Computerized pharmacy surveillance and alert system for drug-related problems.

WHAT IS KNOWN AND OBJECTIVE: Because of the impact of drug-related problems (DRPs) on morbidity and mortality, there is a need for computerized strategies to increase drug safety. The detection and identification of the causes of potential DRPs can be facilitated by the incorporation of a pharmacy warning system (PWS) in the computerized prescriber order entry (CPOE) and its application in the routine validation of inpatient drug therapy. A limited number of studies have evaluated a clinical decision support system to monitor drug treatment. Most of these applications have utilized a small range of drugs with alerts and/or types of alert. The objective of this study was to describe the implementation of a PWS integrated in the electronic medical record (EMR). METHODS: The PWS was developed in 2003-2004. Pharmacological information to generate drug alerts was entered on demographic data, drug dosage, laboratory tests related to the prescribed drug and drug combinations (interactions, duplications and necessary combinations). The PWS was applied in the prescription reviews conducted in patients admitted to the hospital in 2012. RESULTS AND DISCUSSION: Information on 83% of the drugs included in the pharmacopeia was introduced into the PWS, allowing detection of 2808 potential DRPs, representing 79·1% of all potential DRPs detected during the study period. Twenty per cent of PWS DRPs were clinically relevant, requiring pharmacist intervention. WHAT IS NEW AND CONCLUSION: The PWS detected most potential DRPs, thus increasing inpatient safety. The detection ability of the PWS was higher than that reported for other tools described in the literature.

Diagnóstico de intoxicación por Nerium oleander: ¿un único método analítico es suficiente? / No disponible

No disponible

Probable síndrome serotoninérgico por interacción entre amitriptilina, paroxetina y linezolid / Likely serotoninergic syndrome from an interaction between amitryptiline, paroxetine, and linezolid

No disponible

[Economic evaluation of voriconazole versus amphotericin B in the treatment of invasive aspergilosis]. / Evaluación económica del uso de voriconazol versus anfotericina B en el tratamiento de la aspergilosis invasiva.

OBJECTIVE: Invasive aspergillosis is an infection with high incidence and mortality. Voriconazole is a new antifungal agent that presents a high efficacy against Aspergillus. The aim of this evaluation was to carry out a pharmacoeconomic analysis of the use of voriconazole versus amphotericin B deoxycholate in the treatment of invasive aspergillosis in Spain. MATERIAL AND METHODS: A cost-effectiveness analysis has been performed by building a decision analytical model. Effectiveness data, probabilities of the different branches of the decision tree and consumption of healthcare resources were obtained from a clinical trial that compared voriconazole versus amphotericin B in the treatment of invasive aspergillosis and from a local expert panel in order to incorporate the model in the daily medical practice in our country. Only direct medical costs were included in the model (drug acquisition, length of hospital stay, analytical tests and treatment of therapeutic failures). The perspective chosen for this analysis was hospital assistance and the time horizon selected was 12 weeks, the maximum time that patients were followed up in the referenced clinical trial. RESULTS: Therapeutic success was reached in 52.8% of patients treated with voriconazole and in 31.6% of the group treated with amphotericin B. The cost of treating a patient with voriconazole or amphotericin B was of 56,296 and 56,382 Euros respectively, while the cost/effectiveness ratio was of 106,621 and 178,424 Euros. The incremental analysis performed shows how the use of voriconazole versus amphotericin B produces a healthcare resources saving of 406 Euros per patient. CONCLUSIONS: Voriconazole is more efficient than amphotericin B deoxycholate in the treatment of invasive aspergillosis, (thus) resulting in healthcare resources saving due to better clinical results with lower associated costs.

Evaluación económica del uso de voriconazol versus anfotericina B en el tratamiento de la aspergilosis invasiva / Economic evaluation of voriconazole versus amphotericin B in the treatment of invasive aspergilosis

Introducción: La aspergilosis invasiva es una infección con una incidencia creciente y una elevada mortalidad asociada. Voriconazoles un antifúngico que ha demostrado una alta eficacia en el tratamiento de esta enfermedad. El objetivo de este estudio ha sido efectuar un análisis farmacoeconómico del uso de voriconazol versus anfotericina B deoxicolato, en el tratamiento de la aspergilosis invasiva en nuestro país. Material y métodos: Se ha elaborado un análisis coste-efectividad empleando un modelo farmacoeconómico elaborado a través de un análisis de decisión. Los datos de efectividad, las probabilidades del árbol de decisión y el consumo de recursos, fueron obtenidos de un ensayo clínico que comparó ambas alternativas terapéuticas y de un panel de expertos local, con el fin de incorporar el modelo a la práctica médica habitual de nuestro medio. Solamente se han incluido en este análisis los costes médicos directos (coste de la medicación, días de hospitalización, analíticas y tratamiento del fallo terapéutico).La perspectiva elegida para el análisis ha sido el hospital, y el horizonte temporal escogido ha sido de 12 semanas, tiempo máximo que los pacientes fueron seguidos en el ensayo clínico de referencia. Resultados: En el estudio de referencia, los pacientes tratados con voriconazol presentaron éxito terapéutico en el 52,8 frente al31,6% en el grupo tratado con anfotericina B deoxicolato. El coste de tratar un paciente con voriconazol o con anfotericina B deoxicolato, fue de 56.296 y 56.382 € respectivamente, mientras que el cociente coste/efectividad medio fue de 106.621 y 178.424 €, al emplear ambas opciones en evaluación. El análisis coste-efectividad incremental efectuado muestra queel uso de voriconazol versus el de anfotericina B deoxicolato,supone un ahorro de recursos sanitarios de 406 € por paciente. Conclusiones: Voriconazol es una opción más eficiente que la anfotericina B deoxicolato en el tratamiento de la aspergilosis invasiva, lo que se traduce en un ahorro de recursos, derivado de producir mejores resultados clínicos con costes asociados más bajos

Objective: Invasive aspergillosis is an infection with high incidence and mortality. Voriconazole is a new antifungal agent that presents a high efficacy against Aspergillus. The aim of this evaluation was to carry out a pharmacoeconomic analysis of the use of voriconazole versus amphotericin B deoxycholate in the treatment of invasive aspergillosis in Spain. Material and methods: A cost-effectiveness analysis has been performed by building a decision analytical model. Effectiveness data, probabilities of the different branches of the decision tree and consumption of healthcare resources were obtained from a clinical trial that compared voriconazole versus amphotericin B in the treatment of invasive aspergillosis and from a local expert panel in order to incorporate the model in the daily medical practice in our country. Only direct medical costs were included in the model (drug acquisition, length of hospital stay, analytical tests and treatmentof therapeutic failures).The perspective chosen for this analysis was hospital assistance and the time horizon selected was 12 weeks, the maximum time that patients were followed up in the referenced clinical trial. Results: Therapeutic success was reached in 52.8% of patients treated with voriconazole and in 31.6% of the group treated with amphotericin B. The cost of treating a patient with voriconazole or amphotericinB was of 56,296 and 56,382 € respectively, while the cost/effectiveness ratio was of 106,621 and 178,424 €.The incremental analysis performed shows how the use of voriconazole versus amphotericin B produces a healthcare resources saving of 406 € per patient. Conclusions: Voriconazole is more efficient than amphotericin B deoxycholate in the treatment of invasive aspergillosis, (thus)resulting in healthcare resources saving due to better clinical results with lower associated costs