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1.
Artigo em Inglês | MEDLINE | ID: mdl-32237953

RESUMO

Introduction: There are positive aspects regarding the prescribing of fixed dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower- and middle-income countries (LMICs) which have the greatest prevalence of both infectious and noninfectious diseases and issues of affordability.Areas covered: Review of potential advantages, disadvantages, cost-effectiveness, and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where there are concerns with their value.Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates, and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis, and hypertension are valued and listed in the country's essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which are being addressed.


Assuntos
Farmacoeconomia , Prescrição Inadequada/prevenção & controle , Medicamentos sob Prescrição/administração & dosagem , Análise Custo-Benefício , Países em Desenvolvimento , Combinação de Medicamentos , Custos de Medicamentos , Interações Medicamentosas , Humanos , Prescrição Inadequada/estatística & dados numéricos , Adesão à Medicação , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Medicamentos sob Prescrição/economia
2.
Expert Rev Respir Med ; 13(7): 679-689, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31189394

RESUMO

Background: There is an increasing prevalence of asthma and chronic obstructive pulmonary disease (COPD) worldwide, leading to increased inhaler use. However, there are concerns with inhaler compliance resulting in different patented inhalers and longer-acting formulations. As a result, inhalers are now among the highest expenditure items in ambulatory care in Scotland leading to multiple initiatives to keep within budget without compromising care. Method: This study assesses inhaler utilization and expenditure between 2001 and 2017 alongside health authority initiatives. Results: There was an increase by 137% in inhaler utilization between 2001 and 2017, and a two-fold increase in expenditure, driven by the increasing use of patented combination inhalers to address concerns. This is very different to the oral markets where expenditure on proton pump inhibitors, statins, and antihypertensives have fallen considerably recently despite increased volumes due to the increasing use of low-cost generics. However, inhaler expenditure has started to fall with an increasing use of lower cost combinations and initiatives to reduce the steroid burden alongside monitoring patient care. Conclusion: Challenges with using and changing inhalers has meant this market has not followed other high-volume drug classes following patent loss. This is starting to change, with the situation monitored to enhance efficient prescribing alongside continued good quality care.


Assuntos
Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Nebulizadores e Vaporizadores/estatística & dados numéricos , Cooperação do Paciente , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Desenho de Equipamento , Humanos , Escócia
3.
J Comp Eff Res ; 8(7): 535-547, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31023070

RESUMO

Aim: Increasing use of selective serotonin-reuptake inhibitors (SSRIs) in Scotland, coupled with safety concerns with some SSRIs, and the increasing availability of generic SSRIs, have resulted in multiple initiatives to improve the quality and efficiency of their prescribing in Scotland. Our aim is to assess their influence to provide future direction. Materials & methods: The prescription costs analysis database was used to document utilization and expenditure on SSRIs between 2001 and 2017 alongside documenting the initiatives. Results: Multiple interventions over the years increased international nonproprietary name prescribing up to 99.9% lowering overall costs. This, coupled with initiatives to limit escitalopram prescribing due to concerns with its value, resulted in a 73.7% reduction in SSRI expenditure between 2001 and 2017 despite a 2.34-fold increase in utilization. Safety warnings resulted in a significant reduction in the prescribing of paroxetine, citalopram and escitalopram alongside a significant increase in sertraline Conclusion: Multiple initiatives have increased the quality and efficiency of SSRI prescribing in Scotland providing direction to others.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Medicina Estatal/organização & administração , Citalopram/administração & dosagem , Citalopram/economia , Bases de Dados Factuais , Medicamentos Genéricos/economia , Humanos , Paroxetina/administração & dosagem , Paroxetina/economia , Padrões de Prática Médica/economia , Honorários por Prescrição de Medicamentos/estatística & dados numéricos , Escócia , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Inibidores Seletivos de Recaptação de Serotonina/economia , Sertralina/administração & dosagem , Sertralina/economia , Medicina Estatal/economia
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