Cost saving analysis of prediabetes intervention modalities in comparison with inaction using Markov state transition model-A multiregional case study.

BACKGROUND: Prediabetes management is a priority for policymakers globally, to avoid/delay type 2 diabetes (T2D) and reduce severe, costly health consequences. Countries moving from low to middle income are most at risk from the T2D "epidemic" and may find implementing preventative measures challenging; yet prevention has largely been evaluated in developed countries. METHODS: Markov cohort simulations explored costs and benefits of various prediabetes management approaches, expressed as "savings" to the public health care system, for three countries with high prediabetes prevalence and contrasting economic status (Poland, Saudi Arabia, Vietnam). Two scenarios were compared up to 15 y: "inaction" (no prediabetes intervention) and "intervention" with metformin extended release (ER), intensive lifestyle change (ILC), ILC with metformin (ER), or ILC with metformin (ER) "titration." RESULTS: T2D was the highest-cost health state at all time horizons due to resource use, and inaction produced the highest T2D costs, ranging from 9% to 34% of total health care resource costs. All interventions reduced T2D versus inaction, the most effective being ILC + metformin (ER) "titration" (39% reduction at 5 y). Metformin (ER) was the only strategy that produced net saving across the time horizon; however, relative total health care system costs of other interventions vs inaction declined over time up to 15 y. Viet Nam was most sensitive to cost and parameter changes via a one-way sensitivity analysis. CONCLUSIONS: Metformin (ER) and lifestyle interventions for prediabetes offer promise for reducing T2D incidence. Metformin (ER) could reduce T2D patient numbers and health care costs, given concerns regarding adherence in the context of funding/reimbursement challenges for lifestyle interventions.

Exploring physicians' prescribing behavior in patients with multiple sclerosis in Saudi Arabia: a sequential explanatory mixed-methods.

BACKGROUND: Multiple sclerosis (MS) is the most common disabling neurological disease in young adults worldwide with majority of patients manifest symptoms between 20 and 40 years of age. The aims of this study are to explore physicians' perspectives, views, and behaviors in diagnosing and treating patients with MS in Saudi Arabia and investigate the prescribing pattern of disease-modifying therapies (DMTs). METHODS: A sequential explanatory mixed-method approach was used to achieve the study objectives. The quantitative arm of the study consisted of patient data extracted from the Saudi MS registry from 2015 to 2018. The qualitative study consisted of in-depth semi-structured interviews with physicians using a validated interview topic guide comprising 28 open-ended questions. RESULTS: We extracted data of 2,507 patients from 20 different hospitals across Saudi Arabia. Patients' mean age was 34 ± 10 years; two-thirds (n = 1,668) were female. 92% (n = 2,292) had relapsing-remitting multiple sclerosis, and 5% (n = 126) had secondary-progressive multiple sclerosis. In general, patients with MS received at least one drug as the DMT or DMTs and corticosteroids for those with relapse. Qualitatively, nine physicians agreed to participate in the interviews. Of them, five (55%) were male and four were female from different regions. Thematic analysis yielded three main themes: practice, views, and challenges. CONCLUSIONS: The prevalence of MS in Saudi Arabia is raising but is still much lower than that reported in the Gulf region. A national MS guideline is needed to streamline diagnosis and treatment criteria, avoid any delay in treatment, and guide physicians who provide care for patients with MS.

Job Motivation and Satisfaction Among Female Pharmacists Working in Private Pharmacy Professional Sectors in Saudi Arabia.

Background: Pharmacists' job satisfaction has been of interest for many years and is of great importance in several respects, such as productivity and ultimately organizational performance. Objective: This study aimed to investigate the perceived motivational factors and levels of job satisfaction of female pharmacists working in private pharmaceutical sectors. Methods: This was a cross-sectional study using a web-based survey of randomly selected female pharmacists working in different private settings including community pharmacies, pharmaceutical companies, private hospitals, and other private sectors using a pre-validated satisfaction scale (Warr-Cook-Wall scale). Results: A total of 232 female pharmacists participated in the study with a mean age of 26.1±2.4 years. Of the total respondents, more than half (58%) worked for pharmaceutical companies, 25% worked in community pharmacies, and 16.8% were from hospital pharmacies. The most attractive motivating factors that encourage female pharmacists toward better performance were having the opportunity to learn new skills, being in contact with people both locally and internationally, gaining a sense of achievement, and being recognized, appreciated, and rewarded. The participants of this study were shown to have a moderate job satisfaction level. Conclusion: This study revealed that the non-Saudi, part-time pharmacists who never expected a promotion were less satisfied than the Saudi, full-time employees who expected a promotion within a year.

Resource Utilization and Caring Cost of People Living with Human Immunodeficiency Virus (PLHIV) in Saudi Arabia: A Tertiary Care University Hospital Experience.

The human immunodeficiency virus (HIV) is associated with a significant burden of disease, including medical and non-medical costs. Therefore, it is considered to be a priority for all health authorities. The aim of this study is to determine healthcare and treatment costs of caring for PLHIV at one of the tertiary care university hospitals in Riyadh, Saudi Arabia. This was a micro-costing, retrospective, observational study from a tertiary care university hospital and included all confirmed HIV-infected patients who visited infectious disease clinics in the period from 1 January 2015 to 31 December 2018. A total of 42 PLHIV were included in this study. The mean age of the study participants was 38.76 ± 11.47 years with a mean disease duration of 5.27 ± 4.81 years. The majority of patients were male (85.7%) and Saudi (88.1%). More than half of included patients (59.5%) had a CD4 count of more than 500. During the study period, 26 patients (61.9%) were initiated on a single-tablet regimen. Overall, the main cost-driver was antiretroviral medications, which cumulatively represented more than 64% of the total cost. Patients who developed opportunistic infections had a statistically significant (p = 0.033) higher financial impact, both as a total and on a patient level, than those presented without opportunistic infections. On a patient level, the mean and median costs were higher and statistically significant for those with co-morbidities than those without co-morbidities (p = 0.002). The majority of the economic burden of PLHIV is attributable to antiretroviral therapy use. The healthcare costs of PLHIV can vary greatly, depending on the presenting illness, clinical stage, developed opportunistic infection, co-morbidity, and pharmacological therapy.

Exploring the status and views of managed entry agreements in Saudi Arabia: mixed-methods approach.

BACKGROUND: Healthcare payers are increasingly adopting managed entry agreements (MEAs) between themselves and manufacturers, to overcome the challenge of sustaining access in an era of innovative and high-cost medicines. This study aims to investigate current MEA activity in Saudi Arabia and explore the challenges encountered when implementing such agreements. METHODS: An explanatory sequential mixed-methods approach was used. Quantitative data on MEAs were collected, followed by qualitative semi-structured interviews with different stakeholders. RESULTS: Our questionnaire garnered responses from 18 pharmaceutical companies from 3 different continents and identified 25 agreements in Saudi Arabia since 2010. Financial-based agreements were more prevalent than outcomes-based agreements at 44% versus 32%, respectively. Stakeholders showed positive attitudes toward MEAs, valuing their benefits in facilitating market access for both costly and innovative medicines. The main challenges included data availability, administrative and financial burden, lack of expertise, confidentiality, and lack of clear regulations. CONCLUSIONS: Despite clear implementation challenges, a growing tendency toward MEAs exists in Saudi Arabia because of the potential benefits they bring to patients, healthcare providers, payers, and manufacturers. It is believed that the newly established health technology assessment center in Saudi Arabia will bring more clarity and shape the concept of MEAs in the country.

Pharmaceutical companies' views on a health technology assessment (HTA) entity in Saudi Arabia.

Saudi Arabia is undergoing a massive healthcare transformation to fulfill its new, national "Vision 2030." To align with this objective, Saudi Arabia is establishing a new, independent and evidence-based health technology assessment (HTA) entity to help it maximize health gains through efficient use of resources. This study was designed to ascertain how pharmaceutical companies perceive the creation of such a national HTA entity in Saudi Arabia; what they think about it and expect from it. To achieve the study's aim, we held a workshop in Riyadh, Saudi Arabia, lasting four and a half hours and hosted by the Saudi Ministry of Health (MOH). We invited 16 market access directors and managers from different multinational pharmaceutical companies to discuss the establishment of a national HTA entity. The findings from the workshop were structured around three axes: vision and remit; HTA method; and implementation and practical considerations. Overall, the pharmaceutical company participants were positive about HTA's value for the Saudi healthcare system and expressed willingness to adapt to meet its future requirements.

Prevalence of the co-prescription of tamoxifen and CYP2D6 inhibitors in Saudi population: A cross sectional study.

Consumption of Cytochrome P450 2D6 (CYP2D6) inhibiting drugs along with tamoxifen treatment results in decrease in plasma concentration of endoxifen, the major active tamoxifen metabolite. Simultaneous use of CYP2D6 inhibitors, such as selective serotonin reuptake inhibitors (SSIs), as well as lesser tamoxifen adherence may negatively impact tamoxifen efficacy in patients with breast cancer. The objective of our study was to assess the co-prescription of CYP2D6 inhibitors and tamoxifen use and also to relate concomitant CYP2D6 inhibitor use and tamoxifen adherence to breast cancer in Riyadh, Saudi Arabia. All patients treated for breast cancer who had at least one tamoxifen prescription in their electronic medical records (EMRs) from June 2015 to June 2017 were included. Patients who had other adjuvant hormonal therapy were excluded from the study. In total, 499 patients (25 males and 474 females) with breast cancer using tamoxifen were included. Our study was purely observational study revealed that prescription of weak inhibitors with tamoxifen increased in the second year as opposed to decrease in the prescription of strong inhibitors. Also, a substantial percentage of patient population were found to be non-adherent to the tamoxifen therapy in this study.

What local experts expect from a health technology assessment (HTA) entity in Saudi Arabia: workshop conclusions.

Objectives: Saudi Arabia is undergoing a massive health-care transformation to fulfill its new, national 'Vision 2030.' To align with this objective, Saudi Arabia is establishing a new, independent and evidence-based health technology assessment (HTA) entity to help it maximizes health gains through efficient use of resources. This study was designed to ascertain how local experts perceive the creation of such a national HTA entity in Saudi Arabia; what they think about it and expect from it.Methods: To achieve study aim, we held two workshops in Riyadh, Saudi Arabia, each lasting three and a half hours and each hosted by the Saudi Ministry of Health (MOH). We invited 26 local experts from a variety of professional backgrounds to discuss the establishment of a national HTA entity.Results: The findings from experts workshops were structured around four axes, namely vision and remit; services provided and technologies covered; process and method; and implementation and practical considerations.Conclusion: This paper discusses the findings of the local experts convened at the workshops relative to their expectations for and views about a national HTA entity within Saudi Arabia.

Vaccination status of patients using anti-TNF therapy and the physicians' behavior shaping the phenomenon: Mixed-methods approach.

OBJECTIVE: Anti-tumor necrosis factor (Anti-TNF) therapy improves the prognosis and reduces the morbidity and mortality associated with many chronic inflammatory autoimmune diseases. However, as it is linked to an increased infection risk, appropriate vaccination is required. The study aimed at investigating the vaccination status of patients receiving Anti-TNF therapy and physicians' perceptions of and views about vaccinating these patients. METHODS: A sequential explanatory mixed-methods approach was used. The study comprised a quantitative, retrospective drug utilization review for determining institutional consumption of Anti-TNF therapy and an assessment of vaccination status in patients prescribed Anti-TNF therapy to audit physicians' adherence to Anti-TNF therapy-related vaccination recommendations. Patient data from electronic medical records (EMRs) obtained from tertiary care hospitals between September 2015 and September 2017 were used. Further, a qualitative study using a phenomenographic approach with semi-structured interviews of 12 physicians was carried out to explore the physicians' perceptions, views, and recommendations of vaccinating patients who are undergoing Anti-TNF therapy and identifying factors that may cause poor adherence to vaccination recommendations. RESULTS: Forty-three of 310 patients receiving Anti-TNF therapy were vaccinated. Infliximab was the most frequently prescribed agent, accounting for 96.7% of total orders. Eight of the 12 physicians stated that they were aware of vaccination guidelines and seven viewed pre-Anti-TNF therapy vaccination as essential because of the high infection risk and claimed to incorporate it in their daily practice. Barriers to adherence included ignorance of recommendations, workload, vaccine unavailability, and advanced disease state. CONCLUSION: Although the recommendations published by professional medical societies emphasized the importance of vaccination before initiating Anti-TNF therapy, few patients were vaccinated. Medical administration in hospitals should develop policies, procedures, and guidelines for vaccination; implement education programs for physicians and patients and procure vaccines in a timely way to improve their use.

The impact of perceived organizational support and resilience on pharmacists' engagement in their stressful and competitive workplaces in Saudi Arabia.

BACKGROUND: In recent years, organizations around the globe have begun measuring the engagement level of employees in order to improve productivity and profitability. Employee engagement has the potential to significantly affect employee retention and loyalty. OBJECTIVE: To explore pharmacists' perceptions of the organizational support and impact of resilience and perceived organizational support on employee engagement in a stressful and competitive work environment. METHODS: We carried out a cross-sectional survey of 81 pharmacists, who were selected as a random sample in Saudi Arabia. Those pharmacists were assigned in highly competitive jobs within organizations such as pharmaceutical companies, hospitals and pharmaceutical distributors. We used the Utrecht Work Engagement Scale (UWES), the Brief Resilience Scale (BRS), and the Perceived Organizational Support Scale (POS) to collect the data, which then was analyzed using the descriptive and analytical tests and multiple logistic regressions in IBM® SPSS® version 24.0. RESULTS: Eighty one out of 100 surveys were collected back with responses-the response rate was 81% (n = 81). We obtained moderate levels of perceived organizational support and resilience; means were 4.6 ±â€¯0.8 and 3.2 ±â€¯0.45, respectively. Demographic variables, resilience, and perceived organizational support predicted were approximately 29.2%, 29.6%, and 36.2%, respectively, of the variance in employee engagement. We also found a significant correlation between the pharmacists' perceptions of organizational support and their engagement (ß = 0.31, p < 0.05), but no statistically significant relationship between resilience and employee engagement. CONCLUSIONS: This study showed how pharmacists' perceptions of organizational support are related to their engagement in the workplace, demonstrating a significant relationship between perceived organizational support and employee engagement.

Rivaroxaban prescribing in a Saudi tertiary care teaching hospital.

PURPOSE: This drug utilization review (DUR) aimed to describe the use of rivaroxaban in a tertiary care teaching hospital and to audit the hospital physicians' prescribing practice. METHODS: This study reviewed rivaroxaban prescriptions for patients admitted to a tertiary care teaching hospital in Riyadh, Saudi Arabia, between October 1, 2016 and January 15, 2017. It included all in-patients who received at least one dose of rivaroxaban, using data from the hospital's health information system (HIS). Appropriateness of prescribing was evaluated based on documented indication, dosing according to the patient's renal function for each approved indication, and restriction policy as per hospital department. RESULTS: During the study period, a total of 343 rivaroxaban prescriptions for 322 patients were identified. Overall, more than 56% of rivaroxaban prescriptions met at least one inappropriate criterion. Inappropriate dosing per patient's creatinine clearance (CrCl) was recognized in 42% of rivaroxaban prescriptions with the majority of these prescriptions issued for lower doses in 82.9% of prescriptions and non-approved indications identified in 14% of rivaroxaban prescriptions. CONCLUSIONS: The introduction of oral rivaroxaban represents a paradigm shift in anticoagulation management. Future longer, larger multi-center research is needed to identify the most effective interventions to enhance rivaroxaban knowledge translation and reduce the likelihood of inappropriate rivaroxaban prescribing and associated economic and side effects sequelae.

Assessing the level of knowledge and available sources of information about hepatitis C infection among HCV-infected Egyptians.

BACKGROUND: Egypt has the largest proportion of hepatitis C virus (HCV) infection worldwide and there is an urgent need to increase community awareness and knowledge about the disease in the country. The main aim of this study was to assess the level of knowledge and awareness about HCV in clinically diagnosed HCV patients in Egypt. METHODS: This was a prospective, cross-sectional study conducted between 1 February 2014 and 30 April 2014 in Cairo, Egypt using validated questionnaire as an instrument for data collection. A structured questionnaire was developed based on similar published surveys. Data collected included demographic characteristics, exposure to the disease, health insurance status, the source of medical information, and knowledge of different routes of transmission; a point was given for each correct answer with a possible score of 0 to 12. RESULTS: A total of 203 patients took part in this study with a response rate of 90%. Most-142 (70%)-were married, 119 (63%) were unemployed, 127 (62.9%) were aged above 50 years, 88 (45.1%) were living in Cairo, and 45 (22.4%) had a college degree. Half of the participants believed that HCV infection is not transmitted through sex, while 79 (39.9%) did not know that HCV could be transmitted from a mother to her infant during labor. A quarter of participants believed that HCV vaccine is available, and 45 (24.6%) never knew if their treatment was successful. The median knowledge score of HCV infection in the survey was 7.5; 100 (50.3%) participants had ≤ median knowledge score of HCV infection. Logistic regression analysis showed a duration of infection (OR 1.647, CI 1.189-2.82) and the participants who visited physicians when only they felt sick were less likely to have the above median knowledge score (> 7.5) of HCV infection (OR 0.41, 95% CI 0.19-0.87). CONCLUSIONS: Considering the unsatisfactory level of HCV knowledge among infected patients, Egyptian healthcare authorities should organize national awareness campaigns encouraging HCV testing based on educational interventions and activities to improve the level of knowledge. More investment in research is also needed to limit the further growth of the HCV disease burden in Egypt.