Pharmacoeconomic study of anti-influenza virus drugs in Japan based on a network meta-analysis.

BACKGROUND: An analysis was conducted in Japan to determine the most cost-effective neuraminidase inhibitor for the treatment of influenza virus infections from the healthcare payer's standpoint. OBJECTIVE: This study reanalysed the findings of a previous study that had some limitations (no probabilistic sensitivity analysis and quality of life scores measured by the EQ-5D-3L instead of the EQ-5D-5L) and used a decision tree model with only three health conditions. METHODS: This study incorporated new data from a network meta-analysis study into the first examination. The second examination involved constructing a new decision tree model encompassing seven health conditions and identifying costs, which consisted of medical costs and drug prices based on the 2020 version of the Japanese medical fee index. Effectiveness outcomes were measured using EQ-5D-5L questionnaires for adult patients with a history of influenza virus infections within a 14-day time horizon. Deterministic and probabilistic sensitivity analyses were performed to examine the uncertainty. RESULTS: In the first examination, the base-case cost-effectiveness analysis confirmed that oseltamivir outperformed laninamivir, zanamivir and peramivir, making it the most cost-effective neuraminidase inhibitor. The second examination revealed that oseltamivir dominated the other agents. Both deterministic and probabilistic sensitivity analyses showed robust results that validated oseltamivir as the most cost effective among the four neuraminidase inhibitors. CONCLUSIONS: This study thus reaffirms oseltamivir's position as the most cost-effective neuraminidase inhibitor for the treatment of influenza virus infections in Japan from the perspective of healthcare payment. These findings can help decision makers and healthcare providers in Japan.

Communication training for pharmacy students with standard patients using artificial intelligence.

INTRODUCTION: The objective structured clinical examination (OSCE) is among validated approaches used to assess clinical competence through structured and practical evaluation. Most studies of OSCE have used standardized patients (SPs). However, to our knowledge, there is limited information regarding the specific communication skills enhanced by providing communication training (CT) with SPs. Recently, an artificial intelligence (AI) technology was developed. The aim of this study was to evaluate the experience and outcomes of CT with SPs and impact of using AI for this training. METHODS: This study targeted fourth-year students participating in a pre-learning course for pharmacy practice experience offered at a Japanese university in 2020. The ENcode, Decode, Control, and REgulate model, which evaluates 24 communication skills, was utilized as a questionnaire-based survey. The survey was conducted prior to CT, following CT, and after a second CT session six weeks later with AI. RESULTS: Seven skills, namely "desire suppression," "expectation acceptance," "facial expression," "emotional communication," "dominance," "maintaining relationships," and "dealing with disagreements," were enhanced by the CT with SPs. These skills were included in the broad categories of "management" and "expression" skills. They were not significantly enhanced by following AI training. However, differences observed between the students who underwent AI training and those who did not demonstrated a positive effect in almost all skills, suggesting that AI training can enhance certain skills. CONCLUSIONS: CT with SPs enhances students' "management" and "expression" skills. Additionally, AI shows potential for improving the effect of CT.

Study on the Optimal Conditions for Long-term Storage of Melatonin Powder as an In-hospital Preparation.

Melatonin is often prescribed to children with epilepsy. It is supplied as an in-hospital preparation in Japan, but information on the storage conditions of such formulations is lacking. In this study, we used an analytical method to perform periodic measurements in order to establish expiration periods and storage conditions for compounded melatonin powder. A dispenser was used to envelop compounded melatonin powder in wrapping paper, after which the powders were preserved in 1) an opened transparent plastic bag, 2) a closed opaque plastic bag, 3) a closed transparent plastic bag with a desiccant, and 4) a closed opaque plastic bag with a desiccant. The bags were then stored at room temperature (15°C to 25°C), in a refrigerator (4°C), and in a freezer (-20°C). Chromatographic analysis was performed using an ODS-C18 column (40°C, ? = 210 nm) with a mobile phase consisting of methanol: 0.1 M sodium phosphate buffer (55:45, v/v) at a flow rate of 1 mL/min. The measurements were made at the following time points: 0 days, 7 days, 14 days, 28 days (1 month), 56 days (2 months), 84 days (3 months), 112 days (4 months), 140 days (5 months), and 168 days (6 months). The residual rates of melatonin for all time points, at all temperatures, under all conditions exceeded 95%. These experimental data suggested that the melatonin powder is stable for at least 6 months at room temperature of 15°C to 25°C.

A Cost-Effectiveness Analysis of Neuraminidase Inhibitors for Influenza Virus Infections in an Adult-Outpatient Setting in Japan.

BACKGROUND: Pharmacoeconomic studies have been less performed in Japan. The objective of this study was to clarify which neuraminidase inhibitor (NI; oseltamivir, zanamivir, laninamivir, and peramivir) is most cost-effective in an adult outpatient setting in Japan. OBJECTIVE: To clarify which neuraminidase inhibitor (NI; oseltamivir, zanamivir, laninamivir, and peramivir) is most cost-effective in an adult outpatient setting in Japan. METHODS: Cost-effectiveness analysis was constructed from the healthcare payer's perspective. A decision tree model was constructed with probabilities from relevant randomized controlled trials. Costs included medical costs and drug prices. Medical costs were obtained from the medical fee schedule table (2016 version). We also applied authorized medication costs. Outcomes of effectiveness were measured using EQ-5D-3L questionnaires for adult patients who had experienced influenza virus infections previously. Time horizon was 14 days in this study. RESULTS: Cost-effectiveness ratios for oseltamivir, zanamivir, laninamivir, and peramivir were 393 674 Yen/quality-adjusted life year (QALY; US$3883.41/QALY), 408 241 (US$4027.10), 407 980 (US$4024.53), and 444 264 (US$4382.45), respectively. The cost-effectiveness analysis base-case analysis revealed oseltamivir as the most cost-effective NI. Zanamivir was dominated. Incremental cost effectiveness ratio (ICER) for laninamivir and peramivir were 1 129 459 Yen/QALY (US$11 141.58/QALY) and 1 287 118 (US$12 696.81), respectively. One-way sensitivity analyses revealed that minimum ICERs for laninamivir based on "quality of life (QOL) values (95% confidence interval)" was -596 850 Yen/QALY (US-$5887.64/QALY) owing to high cost and less effective. Also, maximum ICER for peramivir based on"QOL values" was 14 717 518 Yen/QALY (US$145 181.32/QALY); a value more than the 5 000 000 Yen/QALY threshold. CONCLUSIONS: The study results reveal oseltamivir as the most cost-effective NI for the treatment of influenza virus infection in an adult outpatient setting. Our findings may provide decision makers with scientific evidence for clinical and economic evaluation to achieve optimal therapeutic outcomes.

[Relevance between Methods of Obtaining Drug Information and the Utilization of the Information in Community Pharmacies -Research on Awareness of Drug Information of "Increased Risk of Developing Diabetes in Patients Treated with HMG-CoA Reductase Inhibitors" in Community Pharmacies].

Lipid lowering therapy using statins prevents the risk of cardiovascular events. However, since the year 2000, there have been some reports that statins increased the risk of developing diabetes (SIRDD). It is socially demanded that pharmacists must apply pharmacotherapy to patients by utilizing drug information like the above, such as selecting appropriate drugs and providing correct drug information. Accordingly, pharmacists must correct drug information, and they should analyze and evaluate such information. Therefore, we conducted a questionnaire survey for pharmacists in community pharmacies with an aim to verify relevance between methods of obtaining drug information and the utilization of the information of "SIRDD" as a subject. We sent a questionnaire by letter to 1522 pharmacists in Fukushima and Mie prefecture, and received the results of the questionnaire from them using "Google forms" that is software to make web questionnaire and letters. We obtained responses from 356 (23.4%) pharmacists out of 1522. The number of responses from the pharmacists that "know" the information of "SIRDD" was 135 (37.9%). We found that these pharmacists obtained the information by websites of pharmaceutical companies, m3, Inc. (Portal site for medical professionals), and Pharmaceuticals and Medical Devices Agency (PMDA), as the sources of information. Our results suggested that pharmacists responded that they "know" "SIRDD" utilized websites as a quick information tool. The difference in network environments will relate to the difference of providable medical quality. So, it is very important to maintain appropriate network environment in cooperation with medical institutions, professional associations and the government.

[Survey on the Pharmacists Perceptions of Clinical Trial Literature Accessibility].

The purpose of this study is to understand the reading habits of Japanese pharmacists regarding clinical trial literature in 2014. Questionnaires were mailed to 1997 pharmacists in Miyagi Prefecture. Six hundreds and five [342 (56.5%) hospital pharmacists and 254 (42.0%) community pharmacists] responded to questionnaires (Response rate: 30.3%). Regarding the question, "Do you habitually read clinical trial literature?", 19.5% of hospital and 8.3% community pharmacists responded "yes", respectively, which showed both pharmacists are not habitual readers of clinical trial literature. That would be because they did not study critical reading of clinical trial literature at pharmacy schools as well as their work environments to access and retrieve clinical trial literature were limited.

Effects of an evidence-based medicine workshop on Japanese pharmacy students' awareness regarding the importance of reading current clinical literature.

BACKGROUND: Drug literature evaluation has been taught at pharmacy schools in the United States, allowing pharmacy students to learn how to read clinical literature critically. In advanced pharmacy practice experiences, preceptors often assign pharmacy students to journal clubs in which they repeatedly train how to read such literature. This enables them to understand the importance of reading clinical literature prior to graduation. The objective of this study was to create evidence-based medicine (EBM) workshop that would enhance Japanese pharmacy students' awareness regarding the importance of reading up-to-date clinical literature. METHODS: The EBM workshop were designed as a one-day workshop consisting of student presentations regarding their opinions about reading clinical literature, a lecture on methods for reading required literature critically, and small group discussions using the KJ (Kawakita Jiro) Method. To evaluate the effectiveness of the EBM workshop, students were administered questionnaire surveys both before and after the workshop. The students also took a 15-question test on EBM. Regarding the questionnaires, students were asked to respond to dichotomous items (yes/no) and to indicate on a 7-point Likert scale the extent to which they agreed with statements about clinical literature. Student responses to both the pre- and post-workshop questionnaires were then compared to evaluate the effectiveness of the EBM workshop. RESULTS: A total of 37 students participated in the EBM workshop. Significant improvement was seen between the pre- and post-workshop questionnaires in responses regarding whether they thought that pharmacists should read clinical literature regularly (pre-workshop: 5.70 ± 0.17 versus 6.51 ± 0.13 post-workshop; p < 0.0001), whether they were confident in their ability to read clinical literature (1.81 ± 0.15 versus 3.92 ± 0.18; p < 0.0001), and whether they could discuss treatment with nurses and physicians based on the results of clinical literature if they were a hospital pharmacist (2.49 ± 0.22 versus 3.86 ± 0.21; p < 0.0001). Significant improvement was also seen in scores on the EBM tests (11.4 ± 0.29 versus 12.6 ± 0.22; p < 0.0001). CONCLUSION: Our EBM workshop significantly enhanced student awareness regarding the importance of reading up-to-date clinical literature. It is therefore expected that students who participated in our EBM workshop will contribute to improvements in the quality of the pharmacy profession in the future.

Drug interaction between methamphetamine and antihistamines: behavioral changes and tissue concentrations of methamphetamine in rats.

Methamphetamine is a psychomotor stimulant, whereas first generation antihistamines cause sedation. Several studies have demonstrated that first generation antihistamines potentiate methamphetamine-induced psychomotor activation and two possible mechanisms have been postulated. One is blockage of the central histaminergic neuron system and the other is inhibition of dopamine reuptake. However, the exact mechanism is still controversial. In this study, we examined in behavioral tests the effects of selected antihistamines on methamphetamine-induced psychomotor activation in rats, and measured plasma and brain tissue concentrations of methamphetamine. We found that some antihistamines significantly potentiate methamphetamine-induced psychomotor activation in rats and that plasma and brain tissue concentrations of methamphetamine in rats treated with methamphetamine in combination with D-chlorpheniramine were markedly higher than those in rats treated with methamphetamine alone. These results suggest that the potentiating effects of antihistamines are due to not only central effects but also the alteration of the pharmacokinetics of methamphetamine.

Brain and heart specific alteration of methamphetamine (MAP) distribution in MAP-sensitized rat.

The repeated administration of methamphetamine (MAP) causes behavioral sensitization in animals. We previously reported that the high accumulation of MAP was observed in the MAP-sensitized animal brain, which suggested that this phenomenon is an important factor in the development or expression of behavioral sensitization. The purpose of the present study is to elucidate the MAP distribution in the MAP-sensitized rat using gas chromatography/mass spectrometry (GC/MS). As a result, the MAP distribution in the heart at 10 min when showing a high accumulation of MAP in the MAP-sensitized rat brain was significantly higher than that of the control rat, whereas no significant differences in the liver, kidney, abdominal muscle, femoral muscle and blood were observed. In the brain and heart, there was no different distribution at 1 min, reflecting only the influx process from blood to brain and heart. On the contrary, there was the significant difference at 10 min, reflecting both the influx and efflux process, suggesting that the efflux process of MAP from brain or heart to blood may be slow due to MAP sensitization. In conclusion, it was clear that the brain and heart specific alteration of the MAP distribution occurred in the MAP sensitization. It was considered that the high accumulation of MAP in the MAP-sensitized rat brain may be related to the expression of behavioral sensitization and that the delayed efflux of MAP in the MAP-sensitized rat heart may be connected with the cardiac toxicity.