Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic

Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18-97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071-5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.

POS1416 THE IMPACT OF NON-PERSISTENCE ON RESOURCE UTILIZATION COSTS IN IMMUNE-MEDIATED RHEUMATIC DISEASES

Background:

Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic progressive immune-mediated rheumatic diseases (IMRD) that can cause a progressive disability and joint deformation and thus can impact in healthcare resource utilization (HCRU) and costs.

Objectives:

To describe the HCRU and treatment costs in IMRD patients initiating subcutaneous tumour necrosis factor-alpha inhibitors (SC-TNFi) therapy, based on treatment persistence.

Methods:

Retrospective cohort study including all naïve patients initiating SC-TNFi therapy for IMRD from 2015-2018 in a tertiary university hospital.

Patients were divided into two cohorts: persistent and non-persistent. Treatment persistence was estimated as the duration of time from SC-TNFi therapy initiation to discontinuation during one year of follow-up.

SC-TNFi therapy and HCRU costs (outpatient care, rheumatology specialized outpatient care, inpatient care, emergency care, laboratory testing and other non- biological therapies) were calculated one year before and after initiation of SC-TNFi and compared between persistence and non-persistence groups.

Results:

110 patients were identified.

Baseline characteristics: Non-persistent cohort (n=25) versus Persistent cohort (n=85): median age 48.6(12.7) vs 47.3(15.4) (p=0.692). Female (n=12;48%) vs (n=49;57.6%) (p=0.493). Race: Caucasian (n=22;88%), Asiatic (n=3;12%), Other (n=0;0%) vs Caucasian (n=75;88.2%), Asiatic (n=5;5.9%), Other (n=5;5.9%) (p=0.351).IMRD: RA (n=14;56%),PsA (n=2;8%), AS (n=4;16%), other spondyloarthropathy (n=5;20%) vs RA (n=34;40%),PsA (n=11;12.9%), AS (n=24;28.3%), other spondyloarthropathy (n=16;18.8%) (p=0.470). SC-TNFi therapy: adalimumab (n=4;16%), etanercept commercial (n=4;16%), etanercept biosimilar1 (n=5;20%), etanercept biosimilar2 (n=5;20%), golimumab (n=5;20%), certolizumab (n=2;8%) vs adalimumab (n=22;25.9%), etanercept commercial (n=11;12.9%), etanercept biosimilar1 (n=7;8.3%), etanercept biosimilar2 (n=10;11.8%), golimumab (n=24;28.2%), certolizumab (n=11;12.9%) (p=0.398).

Overall cost of SC-TNFi treatment: Non-persistent 11218.81€ (6444.32), persistent 10470.19€ (3465.48); p= 0.658.

Table 1.

HCRU costs

Non-persistent(n=25)Persistent(n=85)Total(n=110)PHCRU costs 12 months prior to SC-TNFi initiation,€(SD)Outpatient care243.48(828.86)87.17(293.61)122.70(471.20)0.204Rheumatology outpatient care216.39(169.88)174.79(101.06)184.24(120.55)0.224Inpatient care500.41(1542.93)170.34(846.47)245.36(1046.74)0.571Emergency care37.77(66.00)39.30(83.16)38.95(79.31) 0.850Laboratory testing376.12(195.59)388.20(207.07)385.46(203.70)0.458Other non-biological therapies10.77(39.83)36.79(250.55)30.88(221.01) 0.803Total1384.94(1816.17)896.60(1247.60)1007.59(1402.87)0.299HCRU costs 12 months post SC-TNFi initiation,€(SD)Outpatient care106.11 (172.85)76.67 (112.90)83.36 (128.67) 0.682Rheumatology outpatient care327.29(170.10)195.58(100.05)225.52(130.99)<0.001Inpatient care89.35(446.77)80.86(466.54)82.79(460.11) 0.969Emergency care89.14(171.89)36.06(106.23)48.12(125.31) 0.198Laboratory testing182.14(128.62)146.86(141.48)154.88(138.89) 0.061Other non-biological therapies3859.80(4043.86)25.89(116.05)897.24(2493.21)<0.001Total4653.84(4269.61)561.93(682.14)1491.91(2709.23)<0.001

Conclusion:

- Non-persistence was observed in less than a quarter of the patients.

- No differences in the costs of SC-TNFi treatment were observed between the persistent and non-persistent groups, leading us to believe that persistence may not be associated with SC-TNFi costs offsets for patients with IMRD.

- During the period post SC-TNFi initiation, the costs of rheumatologic outpatient care and treatment with other non-biological therapies as well as total costs were statistically significantly lower in the persistent cohort. These results suggest that persistence may be associated with HCRU cost savings for IMRD patients.

Disclosure of Interests:

None declared