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Bloudek LM, Nguyen V, Grueger J, Sullivan SD. Are Drugs Priced in Accordance With Value? A Comparison of Value-Based and Net Prices Using Institute for Clinical and Economic Review Reports. Value Health 2021; 24:789-794. [PMID: 34119076 DOI: 10.1016/j.jval.2021.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/19/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The Institute for Clinical and Economic Review (ICER) is an independent organization that reviews drugs and devices with a focus on emerging agents. As part of their evaluation, ICER estimates value-based prices (VBP) at $50 000 to $150 000 per quality-adjusted life-year (QALY) gained thresholds. We compared actual estimated net prices to ICER-estimated VBPs. METHODS We reviewed ICER final evidence reports from November 2007 to October 2020. List prices were combined with average discounts obtained from SSR Health to estimate net prices. If a drug had been evaluated more than once for the same indication, only the more recent VBP was included. RESULTS A total of 34 ICER reports provided unique VBPs for 102 drugs. The net price of 81% of drugs exceeded the $100 000 per QALY VBP and 71% exceeded the $150 000 per QALY VBP. The median change in net price needed to reach the $150 000 per QALY VBP was a 36% reduction. The median decrease in net price needed was highest for drugs targeting rare inherited disorders (n = 15; 62%) and lowest for cardiometabolic disorders (n = 6; 162% price increase). The reduction in net prices needed to reach ICER-estimated VBPs was higher for drugs evaluated for the first approved indication, rare diseases, less competitive markets, and if the drug approval occurred before the ICER report became available. CONCLUSION Net prices are often above VBPs estimated by ICER. Although gaining awareness among decision makers, the long-term impact of ICER evaluations on pricing and access to new drugs continues to evolve.
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Affiliation(s)
- Lisa M Bloudek
- CHOICE Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA.
| | | | - Jens Grueger
- CHOICE Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Sean D Sullivan
- CHOICE Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
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Zezza MA, Bachhuber MA. Payments from drug companies to physicians are associated with higher volume and more expensive opioid analgesic prescribing. PLoS One 2018; 13:e0209383. [PMID: 30566426 PMCID: PMC6300290 DOI: 10.1371/journal.pone.0209383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND While the rise in opioid analgesic prescribing and overdose deaths was multifactorial, financial relationships between opioid drug manufacturers and physicians may be one important factor. METHODS Using national data from 2013 to 2015, we conducted a retrospective cohort study linking the Open Payments database and Medicare Part D drug utilization data. We created two cohorts of physicians, those receiving opioid-related payments in 2014 and 2015, but not in 2013, and those receiving opioid-related payments in 2015 but not in 2013 and 2014. Our main outcome measures were expenditures on filled prescriptions, daily doses filled, and expenditures per daily dose. For each cohort, we created a comparison group that did not receive an opioid-related payment in any year and was matched on state, specialty, and baseline opioid expenditures. We used a difference-in-differences analysis with linear generalized estimating equations regression models. RESULTS We identified 6,322 physicians who received opioid-related payments in 2014 and 2015, but not in 2013; they received a mean total of $251. Relative to comparison group physicians, they had a significantly larger increase in mean opioid expenditures ($6,171; 95% CI: 4,997 to 7,346), daily doses dispensed (1,574; 95%CI: 1,330 to 1,818) and mean expenditures per daily dose ($0.38; 95% CI: 0.29 to 0.47). We identified 8,669 physicians who received opioid-related payments in 2015, but not in 2013 or 2014; they received a mean total of $40. Relative to comparison physicians, they also had a larger increase in mean opioid expenditures ($1,031; 95% CI: 603 to 1,460), daily doses dispensed (557; 95% CI: 417 to 697), and expenditures per daily dose ($0.06; 95% CI: 0.002 to 0.13). CONCLUSIONS Our findings add to the growing public policy concern that payments from opioid drug manufacturers can influence physician prescribing. Interventions are needed to reduce such promotional activities or to mitigate their influence.
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Affiliation(s)
- Mark A. Zezza
- New York State Health Foundation, New York City, New York, United States of America
- * E-mail:
| | - Marcus A. Bachhuber
- Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, United States of America
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Andersen M. Constraints on Formulary Design Under the Affordable Care Act. Health Econ 2017; 26:e160-e178. [PMID: 28233420 DOI: 10.1002/hec.3491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/30/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
I study the effect of prescription drug essential health benefits (EHB) requirements from the Affordable Care Act on prescription drug formularies of health insurance marketplace plans. The EHB regulates the number of drugs covered but leaves other dimensions (cost sharing and utilization management) of the formulary unregulated. Using data on almost all formularies in the country, I demonstrate that requiring insurers to cover one additional drug adds 0.22 drugs (3.3%) to the average formulary, mostly owing to firms increasing the number of drugs covered to comply with the EHB requirement. The EHB requirement also increases the probability that a drug is subject to utilization management and is assigned to a higher (more costly) formulary tier. My results suggest that newly covered drugs are 22.3 percentage points more likely to be subject to utilization management, compared to 36.7% for the average covered drug. Using formularies for Medicare Advantage plans, which are subject to uniform, nationwide benefit design standards, and the formulary status of newly approved drugs that do not satisfy the EHB requirement, I reject the hypotheses that consumer demand or effects on plan entry can explain my results. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Martin Andersen
- Department of Economics, University of North Carolina at Greensboro, Greensboro, NC, USA
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Jódar-Sánchez F, Malet-Larrea A, Martín JJ, García-Mochón L, López Del Amo MP, Martínez-Martínez F, Gastelurrutia-Garralda MA, García-Cárdenas V, Sabater-Hernández D, Sáez-Benito L, Benrimoj SI. Cost-utility analysis of a medication review with follow-up service for older adults with polypharmacy in community pharmacies in Spain: the conSIGUE program. Pharmacoeconomics 2015; 33:599-610. [PMID: 25774017 DOI: 10.1007/s40273-015-0270-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The concept of pharmaceutical care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. OBJECTIVE The objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of a medication review with follow-up (MRF) service for older adults with polypharmacy in Spanish community pharmacies against the alternative of having their medication dispensed normally. METHODS The study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of 6 months. The target population was older adults with polypharmacy, defined as individuals taking five or more medicines per day. The study was conducted in 178 community pharmacies in Spain. Cost-utility analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as quality-adjusted life-years (QALYs). In order to analyze the uncertainty of ICER results, we performed a non-parametric bootstrapping with 5000 replications. RESULTS A total of 1403 older adults, aged between 65 and 94 years, were enrolled in the study: 688 in the intervention group (IG) and 715 in the control group (CG). By the end of the follow-up, both groups had reduced the mean number of prescribed medications they took, although this reduction was greater in the IG (0.28 ± 1.25 drugs; p < 0.001) than in the CG (0.07 ± 0.95 drugs; p = 0.063). Older adults in the IG saw their quality of life improved by 0.0528 ± 0.20 (p < 0.001). In contrast, the CG experienced a slight reduction in their quality of life: 0.0022 ± 0.24 (p = 0.815). The mean total cost was <euro>977.57 ± 1455.88 for the IG and <euro>1173.44 ± 3671.65 for the CG. In order to estimate the ICER, we used the costs adjusted for baseline medications and QALYs adjusted for baseline utility score, resulting in a mean incremental total cost of -<euro>250.51 ± 148.61 (95 % CI -541.79 to 40.76) and a mean incremental QALY of 0.0156 ± 0.004 (95 % CI 0.008-0.023). Regarding the results from the cost-utility analysis, the MRF service emerged as the dominant strategy. CONCLUSION The MRF service is an effective intervention for optimizing prescribed medication and improving quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that the MRF service is cost effective.
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Sullivan SD, Yeung K, Vogeler C, Ramsey SD, Wong E, Murphy CO, Danielson D, Veenstra DL, Garrison LP, Burke W, Watkins JB. Design, implementation, and first-year outcomes of a value-based drug formulary. J Manag Care Spec Pharm 2015; 21:269-75. [PMID: 25803760 PMCID: PMC10398289 DOI: 10.18553/jmcp.2015.21.4.269] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Value-based insurance design attempts to align drug copayment tier with value rather than cost. Previous implementations of value-based insurance design have lowered copayments for drugs indicated for select "high value" conditions and have found modest improvements in medication adherence. However, these implementations have generally not resulted in cost savings to the health plan, suggesting a need for increased copayments for "low value" drugs. Further, previous implementations have assigned equal copayment reductions to all drugs within a therapeutic area without assessing the value of individual drugs. Aligning the individual drug's copayment to its specific value may yield greater clinical and economic benefits. In 2010, Premera Blue Cross, a large not-for-profit health plan in the Pacific Northwest, implemented a value-based drug formulary (VBF) that explicitly uses cost-effectiveness analyses after safety and efficacy reviews to estimate the value of each individual drug. Concurrently, Premera increased copayments for existing tiers. OBJECTIVE To describe and evaluate the design, implementation, and first-year outcomes of the VBF. METHODS We compared observed pharmacy cost per member per month in the year following the VBF implementation with 2 comparator groups: (1) observed pharmacy costs in the year prior to implementation, and (2) expected costs if no changes were made to the pharmacy benefits. Expected costs were generated by applying autoregressive integrated moving averages to pharmacy costs over the previous 36 months. We used an interrupted time series analysis to assess drug use and adherence among individuals with diabetes, hypertension, or dyslipidemia compared with a group of members in plans that did not implement a VBF. RESULTS Pharmacy costs decreased by 3% compared with the 12 months prior and 11% compared with expected costs. There was no significant decline in medication use or adherence to treatments for patients with diabetes, hypertension, or dyslipidemia. CONCLUSIONS The VBF and copayment changes enabled pharmacy plan cost savings without negatively affecting utilization in key disease states.
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Affiliation(s)
- Sean D Sullivan
- University of Washington, 1959 N.E. Pacific Ave., Seattle, WA 98196.
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Abstract
Recent years have seen a formalization of medication review by pharmacists in all settings of care. This article describes the different types of medication review provided in primary care in the UK National Health Service (NHS), summarizes the evidence of effectiveness and considers how such reviews might develop in the future. Medication review is, at heart, a diagnostic intervention which aims to identify problems for action by the prescriber, the clinician conducting the review, the patient or all three but can also be regarded as an educational intervention to support patient knowledge and adherence. There is good evidence that medication review improves process outcomes of prescribing including reduced polypharmacy, use of more appropriate medicines formulation and more appropriate choice of medicine. When 'harder' outcome measures have been included, such as hospitalizations or mortality in elderly patients, available evidence indicates that whilst interventions could improve knowledge and adherence they did not reduce mortality or hospital admissions with one study showing an increase in hospital admissions. Robust health economic studies of medication reviews remain rare. However a review of cost-effectiveness analyses of medication reviews found no studies in which the cost of the intervention was greater than the benefit. The value of medication reviews is now generally accepted despite lack of robust research evidence consistently demonstrating cost or clinical effectiveness compared with traditional care. Medication reviews can be more effectively deployed in the future by targeting, multi-professional involvement and paying greater attention to medicines which could be safely stopped.
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Kjeldsen LJ, Jensen TB, Jensen JJ. Physicians' evaluation of clinical pharmacy revealed increased focus on quality improvement and cost savings. Dan Med Bull 2011; 58:A4261. [PMID: 21535981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The aims of the present study were to evaluate physicians' satisfaction with medication services delivered by a clinical pharmacist (CP); to investigate and document to which extent a CP could improve the medication quality and reduce medication costs at an intensive care unit (ICU); and to explore which types of tasks the CP was asked to perform. MATERIAL AND METHODS The project was conducted at an ICU from 1 February to 31 August 2008. The intervention consisted of certain tasks being performed by a CP. The intervention was evaluated on the basis of documentation of the intervention performed and on a questionnaire filled in by physicians at the end of the study. RESULTS The majority of the physicians reported that the CP's intervention had raised their attention to medication costs (70%) and medication quality (76%). This physician-reported impression correlated with the CP's intervention which improved medication quality and catalysed an annual estimated cost saving of at least DKK 330,000, which was achieved by targeting particular medication areas. The CP was asked to perform various medication-related tasks during the project period. Indeed, the physicians reported that they found the CP qualified to perform several medication-related tasks--and many physicians reported that they had benefitted from input regarding those tasks. CONCLUSION The intervention occasioned positive physician feedback on clinical pharmacy services and the study shows that the CP was perceived by the physicians as a valuable professional collaborator.
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Madsen UK. [Influence of the reimbursement scheme on the consumption of drugs]. Ugeskr Laeger 2009; 171:783-786. [PMID: 19265600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Several factors have the potential to influence the consumption of medicine, including the reimbursement status. Examples of consumption patterns are compared to reimbursement status over time. In some situations the reimbursement status and changes herein may be a contributing factor for the consumption pattern, e.g. in the case of the selective COX-2 inhibitors. In other situations, the opposite is the case, e.g. medicinal products used for the treatment of hypertension, where there is under-treatment despite the fact that general reimbursement has existed for a number of years. General conclusions are therefore not possible.
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Linton A, Garber M, Fagan NK, Peterson M. Factors associated with choice of pharmacy setting among DoD health care beneficiaries aged 65 years or older. J Manag Care Pharm 2007; 13:677-86. [PMID: 17970605 PMCID: PMC10438082 DOI: 10.18553/jmcp.2007.13.8.677] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Department of Defense (DoD) health care planners want to stimulate a voluntary migration of prescription fills from military and community pharmacies to its mail-order pharmacy, a lower-cost dispensing option for the department. Beneficiary cost share for a 90-day supply of generic/ brand medication is $0/$0 at military (DoD) pharmacies, $3/$9 at the DoD mail-order pharmacy, and $9/$27 at network community pharmacies. OBJECTIVE To examine the pharmacy use patterns among the beneficiary population age 65 years or older, traditionally the heaviest users of the TRICARE DOD prescription drug benefit, to identify factors that are associated with beneficiary use of pharmacy setting(s). METHODS Outpatient prescription fill records were examined for TRICARE beneficiaries age 65 years or older (N = 300,084) residing in North Carolina, Texas, and California for dates of service from December 1, 2004 through February 28, 2005. Binary logistic regression models were run for each type (military, community, and mail order) and number of pharmacy settings used by beneficiary gender, age group, catchment area status (located either within or outside a 40-mile radius of each military pharmacy), state, and number of medications obtained (defined as count of unique combinations of strength, and route of administration). The mean number of medications per beneficiary and cost per medication were tabulated for each type and number of settings used. RESULTS In the 3-month period from December 1, 2004 through February 28, 2005, beneficiary use of military, community, and mail-order pharmacies was 45.4%, 67.6%, and 22.1%, respectively. About 67% of the study population used 1 setting exclusively and 2.4% used all 3 settings. Noncatchment residents were significantly less likely (adjusted odds ratio [AOR]= 0.080; 95% confidence interval [CI], 0.078-0.082) to use a military pharmacy exclusively and significantly more likely to use a community pharmacy (AOR = 4.64; 95% CI, 4.55-4.73) or the mail-order pharmacy (AOR = 3.92; 95% CI, 3.80-4.05) exclusively than were catchment residents. Beneficiaries taking 10 or more medications were more likely (AOR = 8.43; 95% CI, 8.21-8.65) to use multiple settings than were those who obtained 3 or fewer medications. Single-setting users obtained a median of 4 (interquartile range [IQ]) 2-7) medications with a median copayment of $7.00 (IQ $0-$13.19) per medication. Those who used all 3 settings obtained a median of 9 (IQ 7-12) medications with a median copayment of $4.33 (IQ $3.00-$6.00) per medication. Among beneficiaries who obtained 6 or more unique medications during the 90-day study period, approximately 25% used the mail-order pharmacy to obtain 1 or more prescription fills. CONCLUSION A significant portion of the study population did not use the mail-order pharmacy despite the financial incentive to use mail-order rather than community pharmacies. Relatively small financial incentives alone may be inadequate for promoting a switch to the mail-order option among those beneficiaries not already using it in a pharmacy benefit plan with low copayments. Larger monetary and other incentives may be necessary to achieve the desired transfer of prescriptions fills to the mail-order pharmacy and the associated reduction in military pharmacy workload.
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Affiliation(s)
- Andrea Linton
- Office of Assistant Secretary of Defense, Health Affairs, TRICARE Management Activity, Health Programs Analysis and Evaluation, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041, USA.
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Arda B, Sipahi OR, Yamazhan T, Tasbakan M, Pullukcu H, Tunger A, Buke C, Ulusoy S. Short-term effect of antibiotic control policy on the usage patterns and cost of antimicrobials, mortality, nosocomial infection rates and antibacterial resistance. J Infect 2007; 55:41-8. [PMID: 17512598 DOI: 10.1016/j.jinf.2007.02.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 01/18/2007] [Accepted: 02/27/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In 2003 Turkish government released a new budget application instruction for regulating the usage of parenteral antibiotics inside and outside of the hospitals. In this study it was aimed to evaluate the effect of this instruction on the overall usage of restricted antibiotics, their cost, overall mortality, bacterial resistance patterns and nosocomial infection rates in intensive care units (ICUs) of our setting for March-October 2002 and March-October 2003 periods. METHODS AND RESULTS Overall daily defined dose/1000 patients/day of restricted drugs decreased, whereas unrestricted drugs increased significantly after the instruction. The cost of all analysed drugs in 2003 period was 540,303USD (-19.6%) less than 2002 period. Nosocomial infection rates in ICUs decreased significantly (p<0.05). When all microbiologically confirmed nosocomial bacteremia cases during the study period were analysed, amoxycilline/clavulanate, ciprofloxacin, cefuroxime, cefotaxime, piperacilline/tazobactam resistance and ESBL rate in Klebsiella pneumoniae decreased significantly (p<0.05). Amikacin resistance in Escherichia coli and Acinetobacter baumannii increased significantly (p<0.05). CONCLUSION Antibiotic control is one of the most important and significant ways to save money, and to prevent antibacterial resistance.
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Affiliation(s)
- Bilgin Arda
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bornova, Izmir, Turkey
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Glassou EN, Tilsted D. [Compulsive treatment in a psychiatry--an economic evaluation of participation in the Breakthrough model]. Ugeskr Laeger 2007; 169:2118-21. [PMID: 17553396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND By use of the Breakthrough Series Collaborative a national quality project was launched in Denmark in 2004. The purpose was to improve the quality of compulsive treatment. Due to participation in the project the psychiatric ward at Herning Hospital reduced the frequency and duration of compulsive treatment significantly compared to 2003. The objective of this study was to evaluate changes in costs per discharged patient and bed-day before and after the intervention. To illustrate quality improvements beyond the purpose of the national project the consumption of antipsychotics was included in the evaluation. MATERIALS AND METHODS Specification of working hours per discharged patient and bed-day and an average hourly rate for a nurse provide the basis for the valuation. The cost of antipsychotics is based on an average daily use per discharged patient and bed-day. The monetary unit is Danish Kroner. RESULTS The wage costs per discharged patient were 18,487 before and 19,010 after the intervention. Per bed-day the costs were 2,642 and 2,679, respectively. Medicine costs per discharged patient were 198 before and 148 after the intervention while the costs per bed-day were 28 and 21, respectively. CONCLUSION This evaluation of costs shows that it is possible to develop and implement quality improvements without increasing costs. A decrease in medicine costs indicates that the effect reaches further than the quality in compulsive treatment.
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Osinaga EA, Inchaurregui LCA, Ikobaltzeta IE, Alonso NB, Del Pozo JG. A pharmacoepidemiological study of the consumption of antiparkinson drugs in the Basque Autonomous Community (Spain) (1992-2004). Parkinsonism Relat Disord 2007; 13:500-4. [PMID: 17532251 DOI: 10.1016/j.parkreldis.2007.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 02/19/2007] [Accepted: 03/29/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE To monitor the rise in consumption of antiparkinson drugs as well as the prevalence of this illness in the Basque Autonomous Community (Spain) over a period of 13 years (1992-2004). METHODS A retrospective population-based study where consumption of antiparkinson drugs was conducted using data obtained from the ECOM (Especialidades Consumo de Medicamentos) database of the Spanish Ministry of Health, which contains the number of prescriptions filled in community pharmacies and charged to the National Health System. The results are expressed as DID, Defined daily doses per 1000 inhabitants per day. CONCLUSIONS Consumption of antiparkinson drugs has increased in the Basque Autonomous Community.
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Affiliation(s)
- Eider Abasolo Osinaga
- Preventive Medicine and Public Health Department of the Faculty of Pharmacy, Basque Country University, Paseo de la Universidad, 7. 01006 Vitoria-Gasteiz, Spain.
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Bradford WD, Kleit AN, Nietert PJ, Ornstein S. Effects of direct-to-consumer advertising of hydroxymethylglutaryl coenzyme a reductase inhibitors on attainment of LDL-C goals. Clin Ther 2006; 28:2105-18; discussion 2104. [PMID: 17296467 DOI: 10.1016/j.clinthera.2006.12.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although highly controversial, directto-consumer (DTC) television advertising for prescription drugs is an established practice in the US health care industry. While the US Food and Drug Administration is currently reexamining its regulatory stance, little evidence exists regarding the impact of DTC advertising on patient health outcomes. OBJECTIVE The objective of this research was to study the relationship between heavy television promotion of 3 major hydroxymethylglutaryl coenzyme A reductase inhibitors ("statins") and the frequency with which patients are able to attain low-density lipoprotein cholesterol (LDL-C) blood-level goals after treatment with any statin. METHODS We used logistic regression to determine achievement of LDL-C goals at 6 months after statin treatment, using electronic medical record extract data from patients from geographically dispersed primary care practices in the United States. We identified LDL-C blood levels as being at or less than goal, as defined by risk-adjusted guidelines published by the National Heart, Lung, and Blood Institute from the Adult Treatment Panel III (ATP III) data. A total of 50,741 patients, identified from 88 practices, were diagnosed with hyperlipidemia and had begun therapy with any statin medication during the 1998-2004 time period. In addition, total dollars spent each month on television advertising at the national and local levels for atorvastatin, pravastatin, and simvastatin were obtained. DTC advertising data were merged by local media market where the physician practice was located and by the month in which the patient was first prescribed a statin. The models were run for all patients who initiated therapy, and also on a subsample of patients who continued to receive prescriptions for the drugs for at least 6 months. Logistic regressions were used to predict the likelihood that each patient attained the ATP III LDL-C blood-level goals as a function of DTC advertising and other factors. RESULTS High levels of national DTC advertising when therapy was initiated were found to increase the likelihood that patients attained LDL-C goals at 6 months by 6% (P < 0.001)-although the effect was concentrated among patients with the least-restrictive ATP III LDL-C goals (<or=160 mg/dL). This result was found in both the entire set of patients as well as the restricted sample of patients who maintained therapy for at least 6 months. CONCLUSIONS The results of this study suggest that higher levels of DTC television advertising of statin treatment were significantly associated with improvements in the likelihood of attaining cholesterol-management goals for at least some patients. While this paper does not address the impact of DTC advertising on the costs of care or on unnecessary switching between statin treatments, the results do suggest that DTC advertising can have beneficial effects, which should be a factor when additional restrictions on DTC advertising are considered. This result-that DTC ad vertising might have beneficial effects-should be weighed against existing studies that have found that patients' suggestions (conceptually which could be induced by DTC advertising) may be associated with overprescribing (eg, in the case of the use of antidepressants for adjustment disorder).
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Affiliation(s)
- W David Bradford
- Center for Health Economic and Policy Studies, Department of Health Administration and Policy, Medical University of South Carolina, Charleston 29425, USA.
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Awad AI, Himad HA. Drug-use practices in teaching hospitals of Khartoum State, Sudan. Eur J Clin Pharmacol 2006; 62:1087-93. [PMID: 17091270 DOI: 10.1007/s00228-006-0216-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 09/20/2006] [Accepted: 10/02/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The present study was carried out to investigate current prescribing and dispensing practices in the largest two teaching hospitals in Sudan and compare them with those of published studies in developing countries. METHODS A descriptive, quantitative and cross-sectional study was conducted among hospital outpatients. The sample was selected using systematic random sampling. In each hospital, prescribing indicators were investigated through collection of data on 100 patient encounters, determination of consultation time and dispensing time for 100 patients, and by interview of 100 patients for the evaluation of dispensing practices. RESULTS The present findings showed that 96% (95% CI: 92.0-98.1%) of patient encounters did not include one or more necessary elements. Strength of drug and the quantity to be dispensed were omitted in 57.5% (95% CI: 50.3-64.4%) and 91% (95% CI: 85.9-94.4%) of patient encounters, respectively. Other variables measured per patient encounter were mean (SD) number of drugs prescribed, 1.9 (0.9); percentage prescribed by generic name, 43.6 % (95% CI: 38.6-48.8%); percentage of patient encounters involving an antibiotic, 65.0% (95% CI: 57.9-71.5%); percentage of patient encounters with an injection prescribed, 10.5% (95% CI: 6.5-15.8%). The mean (SD) consultation and dispensing times were 4.5 (2.8) min and 46.3 (21.8) s, respectively. The percentages of dispensed drugs that were adequately labeled was 37.6% (95% CI: 33.1-41.8%), whilst adequate patient knowledge was demonstrated for 37.2% (95% CI: 32.3-42.0%) of drugs. CONCLUSIONS Cost-effective, multifaceted interventions are needed to improve current prescribing and dispensing practices at the teaching hospitals in Khartoum State, Sudan.
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Affiliation(s)
- Abdelmoneim Ismail Awad
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait.
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Dhippayom T, Walker R. Impact of the reclassification of omeprazole on the prescribing and sales of ulcer healing drugs. ACTA ACUST UNITED AC 2006; 28:194-8. [PMID: 17066243 DOI: 10.1007/s11096-006-9031-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 05/19/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate if the reclassification of omeprazole from a prescription only medicine to pharmacy sale status had an impact on the prescribing and sales of ulcer-healing drugs and whether deprivation had any influence on this. SETTING Primary care, Wales, UK. METHOD Retrospective analysis (March 2002 to February 2005) of prescription data and pharmacy sales data. MAIN OUTCOME MEASURE Number of items per 1,000 population. RESULTS The number of prescription items for ulcer-healing drugs across Wales increased in each year of the study. The number of items per 1,000 population for proton pump inhibitors increased by 12.4% (473.3 to 531.8 items) in 2003/04 and 13.8% (531.8 to 605.1 items) in 2004/05, whereas the number of items per 1,000 population for H2 antagonists fell by 6.2% (149.1 to 139.9 items), and 5.7% (139.9 to 131.9 items) during 2003/04 and 2004/05, respectively. The sale of items per 1,000 population of H(2) antagonists increased by 34.3% (19.8 to 26.6 items) in 2003/04, but fell by 8.6% (26.6 to 24.3 items) in 2004/05. In February 2005, 12 months after reclassification, omeprazole accounted for 7.6% (2.0 items per 1,000 population) of the total sales (26.3 items per 1,000 population) of ulcer-healing drugs from pharmacies in Wales. Areas with high multiple deprivation and unemployment were significantly associated with the prescribing of ulcer-healing drugs, H2 antagonists and proton pump inhibitors. Multiple deprivation, unemployment and low income explained 21% of the variation in prescribing of ulcer-healing drugs. The sale of omeprazole through pharmacies was not related to these deprivation characteristics. CONCLUSION Twelve months after the reclassification of omeprazole the market growth of H2 antagonists sold from pharmacies was halted although there was no apparent impact on the prescription of ulcer-healing drugs. As a consequence there was no saving to the health service drug budget associated with the reclassification of omeprazole.
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Affiliation(s)
- Teerapon Dhippayom
- Welsh School of Pharmacy, Cardiff University, King Edward VII Avenue, Cardiff, Wales, CF10 3XF, UK.
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Chang MT, Wu TH, Wang CY, Jang TN, Huang CY. The impact of an intensive antimicrobial control program in a Taiwanese medical center. ACTA ACUST UNITED AC 2006; 28:257-64. [PMID: 17066241 DOI: 10.1007/s11096-006-9035-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Accepted: 05/16/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study evaluates the short term impacts of an intensive control program for the appropriate us of antimicrobials, and to provide a novel strategy for antimicrobial control in inpatient wards in Taiwan. METHOD In September 2002, a dual intensive antimicrobial control program was implemented within a 921-bed medical center in Taiwan. The study sample included all patients admitted to the medical center during the basal period (October-December 2001) and the intervention period (October-December 2002), where at least one type of parenteral antimicrobial was administered. The sample comprised of 5046 patients during the basal period and 5054 patients during the intervention period. MAIN OUTCOME MEASURE Analysis of the impact of the intensive antimicrobial control program was undertaken by comparing clinical outcomes, parenteral antimicrobial consumption and bacterial susceptibilities, before and after the establishment of the intensive antimicrobial control program. RESULTS No statistical differences were found between the basal and intervention periods with regard to either the demographic variables, such as age and gender, or the incidence of nosocomial infections. The clinical outcomes, including length of stay in the medical center, mortality and readmission rates, were also similar for both periods. As compared to the basal period, the consumption of parenteral antimicrobials--in defined daily doses (DDDs) per 100 patient days (PDs)--declined by 13.2% during the intervention period (71.2 vs. 61.8). There were significant increases in the susceptibilities of Pseudomonas aeruginosa to both amikacin and ciprofloxacin, and Serratia spp. to ciprofloxacin (P < 0.05), while all others remained stable. CONCLUSION This study reports positive responses to intensive antimicrobial control measures among health professionals within a Taiwanese medical center. Following the implementation of the intensive control program, both prescriptions and consumption levels of parenteral antimicrobials were reduced without compromising the clinical outcomes of patients, while the susceptibility patterns of bacterial organisms mostly remained stable. Long-term control of parenteral antimicrobials under such a program may well produce significant benefits for inpatients through the overall rationalization of antimicrobial usage, leading to potential reductions in both the incidence of adverse effects and the burden of resistant organisms. A method of incorporating this intensive control program into a computerized prescription order system is currently under construction.
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Affiliation(s)
- Ming-Tsung Chang
- Department of Pharmacy, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Abstract
This study used administrative claims data to compare the relative risks for hospitalization among commercially insured patients with schizophrenia receiving atypical and typical antipsychotic drugs. Cox proportional hazard regression estimates, adjusted for differences in patient characteristics, suggested that among patients treated with the 4 atypical antipsychotic drugs, only olanzapine had a significantly higher risk for hospitalization than the typical antipsychotic drugs (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.20-2.75). In addition, risk for hospitalization with olanzapine was significantly higher than that for risperidone (HR, 1.34; 95% CI, 1.03-1.74) and numerically higher than that for quetiapine (HR, 1.40; 95% CI, 0.94-2.07). Overall, olanzapine was associated with a higher risk for hospitalization than the typical antipsychotic drugs and among the atypical antipsychotic drugs, risperidone and, potentially, quetiapine.
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Affiliation(s)
- Frank Gianfrancesco
- Hecon Associates Inc., 9833 Whetstone Drive, Montgomery Village, MD 20886, USA.
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Wonder MJ, Wyber D. Drugs Down Under. Health Aff (Millwood) 2006; 25:1185; author reply 1185-6. [PMID: 16835205 DOI: 10.1377/hlthaff.25.4.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Thakrar A. [Regular surveys of elderly persons' medications have positive effects]. Lakartidningen 2006; 103:2068-9. [PMID: 16881285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Abstract
Peter Neumann's paper on the Drug Effectiveness Review Project (DERP) is a constructive if incomplete point of departure for discussing the work done by the project and the use of that work by decision-makers in states and elsewhere. This Perspective attempts to establish the proper context for judging the DERP by comparing its product and processes with those commonly produced and used by industry and other parties. It also provides a direct response to the criticisms of the project noted by Neumann.
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Affiliation(s)
- Mark Gibson
- Center for Evidence-based Policy, Oregon Health and Science University, Portland, USA.
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Abstract
Consumers Union, publisher of Consumer Reports magazine, has used the drug class reviews of the Drug Effectiveness Review Project (DERP) as one critical component of a free public information project on the comparative effectiveness, safety, and cost of prescription drugs. The project translates the DERP findings for consumers. Drawing on other sources and adding information on drug costs, the project chooses Best Buy drugs in each category it evaluates. This guidance can help consumers save up to thousands of dollars per year, and it has the potential to reduce overall drug spending.
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Mabasa VH, Ma J. Effect of a therapeutic maximum allowable cost (MAC) program on the cost and utilization of proton pump inhibitors in an employer-sponsored drug plan in Canada. J Manag Care Pharm 2006; 12:371-6. [PMID: 16792443 PMCID: PMC10437583 DOI: 10.18553/jmcp.2006.12.5.371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Therapeutic maximum allowable cost (MAC) is a managed care intervention that uses reference pricing in a therapeutic class or category of drugs or an indication (e.g., heartburn). Therapeutic MAC has not been studied in Canada or the United States. The proton pump inhibitor (PPI) rabeprazole was used as the reference drug in this therapeutic MAC program based on prices for PPIs in the province of Ontario. No PPI is available over the counter in Canada. OBJECTIVE To evaluate the utilization and anticipated drug cost savings for PPIs in an employer-sponsored drug plan in Canada that implemented a therapeutic MAC program for PPIs. METHODS An employer group with an average of 6,300 covered members, which adopted the MAC program for PPIs in June 2003, was compared with a comparison group comprising the book of business throughout Canada (approximately 5 million lives) without a PPI MAC program (non-MAC group). Pharmacy claims for PPIs were identified using the first 6 characters of the generic product identifier (GPI 492700) for a 36-month period from June 1, 2002, through May 31, 2005. The primary comparison was the year prior to the intervention (from June 1, 2002, through May 31, 2003) and the first full year following the intervention (June 1, 2004, through May 31, 2005). Drug utilization was evaluated by comparing the market share of each of the PPIs for the 2 time periods and by the days of PPI therapy per patient per year (PPPY) and days of therapy per prescription (Rx). Drug cost was defined as the cost of the drug (ingredient cost), including allowable provincial pharmacy markup but excluding pharmacy dispense fee. Cost savings were calculated from the allowed drug cost per claim, allowed cost per day, and allowed cost PPPY. RESULTS (All amounts are in Canadian dollars.) The MAC intervention group experienced an 11.7% reduction in the average cost per day of PPI drug therapy, from 2.14 US dollars in the preperiod to 1.89 US dollars in the postperiod, compared with a 3.7% reduction in the comparison group (2.16 US dollars vs. 2.08 US dollars). Utilization dropped by 11.9% in the intervention group, from 166.7 days of PPI drug therapy PPPY to 146.9 days PPPY, compared with an increase of 7.9% in the comparison group, from 136.1 days to 146.8 days PPPY. The combined effect of the decrease in drug cost per day and utilization was a 22.1% reduction in allowed drug cost PPPY in the intervention (MAC) group (from 357 US dollars to 278 US dollars PPPY) versus a 4.1% increase in the comparison group (from 293 US dollars to 305 US dollars PPPY). CONCLUSION A MAC program for PPIs for one employer in Canada was associated with savings for the drug plan sponsor of approximately 8% in actual drug cost per day of therapy compared with the comparison group. Total savings after consideration of utilization was approximately 26% for the intervention group versus the comparison group.
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Affiliation(s)
- Vincent H Mabasa
- Royal Columbian Hospital, Fraser Health Authority, 330 E. Columbia St., New Westminster, British Columbia, Canada V3L 3W7.
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Dunn JD, Cannon E, Mitchell MP, Curtiss FR. Utilization and drug cost outcomes of a step-therapy edit for generic antidepressants in an HMO in an integrated health system. J Manag Care Pharm 2006; 12:294-302. [PMID: 16792435 PMCID: PMC10437751 DOI: 10.18553/jmcp.2006.12.4.294] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Antidepressants do not differ significantly in their ability to treat depression. Excluding the tricyclic antidepressants (TCAs), these drugs also do not differ significantly in their incidence of adverse events. Therefore, the initial choice of antidepressant medication should be based, in part, on cost. The objective of this study was to evaluate the impact on utilization and costs of a generic steptherapy edit for antidepressant drugs excluding TCAs in a health maintenance organization (HMO) in an integrated health system (IHS). METHODS The pharmacy department of the 440,000-member HMO in an IHS collaborated with the Behavioral Health Clinical Program to design an intervention that required generic antidepressants as first-line pharmacotherapy. Under the GenericStart! Program, a brand-name antidepressant was covered only after trial with a generic antidepressant, excluding TCAs. A step-therapy edit was added to the pharmacy claims processing system on January 1, 2005. All new starts, defined as members with no claims history of antidepressant treatment within the preceding 6 months, were required to use a generic antidepressant. The member copayment was waived for the first prescription. All generic antidepressants were in tier 1 of the drug formulary, with an average copayment of $5 to $10. All brand-name antidepressants were in either tier 2 (preferred brand), with an average copayment of $20 to $25 or 25% coinsurance, or tier 3 (nonformulary brand), with an average copayment of $40 to $45 or 50% coinsurance. Pharmacy claims data from a national pharmacy benefit manager (PBM) without interventions for antidepressants in 2004 or 2005 were used for the comparison group. RESULTS The generic antidepressant dispensing rate increased by 20 points (32.5% to 52.5%) in the intervention group but only 7.4 points (24.9% to 32.3%) in the comparison group in 2005 compared with 2004. The principal measure of antidepressant drug cost per day of therapy in the intervention group decreased by 11.7% (from $2.40 to $2.12) in 2005 compared with 2004 versus a 2.7% decrease (from $2.60 to $2.53) in the comparison group (P <0.001). Days of antidepressant drug therapy per member per month (PMPM) dropped by 1.5% (from 1.74 to 1.71) in the intervention group versus a decrease of 5.0% (from 1.37 to 1.30) in the comparison group in 2005 compared with 2004. The combination of change in drug cost and utilization resulted in a 13.0% decrease in antidepressant drug cost, from $4.16 PMPM in 2004 to $3.62 in 2005, compared with a 7.6% decrease (from $3.57 to $3.30 PMPM) in the comparison group. The 9.0% difference in drug cost per day represents drug cost savings of approximately $0.36 PMPM or $1,880,562 in 2005 dollars for this HMO of approximately 440,000 members. CONCLUSION A step-therapy edit requiring HMO members to use a generic antidepressant, excluding tricyclics, prior to use of a brand-name antidepressant resulted in drug cost savings of 9.0% for the entire class of antidepressants, equal to $1,880,562 ($0.36 PMPM) in 2005 dollars in the first year of the intervention. A small (-1.5%) decrease in use of antidepressants occurred in the intervention group, which was less than the 5.0% decrease in utilization of antidepressants in the comparison group.
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Affiliation(s)
- Jeffrey D Dunn
- SelectHealth, 4646 West Lake Park Blvd., Suite N3, Salt Lake City, Utah 84120, USA.
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Perrin PB. DUR by pharmacists--lessons learned for MTMS. Consult Pharm 2006; 21:257; author reply 257. [PMID: 16676476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
The Drug Effectiveness Review Project (DERP) is a process with challenges as well as rewards. This Perspective explores the issues that hamper the DERP's effectiveness and discusses the changes it has generated in the drug review process for pharmacy and therapeutics (P&T) committees. The need for more timely and substantial evidence is a key barrier to all drug review processes; here I offer some alternative methods for comparing new drugs that have few comparators. A perfect process is a long way off. However, continuing to explore the methodologies in place today can lead us to more effective processes and metrics.
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Affiliation(s)
- Alan H Heaton
- Blue Cross and Blue Shield of Minnesota, Eagan, Minnesota, USA.
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Abstract
The Drug Effectiveness Review Project (DERP) is an alliance of fifteen states and two private organizations, which have pooled resources to synthesize and judge clinical evidence for drug-class reviews. The experience shines a bright light on challenges involved in implementing an evidence-based medicine process to inform drug formulary decisions: When should evidence reviewers accept surrogate markers and assume therapeutic class effects? How open and participatory should review procedures be? Should reviewers consider cost-effectiveness information? What is the appropriate role of the public sector in judging evidence? The DERP illustrates that attempts to undertake evidence-based reviews, apart from the methods themselves, which continue to evolve, involve questions of organization, process, and leadership.
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Affiliation(s)
- Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston,Massachusetts, USA.
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Abstract
Drug class reviews are blunt tools for medical decision making. The practice of evidence-based medicine is far more than simply systematic reviews: The patient and doctor are integral. Here we highlight areas of evidence-based coverage decision making where greater balance and transparency could serve to improve the current process, and we recommend elements of a more positive approach that could optimize patient outcomes under resource constraints.
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Shibata MC, Nilsson C, Hervas-Malo M, Jacobs P, Tsuyuki RT. Economic implications of treatment guidelines for congestive heart failure. Can J Cardiol 2005; 21:1301-6. [PMID: 16341301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Congestive heart failure (CHF) is the most common cause of cardiovascular hospital admission. A significant proportion of the costs of CHF is due to hospitalizations. The present study evaluated the economic impact of a modest increase in the use of angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, spironolactone and digoxin on CHF hospitalizations. Patients with CHF were identified through the Canadian Institute for Health Information (CIHI) database. The efficacy of ACE inhibitors, beta-blockers, spironolactone and digoxin in the first year of treatment were retrieved from the Survival and Ventricular Enlargement (SAVE) trial, a meta-analysis, the Randomized Aldactone Evaluation Study (RALES) and the Digitalis Investigation Group (DIG) trial, respectively. Cost of CHF hospitalization was based on the National List of Provincial Costs. Costs of drug treatment were based on the 2002 Alberta Health and Wellness Drug Benefit list. Physician visits for drug titration were also included in the model. A total of 85,679 patients with CHF were identified with a total of 106,130 hospital discharges. A 10% increase in use of ACE inhibitors, beta-blockers, spironolactone and digoxin would incur in a total cost due to avoidable hospital admissions of 0.4 million dollars, 1.3 million dollars, 3.7 million dollars and 1.2 million dollars, respectively. Similarly, the costs of drug treatment would be 2.2 million dollars, 1.3 million dollars, 0.3 million dollars and 0.5 million dollars, respectively. An increase in the use of the above medications would save 6.6 million dollars due to avoidable hospital admissions. The total cost of drug treatment was 4.3 million dollars, giving a net savings of 2.3 million dollars in the first year. The implementation of evidence-based therapy for CHF treatment is not only clinically efficacious, but also economically attractive.
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Skrepnek GH, Abarca J, Malone DC, Armstrong EP, Shirazi FM, Woosley RL. Incremental Effects of Concurrent Pharmacotherapeutic Regimens for Heart Failure on Hospitalizations and Costs. Ann Pharmacother 2005; 39:1785-91. [PMID: 16219900 DOI: 10.1345/aph.1g124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUNDInappropriate medication use in patients with heart failure (HF) presents challenges in providing optimal, evidence-based care.OBJECTIVETo evaluate the incremental differences of concurrent and persistent use of angiotensin-converting enzyme (ACE) inhibitors, β-blockers, loop diuretics, and digoxin on the one-year, all-cause risk of hospitalization and total healthcare costs associated with treatment of HF in patients enrolled in a managed care organization within the US.METHODSA retrospective database analysis was conducted spanning from January 1, 1997, to December 31, 1999. Multivariate regression methods were used to examine the association between treatment regimens and hospitalizations or costs after controlling for patient demographics and risk factors.RESULTSOf the 1903 patients meeting inclusion criteria, 32.3% (n = 615) received none of the 4 HF agents studied and were associated with a 2.5 times greater risk (p ≤ 0.001) of hospitalization and 43.6% higher (p ≤ 0.001) total costs compared with all other patients with HF. Comparatively, 13.9% (n = 264) utilized the HF medications investigated for at least 6 months. Of those with persistent use of ≥3 agents, approximate decreases in hospitalizations were noted of 80% (p ≤ 0.001) and total costs of 70% (p ≤ 0.001) relative to patients receiving no HF therapy.CONCLUSIONSA substantial portion of patients with HF may be receiving suboptimal pharmacotherapeutic care in real-world practice settings, potentially incurring large increases in hospitalizations and total costs. Quality improvement initiatives should seek to identify and manage those not being treated according to guideline recommendations.
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Affiliation(s)
- Grant H Skrepnek
- College of Pharmacy, University of Arizona, Tucson, AZ 85721-0207, USA.
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Abstract
BACKGROUND Erythropoiesis-stimulating proteins, such as erythropoietin alfa and darbepoetin alfa, have positively impacted anemia management. These medications improve patient outcomes and quality of life. Their costs, however, remain a major barrier for health systems. OBJECTIVE To evaluate the development, implementation, and cost-effectiveness of an inpatient therapeutic interchange protocol for erythropoiesis-stimulating proteins at a large, tertiary care, university-affiliated health system. METHODS Virginia Commonwealth University Health System (VCUHS) developed and implemented a therapeutic interchange program to convert therapy for all inpatients undergoing dialysis from erythropoietin alfa to darbepoetin alfa for treatment of chronic kidney disease–related anemia. An evaluation of the economic impact of this program on drug expenditures over a fiscal quarter (2003) was conducted using historical comparator data (2002). RESULTS Preliminary evaluation of the program demonstrated cost-savings and reduced drug utilization of erythropoiesis-stimulating proteins in hospitalized dialysis patients. For the first quarter of 2003 compared with the first quarter of 2002, VCUHS realized a cost-savings of nearly $10 000, which was related to the program's aggressive screening procedure. When these data were normalized for equal numbers of patients in each group receiving one of the drugs, the actual cost-savings was over $2000. These cost-savings are largely due to reduced utilization of these expensive biotechnology products with implementation of a dosing protocol. CONCLUSIONS VCUHS has successfully developed and implemented a darbepoetin alfa therapeutic interchange protocol for hospitalized dialysis patients. This has translated into reduced use of erythropoiesis-stimulating proteins, resulting in cost-savings for the health system.
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Affiliation(s)
- Donald F Brophy
- School of Pharmacy, Virginia Commonwealth University/Medical College of Virginia (VCU/MCV), Richmond, VA 23298-0533, USA.
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Van Ganse E, Laforest L, Alemao E, Davies G, Gutkin S, Yin D. Lipid-modifying therapy and attainment of cholesterol goals in Europe: the Return on Expenditure Achieved for Lipid Therapy (REALITY) study. Curr Med Res Opin 2005; 21:1389-99. [PMID: 16197657 DOI: 10.1185/030079905x59139] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have been conducted in actual clinical practice settings to evaluate the ways in which dyslipidemia is managed using lipid-modifying therapies. OBJECTIVE To determine lipid-modifying therapy practices and their effects on low-density lipoprotein cholesterol (LDL-C) and/or total cholesterol (TC) goal attainment in Europeans based on prevailing guidelines at the time of therapy in each country. METHODS Retrospective cohort analysis involving 58,223 patients initiated on lipid-modifying therapies in 10 European countries, with a median patient follow-up on lipid-modifying therapy of 15.3 months. Data on prescriptions of lipid-modifying therapies, laboratory data including LDL-C and TC, achievement of cholesterol goals for LDL-C and/or TC, and hospitalizations were obtained from healthcare administrative databases and/or patient chart reviews. RESULTS Across Europe, statin monotherapy was the initial lipid-modifying treatment in 51,786 (89.3%) of 58,009 patients with available data. In addition, 38,853 (89.5%) of 43,410 patients with available follow-up statin potency data were initiated on statin regimens of medium or lower equipotency. Low-equipotency regimens include atorvastatin 5 mg, simvastatin 10 mg, and pravastatin 20 mg, whereas medium-equipotency regimens include atorvastatin 10 mg, simvastatin 20 mg, and pravastatin 40 mg. Regimens were adjusted to higher equipotency via either up-titration or switches to combination regimens in 16.2% of patients. On average, 40.5% of patients across Europe who were not initially at guideline recommended cholesterol goals (either LDL-C or TC) and had follow-up data attained recommended cholesterol levels, including <30% of patients in Spain, Italy, or Hungary. In many countries, the likelihood of goal attainment was inversely associated with baseline cardiovascular risk and/or LDL-C levels. CONCLUSIONS Lipid management strategies in Europe during the study period were dominated by statin monotherapy. Even after prolonged follow-up on lipid-modifying therapy, approximately 60% of Europeans studied did not achieve guideline recommended cholesterol goals. Future emphasis must be placed on subsequent lipid panel monitoring, as well as the use of more efficacious, well-tolerated lipid-modifying therapies such as dual cholesterol inhibitors to enable more European patients to attain their recommended cholesterol goals.
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Affiliation(s)
- Eric Van Ganse
- Pharmacoepidemiology EA 3091 Centre Hospitalier Lyon-Sud, Pierre Bénite, France.
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Abstract
BACKGROUND Pharmaceuticals represent an increasing share of private and public health care expenditures. The aim of this study was to characterise users and to determine the pattern of uses of prescribed medicines and to identify determinants of medicine use in a multi-ethnic Swedish general practice population. METHODS The study was performed in 1055 of 1442 consecutive adult patients visiting the Jordbro Health Centre (JHC) in Stockholm, Sweden. RESULTS In a regression analysis adjusted for the influence of confounders, subjects reporting 10-30 complaint symptoms, subjects with chronic disease and subjects that had a cost limitation card all reported a higher number of used medicines than subjects with a few (0-10) symptoms and those without chronic disease and a cost limitation card. In a Poisson's regression analysis, high age, female gender, not working, more than 10 symptoms, chronic disease and having a cost limitation card were related to use of prescribed medicines. All included variables predicted 19% of the explanation. Marital status, multi-symptomatology, chronic disease and having a cost limitation card were related to polypharmacy in a logistic regression analysis. CONCLUSION A high number of complaint symptoms, chronic disease and having a cost limitation card were all significantly and independently related to use of medicines and polypharmacy.
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Affiliation(s)
- Ahmad Al-Windi
- Family Medicine Stockholm, Karolinska Institute, Huddinge, Sweden.
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Abstract
PURPOSE Health care providers' knowledge of whether the medications they prescribed were on the formulary of their patients' insurance plan and factors associated with this knowledge were examined. METHOD The 2000 National Ambulatory Medical Care Survey was used to construct a nationally representative sample of outpatient prescription drugs and determine providers' knowledge of the formulary status of the drugs they prescribed. In addition to univariate analysis, random-effects logistic regression models were conducted to examine the association between providers' knowledge of whether a patient's medication was on the formulary, payment types, and provider and medication characteristics. RESULTS Providers did not know whether the drug they prescribed was on the formulary for over 64% of the prescriptions. Physicians were more likely to know whether HMO patients' medications were on the formulary. Internal medicine physicians were significantly less likely to know if their patients' medications were on the formulary than general and family practice physicians. Among HMO-paid outpatient visits, providers practicing in the West were significantly less likely to know if their patients' medications were on the formulary than those practicing in the Northeast. CONCLUSION In over half of cases, health care providers did not know whether the medications they prescribed were on the formulary.
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Affiliation(s)
- Ya-Chen Tina Shih
- Department of Biostatistics and Applied Mathematics, Section of Health Services Research, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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López-Medrano F, San Juan R, Serrano O, Chaves F, Lumbreras C, Lizasoaín M, Herreros de Tejada A, Aguado JM. [Impact of a non-compulsory antibiotic control program (PACTA): cost reductions and decreases in some nosocomial infections]. Enferm Infecc Microbiol Clin 2005; 23:186-90. [PMID: 15826540 DOI: 10.1157/13073141] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Antibiotics account for 30% of hospital pharmacy expenses. More than 50% of the prescriptions are considered inappropriate; hence, programs devoted to optimizing the prescription of antibiotics should be developed. We present the results of a non-compulsory program for the assessment and control of antibiotic treatment in the University Hospital 12 de Octubre in Madrid. METHODS The program was applied in the hospitalization units of six medical and surgical departments. Treatments in all patients were checked daily and recommendations were made in writing, according to previously established criteria. The program was used for 12 months and the results were compared with those of the previous 12 months. RESULTS 1,280 treatments were reviewed and 524 recommendations were made (80% of them were accepted). There was a 13.82% reduction in the number of defined daily doses of antibiotics/100 inpatient-days. Antibiotic expenditure decreased by 65,352 euros (5,446 euros/month), implying a reduction of 1.21 euros/hospitalization-bed/day. There were no statistically significant differences in length of hospital stay or mortality between the two periods. A reduction in the incidence of Clostridium difficile diarrhea (p < 0.0001) and Candida spp. isolations (p < 0.05) was observed. CONCLUSIONS Following application of a non-compulsory control program, antibiotic prescription improved and expenditure decreased, with no change in length of hospital stay or mortality. There was a reduction in the incidence of some nosocomial infections. Acceptation of the program by the physicians of the departments implicated was favorable.
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Abstract
There are a number of effective but highly toxic drugs that exhibit a narrow therapeutic index and marked interpatient pharmacokinetic variability. Individualized therapy with such drugs requires therapeutic drug monitoring (TDM) to obtain the desired clinical effects safely. Cost-effectiveness analysis in health care is still at an early stage of development, especially for TDM. A systematic review was carried out to document studies that have addressed the cost-effectiveness of TDM. The Cochrane database and Medline were searched. References identified by this approach were then searched manually for relevant articles. Very few studies have been performed that document the cost-effectiveness of TDM, and TDM has been demonstrated to be cost-effective only for aminoglycosides. For the other classes of drugs that are monitored, the rationale for TDM has been supported, but appropriate cost-effectiveness analyses have not been performed. Because the use of many of these drugs without TDM would increase the risk of under- or overdosing, emphasis should not be placed solely on cost-effectiveness but rather on how such interventions can be applied in the most cost-effective and clinically useful manner.
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Affiliation(s)
- D J Touw
- Apotheek Haagse Ziekenhuizen, 2504 AC Den Haag, The Netherlands.
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Curtiss FR. P&T committees--black boxes versus AMCP format, and what is the true cost and value of pimecrolimus. J Manag Care Pharm 2005; 11:93-4, 95-6. [PMID: 15667238 PMCID: PMC10438156 DOI: 10.18553/jmcp.2005.11.1.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Wettermark B, Pehrsson A, Jinnerot D, Bergman U. Drug utilisation 90% profiles--a useful tool for quality assessment of prescribing in primary health care in Stockholm. Pharmacoepidemiol Drug Saf 2004; 12:499-510. [PMID: 14521137 DOI: 10.1002/pds.852] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To analyse strengths and weaknesses of a simple method for assessing the general quality of drug prescribing and to study the acceptance of the method among general practitioners (GPs). METHODS Prescriptions dispensed during October-December 1999 and 2000, respectively, were analysed for 38 Primary Health Care centres (PHC) in Stockholm participating in an intervention project with the aim of increasing cost-consciousness among GPs. Focus was on quality of prescribing rather than on costs. Prescribing profiles focusing on the number of drugs constituting 90% of the volume (= DU90%) and the adherence to local drug committee guideline within this segment were presented for the prescribers. The credibility and usefulness of the method was evaluated by a questionnaire. RESULT Among the PHCs, the total number of drugs prescribed varied between 358 and 674. The number of drugs in the DU90%-segment varied between 117 and 194. The adherence to guideline within this segment varied between 56% and 74% and increased over time. The prescribers found the DU90%-profiles clear and relevant and considered the method to be a useful tool for improving the quality of drug prescribing. CONCLUSION Providing DU90%-profiles with guideline adherence as feedback was shown to be a valuable tool in general practice for assessing the overall quality in prescribing and to form the basis for more disease- or patient-specific analyses.
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Affiliation(s)
- Björn Wettermark
- Department of Medical Laboratory Sciences, Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden.
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EURO-MED STAT Group. EURO-MED-STAT: monitoring expenditure and utilization of medicinal products in the European Union countries: a public health approach. Eur J Public Health 2003; 13:95-100. [PMID: 14533757 DOI: 10.1093/eurpub/13.suppl_1.95] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is uncertainty about the level of utilization and expenditure for medicines in the European Union (EU), making assessment of their impact on public health difficult. Our aim is to develop indicators to monitor price, expenditure and utilization of medicinal products in the EU, so as to facilitate comparisons. METHODS There are four major tasks. Task 1: To catalogue data sources and available data in each EU Member State. Task 2: To assess the reliability and comparability of data among the EU Member States by ATC/DDD on country coverage, reimbursement, prescriptions, price category (e.g. wholesale, hospital, retail) and private versus public spending. Task 3: To develop Standard Operating Procedures for data management and to define clearly the proposed indicators in terms of objective, definition, description, rationale, and data collection. Task 4: To pool, compare and report the validated data according to the established indicators, using cardiovascular medicines as an example. RESULTS Preliminary results from Tasks 1 and 2 are available and demonstrate the methodological difficulties in comparing data from different countries. Multiple data sources must be used. These cover different populations, and refer to different prices or costs. Nevertheless, useful data can be derived, illustrated by the example of lipid lowering medicines. The data shows that only five products are commonly available in all countries. Even when a medicine is available in all countries, there may be substantial differences in packages, which can hinder comparison. Data on utilization of statins shows high usage in Scandinavian countries and least in Italy. CONCLUSION The preliminary results of EURO-MED-STAT show wide differences in availability, and use of medicines across Europe that may have substantial implications for public health.
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Abstract
OBJECTIVES To analyse clinical pharmacists interventions in the ICU of the Penang General Hospital (Penang, Malaysia) and to assess the pharmaco-economic impact of these interventions. METHODS A clinical pharmacist reviewed drug prescriptions during one month. Drug-related problems were documented on a prepared from including a suggestion for a change in prescribing. Such recommendations were submitted to the nursing/medical staff. Acceptance of the recommendation was entirely at the discretion of the medical staff. All recommendations were analysed with respect to potential pharmaco-economic impact: cost savings, cost avoidance or cost addition. RESULTS The ICU pharmacist made 57 recommendations, of which the medical staff rejected only 5%. The majority of detected drug-related problems referred to unnecessary drug therapy (37%). Recommendations resulted in net cost savings of RM 15,227 (USD 4,007). This corresponded with RM 634 per patient intervened by the pharmacist. CONCLUSION Pharmacists interventions in the ICU of a Malaysian hospital resulted in significant cost savings in terms of drug expenses and can therefore be suggested as a routine practice in our hospital.
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Affiliation(s)
- Syed Tabish Razi Zaidi
- Department of Pharmaceutical Care, King Abdul Aziz Hospital, National Guards Health Affairs-Eastern Region, P.O. Box # 2477, Al Ahsa 31982, Kingdom of Saudi Arabia.
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García del Pozo J, Isusi Lomas L, Carvajal García-Pando A, Martín Rodríguez I, Sáinz Gil M, García del Pozo V, Velasco Martín A. [Evolution of antipsychotic drug consumption in the autonomous community of Castile and Leon, Spain (1990-2001)]. Rev Esp Salud Publica 2003; 77:725-33. [PMID: 14965064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Over the past ten years, new drugs and new approaches to treatment have been implemented making it possible to assume changes in the use of antipsychotic drugs in our environment. This study is aimed at characterizing the pattern of use of antipsychotic drugs in Castile and Leon throughout the 1990-2001 period as well as ascertaining the bearing which the marketing of new antipsychotic drugs may have had on the pattern of consumption of these drugs. METHODS The drug consumption data was obtained from the Ministry of Health and Consumer Affairs' consumption database ECOM (Especialidades Consumo de Medicamentos). This database contains information on the consumption of medications dispensed charged to the Social Insurance system in community pharmacies nationwide. To estimate the consumption outside of the National Health System, data from the IMS (International Marketing Services) firm for the years 2000 and 2001 was used. The data was given in Defined Daily Doses/1000 inhabitants/day. RESULTS The use of antipsychotic drugs rose by 146% within the 1990-2001 period. Throughout the period studied, haloperidol was the antipsychotic drug most used in Spain and in Castile and Leon. The atypical antipsychotic drugs totaled 49% of the total consumption for 2001 and 90% of the costs, a strong trend being found toward an increase in the consumption of these atypical antipsychotic drugs in detriment to the typical antipsychotic drugs. It has been estimated that 14% of the antipsychotic drugs used in Castile and Leon were used outside of the National Health System.. Appreciable differences exist among the different provinces. CONCLUSIONS The consumption of antipsychotic drugs in Castile and Leon grew by 146% throughout the twelve months studied. The marketing of new atypical antipsychotic drugs and the legal measures related to the deinstitutionalization of mental patients may have played a major role in this increase. The marketing of the new antipsychotic drugs has led to a change in their pattern of use and has give rise to an rise in the direct costs. The consumption of these medications not charged to the National Health System is minor, but not negligible.
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Abstract
CONTEXT It is recommended that children younger than 5 years with sickle cell disease (SCD) take daily prophylactic antibiotics to prevent pneumococcal infections; however, how much prophylactic medication they actually are dispensed is unclear. OBJECTIVES To measure the amount of prophylactic antibiotics dispensed to young children with SCD and to investigate factors associated with increased delivery of medication. DESIGN, SETTING, AND PATIENTS Retrospective longitudinal study conducted January 1995 through December 1999 using Tennessee and Washington State Medicaid administrative claims and encounter data. Children (N = 261) who had 1 inpatient or 2 outpatient claims or encounters listing an International Classification of Diseases, Ninth Revision, Clinical Modification code for SCD, were younger than 4 years at study entry (mean age, 1.4 years), and were continuously enrolled in Medicaid for a 1-year period. MAIN OUTCOME MEASURE Number of days during a 365-day period covered by prescription fills for a penicillin or macrolide antibiotic, or for trimethoprim-sulfamethoxazole. RESULTS In a 365-day period, patients were dispensed a mean of 148.4 (SD, 121.3; median, 114; interquartile range [IQR], 39-247) days of prophylactic medication. The total amount of medication dispensed varied widely: 10.3% of patients received none and 21.5% received more than 270 days of medication. In a 365-day period, a mean of 12.7 (SD, 10.5; range, 0-40) prophylactic prescriptions were filled per patient. The median prescription duration was 10 days. In a multivariate linear regression model adjusting for state, sex, age at study entry, inclusion year, residence in urban community, outpatient inclusion encounter, required prescription co-payment, and number of outpatient visits for nonpreventive care, each preventive visit was associated with 12.0 (95% confidence interval [CI], 2.3-21.7) additional days of prophylactic antibiotics, and each emergency department visit was associated with 10.0 (95% CI, 1.2-18.8) additional days. CONCLUSIONS Publicly insured children with SCD may receive inadequate antibiotic prophylaxis against pneumococcal infections, placing them at increased risk of morbidity and mortality; however, increased numbers of outpatient visits for preventive care are associated with improved provision of prophylactic antibiotics.
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Affiliation(s)
- Colin M Sox
- Department of Pediatrics, University of Washington, Seattle 98195-7183, USA.
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Palcevski G, Ahel V, Vlahović-Palcevski V, Ratchina S, Rosovic-Bazijanac V, Averchenkova L. Antibiotic use profile at paediatric clinics in two transitional countries. Pharmacoepidemiol Drug Saf 2003; 13:181-5. [PMID: 15072118 DOI: 10.1002/pds.880] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE In this study, we evaluated antibiotic utilisation pattern at two paediatric clinics in different European (transitional) countries: Croatia (Rijeka) and Russia (Smolensk). METHODS Antibiotic utilisation during the year 2000 was observed using the ATC/defined daily doses (DDD) methodology (ATC code-J01). Drug-usage data was expressed in numbers of DDD/100 bed-days and the DU90% profile. RESULTS In Rijeka, 35 different systemic antibiotics were used and in Smolensk 22. The overall consumption of antibiotic drugs in Rijeka was more than three times higher than in Smolensk (28.96 vs 8.3 DDD/100 bed-days). The top five antibiotic drugs used in Smolensk were amoxicillin, mydecamicin, ampicilin, doxycylin, gentamicin; and in Rijeka cefuroxime axetil, ceftriaxone, azytromycin, ceftibuten and amoxicillin. CONCLUSION Differences in antibiotic prescribing patterns are greater than expected. The pattern of antibiotic utilisation in both countries implies that regional control measures and guidelines for antibiotic use in children should be urgently established.
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Affiliation(s)
- Goran Palcevski
- Department of Paediatrics, University Hospital Centre Rijeka, Rijeka, Croatia.
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Glowacki RC, Schwartz DN, Itokazu GS, Wisniewski MF, Kieszkowski P, Weinstein RA. Antibiotic combinations with redundant antimicrobial spectra: clinical epidemiology and pilot intervention of computer-assisted surveillance. Clin Infect Dis 2003; 37:59-64. [PMID: 12830409 DOI: 10.1086/376623] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2002] [Accepted: 04/18/2003] [Indexed: 11/03/2022] Open
Abstract
Redundant antibiotic combinations are a potentially remediable source of antibiotic overuse. At a public teaching hospital, we determined the incidence, cost, and indications for such combinations and measured the effects of a pharmacist-based intervention. Of 1189 inpatients receiving >or=2 antibiotics, computer-assisted screening identified 192 patients (16.1%) receiving potentially redundant combinations. Chart reviews showed that 137 episodes (71%) were inappropriate. Physician overprescribing errors were found in 77 episodes (56%); most involved redundant coverage for gram-positive or anaerobic organisms. In 76 episodes (55%), lapses in the medication ordering and distribution system led to the persistence in the pharmacy records of regimens no longer active according to the patient charts. The incidence of redundant antibiotic combinations was significantly higher in the intensive care unit and surgery services, compared with medical services. Interventions to discontinue redundant agents were successful in 134 (98%) of the 137 episodes. Potential drug cost savings and reduction in redundant antibiotic combination days were 10,800 dollars and 584 days, respectively; pharmacist time for patient review and intervention cost 2880 dollars. Use of redundant antibiotic combinations was common, and a pharmacist-based intervention was feasible, with a potential annualized cost savings of 48,000 dollars.
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Affiliation(s)
- Robert C Glowacki
- John H. Stroger, Jr., Hospital of Cook County, and University of Illinois at Chicago College of Pharmacy, Chicago, IL 60612, USA.
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Breekveldt-Postma NS, Zwart-van Rijkom JEF, Egberts ACG, Leufkens HGM, Herings RMC. [Rising costs of drugs in hospitals in the period 1996-2000 and over the next few years]. Ned Tijdschr Geneeskd 2002; 146:2547-51. [PMID: 12532669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To obtain an impression of drug expenditure in hospitals and in particular the costs due to novel more expensive drugs both in the past and in the future. DESIGN Descriptive. METHOD Data on intramurally supplied drugs were collected from 6 of the 95 general hospitals, 5 of the 14 top clinical hospitals, 4 of the 8 university hospitals and I of the 13 categorical hospitals for the period 1 January 1996-31 December 2000. The data were extrapolated to the entire of the Netherlands per hospital category and per year on the basis of the adherence figures. The drug costs were calculated on the basis of cost prices. For the most important new potential drugs it was ascertained whether they would actually become available and if they would substantially contribute to the drug expenditure. RESULTS In 2000, the total drug expenditure within all Dutch hospitals was estimated to be [symbol: see text] 402 million. A substantial part of the costs could be attributed to the use of anticancer drugs (19%) and antibiotics (14%). In 2000, about 12% of the drug expenditure could be attributed to the use of novel, expensive drugs. The total costs of drugs increased on average by 8% per year during the period 1996-2000. The contribution of novel, expensive drugs nearly doubled during this period, and anticancer drugs were the most significant factor in this. A large proportion of the potentially new drugs were innovative anticancer drugs and drugs used to treat immune diseases. These compounds are likely to be expensive. Based on these findings it is expected that over the next few years, drug expenditure within hospitals to grow by at least 20% per year.
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De Las Cuevas C, Sanz EJ, De La Fuente JA. Variations in antidepressant prescribing practice: clinical need or market influences? Pharmacoepidemiol Drug Saf 2002; 11:515-22. [PMID: 12426937 DOI: 10.1002/pds.715] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the antidepressant prescribing patterns of community psychiatrists, and the prescriptions issued by general practitioners and private physicians during 1999 in order to analyse and discuss the intensity and sources of variations between doctors. METHODS All reimbursed prescriptions for antidepressants written in 1999 by community psychiatrists and general practitioners working for the Canary Islands Health Service at Santa Cruz de Tenerife were collected from official sources. Prescriptions were available individualized for each psychiatrist but were collected globally for the others. Drugs were classified according to the Anatomic Therapeutic Chemical (ATC-1999 edition) System and use was quantified in terms of defined daily doses (DDDs). As an indicator of the quality of drug prescribing, the DU90% was used. RESULTS The total use of antidepressant in Tenerife was 21.4 DDD/1000 inhabitants/day. The most frequently prescribed substances were fluoxetine, paroxetine and sertraline, which accounted for 58% of all prescriptions. Each psychiatrist used between 10 and 20 different substances and between 15 and 26 different trade names. Prescribing by general practitioners mirrored that of psychiatrist, and private doctors (mainly psychiatrist) were found to have a different pattern of prescribing with higher use of new and uncommon antidepressants. Psychiatrists acknowledge the pressures of promotion by the pharmaceutical industry and half of them recognize a personal relationship with some 'company representatives'. CONCLUSION There is a remarkable degree of variation in antidepressant prescribing by psychiatrists and general practitioners, this is due to economic and social factors as much as to morbidity differences.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Psychiatry, University of La Laguna, Tenerife, Canary Islands, Spain.
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Abstract
PURPOSE The establishment of recommended dosing regimens has always been a difficult aspect of drug development. This paper examines the extent to which postmarketing prescribing deviates from initially recommended dosing regimens. We used the World Health Organization's (WHO) periodically updated compilation of the 'Defined Daily Dose' (DDD) to reflect prevailing patterns of prescribing in national markets. The aim of this study was to evaluate DDD changes over time (1982-2000) and to identify possible determinants of these changes. METHODS Data on DDD changes were obtained from the WHO's Oslo Collaborating Centre. We performed a case-control analysis in which we compared drugs with (cases) and without (controls) postmarketing changes in DDD on possible determinants associated with DDD change. RESULTS We found 115 instances of a change of DDD in the period 1982-2000 (45 (39.1%) increases and 70 (60.9%) decreases). Antibiotics showed the greatest number of changes in DDD: predominantly increases in the 1980s, while the 1990s were dominated by decreases in DDD of mostly cardiovascular drugs. CONCLUSION Changes in DDD reflect the outcome of a melange of forces, including misconceptions of dose requirements during pre-market development of drug and postmarketing changes in pharmacotherapeutic knowledge, clinical concepts, economic forces, and, in the case of anti-infective agents, changing patterns of resistance/sensitivity of target microorganisms to the anti-infective agent(s) in question.
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Affiliation(s)
- Eibert R Heerdink
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), The Netherlands.
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Wilton P, Smith R, Coast J, Millar M. Strategies to contain the emergence of antimicrobial resistance: a systematic review of effectiveness and cost-effectiveness. J Health Serv Res Policy 2002; 7:111-7. [PMID: 11934376 DOI: 10.1258/1355819021927764] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To conduct a systematic review of the literature to describe and critically appraise studies reporting on the cost and/or effectiveness of interventions proposed to control the emergence of antimicrobial resistance (AMR). METHODS The search for relevant studies encompassed consultation with world experts in AMR, and electronic bibliographic database search of: Medline (1960-2000); ISI (1981-2000); EMBASE (1988-2000); Grey Literature (1999-2000); Database of Reviews of Effectiveness (DARE) and the NHS Health Economic Evaluation Database (HEED) at York University's Centre for Reviews and Dissemination (CRD) (numerous years); OPAC (1975-2000); and the Cochrane Library Online (1990-2000). Only studies that concerned the effectiveness or cost-effectiveness of measures specifically designed to contain the emergence of AMR were reviewed. Standardised data extraction sheets, based on existing checklists for effectiveness and cost-effectiveness, were used to assess the validity of each study using the 'risk of bias criteria' suggested in the Cochrane Handbook. Only studies categorised as being at low or moderate risk of bias were reported fully. The reliability of the data review process was monitored by comparison of several, random, independent assessments by all authors. The mix of study methods (i.e. including studies based on non-randomised controlled trials) meant that formal meta-analysis was not possible, and thus a qualitative review was performed. RESULTS In total, 43 studies were reviewed, with 21 classed as being at moderate or low risk of bias and therefore reported in the paper. These studies covered policies on: restricting the use of antimicrobials (five studies, suggesting that restriction policies can alter prescriber behaviour, although with limited evidence of subsequent effect on AMR); prescriber education, feedback and use of guidelines (six studies, with no clear conclusion); combination therapies (seven studies, showing the potential to lower drug-specific resistance, although for an indeterminate time period); vaccination (three studies showing cost/effectiveness). Most of these studies were: from the developed world, principally the USA; hospital-based, with few community level interventions; and concerned with effectiveness, not cost-effectiveness. CONCLUSIONS Overall, there is an absence of good evidence concerning what is effective, and especially cost-effective, in reducing the emergence of AMR. However, in addition to more research concerning these forms of intervention, the paper highlights four specific areas for further investigation: validating intermediate or surrogate outcome measures to enable better use to be made of the literature on intermediate measures; development and evaluation of 'macro' strategies; research into specific aspects of AMR in developing countries; and empirical and methodological research concerning the economic evaluation of interventions.
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Affiliation(s)
- Paula Wilton
- Health Economics Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
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