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Shakur AA, Ranjan RK, Sinha R, Hameed S, Mohan L. A Study of Drug Utilization Pattern and Pharmacoeconomic Analysis of Immunosuppressant Drugs in Patients With Skin Disorders in a Tertiary Care Hospital in Bihar. Cureus 2023; 15:e48541. [PMID: 37954626 PMCID: PMC10632555 DOI: 10.7759/cureus.48541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
Aims The cost-effective therapy of immunosuppressant drugs in dermatological conditions will not only lead to adherence to rational prescribing but will also increase patient compliance with fewer dropouts due to cost factor. Thus, this study was done to determine and compare the drug utilization pattern, prescribed daily dose/defined daily dose (PDD/DDD) defined by WHO, and the cost-effectiveness ratio of different immunosuppressants. Methods and material Prescriptions for patients with skin disorders prescribed with any one systematic or topical immunosuppressant were collected. The utilization of drugs in different skin disorders was expressed as frequency and percentage. PDD was compared with DDD as per the WHOCC-Anatomical Therapeutic Chemical (ATC)/DDD index. The pharmacoeconomic analysis was done using a cost-effectiveness ratio. Statistical analysis Descriptive statistics were used to calculate percentages, frequency, and 95% CI. The cost-effectiveness ratio in terms of SFDs (symptom-free days) was defined as the total cost of the initial antibiotic during the study period divided by the number of SFDs (cost/ SFD) and was expressed as mean±standard deviation, and the Kruskal-Wallis test was used to determine statistical significance of difference. Results Immunosuppressants were prescribed in 117 (19.12%) prescriptions out of a total of 612 prescriptions. Deflazacort was the most utilized systemic immunosuppressant prescribed in 27.18% of cases and was commonly prescribed for irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) followed by prednisolone and betamethasone. Tacrolimus was the most utilized topical immunosuppressant prescribed in 15.90% of patients and was commonly used for ICD and vitiligo followed by clobetasol and mometasone. Betamethasone, prednisolone, clobetasol, and mometasone had better cost-effectiveness. PDD/DDD of all immunosuppressants was less than one except prednisolone, which had a PDD/DDD ratio of 3.52. Conclusions The cost-effectiveness of steroids has the advantage of providing better patients' adherence to pharmacotherapy, but over-prescribing could also lead to long-term adverse effects of steroids. Pharmacovigilance research should also incorporate pharmacoeconomic analysis to determine the relation between these two aspects.
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Affiliation(s)
- Adil A Shakur
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Raushan K Ranjan
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rajesh Sinha
- Department of Skin and Venereal Diseases, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Saajid Hameed
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Lalit Mohan
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Kavita K, Mehta H, Ghai S, Kumari Saini S, Narang T. Self-reported prevalence of skin problems among residents of a peri-urban community of Chandigarh. Indian J Dermatol Venereol Leprol 2023; 0:1-3. [PMID: 37609756 DOI: 10.25259/ijdvl_982_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/29/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Kavita Kavita
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India
| | - Sandhya Ghai
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sushma Kumari Saini
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India
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Emergency Use and Efficacy of an Asynchronous Teledermatology System as a Novel Tool for Early Diagnosis of Skin Cancer during the First Wave of COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052699. [PMID: 35270391 PMCID: PMC8910370 DOI: 10.3390/ijerph19052699] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022]
Abstract
Background: After the outbreak of the corona virus disease-19 (COVID-19) pandemic, teledermatology was implemented in the Hungarian public healthcare system for the first time. Our objective was to assess aggregated diagnostic agreements and to determine the effectiveness of an asynchronous teledermatology system for skin cancer screening. Methods: This retrospective single-center study included cases submitted for teledermatology consultation during the first wave of the COVID-19 pandemic. Follow-up of the patients was performed to collect the results of any subsequent personal examination. Results: 749 patients with 779 lesions were involved. 15 malignant melanomas (9.9%), 78 basal cell carcinomas (51.3%), 21 squamous cell carcinomas (13.8%), 7 other malignancies (4.6%) and 31 actinic keratoses (20.4%) were confirmed. 87 malignancies were diagnosed in the high-urgency group (42.2%), 49 malignancies in the moderate-urgency group (21.6%) and 16 malignancies in the low-urgency group (4.6%) (p < 0.0001). Agreement of malignancies was substantial for primary (86.3%; κ = 0.647) and aggregated diagnoses (85.3%; κ = 0.644). Agreement of total lesions was also substantial for primary (81.2%; κ = 0.769) and aggregated diagnoses (87.9%; κ = 0.754). Conclusions: Our findings showed that asynchronous teledermatology using a mobile phone application served as an accurate skin cancer screening system during the first wave of the COVID-19 pandemic.
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Joshi TP, Ren V. Teledermatology in the Control of Skin Neglected Tropical Diseases: A Systematic Review. Dermatol Pract Concept 2021; 11:e2021130. [PMID: 34631272 DOI: 10.5826/dpc.1104a130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 10/31/2022] Open
Abstract
Introduction Neglected tropical diseases (NTDs) include a group of about 20 illnesses that have garnered relatively little attention, despite their ability to inflict significant suffering and disability. Skin neglected tropical diseases (sNTDs) are a subset of NTDs that present with cutaneous manifestations and are well known for their ability to generate stigma and promote poverty. Teledermatology (TD) represents a potential method to control sNTDs. Objective We sought to analyze the potential for TD to ease the burden of sNTDs. Methods We performed a systematic literature search using the Texas Medical Center Library One Search, which scans 167 databases, including Embase, PubMed, and Scopus. We included all original investigations published after 2011 that assessed the impact of TD intervention in the control of one or more sNTDs. We excluded studies not written in English and studies that did not perform any outcome analyses. Results Twenty studies met our search criteria, and 18 expressed positive attitudes towards TD. Overall, we found that TD may be a sustainable, cost-effective strategy for expanding access to care for individuals afflicted with sNTDs. However, poor image quality, lack of access to further diagnostic tests, and ethical, legal, and cultural issues pose as barriers to TD utilization. Conclusion TD may be helpful in achieving control of sNTDs but has its limitations. An integrated approach, which employs TD in conjunction with other strategies, represents a realistic path for alleviating sNTDs.
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Affiliation(s)
| | - Vicky Ren
- Department of Dermatology, Baylor College of Medicine
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陈 海, 石 庆, 孔 令, 桑 冉, 余 美, 苏 君, 朱 裕, 朱 锦. [Clinical value of individualized pharmaceutical services for patients receiving vancomycin for severe infections: a retrospective case-control study based on real-world data]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1380-1389. [PMID: 33118508 PMCID: PMC7606247 DOI: 10.12122/j.issn.1673-4254.2020.10.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the clinical value of individualized pharmaceutical services for patients receiving vancomycin for severe infections and establish clinical monitoring procedures during vancomycin treatment. METHODS Data were collected from patients with severe infections who received vancomycin treatment with individualized pharmacy services (test group, 144 cases) or without such services (control group, 884 cases) between January, 2017 and December, 2018. Using propensity score matching, the patients in the two groups with comparable baseline data were selected for inclusion in the study (62 in each group), and the efficacy, safety and economic indicators were compared between the two groups. RESULTS The curative effects of the treatment did not differ significantly between the two groups, with the overall response rates of 95.16% in the test group and 91.94% in the control group (P > 0.05). The percentage of neutrophils before vancomycin treatment and calcitonin level after the treatment differed significantly between the two groups (P < 0.05). No significant difference was found in the incidence of adverse events associated with the treatment between the test and control groups (8.06% vs 9.68%, P > 0.05); a significant difference in creatinine level was noted between the two groups after vancomycin treatment (P < 0.05). The number of days of medication, the cost of vancomycin and its proportion in the total expenses differed significantly between the two groups (P < 0.05). Cost-effectiveness analysis showed a better cost-effectiveness in the test group than in the control group (50052.78 vs 57601.23). The intensity of vancomycin use was also lower in the test group than in the control group (0.11 vs 0.36). CONCLUSIONS The participation of clinical pharmacists during the treatment can improve the clinical benefits of vancomycin in patients with severe infections.
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Affiliation(s)
- 海琴 陈
- 蚌埠医学院第一附属医院药剂科,安徽 蚌埠 233000Department of Pharmacy, First Affiliated Hospital, Bengbu Medical College, Bengbu 233000, China
- 蚌埠医学院药学院,安徽 蚌埠 233000Faculty of Pharmacy, Bengbu Medical College, Bengbu 233000, China
| | - 庆平 石
- 蚌埠医学院第一附属医院药剂科,安徽 蚌埠 233000Department of Pharmacy, First Affiliated Hospital, Bengbu Medical College, Bengbu 233000, China
- 蚌埠医学院药学院,安徽 蚌埠 233000Faculty of Pharmacy, Bengbu Medical College, Bengbu 233000, China
| | - 令提 孔
- 蚌埠医学院第一附属医院药剂科,安徽 蚌埠 233000Department of Pharmacy, First Affiliated Hospital, Bengbu Medical College, Bengbu 233000, China
- 蚌埠医学院药学院,安徽 蚌埠 233000Faculty of Pharmacy, Bengbu Medical College, Bengbu 233000, China
| | - 冉 桑
- 蚌埠医学院第一附属医院药剂科,安徽 蚌埠 233000Department of Pharmacy, First Affiliated Hospital, Bengbu Medical College, Bengbu 233000, China
- 蚌埠医学院药学院,安徽 蚌埠 233000Faculty of Pharmacy, Bengbu Medical College, Bengbu 233000, China
| | - 美玲 余
- 蚌埠医学院第一附属医院药剂科,安徽 蚌埠 233000Department of Pharmacy, First Affiliated Hospital, Bengbu Medical College, Bengbu 233000, China
- 蚌埠医学院药学院,安徽 蚌埠 233000Faculty of Pharmacy, Bengbu Medical College, Bengbu 233000, China
| | - 君 苏
- 蚌埠医学院第一附属医院药剂科,安徽 蚌埠 233000Department of Pharmacy, First Affiliated Hospital, Bengbu Medical College, Bengbu 233000, China
- 蚌埠医学院药学院,安徽 蚌埠 233000Faculty of Pharmacy, Bengbu Medical College, Bengbu 233000, China
| | - 裕林 朱
- 蚌埠医学院第一附属医院药剂科,安徽 蚌埠 233000Department of Pharmacy, First Affiliated Hospital, Bengbu Medical College, Bengbu 233000, China
- 蚌埠医学院药学院,安徽 蚌埠 233000Faculty of Pharmacy, Bengbu Medical College, Bengbu 233000, China
| | - 锦秀 朱
- 蚌埠医学院第一附属医院药剂科,安徽 蚌埠 233000Department of Pharmacy, First Affiliated Hospital, Bengbu Medical College, Bengbu 233000, China
- 蚌埠医学院药学院,安徽 蚌埠 233000Faculty of Pharmacy, Bengbu Medical College, Bengbu 233000, China
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