toxicology, University of California, Riverside, CA 92521, USA
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Abstract
We analyzed the cost of antimicrobial prescribing across freestanding children's hospitals. A few specific antimicrobials accounted for a large proportion of expenditures, and antimicrobial spending varied substantially across hospitals, even within specific clinical conditions. Antimicrobial stewardship programs should consider these data to incorporate high-value antimicrobial prescribing when clinically appropriate.
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Caldwell GW. In silico tools used for compound selection during target-based drug discovery and development. Expert Opin Drug Discov 2015; 10:901-23. [DOI: 10.1517/17460441.2015.1043885] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Gary W Caldwell
- Janssen Research & Development LLC, Discovery Sciences, Spring House, PA, USA
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Schumock GT, Li EC, Suda KJ, Wiest MD, Stubbings J, Matusiak LM, Hunkler RJ, Vermeulen LC. National trends in prescription drug expenditures and projections for 2015. Am J Health Syst Pharm 2015; 72:717-36. [DOI: 10.2146/ajhp140849] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Glen T. Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago
| | - Edward C. Li
- Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME
| | - Katie J. Suda
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, University of Illinois at Chicago
| | - Michelle D. Wiest
- Pharmacy Services, UC Health, Cincinnati, OH, Clinical Associate Professor, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati
| | - Joann Stubbings
- Department of Pharmacy Systems, Outcomes and Policy, and Assistant Director, Specialty Pharmacy Services, College of Pharmacy, University of Illinois at Chicago
| | | | | | - Lee C. Vermeulen
- Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison
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Patel BN, Audet PR. A review of approaches for the management of specialty pharmaceuticals in the United States. PHARMACOECONOMICS 2014; 32:1105-14. [PMID: 25118989 PMCID: PMC4209107 DOI: 10.1007/s40273-014-0196-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
With increased innovation and development of specialty pharmaceuticals, the US and global healthcare industries are looking to implement appropriate management strategies to control both utilization and costs. Specialty pharmaceuticals are high-cost medications that treat complex, chronic, rare, and difficult-to-manage conditions. These drugs require special drug handling, appropriate clinical outcomes monitoring, and effective cost controls. The primary scope of this article is to discuss various strategies being implemented for specialty pharmaceutical utilization and cost management and correlated outcomes in the USA; these outcomes include enhanced health insurance plan benefit designs with formulary modifications and greater patient cost burden. Additional methods to manage specialty pharmaceuticals include the use of specialty pharmacies for drug distribution, increased emphasis on coordination of care and evidence-based medicine, as well as healthcare reform and regulations. Healthcare spending, both in the US and globally, continues to increase, with a rising proportion of drug spend towards specialty pharmaceuticals. Continued specialty pharmaceutical innovation and introduction of biosimilar products will evolve the currently utilized management strategies for these drugs.
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Affiliation(s)
- Bijal Nitin Patel
- University of the Sciences, Mayes College of Healthcare Business and Policy, 600 S. 43rd Street, Philadelphia, PA 19104 USA
| | - Patricia R. Audet
- University of the Sciences, Mayes College of Healthcare Business and Policy, 600 S. 43rd Street, Philadelphia, PA 19104 USA
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