Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.411
Filtrar
1.
J Dairy Sci ; 103(1): 473-491, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629507

RESUMO

Antibiotics use (ABU) in animal agriculture has been implicated in the emergence of antibiotic resistance, a global public health threat. Economically justifiable antibiotic reduction strategies can motivate farmers to reduce ABU for clinical mastitis (CM) and metritis, the most common reasons for ABU on dairy farms. Our objective was to quantify the reduction in incidence of CM, metritis, and ABU, and the herd performance of a representative US herd that uses genomic selection for Lifetime Net Merit 2018 (NM$) selection index, compared with genetic selection based only on the mastitis (MAST) or metritis resistance (METR) trait or a health trait subindex (HTH$). A stochastic dynamic simulation model of a 1,000-cow herd with multi-trait genetics for 19 correlated traits included in the NM$ affected the performance of animals. The incidence of CM and metritis for each animal was affected by the genetic and environmental components of the MAST or METR, along with a standard phenotypic function that calculated the daily underlying herd probability to contract CM or metritis. Selection decisions were made based on genomic estimated breeding values of the traits of interest. A strategy named AI-NM$ based decisions on the NM$ trait so that the correlated genetic trends in MAST and METR are improved. Three other strategies named AI-MAST, AI-METR, and AI-HTH$ maximized respectively MAST, METR, and HTH$ genetic merit, but with a tradeoff in NM$ genetic merit. The cumulative true breeding values (TBV) of NM$ for 15 yr showed a difference of $4,947 per cow between the AI-NM$ (best strategy for NM$) and AI-METR (worst strategy for NM$). However, the 15-yr cumulative TBV of MAST was 26.50 percentage points (PP) higher in AI-MAST, and 18.5 PP higher for METR in AI-METR, compared with AI-NM$. As a result, the 15-yr cumulative phenotypic CM and metritis incidence was respectively 94.03 PP and 58 PP lower in AI-MAST and AI-METR compared with AI-NM$. Therefore the corresponding 15-yr cumulative ABU decreased by 42% in AI-MAST and by 53% in AI-METR. We found that AI-MAST had the lowest CM incidence across the 15 yr, whereas AI-METR had the lowest incidence of metritis and the smallest total ABU for 15 yr. To achieve the lowest incidence of CM, metritis, and ABU strategies AI-MAST, AI-METR, and AI-HTH$ had to incur 15-yr discounted cumulative losses per cow of $1,486, $1,434, and $1,130, respectively, compared with AI-NM$. Hence, AI-NM$ had the best financial performance, despite having slightly higher incidence of CM, metritis, and ABU.


Assuntos
Antibacterianos/economia , Cruzamento , Doenças dos Bovinos/economia , Indústria de Laticínios/economia , Doença Inflamatória Pélvica/veterinária , Seleção Genética , Animais , Bovinos , Doenças dos Bovinos/tratamento farmacológico , Doenças dos Bovinos/epidemiologia , Cruzamentos Genéticos , Uso de Medicamentos/economia , Feminino , Genômica , Incidência , Doença Inflamatória Pélvica/tratamento farmacológico , Doença Inflamatória Pélvica/economia , Doença Inflamatória Pélvica/epidemiologia , Fenótipo
2.
Artigo em Inglês | MEDLINE | ID: mdl-31547325

RESUMO

The over-use of antibiotics has been identified as a major global challenge, where there is insufficient knowledge about the use of antibiotics in primary healthcare settings, especially at a population level. This study aims to investigate the trends and patterns of antibiotic sales in primary care in Hubei, China over a six-year period from 2012 to 2017. Antibiotic sales were expressed with Defined Daily Doses per 1000 inhabitants per day (DIDs) and compared with European countries using the 12 quality indicators proposed by the scientific advisory board of the European Surveillance of Antimicrobial Consumption (ESAC) project. Antibiotic sales increased from 12.8 DID in 2012 to 15.3 DID in 2013, and then declined afterwards. The most commonly used antibiotics, J01C (beta-lactam antimicrobials, penicillins), accounted for 40.5% of total antibiotic sales. Parenteral administration of antibiotics accounted for over 50% of total antibiotic sales. Total antibiotic sales were almost on a par with the 31 European countries monitored by the ESAC project, but cephalosporin sales were higher than at least three quarters of the compared countries, resulting in a significant higher proportion of third-generation cephalosporin consumption (13.8-19.43%). The relative consumption of Fluoroquinolone (9.26-9.89%) was also higher than at least half of the compared countries. There is a lack of robust evidence to show that antibiotic consumption in primary care is lower in Hubei compared with other countries. The preference of clinicians in China to use broad-spectrum and parenteral antibiotics deserves further study and policy attention.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Antibacterianos/classificação , Antibacterianos/economia , China , Comércio , Uso de Medicamentos/economia , Humanos
3.
Am J Health Syst Pharm ; 76(18): 1413-1419, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31372630

RESUMO

PURPOSE: Inhaled epoprostenol and inhaled nitric oxide are pulmonary vasodilators commonly used in the management of acute respiratory distress syndrome and right ventricular failure; however, they have vastly different cost profiles. The purpose of the project was to transition from nitric oxide to epoprostenol as the inhaled pulmonary vasodilator (IPV) of choice in adult critically ill patients and evaluate the effect of the transition on associated usage and costs. METHODS: A single-center, prospective, before and after quality improvement project including adult patients receiving inhaled nitric oxide, inhaled epoprostenol, or both was conducted in 7 adult intensive care units, operating rooms, and postanesthesia care units of a tertiary care academic medical center. The total number of patients, hours of therapy, and costs for each agent were compared between stages of protocol implementation and annually. RESULTS: Seven hundred twenty-nine patients received inhaled nitric oxide, inhaled epoprostenol, or both during the study period. The monthly inhaled nitric oxide use in number of patients, hours, and cost decreased during all stages of the project (p < 0.01). The monthly inhaled epoprostenol use in number of patients, hours, and cost increased during all stages (p < 0.01). Overall, total IPV use increased during the study. However, despite this increase in usage, there was a 47% reduction in total IPV cost. CONCLUSION: Implementation of a staged protocol to introduce and expand inhaled epoprostenol use in adult critically ill patients resulted in decreased use and cost of inhaled nitric oxide. The total cost of all IPV was decreased by 47% despite increased IPV use.


Assuntos
Epoprostenol/administração & dosagem , Óxido Nítrico/administração & dosagem , Melhoria de Qualidade/organização & administração , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Vasodilatadores/administração & dosagem , Administração por Inalação , Adulto , Redução de Custos/economia , Redução de Custos/estatística & dados numéricos , Estado Terminal/terapia , Custos de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Epoprostenol/economia , Implementação de Plano de Saúde , Humanos , Pulmão/irrigação sanguínea , Pulmão/efeitos dos fármacos , Óxido Nítrico/economia , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Melhoria de Qualidade/economia , Melhoria de Qualidade/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Adulto/economia
4.
J Manag Care Spec Pharm ; 25(8): 859-866, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347980

RESUMO

BACKGROUND: Discarding unused drugs after dose changes or discontinuation can significantly affect pharmacy budgets. This is especially concerning for expensive oncology agents. However, few economic studies account for drug wastage, providing an inaccurate estimate of a drug's actual economic cost, cost-effectiveness, and value. OBJECTIVES: To (a) compare the economic impact of drug wastage between ribociclib and palbociclib-clinically similar oral medications for metastatic breast cancer-using 3 approaches (Markov model, pharmacy acquisition cost model, and a retrospective claims analysis) and (b) compare the modeling results with a published estimate of drug wastage for palbociclib from a claims analysis. METHODS: A Markov model and a pharmacy acquisitions cost model were developed to evaluate the economic impact of dose reductions for ribociclib and palbociclib over a 1-year time period. Data inputs were pharmacy costs (RED BOOK wholesale acquisition cost) and proportion of patients experiencing dose reductions from either ribociclib randomized clinical trials (MONALEESA-2, -3, or -7) or real-world observational data (Symphony Health retrospective claims analysis). The latter constituted the third approach for quantifying drug wastage. The economic impact of dose reductions for ribociclib and palbociclib in postmenopausal women with previously untreated HR-positive/HER2-negative advanced breast cancer was assessed. Drug wastage was defined as drug doses that could not be used by a patient following a dose reduction. The cost of drug wastage was defined as the cost associated with an unused drug resulting from a dose reduction. The predicted results from the 2 models were compared with a previously published claims analysis that estimated the effect of treatment costs and drug wastage for palbociclib based on the observed dosing patterns from the Symphony Health Solutions database. RESULTS: In the Markov model, relative to ribociclib, palbociclib users experienced drug wastage of $112,382 total, or $1,124 per treated patient, per year due to dose changes. In the pharmacy acquisition cost model, relative to ribociclib, palbociclib usage was associated with an increased cost of $7,196 per patient per year (based on a mid-cycle dose reduction) comprising dosing-based cost differences and drug wastage cost for palbociclib of $3,727. The previously published claims analysis found that palbociclib users experiencing a dose reduction had drug wastage costs of $5,471 per patient. CONCLUSIONS: In both models, dose reductions for ribociclib patients resulted in no wastage, since unused tablets could be administered in subsequent cycles, while dose reductions for palbociclib resulted in drug wastage and increased costs. The results from both models were consistent with previously published results from the claims analysis, demonstrating drug wastage costs for palbociclib. DISCLOSURES: This study received financial support from Novartis Pharmaceuticals, which has products approved for treatment of breast cancer. Tang was employed by Novartis during this study; Zacker and Dalal are employed by Novartis and own company stock. Biskupiak, Brixner, and Oderda received payment from Novartis for this study. Brixner serves as a consultant for Millcreek Outcomes Group and also declares consulting fees from Abbvie, AstraZeneca, Abbott, Becton Dickinson, and Xcenda, unrelated to this study.


Assuntos
Aminopiridinas/economia , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/economia , Uso de Medicamentos/economia , Piperazinas/economia , Purinas/economia , Piridinas/economia , Aminopiridinas/uso terapêutico , Análise Custo-Benefício/economia , Custos de Medicamentos , Estudos de Avaliação como Assunto , Feminino , Custos de Cuidados de Saúde , Humanos , Pessoa de Meia-Idade , Modelos Econômicos , Piperazinas/uso terapêutico , Purinas/uso terapêutico , Piridinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
5.
Am J Health Syst Pharm ; 76(15): 1105-1121, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31199861

RESUMO

PURPOSE: Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2019 in nonfederal hospitals, clinics, and overall (all sectors). METHODS: Drug expenditure data through calendar year 2018 were obtained from the IQVIA National Sales Perspectives database and analyzed. New drug approvals, patent expirations, and other factors that may influence drug spending in hospitals and clinics in 2019 were also reviewed. Expenditure projections for 2019 for nonfederal hospitals, clinics, and overall (all sectors) were made through a combination of quantitative analyses and expert opinion. RESULTS: U.S. prescription sales in calendar year 2018 totaled $476.2 billion, a 5.5% increase from 2017 spending. The top 3 drugs by expenditures were adalimumab ($19.1 billion), insulin glargine ($9.3 billion), and etanercept ($8.0 billion). Prescription expenditures in nonfederal hospitals totaled $35.8 billion, a 4.8% increase from 2017. Expenditures in clinics in 2018 increased by 13.0% to $80.5 billion. The increase in spending in nonfederal hospitals was largely driven by new products and increased utilization of existing products. The list of the top 25 drugs by expenditures in nonfederal hospitals and clinics was dominated by specialty drugs. CONCLUSION: We predict continued moderate growth of 4-6% in overall drug expenditures (across the entire U.S. market). We expect the clinic sector to continue to experience high (11-13%) growth in drug spending in 2019. Finally, for nonfederal hospitals we anticipate growth in the range of 3-5%. These estimates are at the national level. Health-system pharmacy leaders should carefully examine local drug utilization patterns to determine their own organization's anticipated spending in 2019.


Assuntos
Custos de Medicamentos/tendências , Gastos em Saúde/tendências , Medicamentos sob Prescrição/economia , Bases de Dados Factuais/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/tendências , Gastos em Saúde/estatística & dados numéricos , Humanos , Estados Unidos
7.
Health Serv Res ; 54(4): 752-763, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31070264

RESUMO

OBJECTIVE: To analyze factors associated with changes in prescription drug use and expenditures in the United States from 1999 to 2016, a period of rapid growth, deceleration, and resumed above-average growth. DATA SOURCES/STUDY SETTING: The Medical Expenditure Panel Survey (MEPS), containing household and pharmacy information on over five million prescription drug fills. STUDY DESIGN: We use nonparametric decomposition to analyze drug use, average payment per fill, and per capita expenditure, tracking the contributions over time of socioeconomic characteristics, health status and treated conditions, insurance coverage, and market factors surrounding the patent cycle. DATA COLLECTION/EXTRACTION METHODS: Medical Expenditure Panel Survey data were combined with information on drug approval dates and patent status. PRINCIPAL FINDINGS: Per capita utilization increased by nearly half during 1999-2016, with changes in health status and treated conditions accounting for four-fifths of the increase. In contrast, per capita expenditures more than doubled, with individual characteristics only explaining one-third of the change. Other drivers of spending during this period include the changing pipeline of new drugs, drugs losing exclusivity, and changes in generic competition. CONCLUSIONS: Long-term trends in treated conditions were the fundamental drivers of medication use, whereas factors involving the patent cycle accelerated and decelerated spending growth relative to trends in use.


Assuntos
Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Medicamentos sob Prescrição/economia , Medicamentos Genéricos/economia , Nível de Saúde , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro de Serviços Farmacêuticos/estatística & dados numéricos , Patentes como Assunto/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos
8.
J Manag Care Spec Pharm ; 25(6): 646-651, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31134855

RESUMO

BACKGROUND: Dipeptidyl peptidase-4 (DPP-4) inhibitors have repeatedly shown no reduction in the clinical outcomes of cardiovascular death, myocardial infarction, stroke, or all-cause mortality. Because the treatment of diabetes is generally one of the top drug categories by cost to health plans and self-funded employers, it is necessary to evaluate coverage of DPP-4 inhibitors, considering their lack of cardiovascular benefit relative to other treatment options. OBJECTIVE: To describe the cost and utilization outcomes of drugs used to treat diabetes after exclusion of DPP-4 inhibitors in a self-funded managed care plan. METHODS: This study was a retrospective, descriptive analysis of the cost and utilization outcomes after exclusion of DPP-4 inhibitors. Pharmacy claims data and plan membership were analyzed 6 months before DPP-4 inhibitor exclusion (preperiod: December 1, 2016-May 31, 2017) and 6 months after DPP-4 inhibitor coverage ended for all users (postperiod: September 1, 2017-February 28, 2018). The allowed amount, which is not influenced by overlapping plan copay changes, and utilization per member per month (PMPM) were used to estimate the effect of the DPP-4 inhibitor benefit exclusion on plan costs for the antidiabetic class. RESULTS: From preperiod to postperiod, all DPP-4 inhibitor products decreased in utilization by 3.02 claims per 1,000 members per month (PTMPM). Glucagon-like peptide-1 receptor agonists, insulins, sodium-glucose cotransporter-2 inhibitors, and thiazolidinedione claims increased by 0.72, 0.43, 0.30, and 0.48 claims PTMPM, respectively, but there was an absolute decrease of 1.35 claims for antidiabetic medications per 1,000 plan members. However, the days supplied PMPM increased from 2.55 to 2.61 (2.3%) days. Allowed amount PMPM increased by $0.27 from $12.19 in the preperiod to $12.31 in the postperiod (2.2%). However, it is estimated that drug cost inflation accounted for over half of the PMPM increase in allowed costs. CONCLUSIONS: The observed increase in the allowed amount PMPM was attributable in similar amounts by an increase in utilization of medications with higher cost per day supplied and higher drug prices. Future research will evaluate patient-level effects of this benefit change in terms of antidiabetic medication utilization and outcomes. DISCLOSURES: No outside funding supported this study. Davis, Bemberg, and Johnson currently work for or previously worked for the UAMS Evidence-Based Prescription Drug Program, which advises the Employee Benefits Division (EBD) on pharmacy benefit management. The EBD did not provide any additional funding for this study. McAdam-Marx reports grants from AstraZeneca and Sanofi Aventis outside the submitted work. The other authors have no other relevant information to disclose.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/economia , Custos de Medicamentos/estatística & dados numéricos , Hipoglicemiantes/economia , Programas de Assistência Gerenciada/estatística & dados numéricos , Diabetes Mellitus Tipo 2/economia , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Planos de Assistência de Saúde para Empregados/economia , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Humanos , Hipoglicemiantes/uso terapêutico , Revisão da Utilização de Seguros/estatística & dados numéricos , Seguro de Serviços Farmacêuticos/economia , Seguro de Serviços Farmacêuticos/estatística & dados numéricos , Programas de Assistência Gerenciada/economia , Estudos Retrospectivos
9.
J Manag Care Spec Pharm ; 25(6): 688-695, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31134865

RESUMO

BACKGROUND: Medication therapy management (MTM) programs are designed to improve clinical outcomes and enhance appropriate medication use. Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are 2 broad interventions defined within MTM services. While MTM services have been extensively researched, there are few comparisons of CMR versus non-CMR interventions. Given the variability in MTM interventions and lack of a consistent TMR definition in the literature, this study sought to compare CMRs and TMRs that were clearly defined based on Centers for Medicare & Medicaid Services (CMS) criteria. OBJECTIVES: To (a) compare acute inpatient admissions and emergency department (ED) visits between patients participating in MTM services (CMR, TMR, or both) and eligible nonparticipating patients and (b) examine the effect of receiving TMR services on medication adherence. METHODS: This was a retrospective cohort study of patients with Medicare Part D coverage who received MTM services and a 1:1 propensity score-matched control group. Participants had to be eligible for MTM services in 2014 or 2015 based on CMS requirements. CMRs were offered to all MTM-eligible patients, while TMRs were completed based on clinical rules that helped identify medication-related problems (MRPs). The date of MTM intervention, or eligibility for the control group, was considered the index date. Participants had to be continuously enrolled in a Medicare Advantage plan that included prescription drug coverage during the study period and have at least 6 months of data before and after the index date. Medical and pharmacy claims were assessed to examine trend-adjusted inpatient admissions and ED visits from pre-index to post-index date for participants and matched controls. RESULTS: In 2014 and 2015, receipt of TMR interventions was associated with statistically significant reductions in acute inpatient admissions. In 2014, there were 55.2 fewer admits per 1,000 individuals (95% CI = 29-81) and 30.8 fewer admits per 1,000 individuals in 2015 (95% CI = 20-42). Receipt of CMR-only interventions was associated with fewer acute inpatient admissions only when coupled with preidentification of MRPs (36.8 [95% CI = 25-49] fewer admits per 1,000 individuals). In 2015, there were significant reductions in ED visits for participants receiving TMR-only interventions or TMR/CMR interventions (26.1 [95% CI = 11-41] and 12.0 [95% CI = 1-23] fewer ED visits per 1,000 individuals, respectively). In both years, a larger percentage (0.4% for oral diabetes medications; 7.7% for antihypertensives; 3.0% for statins) of MTM participants had greater improvements in medication adherence in the post-index period compared with controls. CONCLUSIONS: Receiving MTM services targeted at resolution of MRPs (TMR or CMR/TMR) resulted in positive reductions in health care utilization and increases in medication adherence. Given the importance of optimal medication utilization, this study highlights the need for additional focus on resolution of MRPs through TMRs and CMRs that can support improved clinical outcomes. DISCLOSURES: No outside funding supported this study. Researchers completed the work as part of their employment with Humana. All authors are or were employees of Humana at the time of the study. There are no other conflicts of interest to disclose. This study was previously presented at AMCP Nexus 2017 on October 16, 2017, in Dallas, TX.


Assuntos
Medicare Part D/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Farmácias/organização & administração , Idoso , Idoso de 80 Anos ou mais , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Medicare Part D/economia , Conduta do Tratamento Medicamentoso/economia , Pessoa de Meia-Idade , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Farmácias/economia , Farmácias/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
12.
J Hosp Infect ; 102(4): 369-376, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30880265

RESUMO

BACKGROUND: Antimicrobial stewardship programmes (ASPs) include strategies that enable sustainable management of rational anti-infective treatment in the clinical setting. The successful introduction of ASPs requires close interdisciplinary collaboration among various health professionals, including the hospital management. So far, ASPs have been evaluated mainly from a clinical-pharmacological and infectious disease perspective. AIM: To identify and evaluate parameters with decisive significance for the economic impact of ASPs. METHODS: A systematic literature search for peer-reviewed health-economic studies associated with antimicrobial stewardship programmes was performed. Primary outcomes included savings in drug costs and lower revenue losses for hospitals. FINDINGS AND CONCLUSIONS: A total of 16 studies met all inclusion criteria. Most of the evidence from published clinical trials demonstrated savings through reduced direct cost of antibiotics. However, there are also studies that prove revenue effects of ASPs through decreases in length of stay and readmission rates.


Assuntos
Antibacterianos/economia , Gestão de Antimicrobianos/economia , Uso de Medicamentos/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitais , Antibacterianos/uso terapêutico , Humanos
13.
J Affect Disord ; 249: 278-285, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30784725

RESUMO

BACKGROUND: We aimed at describing the trends in antidepressants use (AD) by age and sex, during 2007-2011, in 5 European settings (Sweden, Norway, Denmark, Catalonia and Veneto), and to assess whether the differences found across settings could be related to economic, social and cultural determinants. METHODS: We collected data of AD use expressed in defined daily doses (DDD). Data were retrieved from population-based databases. We calculated DDD/1000 inhabitants/day. We analysed which economic, social, and cultural covariates determined between-settings differences in AD consumption. RESULTS: The use of AD showed an increasing trend during the study period, being Selective Serotonin Reuptake Inhibitors the most consumed, followed "others AD". Women and the elderly showed the highest AD consumption. Between-settings variability in AD consumption showed a positive correlation with pharmaceutical expenditure and a negative one with general practitioner's rate. After adjusting by pharmaceutical expenditure and general practitioners rate Masculinity, Long-Term Orientation and Individualism cultural dimensions were associated with AD use by using the Hofstede´s cultural dimensions model. LIMITATIONS: This study has been conducted in administrative databases, with no information on AD use by indication; differences among AD use could be related to their prescription for other disorders. Analyses were based on a small dataset and none of the results reached statistical significance. CONCLUSIONS: AD use increased through 2007-2011. Pharmaceutical expenditure and General Practitioners rate, Masculinity, Long-Term Orientation and Individualism explained the differences in AD use between countries. People's attitude should be considered when designing national campaigns to improve antidepressant use.


Assuntos
Antidepressivos/uso terapêutico , Características Culturais , Transtorno Depressivo/tratamento farmacológico , Uso de Medicamentos/estatística & dados numéricos , Fatores Etários , Idoso , Antidepressivos/economia , Bases de Dados Factuais , Uso de Medicamentos/economia , Feminino , Humanos , Masculino , Masculinidade , Honorários por Prescrição de Medicamentos , Inibidores de Captação de Serotonina/uso terapêutico , Fatores Sexuais , Fatores Socioeconômicos
15.
Drug Alcohol Depend ; 194: 13-19, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30390550

RESUMO

OBJECTIVES: Medical marijuana use may substitute prescription opioid use, whereas nonmedical marijuana use may be a risk factor of prescription opioid misuse. This study examined the associations between recreational marijuana legalization and prescription opioids received by Medicaid enrollees. METHODS: State-level quarterly prescription drug utilization records for Medicaid enrollees during 2010-2017 were obtained from Medicaid State Drug Utilization Data. The primary outcome, opioid prescriptions received, was measured in three population-adjusted variables: number of opioid prescriptions, total doses of opioid prescriptions in morphine milligram equivalents, and related Medicaid spending, per quarter per 100 enrollees. Two difference-in-difference models were used to test the associations: eight states and DC that legalized recreational marijuana during the study period were first compared among themselves, then compared to six states with medical marijuana legalized before the study period. Schedule II and III opioids were analyzed separately. RESULTS: In models comparing eight states and DC, legalization was not associated with Schedule II opioid outcomes; having recreational marijuana legalization effective in 2015 was associated with reductions in number of prescriptions, total doses, and spending of Schedule III opioids by 32% (95% CI: (-49%, -15%), p = 0.003), 30% ((-55%, -4.4%), p = 0.027), and 31% ((-59%, -3.6%), p = 0.031), respectively. In models comparing eight states and DC to six states with medical marijuana legalization, recreational marijuana legalization was not associated with any opioid outcome. CONCLUSIONS: No evidence suggested that recreational marijuana legalization increased prescription opioids received by Medicaid enrollees. There was some evidence in some states for reduced Schedule III opioids following the legalization.


Assuntos
Analgésicos Opioides/administração & dosagem , Legislação de Medicamentos/tendências , Uso da Maconha/tendências , Medicaid/tendências , Maconha Medicinal/administração & dosagem , Medicamentos sob Prescrição/administração & dosagem , Analgésicos Opioides/economia , Uso de Medicamentos/economia , Uso de Medicamentos/tendências , Feminino , Humanos , Legislação de Medicamentos/economia , Masculino , Uso da Maconha/economia , Medicaid/economia , Maconha Medicinal/economia , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Medicamentos sob Prescrição/economia , Fatores de Risco , Estados Unidos/epidemiologia
16.
J Antimicrob Chemother ; 74(1): 234-241, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30376118

RESUMO

Background: The need for antifungal stewardship is gaining recognition with increasing incidence of invasive fungal infection (IFI) and antifungal resistance alongside the high cost of antifungal drugs. Following an audit showing suboptimal practice we initiated an antifungal stewardship programme and prospectively evaluated its impact on clinical and financial outcomes. Patients and methods: From October 2010 to September 2016, adult inpatients receiving amphotericin B, echinocandins, intravenous fluconazole, flucytosine or voriconazole were reviewed weekly by an infectious diseases consultant and antimicrobial pharmacist. Demographics, diagnosis by European Organization for Research and Treatment of Cancer (EORTC) criteria, drug, indication, advice, acceptance and in-hospital mortality were recorded. Antifungal consumption and expenditure, and candidaemia species and susceptibility data were extracted from pharmacy and microbiology databases. Results: A total of 432 patients were reviewed, most commonly receiving AmBisome® (35%) or intravenous fluconazole (29%). Empirical treatment was often unnecessary, with 82% having no evidence of IFI. Advice was given in 64% of reviews (most commonly de-escalating or stopping treatment) and was followed in 84%. Annual antifungal expenditure initially reduced by 30% (£0.98 million to £0.73 million), then increased to 20% above baseline over a 5 year period; this was a significantly lower rise compared with national figures, which showed a doubling of expenditure over the same period. Inpatient mortality, Candida species distribution and rates of resistance were not adversely affected by the intervention. Conclusions: Provision of specialist input to optimize antifungal prescribing resulted in significant cost savings without compromising on microbiological or clinical outcomes. Our model is readily implementable by hospitals with high numbers of at-risk patients and antifungal expenditure.


Assuntos
Antifúngicos/uso terapêutico , Gestão de Antimicrobianos/métodos , Candidemia/tratamento farmacológico , Uso de Medicamentos/normas , Hospitais de Ensino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Farmacorresistência Fúngica , Uso de Medicamentos/economia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Londres , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
17.
Can J Diabetes ; 43(3): 179-185.e1, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30545737

RESUMO

OBJECTIVES: To describe insulin utilization and spending across Canada and investigate how interprovincial variations in long-acting insulin uptake impact provincial spending. METHODS: We conducted a cross-sectional time-series analysis of insulin products dispensed nationally from January 1, 2010, to December 31, 2015, using data from IQVIA (Durham, North Carolina, United States). Analysis was stratified according to insulin type, payer and province. We report annual numbers for national insulin dispensing and spending and provincial numbers for publicly funded long-acting insulin dispensing and spending rates that are standardized by public drug beneficiary enrolment and diabetes prevalence. We report the percent of change of an annual provincial cost-to-utilization index of total insulin spending to total insulin dispensing between 2010 and 2015. RESULTS: Between 2010 and 2015, total insulin utilization increased 21% (4.4 million to 5.3 million prescriptions), and total insulin costs increased 54% ($345 million to $530 million) nationally. The national dispensing rate of long-acting insulin (+96%) and rapid-acting insulin (+38%) increased, while the national dispensing rate for intermediate-acting (-23%), short-acting (-37%) and premixed (-28%) insulins declined. Large interprovincial variation was observed for the rate of long-acting insulin uptake (range, Alberta, +1,505%; British Columbia, +27%) and the rate of long-acting insulin spending (Alberta, +2,177%; British Columbia, +44%) between 2010 and 2015 after standardization. Provinces with higher rates of long-acting insulin uptake experienced faster increases in their cost-to-utilization index (Alberta, +78%; British Columbia, +24%). CONCLUSIONS: Overall, the rate of uptake of long-acting insulins has increased nationally. Uptake varies widely among provinces and is likely to be associated with differential cost increases across public payers in Canada.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Uso de Medicamentos/tendências , Insulina/uso terapêutico , Canadá/epidemiologia , Custos e Análise de Custo , Estudos Transversais , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Uso de Medicamentos/economia , Insulina/economia
18.
J Am Coll Surg ; 228(2): 171-179, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30453056

RESUMO

BACKGROUND: Bariatric surgical procedures are an effective and enduring treatment for severe obesity. In addition to improvements in health status, bariatric operations have been noted to potentially decrease postoperative healthcare costs, particularly medication use. STUDY DESIGN: We performed a longitudinal analysis of 2007-2012 claims data comparing a bariatric surgical cohort with a propensity-matched nonsurgical control group during a 5-year time period. Truven Health Analytics MarketScan Commercial Claims and Encounters Database, with a total enrollment of 56 million covered lives from all insurers and representing all 50 states, was used. An initial sample of 384,343 obese patients was identified, with a total of 5,978 matched 1:1 pairs of obese bariatric surgical patients and nonsurgical control patients designated after matching and propensity score matching procedure. Two thousand seven hundred of those matched pairs had at least 4 years of follow-up after index date. RESULTS: The matched cohorts included 2,700 patients (77.2% female, mean age 47.1 years). During the 4-year follow-up period, bariatric surgical patients had 22.6% lower pharmacy costs compared with nonsurgical control patients (p < 0.001). Mean total pharmacy costs showed a sustained decrease in the surgical group compared with the matched control group ($8,411 vs $9,900; p < 0.001). Medication use in the surgical group declined significantly from 1 year preoperative to 4 years postoperative in contrast to the control group. In the 4-year postoperative period, the numbers of antidiabetic, antihypertensive, and cardiac prescriptions in the surgical patients were reduced by 73.7%, 48.3%, and 48.9%, respectively, compared with the control patients. CONCLUSIONS: Total pharmacy use and costs showed a significant and sustained reduction during a 4-year follow-up period among patients undergoing gastric bypass or band operations in comparison with a propensity-matched control group.


Assuntos
Cirurgia Bariátrica/economia , Uso de Medicamentos/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Obesidade Mórbida/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fármacos Cardiovasculares/economia , Fármacos Cardiovasculares/uso terapêutico , Uso de Medicamentos/economia , Feminino , Humanos , Hipoglicemiantes/economia , Hipoglicemiantes/uso terapêutico , Estudos Longitudinais , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Obesidade Mórbida/tratamento farmacológico , Obesidade Mórbida/economia , Período Pós-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
19.
Int J Clin Pharm ; 41(1): 81-87, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30478491

RESUMO

Background In the South African private sector context, generically similar products are grouped together and the reimbursement rate is set at the average price of the generically equivalent products. Very little evidence exists in low and middle-income countries with regards to the impact of this policy over time. Objectives To determine the impact of the introduction of generics and generic reference pricing on candesartan and rosuvastatin in the South African private health care sector in terms of medicine utilisation, medicine price and medicine expenditure. Setting South African private health sector. Method Medicine claims for candesartan and rosuvastatin was obtained from a Pharmacy Benefit Manager in South Africa. The claims covered a 48-month period from January 2012 to December 2015 and provided a pre- and post-reference price period for analysis. Medicine utilisation was measured as the number of Defined Daily Doses dispensed per 100,000 beneficiaries. Medicine price and expenditure was calculated as the average per Defined Daily Dose. Main outcome measure Medicine utilisation, price and expenditure. Results Candesartan experienced an average 7.0% year-on-year decline in utilisation and rosuvastatin a 5.0% increase. Medicine expenditure reduced by an additional 34.6% and 20.9% for candesartan and rosuvastatin respectively. The total savings was 54.8% for candesartan and 31.9% for rosuvastatin. Conclusion The introduction of generics and generic reference pricing did not have an impact on medicine utilisation, but reduced the price and expenditure of both candesartan and rosuvastatin.


Assuntos
Benzimidazóis/economia , Custos de Medicamentos , Uso de Medicamentos/economia , Medicamentos Genéricos/economia , Gastos em Saúde , Rosuvastatina Cálcica/economia , Tetrazóis/economia , Anticolesterolemiantes/economia , Anticolesterolemiantes/uso terapêutico , Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Benzimidazóis/uso terapêutico , Custos de Medicamentos/tendências , Uso de Medicamentos/tendências , Medicamentos Genéricos/uso terapêutico , Gastos em Saúde/tendências , Humanos , Rosuvastatina Cálcica/uso terapêutico , África do Sul/epidemiologia , Tetrazóis/uso terapêutico
20.
Eur J Health Econ ; 20(2): 195-203, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29362899

RESUMO

AIMS: We determined adalimumab utilisation and associated drug costs in patients with ulcerative colitis (UC), focusing on patients requiring dose escalation. METHODS: The retrospective cohort study analysed the de-identified prescription data of the Arvato Health Analytics (Munich, Germany) database (2010-2015) in adult UC patients undergoing adalimumab therapy. RESULTS: A total of 154 patients were newly treated with adalimumab (average 39.6 years, 53% females), with a mean dose of 2.93 mg/day. Within 12 months, 69 patients (45%) received a dose increase of > 50% (doubled dose in 48 patients; 32%), with the escalation reported at 169.3 ± 99.3 days. A subsequent dose de-escalation to the standard dose occurred in 50 (32%) of patients that initially had a dose increase of > 50% (after 94.7 ± 49.6 days). Direct drug costs were 28,846 € in the overall study population, 24,934 € in patients on standard dose, 36,094 € in patients with dose increase, and 32,742 € in patients with increase and subsequent decrease. CONCLUSION: Dose escalation occurred frequently, and in one third of patients the dose was at least doubled. Dose escalations were associated with substantial increases in direct drug costs. Dose escalation of adalimumab can severely affect both the health care system and the drug budget of the physician. It needs to be considered that other biologic medications may constitute a more cost-effective alternative.


Assuntos
Adalimumab/administração & dosagem , Adalimumab/economia , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/economia , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/economia , Adulto , Custos e Análise de Custo , Bases de Dados Factuais , Custos de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA