RESUMO
OBJECTIVES: Biosimilar infliximab, the first similar biological medicinal product containing monoclonal antibodies to be commercialised, is likely to contribute to a significant reduction in healthcare costs. We aimed to assess the cost savings potential over 1â year of the use of biosimilar infliximab for the treatment of rheumatoid arthritis (RA) patients in Alsace and in France, in a real-life setting. METHODS: The analysis was based on a previously conducted observational study which evaluated the annual cost of the care of patients with RA treated with biological therapies in 2012 in Alsace. Average annual costs to manage RA patients were calculated, taking into account the decrease in the retail price between 2012 and 2015 (as given in the official national price list) and the local negotiated price for biosimilar infliximab. Annual cost savings for different biosimilar prescription scenarios were calculated using 2015 prices. RESULTS: Management of RA patients with biosimilar infliximab was significantly cheaper than with adalimumab or etanercept (11â 907 vs 12â 981 and 13â 551, respectively). The projected annual cost savings reached 13.6â million nationally, if all adult RA patients treated with the originator infliximab switched to the biosimilar drug. These savings, if fully reallocated for the treatment of RA, would enable the treatment of 1141 additional patients. CONCLUSIONS: The study showed a positive financial impact of introducing biosimilar infliximab for the treatment of RA patients in France. Such savings could contribute to improved patient care by allowing more patients to be treated without more money being spent.
RESUMO
BACKGROUND: Medication care is a complicated process in nursing homes. The aim of the study was to offer an overview of inappropriate medication prescription and administration practices in nursing homes in Alsace in order to propose improvement actions to remedy the weaknesses identified. METHODS: This study was conducted prospectively in 10 nursing homes under contract with community pharmacies in Alsace. The practices of prescription were examined to determine the prevalence of potentially inappropriate medications, inappropriate and contraindicated medication associations. Crushing and opening practices were also assessed, daily treatment costs were calculated. RESULTS: Two hundred and eighty-four residents were included (age: 87.1 ± 5.6 years). The average number of drugs per resident was 8.1 ± 4.0 (daily treatment cost: 4.19 ± 5.21 ). On average, 1.5 drugs ± 1.4 per prescription were considered as potentially inappropriate (daily treatment cost: 0.49 ± 0.76 ). The contraindication associations concerned 8 % of prescriptions and involved potentially inappropriate drugs in 60 % of cases. Inappropriate associations mainly concerned nervous system drugs. Thirty-three residents were taking more than 2 psychotropic drugs; 23 had more than one benzodiazepine. Regarding drug administration, practices differed from one nursing home to another. Crushing was performed in 8 nursing homes. It concerned 20 residents (7 %) and 69 drugs. In 50 %, the crushing decision was made by nurses without physician or pharmacist supervision. Fifty-seven percent of crushed drugs had a formulation which did not allow crushing (n=39 drugs). The analysis of those items led to the proposal of improvement actions. CONCLUSION: This study pointed out inappropriate medication practices. Tracking tools for inappropriate clinical practices could be operated by physicians, pharmacists and nursing teams through coordinated multidisciplinary approaches.
Assuntos
Uso de Medicamentos/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Formas de Dosagem , Custos de Medicamentos , Prescrições de Medicamentos/economia , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Feminino , França/epidemiologia , Humanos , Prescrição Inadequada/economia , Masculino , Erros de Medicação/economia , Casas de Saúde/economia , PrevalênciaRESUMO
BACKGROUND: Medication care of patients in nursing homes involves a complex circuit whose related risks need to be identified. The aim of this study was first to map risks related to medication care in a representative panel of nursing homes under contract with community pharmacies in Alsace, then to propose improvement action plans to remedy the weaknesses identified. METHODS: This study was conducted on a representative sample of 23 nursing homes in Alsace in 2014. A self-assessment questionnaire (Interdiag EHPAD), divided into 7 fields and made up of 198 questions, was completed by each of the 23 nursing homes during multidisciplinary meetings that were organized by the OMEDIT (observatoire du médicament, des dispositifs médicaux et de l'innovation thérapeutique of Alsace). The percentages of controlled risks were calculated for each of the 7 fields of the medication circuit, both at nursing home and regional levels. Similarly, the percentages of non-controlled risks were calculated for each of the 198 items. RESULTS: Considering the 7 fields, regional percentages of controlled risks varied from 63% to 85%. The field relative to drug supply was the best controlled, while that relative to prevention was the least controlled. Considering the 198 items, 30 important vulnerability points were identified, among which stand out: failure to report and to analyze adverse drug events, lack of involvement of general practitioner in nursing homes through collaborative approaches and transcription by nurse staff of oral or handwritten prescriptions in medical software. The analysis of those items led to the proposal of 13 improvement actions. CONCLUSION: The study pointed out mainly difficulties linked to the absence of suitable risk management policies and the lack of adjustment between nursing home staffs and general practitioners. In contrast, it revealed that the collaboration between nursing homes and community pharmacies was successful overall. Finally, we hope that this multi-center study, that led to identify concrete proposals, will help nursing homes to improve the quality of medication care for their residents.