Hypertension: rational and cost effective treatment

Caribbean government drug budgets become tighter every year, while the latest prescribing fashions create inflationary costs. Current consensus views on first line drug treatment choices for hypertension, with cheaper, proven drugs, should be followed for the majority of patients, so that the more costly drugs will be affordable for those who really need them. In other words rational drug use must include considerations of cost. Only in this way can equitable health care be made available to all. (AU)

Pharmacoeconomics of intravenous antibiotic use in serious infections

A pharmacoeconomic study of 15 antibiotics available in Barbados was performed. The antibiotics studied were amoxycillin/clavulanate, ampicillin/sulbactam, cefazolin, cefotaxime, ceftazidime, ceftriaxone, clindamycin, cloxacillin, cotrimoxazole, gentamicin, imipenem, metronidazole, piperacillin/tazobactam, and vancomycin. The costs of use of these compound were calculated for a five-day course using a formula comprising eight categories: antibiotic purchase cost, maintenance of intravenous access, drug delivery cost, drug monitoring cost, dose readjustment, general monitoring cost, 'sharps' disposal cost and adverse effects. The cost of adverse effects were not included in this study due to lack of accurate data. The total cost of antibiotic use (in U.S. dollars) ranged from $42.52 to $463.73 per five-day course. Generic compound were less expensive ($45.52-$98.23) than brand-name compounds ($106.18 - $463.73). Antibiotic purchase costs accounted for proportions of total costs ranging from 7 to 93 percent. Non-drug costs represented a much greater proportion of total costs of generic compounds. For most compound the non-drug costs were related to the frequency of dosing, but for gentamicin the non-drug costs were relatively higher because of the need for monitoring of serum gentamicin levels. Efficacy and freedom from side-effects will remain the most important determinants in the choice of antibiotic therapy. However, pharmacoeconomic analyses can provide prescribers with the information required to make cost-effective choices for treatment of their patients (AU)

The economics of pharmaceuticals and health sector reform in the Americas

Increasing pressures on health systems and significant economic changes in many Latin American and Caribbean countries make reforms to the health and pharmaceutical sectors imperative. While health and pharmaceutical needs continue to mount, trade and price liberalization policies implemented to revitalize economies are frequently associated with higher pharmaceutical expenses. Such conditions affect the poor disproportionately, further aggravating existing imbalances in society. The fundamental principle of optimal health sector reform is that access to quality health services is a right of all individuals. From this principle, three objectives are identified: universality and equity in access, quality, and efficiency. Each country must shape health sector reform in accordance with its priorities and social and economic conditions, but pharmaceutical reform must be incoporated within health sector reform and should seek to ensure that all individuals have access to essential drugs and to quality health services. The essential drugs concept, advocated by WHO through its Action Programme on Essential Drugs and PAHO, stresses availability, affordability, quality, and rational use of drugs. Five areas are central to reform strategy: the roles of the public and private sectors, drug financing alternatives, pricing policies, generic strategies, and rational drug use (AU)