Medicare Part D Plans Greatly Increased Utilization Restrictions On Prescription Drugs, 2011-20.

Drug utilization management tools can be employed to ensure that medicines are prescribed cost-effectively, but they can also be implemented in ways that reduce adherence and harm patient health. We examined trends in the prevalence of utilization restrictions on non-protected-class compounds in Medicare Part D plans during the period 2011-20, including prior authorization and step therapy requirements as well as formulary exclusions. Part D plans became significantly more restrictive over time, rising from an average of 31.9 percent of compounds restricted in 2011 to 44.4 percent restricted in 2020. The prevalence of formulary exclusions grew particularly fast: By 2020, plan formularies excluded an average of 44.7 percent of brand-name-only compounds. Formulary restrictions were more common among brand-name-only compared with generic-available compounds, among more expensive compounds, and in stand-alone compared with Medicare Advantage prescription drug plans.

Assessment of antibacterial drug utilization patterns and antibiogram in infectious diseases: a prospective cross-sectional study.

BACKGROUND: Antibacterial drugs are successful in combating most types of infections. Irrational use and higher consumption of these drugs can give rise to the antibiotic resistance globally. OBJECTIVE: To evaluate antibacterial drug prescribing patterns and antibiogram in infectious disease cases admitted to the hospital. METHODS: A cross-sectional, observational study was conducted from September 2019 to February 2020 among inpatients ward at the hospital after ethical approval. All the data was analysed by the mean and percentage values using Microsoft excel. RESULTS: Out of 250 admitted patients, males and females were 156 (62%) and 94 (38%) respectively. The majority of patients 79 (32%) belonged to the age group of 20-40 years. The majority of prescriptions reported were for viral fever 48 (19%), lower respiratory tract infections 40 (16%) and dengue 33 (13%). Antibacterial drugs administered through the intravenous route and the oral route were 301 (83%) and 63 (17%) respectively. The most frequently utilized antibacterial drugs were beta-lactam class ceftriaxone 149 (60%) and the fixed-dose combination, amoxicillin plus clavulanic acid 65 (26%). Further highly prescribed antibacterial drugs were metronidazole 52 (21%), azithromycin 36 (15%), and levofloxacin 24 (10%). In Gram-negative bacteria, Escherichia coli 6 (30%) contributed majorly, while in Gram-positive coagulase-negative, Staphylococci 6 (30%) contributed the highest growth of bacteria for the specific infections in the admitted cases. CONCLUSION: Ceftriaxone and the amoxicillin-clavulanic acid combination were highly prescribed among all antibacterial drugs, followed by metronidazole and azithromycin. The current study showed that in the antibiogram pattern, Escherichia coli and coagulase-negative Staphylococci contributed significantly as causative organisms for infectious disease cases. The present study highlighted demographic distribution, infectious diseases with their antibacterial drug utilization patterns and antibiogram assessment in the admitted patients.

Por que indivíduos saudáveis podem ter escores do Eating Assessment Tool (EAT-10) indicativos de disfagia? / Why healthy individuals may have Eating scores Assessment Tool (EAT-10) indicative of dysphagia?

Contexto: Eating Assessment Tool (EAT-10) é um método clínico de detecção de disfagia, entendida como dificuldade na deglutição. Em pesquisa realizada no Brasil, foi observado que 9,5% de indivíduos saudáveis assintomáticos têm resultados do teste compatível com disfagia. Objetivo: Avaliar os possíveis fatores que influenciam o resultado anormal do teste em indivíduos saudáveis. Método: Estudo transversal realizado na Faculdade de Medicina de Ribeirão Preto (FMRP-USP) em 358 voluntários sem doenças e sem sintomas, nos quais foi aplicado o teste EAT-10. Resultados: Em 316 o resultado nos 10 itens do teste foi zero, e em 42 os resultados da somatória dos 10 itens foi igual ou superior a 3, considerado indicativo de disfagia. O resultado ≥ 3 ocorreu em 10 homens entre 144 (7%) e 32 mulheres entre 214 (15%), (P = 0,01). A mediana (limites) de idades daqueles com resultado zero foi de 39 (20-84) anos, e com resultado ≥ 3 foi de 32 (20-83) anos (P = 0,04). O índice de massa corporal (IMC) não apresentou diferença entre pessoas com e sem indicação de disfagia. O máximo escore possível para o item 5 (dificuldade na ingestão de medicamentos) foi o que obteve o maior percentual (43,9%) de máximo escore possível, sendo o fator mais importante para o resultado anormal. Discussão: Em indivíduos saudáveis, a dificuldade em ingerir medicamentos foi o fator que mais influenciou a ocorrência de resultado do teste EAT-10 indicativo de disfagia. Conclusão: Dificuldade na ingestão de medicamentos sólidos deve ser considerada quando da interpretação do teste.

Clinical pharmacology facing the real-world setting: Pharmacovigilance, pharmacoepidemiology and the economic evaluation of drugs.

Traditionally, clinical pharmacology has focused its activities on drug-organism interaction, from an individual or collective perspective. Drug efficacy assessment by performing randomized clinical trials and analysis of drug use in clinical practice by carrying out drug utilization studies have also been other areas of interest. From now on, Clinical pharmacology should move from the analysis of the drug-individual interaction to the analysis of the drug-individual-society interaction. It should also analyze the clinical and economic consequences of the use of drugs in the conditions of normal clinical practice, beyond clinical trials. The current exponential technological development that facilitates the analysis of real-life data offers us a golden opportunity to move to all these other areas of interest. This review describes the role that clinical pharmacology has played at the beginning and during the evolution of pharmacovigilance, pharmacoepidemiology and economic drug evaluations in Spain. In addition, the challenges that clinical pharmacology is going to face in the following years in these three areas are going to be outlined too.

Drug utilization and medical expenses in psoriasis treatment at a dermatology hospital in Vietnam, 2019-2021.

Introduction: Psoriasis is a persistent, chronic, inflammatory cutaneous disorder that recurs frequently and has negative impacts on the living quality of sufferers. Methods: Data from the Inpatient and Outpatient Department medical records at Can Tho dermatology hospital were used to generate a descriptive statistics report on medicines and medical costs for psoriasis therapy in 2019-2021. Results: The average number of prescription medications varied annually, averaging roughly 0.62±85.4% per prescription. Corticosteroids and calcipotriol were the most commonly recommended drugs for psoriasis. Antihistamines were the most often used medication, with over 12,000 instances among the 28,397 individuals studied. The peak in average per-treatment expenses occurred in 2021 when they fluctuated between US $120 and US $160. In contrast, examination expenses were the most costly, ranging from US $93-$107. Conclusion: The bulk of psoriasis therapy treatments were topical agents, whose quantities rose progressively. Direct examination expenses accounted for the greatest proportion.

Prospective prescription review system correlated with more rational PPI medication use, better clinical outcomes and reduced PPI costs: experience from a retrospective cohort study.

INTRODUCTION: Proton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs. METHODS: A retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10-2020.09) and a postintervention group (2020.10-2021.09). To reduce the bias of patients' baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs. RESULTS: A total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05). CONCLUSION: The implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use.

Impact of the COVID-19 pandemic on community antibiotic consumption in the EU/European Economic Area: a changepoint analysis.

OBJECTIVES: A decrease in community antibiotic consumption in Europe has been observed during the COVID-19 pandemic. The magnitude of this decrease, how fast after the outbreak it occurred, whether it was sustained during the pandemic and whether the seasonal variation in antibiotic consumption was affected, have not yet been evaluated in detail. METHODS: Data on community antibiotic consumption were available from the European Surveillance of Antimicrobial Consumption Network for 28 EU/European Economic Area (EEA) countries between 2010 and 2021. Antibiotic consumption was expressed as DDDs per 1000 inhabitants per day (DID). The impact of the pandemic on antibiotic consumption was investigated using descriptive statistics and non-linear mixed changepoint models for quarterly and yearly data. RESULTS: The decrease in overall antibiotic consumption between 2019 and 2020 (-3.4 DID; -18.6%) was mainly due to a decrease in the consumption of penicillins [Anatomical Therapeutic Chemical (ATC) code J01C] (-1.9 DID; -23.0%), other ß-lactam antibacterials (J01D) (-0.6 DID; -25.8%) and macrolides, lincosamides and streptogramins (J01F) (-0.5 DID; -17.4%) and was sustained during 2021. The changepoint analysis of yearly data (28 countries) estimated a decrease of 3.3 DID in overall antibiotic consumption (J01) between 2019 and 2020. The analysis of quarterly data (16 countries) estimated a decrease in overall antibiotic consumption (J01) of 4.0 DID and a decrease in seasonal variation of 1.2 DID between the first and second quarters of 2020. CONCLUSIONS: The changepoint analysis indicated a significant, sudden and steep decrease in community antibiotic consumption in the EU/EEA immediately after the start of the COVID-19 outbreak in Europe, as well as a decrease in its seasonal variation.

The role of managed care professionals in the management of neovascular age-related macular degeneration and diabetic macular edema.

Managed care professionals play a significant role in the management of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) through formulary management and drug utilization strategies. These strategies are designed to improve access to affordable care and minimize medical costs to both patients and payers. Preserving vision in patients with nAMD and DME is key to improving clinical outcomes and reducing the risk of comorbid conditions, such as depression. With the approval of new intravitreal treatment options, managed care professionals must stay up to date with evidence-based guidelines as well as the addition of cost-effective treatments to drug formularies to better manage health care resources and improve patient outcomes.

The association between cost sharing, prior authorization, and specialty drug utilization: A systematic review.

BACKGROUND: Specialty drugs are identified by high monthly costs and complexity of administration. Payers use utilization management strategies, including prior authorization and separate tiers with higher cost sharing, to control spending. These strategies can negatively impact patients' health outcomes through treatment initiation delays, medication abandonment, and nonadherence. OBJECTIVE: To examine the effect of patient cost sharing on specialty drug utilization and the effect of prior authorization on treatment delay and specialty drug utilization. METHODS: We conducted a literature search in the period between February 2021 and April 2022 using PubMed for articles published in English without restriction on date of publication. We included research papers with prior authorization and cost sharing for specialty drugs as exposure variables and specialty drug utilization as the outcome variable. Studies were reviewed by 2 independent reviewers and relevant information from eligible studies was extracted using a standardized form and approved by 2 reviewers. Review papers, opinion pieces, and projects without data were excluded. RESULTS: Forty-four studies were included in this review after screening and exclusions, 9 on prior authorization and 35 on cost sharing. Patients with lower cost sharing via patient support programs experienced higher adherence, fewer days to fill prescriptions, and lower discontinuation rates. Similar outcomes were noted for patients on low-income subsidy programs. Increasing cost sharing above $100 was associated with up to 75% abandonment rate for certain specialty drugs. This increased level of cost sharing was also associated with higher discontinuation rates and odds. At the same time, decreasing out-of-pocket costs increased initiation of specialty drugs. However, inconsistent results on impact of cost sharing on medication possession ratio (MPR) and proportion of days covered (PDC) were reported. Some studies reported a negative association between higher costs and MPR and PDC; however, MPR and PDC of cancer specialty drugs did not decrease with higher costs. Significant delays in prescription initiation were reported when prior authorization was needed. CONCLUSIONS: Higher levels of patient cost sharing reduce specialty drug use by increasing medication abandonment while generally decreasing initiation and persistence. Similarly, programs that reduce patient cost sharing increase initiation and persistence. In contrast, cost sharing had an inconsistent and bidirectional effect on MPR and PDC. Prior authorization caused treatment delays, but its effects on specialty drug use varied. More research is needed to examine the effect of cost sharing and prior authorization on long-term health outcomes.

Política de medicamentos de alto costo en un hospital público pediátrico: Análisis de utilización y costos / High-cost medication policy at a public pediatric hospital: utilization and cost analysis

Objetivos. Analizar el circuito de utilización de los medicamentos de alto costo (MAC) y los resultados clínicos obtenidos en un hospital de pediatría público de alta complejidad de Argentina y presentar una estrategia de selección replicable para otras instituciones de similares características de la región. Métodos: Estudio prospectivo, descriptivo, aleatorizado, conducido en el Hospital de Pediatría Juan P. Garrahan de la Ciudad Autónoma de Buenos Aires en el período entre el 1 de setiembre de 2018 y el 31 de marzo de 2019. Se evaluaron dos unidades de estudio, la unidad paciente y la unidad MAC. Resultados: Los MAC consumen 7.921.200 dólares estadounidenses (USD) anuales y representan el 41% del costo de los medicamentos del hospital de alta complejidad. El 50% del costo de los MAC estuvo representado por la gammaglobulina (medicamento utilizado en diferentes enfermedades). Los pacientes proceden de toda la Argentina y otros países y un 44% tiene cobertura de salud. Los diagnósticos para los que se prescribieron MAC con mayor frecuencia fueron los relacionados con patología oncológica (leucemia linfoide aguda, leucemia mieloblástica aguda). El 54% de los pacientes presentó mejoría atribuible directamente a la administración de los MAC, 39% no presentó cambios y el 7% empeoró. Conclusiones: La efectividad en los resultados clínicos y el análisis de los circuitos de aprobación indican que, además de la aprobación por las entidades nacional e internacionales, la evaluación responsable por parte de las instituciones efectoras, mediante la discusión interdisciplinaria basada en la mejor evidencia, contribuye a optimizar la utilización de los MAC y la seguridad de los pacientes (AU)

Objectives. To analyze the utilization circuit of high-cost medications (HCM) and the clinical results obtained in a tertiarycare public pediatric hospital in Argentina and to present a selection strategy that may be disseminated to other institutions of similar characteristics in the region. Methods: A prospective, descriptive, randomized study was conducted at Hospital de Pediatría Juan P. Garrahan in Buenos Aires between September 1, 2018 and March 31, 2019. Two study units were evaluated, the patient and the HCM. Results: HCMs account for 7,921,200 US dollars (USD) per year and represent 41% of the cost of drugs in this tertiary-care hospital. Gamma globulin (a drug used for different diseases) accounted for 50% of the cost of HCMs. Patients came from Argentina and other countries and 44% had a health insurance. Cancer (acute lymphoid leukemia, acute myeloblastic leukemia) was the diagnosis for which HCMs were most frequently prescribed. Fifty-four percent of patients showed improvement directly attributable to the administration of HCMs, 39% showed no change, and 7% worsened. Conclusions: The effectiveness in clinical outcomes and the analysis of approval circuits show that, in addition to approval by national and international entities, responsible evaluation by the effector institutions through interdisciplinary discussion based on the best evidence contributes to optimizing the use of HCMs and patient safety (AU)

A cross-country utilization patterns comparison of high expenditure therapeutic groups between Portugal and six European countries: the two sides of the Portuguese coin.

BACKGROUND: Understanding variability in prescribing patterns through comparative drug utilization studies can contribute to improve an efficient, effective and safe use of medicines. OBJECTIVES: To perform a cross-country comparison of consumption patterns of ambulatory high expenditure therapeutic groups between Portugal and six European countries and simulate potential cost-saving scenarios through the adoption of the different prescribing patterns of studied countries. METHODS: Cross-country comparison of 2019 drug consumption patterns between Portugal, Denmark, England, Finland, the Netherlands, Norway, and Spain. Analysis comprised antihypertensive drugs, glucose lowering drugs (GLD), insulins, lipid lowering drugs (LLD) and oral anticoagulants. Cost-saving analysis were performed using the Portugal average annual cost/daily defined dose and the potential reduction in expenditure simulating other European countries consumption pattern scenarios. RESULTS: Portugal had the lowest consumption uptake of metformin and the highest consumption of GLD (30.1%) and LLD (8.5% vs <3%) fixed-dose combinations. Annual cost-savings scenarios showed that Portugal would have saved between 53 M€ and 305 M€ if it had the same prescribing patterns than Norway or the Netherlands, respectively. CONCLUSIONS: Different utilization patterns across countries were found. Although Portugal has the lowest gross domestic product per capita among the countries studied, it had the highest uptake of newly and costly drugs.

Trends in brand and generic drug utilization for dermatology providers from 2013-2019.

BACKGROUND: Prescription drug costs have risen considerably in the United States and are projected to reach $560 billion by 2028. OBJECTIVE: To evaluate brand and generic drug utilization and cost proportions within Medicare Part D. METHODS: Prescription data for dermatology providers were obtained from the Centers for Medicare and Medicaid Services 2013-2019 Medicare Part D Prescribers by Provider datasets. Percentage of brand vs. generic drug claims and costs and cumulative annual growth rates (CAGRs) were calculated. For the most recent year of data (2019), we conducted additional sub-analyses for calculated percentages by prescriber variables. RESULTS: The proportion of brand drug claims increased from 7.4% (in 2013) to 10.5% (2019) with a CAGR of 8.66%. In comparison, generic drug claims increased at a lower rate (CAGR 4.47%). The percentage of brand drug costs increased from 27.5% (in 2013) to 75.1% (2019). LIMITATIONS: Inability to assess and generalize data for prescription patterns under non-Medicare plans. CONCLUSIONS: Our study demonstrates a disproportionate rise in dermatologic brand drug claims and a substantial increase in costs associated with brand drugs. Brand-name drugs are associated with higher out-of-pocket expenses for patients, which can lead to decreased access and adherence to treatment.

Análise das solicitações de medicamentos não padronizados de um hospital universitário terciário / Analysis of requests for non-standard medicines from a tertiary university hospital

Introdução: O uso extensivo de medicamentos não padronizados causa aumento de custos em saúde, além de potencial redução de segurança e uso racional de medicamentos. A Comissão de Farmácia e Terapêutica orienta a prescrição de medicamentos, por meio da avaliação e seleção de medicamentos a serem incluídos no formulário de medicamentos padronizados, com base nas melhores evidências científicas disponíveis e no perfil dos pacientes locais, promovendo o uso racional de medicamentos. O objetivo deste trabalho foi analisar as solicitações de fornecimento de medicamentos não padronizados na instituição. Métodos: Trata-se de um estudo observacional e descritivo onde foram analisadas as solicitações de medicamentos não padronizados realizadas entre fevereiro de 2016 e dezembro de 2021, identificando os medicamentos envolvidos e seus respectivos custos. Resultados: Foram realizadas 203 solicitações no período, sendo 174 incluídas no estudo. Os medicamentos que tiveram mais solicitações foram o rituximabe (41), a imunoglobulina humana (31), o sucralfato (23), a nitazoxanida (12) e o eltrombopague (7). As solicitações com maior custo foram as de imunoglobulina humana (US$ 799,702.38), rituximabe (US$ 717,320.26), eltrombopague (US$ 281,062.50), ruxolitinibe (US$ 167,867.46) e bortezomibe (US$ 149,033.52). As principais clínicas que solicitaram medicamentos não padronizado foram a neurologia (47), a hematologia (30), as moléstias infecciosas e parasitárias (17), e a anestesiologia (12). As solicitações de maior custo foram realizadas pela neurologia (US$ 145,519.08), hematologia (US$ 120,980.25), transplante de medula óssea (US$ 51,635.11) e dermatologia (US$ 44,813.40). Conclusão: O estudo demonstrou que há um fluxo estruturado de solicitação de medicamentos não padronizados na instituição, sendo uma importante ferramenta de gerenciamento dessas solicitações, evitando a aquisição desnecessária de itens que não compõem o elenco terapêutico do hospital.

Introduction: Widespread use of non-formulary drugs (NFD) increases cost and may reduce safety and rational use of medicines. The Pharmacy and Therapeutics Committee provides guidance on drug prescription by evaluating and selecting medications to be included in a hospital's formulary based on best scientific evidence available and local patients' profile, promoting rational use of medicines. The objective of this study was to assess non-formulary drugs prescriptions at a tertiary hospital. Methods: This was a retrospective study. NFD prescribed and its associated costs were assessed through NFD request forms received from February 2016 to December 2021. Results: A total of 203 NFD request forms were received, from which 174 were included in this study. The most frequently prescribed NFD included rituximab (n = 41), immunoglobulin (31), sucralfate (23), nitazoxanide (12), and eltrombopag (7), with the highest costs being with immunoglobulin (US$ 799,702.38), rituximab (US$ 717,320.26), eltrombopag (US$ 281,062.50), ruxolitinib (US$ 167,867.46), and bortezomib (US$ 149,033.52). The most frequent requesting specialties were neurology (n = 47), hematology (30), infectious disease (17) and anesthesiology (12), and highest costs requests were from neurology (US$ 145,519.08), hematology (US$ 120,980.25), bone marrow transplant unit (US$ 51,635.11), and dermatology (US$ 44,813.40). Conclusion: This study showed that a structured request flow for NFD prescription is a critical procedure in order to better manage drug prescription within the hospital, promoting rational use of medicines and preventing unnecessary spending with drugs for which the clinical indication may be covered by a drug already in the hospital's formulary.

Relationship between anticholinergic load and self-perceived health in a population aged 44 years or older / Relação entre carga anticolinérgica e autopercepção de saúde em população com mais de 44 anos

OBJECTIVE: To investigate the relationship between anticholinergic load (ACL) and self-perceived general health in adults in a medium-sized municipality in southern Brazil. METHODS: This cross-sectional study was based on 2015 data from a medium-sized municipality in southern Brazil. All respondents aged 44 years or older who reported using drugs in the 2 weeks before the interview were included (n = 662). The Anticholinergic Drug Scale was used to measure the ACL. Self-perceived health was categorized as positive self-perception (PSP) or negative self-perception (NSP). Crude and adjusted Poisson regression analyses were conducted to investigate the association between ACL and self-perceived health. RESULTS: NSP was found in 50.91% of 662 respondents. Significant ACL, older age, lower economic status, lower education, polypharmacy, and depression correlated with a higher frequency of NSP. Individuals with significant ACL had a prevalence of NSP of 1.27 (95% confidence interval: 1.02 ­ 1.58), and each additional ACL level represented a 6.10% higher chance of worse self-perceived health, regardless of confounding factors. CONCLUSIONS: An association was found between significant ACL and NSP, with an effect dependent on ACL level

OBJETIVO: Investigar a relação entre carga anticolinérgica (CAC) e autopercepção de saúde em adultos de um município de médio porte do sul do Brasil. METODOLOGIA: Trata-se de um estudo transversal com dados de 2015, realizado em um município de médio porte do sul do Brasil. Todos os entrevistados com 44 anos ou mais que relataram uso de drogas nas duas semanas anteriores à entrevista foram incluídos (n = 662). A Anticholinergic Drug Scale (ADS) foi utilizada para medir a CAC. A autopercepção da saúde foi categorizada em autopercepção positiva (APP) ou autopercepção negativa (APN). Análises de regressão de Poisson bruta e ajustada foram realizadas para investigar a associação entre CAC e autopercepção de saúde. RESULTADOS: Entre os 662 participantes, a CAC foi encontrada em 50,91% dos respondentes. CAC significativa, idade avançada, situação econômica mais baixa, menor escolaridade, polifarmácia e depressão foram correlacionados com maior frequência de APN. Indivíduos com CAC significativo apresentaram prevalência de APN de 1,27 (intervalo de confiança de 95%: 1,02 ­ 1,58), e cada nível adicional de CAC representou uma chance 6,10% maior de pior autopercepção de saúde, independentemente de fatores de confusão. CONCLUSÕES: Encontrou-se associação entre ACL significativo e APN, com efeito dependente do valor do CAC

Inequality in Drug Utilization among Chronic Myeloid Leukaemia Patients in Malaysia: A Cost-Utility Analysis.

BACKGROUND: The burden of chronic myeloid leukaemia (CML) is increasing due to longer patient survival, better life expectancy of the general population, and increasing drug prices. Funding is one of the main concerns in the choice of CML medication used worldwide; thus, patient assistance programmes were introduced to ensure accessibility to affordable treatment. In this study, we evaluated CML drug distribution inequality in Malaysia through patient assistance programmes, using pharmaco-economics methods to evaluate CML treatment from the care provider's perspective. METHODS: Patients with CML were recruited from outpatient haematological clinics at the national centre of intervention and referral for haematological conditions and a public teaching hospital. The health-related quality of life or utility scores were derived using the EuroQol EQ-5D-5L questionnaire. Costing data were obtained from the Ministry of Health Malaysia Casemix MalaysianDRG. Imatinib and nilotinib drug costs were obtained from the administration of the participating hospitals and pharmaceutical company. RESULTS: Of the 221 respondents in this study, 68.8% were imatinib users. The total care provider cost for CML treatment was USD23,014.40 for imatinib and USD43,442.69 for nilotinib. The governmental financial assistance programme reduced the total care provider cost to USD13,693.51 for imatinib and USD19,193.45 for nilotinib. The quality-adjusted life years (QALYs) were 17.87 and 20.91 per imatinib and nilotinib user, respectively. Nilotinib had a higher drug cost than imatinib, yet its users had better life expectancy, utility score, and QALYs. Imatinib yielded the lowest cost per QALYs at USD766.29. CONCLUSION: Overall, imatinib is more cost-effective than nilotinib for treating CML in Malaysia from the care provider's perspective. The findings demonstrate the importance of cancer drug funding assistance for ensuring that the appropriate treatments are accessible and affordable and that patients with cancer use and benefit from such patient assistance programmes. To establish effective health expenditure, drug distribution inequality should be addressed.

Trends in pharmaceutical opioid consumption in the WHO Eastern Mediterranean Region, 2010-2019.

Background: Pharmaceutical opioid consumption has been increasing worldwide, but disparities in access to these medications exist. Few countries of the WHO Eastern Mediterranean Region have well defined pain management policies. Aims: This study presents trends in the consumption of pharmaceutical opioids in the 22 countries in the Eastern Mediterranean Region from 2010 to 2019, with comparative intra- and extra-regional analyses; the correlation between pharmaceutical opioid consumption and human development index rankings; and pharmaceutical opioids use in the region. Methods: We calculated the defined daily doses for statistical purposes (S-DDD) per million inhabitants per day of pharmaceutical opioids from 2010 to 2019, and used the mixed effects models to assess changes in consumption. We used regression analyses to establish the strength of associations between human development index level and consumption in the region and elsewhere. Results: Pharmaceutical opioid use has fluctuated in the region since 2010, with a mean sum of S-DDD of 2547 for 2010-2019. Consumption is relatively low in the region irrespective of the human development index. The highest-consuming country reported 369 S-DDD in 2019 and the lowest reported 1 S-DDD. The most used pharmaceutical opioids in the region were fentanyl, morphine, pethidine, oxycodone, and codeine. Conclusion: Consumption could be considered inadequate in several countries of the region. Supporting these countries to improve collection and reporting of consumption data, and providing humanitarian assistance to enhance access to pain relief, should be a priority for the international community.

Use of medications by pregnant women in the Family Health Strategy in the Northeast of Brazil / Uso de medicamentos por gestantes da estratégia saúde da família no Nordeste do Brasil

Abstract Objectives: To evaluate the medication use, exposure to potential risks, and associated factors before and during pregnancy of pregnant women receiving care at the Family Health Strategy in a municipality in the Northeast of Brazil. Methods: This is a cross-sectional study of pregnant women receiving care in the municipality of Barreiras, in Bahia, Brazil. In data analysis process, prevalence and frequency of medication use were estimated. To investigate the association between variables, the outcome measure was expressed by the prevalence ratio (crude and adjusted) with a 95% confidence interval via Poisson regression. Results: The prevalence of medication use before pregnancy was 35% and during pregnancy, it was 80.7%. Analgesics and antianemics were the prevalent groups of medications before and during pregnancy, respectively. Family income (≤1 minimum wage; PR=1.62; CI95%=1.02-2.55) showed an association with prior use; health problems (PR=2.3; CI95%=1.27-4.22) and complaints in pregnancy (PR=2.39; CI95%=1.28-4.47) had an association with use during pregnancy. Conclusion: The characterization of a high prevalence of use of medicines by pregnant women, combined with a trend of failures in family planning could demonstrate the exposure of the risks of using some harmful substances in periods close to conception and pregnancy.

Resumo Objetivos: avaliar o uso de medicamentos, exposição a potenciais riscos e os fatores associados antes e durante a gestação pelas gestantes atendidas na Estratégia Saúde da Família em município do nordeste brasileiro. Métodos: trata-se de um estudo transversal realizado com gestantes atendidas no município de Barreiras, Bahia, Brasil. No processo de análise dos dados, foram estimadas as prevalências e frequências de utilização de medicamentos. Para investigar a associação entre variáveis, a medida do desfecho foi expressa pela razão de prevalência (bruta e ajustada) com intervalo de 95% de confiança pela regressão de Poisson. Resultados: a prevalência do uso de medicamentos antes da gestação foi 35% e durante de 80,7%. Os analgésicos e antianêmicos foram os grupos de medicamentos prevalentes antes e durante a gestação, respectivamente. A renda familiar (≤1 salário mínimo; RP=1,62; IC95%=1,02-2,55), mostrou associação ao uso anterior; problemas de saúde (RP=2,32; IC95%=1,27-4,22) e queixas na gestação (RP=2,39; IC95%=1,28-4,47) tiveram associação para o uso durante. Conclusões: a caracterização de uma alta prevalência do uso de medicamentos por gestantes, aliado a uma tendência de falhas no planejamento familiar pôde demonstrar a exposição dos riscos da utilização de algumas substâncias nocivas em períodos próximos da concepção e na gestação.

Custo de um município do sul do Brasil com medicamentos de uso contínuo dispensados na Atenção Primária à Saúde / Cost of a city in Southern Brazil with continuous use medications dispensed by Primary Health Care

Objetivo: Avaliar o custo com medicamentos básicos de uso contínuo de usuários da Atenção Primária em Saúde de Santa Rosa-RS. Métodos: Estudo transversal e analítico realizado em um município do noroeste do Rio Grande do Sul. Foram incluídos usuários cadastrados nas 17 unidades de estratégia de saúde da família, das áreas urbana e rural, em uso de no mínimo um medicamento de uso contínuo. A coleta de dados foi realizada pelo acesso ao sistema informatizado de prescrição eletrônica. Resultados: Foram incluídos 642 usuários, com idade média de 60,40 anos, sendo 64,3% mulheres. Identificou-se média de 4,68 ± 2,82 medicamentos/prescrição e 47,4% ± 14,48 dos usuários em uso de cinco ou mais medicamentos. Dos medicamentos em uso, 87,9% pertencem ao componente básico da assistência farmacêutica. O custo anual do município por usuário de medicamento foi em média de R$ 250,60. O sistema cardiovascular foi o grupo anatômico com maior custo total. Verificou-se maior frequência de uso de medicamentos entre os idosos, que consequentemente representam o grupo etário com maior custo de tratamento. Conclusão: Evidenciou-se que a maioria dos medicamentos prescritos atua sobre os sistemas cardiovascular e nervoso, e pertence ao componente básico da assistência farmacêutica. O custo com medicamentos demonstrou investimento do município de valores 25 vezes maiores do que o mínimo estabelecido pela legislação vigente, com vistas a garantia de acesso ao tratamento e manutenção da qualidade de vida da população assistida.

Objective: The objective of this study was to evaluate the cost of basic medicines for continuous use by users of Primary Health Care in Santa Rosa-RS. Methods: A cross-sectional and analytical study carried out in primary health care in a city in the Northwest of Rio Grande do Sul, comprising 17 unites of Strategies Family Health. Registered users in urban and rural units were included, using at least one continuous treatment. Data collection was performed by accessing the computerized electronic system. Results: 642 users were included in the study, with an average age of 60.40 ± 14.48 years, 64.3% were women. The average number of prescription drugs was 4.68 ± 2.82/prescription and 47.4% of users were using five or more medications. Of the drugs in use, 87.9% belonging to the basic component of pharmaceutical care. These drugs represent an annual cost per user of R$ 250.60. The cardiovascular system presents itself as the anatomical group with the highest total expenditure. Hydrochlorothiazide was the most prescribed drug and beclomethasone represented the highest individual expense. Conclusion: It became evident that most of the drugs prescribed belonged to the basic component of pharmaceutical care and belonged to the cardiovascular and nervous system. Cost of drug implies the investment of the city of 25 times higher than the established by the current legislation, with a view to guaranteeing access to treatment and maintaining the quality of life of the assisted population.