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Purpose: In this study, prescriptions of 391 patients with type 2 diabetes mellitus selected from pharmacies in Sivas city center by mass sampling method were analyzed and the aim was to investigate the pharmacoeconomic suitability of these drugs considering the chronic complications associated with diabetes. Material and Methods: This study is characterized as a descriptive cost analysis in which retrospective analysis was conducted on 391 prescriptions issued to Type-2 Diabetes Patients after obtaining the required permissions, including approval from the Ethics Committee. Patient prescription data were collected from pharmacies comprising the sample group over a three-month period in Sivas Province. The demographic features such as age and gender of the patients and the medications prescribed for Type 2 Diabetes were analyzed, and the costs associated with these prescription drugs were calculated. In addition, additional diseases of Type 2 Diabetes patients were also scrutinized within the scope of the study. Results: According to the data obtained, the drugs prescribed to diabetic patients with chronic diseases were found to be appropriate. However, when all diabetic patients were examined, it was determined that the prescribed amount of insulin preparations was high and not pharmaceutically appropriate. It was revealed that the cost of type 2 diabetes medications for 391 patients was 77.852,79₺, and the prescription price was 199.11₺. Conclusion: Type 2 diabetes is characterized by insulin resistance in tissues such as liver, muscle and fat as a result of detectable damage to pancreatic beta cells. The disease is also associated with genetics, environmental factors and lifestyle. In our country, 22.6% of the health budget is allocated to the treatment of diabetes and its complications. Due to the increasing frequency of patients with type 2 diabetes, effective and rational treatments to reduce the burden of the disease on the health budget have become an important issue for both payers and policy makers, but it needs to be emphasized and examined from a pharmacoeconomic perspective in future studies. [ABSTRACT FROM AUTHOR]

The objective of this cross-sectional analysis was to identify determinants of increasing medicine expenditures in the US between 2011 and 2020. Prescription medication expenditures from the 2011–2020 Medical Expenditures Panel Survey (MEPS) were used to calculate total annual medication expenditures by payer categories (Out-of-pocket, Medicare, Medicaid, TRICARE/Veterans Administration/CHAMPVA (TVAC), Other Government Sources, Private Insurance, and Other Sources). From here, expenditures were stratified by therapeutic category using Multum Lexicon Drug Class to examine trends in expenditures by therapeutic area. Linear regression was used to identify temporal trends in medication expenditures. From 2011 to 2020, total annual prescription medication expenditures rose from $341.49 to $473.12 billion per year with metabolic agents being the most costly category. Among the metabolic agents, antidiabetic agents were the most costly therapeutic area, with an increasing trend observed from $27.15 to $89.17 billion over the same period. Medicare, Medicaid, Private Insurance, TVAC, and Other Sources also saw an increasing trend in antidiabetic agent expenditure, while no trend was observed for Out-of-pocket and Other Government Sources. Insulin had the highest expenditure among antidiabetic agents. Further studies are warranted to explore specific factors contributing to the increasing trend. • In the US, annual spending on metabolic agents increased from $58.66 billion in 2011 to $100.08 billion in 2020. • Insulin was the most costly metabolic agent in 2020 ($37.98 billion). • Medicare ($38.23 billion) and Medicaid ($8.68 billion) spending accounted for almost half of all US spending on metabolic agents in 2020. [ABSTRACT FROM AUTHOR]

BackgroundTo reduce the burden of patients’ medical care, the Xuzhou Municipal Government has initiated an exploratory study on the supply model and categorized management of nationally negotiated drugs. This study aims to understand the extent to which Xuzhou’s 2021 reform of the National Drug Price Negotiation (NDPN) policy has had a positive impact on the healthcare costs of individuals with different types of health insurance.MethodsThe Interrupted Time Series Analysis method was adopted, and the changes in average medical expenses per patient, average medical insurance payment cost per patient and actual reimbursement ratio were investigated by using the data of single-drug payments in Xuzhou from October 2020 to October 2022.ResultsFollowing the implementation of the policy, there was a significant decrease in the average medical expenses per patient of national drug negotiation in Xuzhou, with a reduction of 62.42 yuan per month (p

ObjectiveTo examine neurotologists' 2013 to 2016 Medicare Part-D data and evaluate commonly prescribed medications, longitudinal changes in prescribing patterns, presumed associated pathologies, and cost distribution across United States.MethodsComprehensive prescription data of Part-D-participating neurotologists was quiered from the 2013 to 2016 Medicare Part-D database. Outcome variables consisted of the 25 most commonly prescribed + refilled medications, cost distribution per medication, presumed associated pathologies, and standardized prescription cost across United States.ResultsOf the 594 available U.S. neurotologists, 336 (57%) were found in the Medicare Part-D database. In 2016, total prescription costs were $4 483 268 with an averaged $13 343 ± $18 698 per neurotologist. The three most frequently filled drugs were fluticasone propionate, ciprofloxacin, and triamterene-hydrochlorothiazide. From 2013 to 2016, the greatest change in prescription pattern was observed with azelastine (+188%), montelukast sodium (+104%), mupirocin (+63%), and mometasone (-91%), whereas the greatest change in relative drug cost distribution was seen in ofloxacin, (+695.7%) neomycin-polymyxin-hydrocortisone (+262.1%), and mometasone (-83%). Triamterene-hydrochlorothiazide, prednisone, montelukast, amoxicillin-clavulanate, azelastine, spironolactone, and mupirocin had statistically significant increases in average number of prescriptions per physician, whereas ofloxacin and mometasone had significant decreases. Medications presumably treating Eustachian tube dysfunction, Meniere's disease, and vestibular migraine had the greatest percent changes across years. Cost distribution of four drugs increased upwards of 100%. Geographic analysis demonstrated that Southern and Midwest regions had higher standardized prescription costs.ConclusionsThis study is the first to analyze neurotologists' trends in prescribing patterns, regional prescription cost distributions, and commonly treated pathologies. This can lead to better standardization of prescribing patterns and cost in the future.

Abstract Background and Aim The traditional method of taking Chinese Medicine involves creating a decoction by cooking medicinal Chinese herbs. However, this method has become less popular, being replaced by the more convenient method of consuming concentrated Chinese herbal extracts, which creates challenges related to the complexity of stacking multiple formulas. Methods We developed the Chinese Intelligence Prescription System (CIPS) to simplify the prescription process. In this study, we used data from our institutions pharmacy to calculate the number of reductions, average dispensing time, and resulting cost savings. Results The mean number of prescriptions was reduced from 8.19 ± 3.65 to 7.37 ± 3.34 ( $$p=2.46\;\times10^{-8}$$ p = 2.46 × 10 - 8 ). The reduction in the number of prescriptions directly resulted in decreased dispensing time, reducing it from 1.79 ± 0.25 to 1.63 ± 0.66 min ( $$p=1.88\;\times10^{-14}$$ p = 1.88 × 10 - 14 ). The reduced dispensing time totaled 3.75 h per month per pharmacist, equivalent to an annual labor cost savings of $15,488 NTD per pharmacist. In addition, drug loss was reduced during the prescription process, with a mean savings of $4,517 NTD per year. The combined savings adds up to a not insignificant $20,005 NTD per year per pharmacist. When taking all TCM clinics/hospitals in Taiwan into account, the total annual savings would be $77 million NTD. Conclusion CIPS assists clinicians and pharmacists to formulate precise prescriptions in a clinical setting to simplify the dispensing process while reducing medical resource waste and labor costs.

Background Tuberculosis (TB) drugs and their import are costly. We assessed how shorter TB drug regimens, which were non-inferior or superior in recent TB trials, can affect the costs for purchasing and importing TB drugs. Methods We estimated the drug costs and import costs of 39 longer and shorter TB drug regimens using TB drug prices from the Global Drug Facility and import cost estimates for a TB program in Karakalpakstan, Uzbekistan. Drug regimens from recent TB trials were compared with TB drug regimens following present or past World Health Organization recommendations. Results We estimated an import cost of $4.19 and a drug cost of $43 per standard 6-month drug-sensitive (DS)-TB regimen. A new 17-week DS-TB regimen from the TBTC Study 31 currently requires more tablets and is more expensive to import ($6.08) and purchase ($233). The TB program can substantially decrease import costs ($2.26–14) and drug costs ($391–2308) per multidrug-resistant (MDR)-TB regimen when using new 6-month or shorter drug regimens from the Nix-TB, NExT, TB PRACTECAL, ZeNix, or BEAT TB trials instead of 9–20-month regimens with import costs of $9.96–507 and drug costs of $354–15 028. For a commonly used 20-month all-oral, bedaquiline-containing MDR-TB regimen, we estimated costs of $41 for drug import and $1773 for drug purchase. Conclusions The implementation of a new and shorter DS-TB regimen may increase the costs for drug purchase and import. The implementation of new and shorter MDR-TB regimens may decrease the costs for drug purchase and/or drug import. [ABSTRACT FROM AUTHOR]

Background and Aim: The traditional method of taking Chinese Medicine involves creating a decoction by cooking medicinal Chinese herbs. However, this method has become less popular, being replaced by the more convenient method of consuming concentrated Chinese herbal extracts, which creates challenges related to the complexity of stacking multiple formulas. Methods: We developed the Chinese Intelligence Prescription System (CIPS) to simplify the prescription process. In this study, we used data from our institutions pharmacy to calculate the number of reductions, average dispensing time, and resulting cost savings. Results: The mean number of prescriptions was reduced from 8.19 ± 3.65 to 7.37 ± 3.34 ( p = 2.46 × 10 - 8 ). The reduction in the number of prescriptions directly resulted in decreased dispensing time, reducing it from 1.79 ± 0.25 to 1.63 ± 0.66 min ( p = 1.88 × 10 - 14 ). The reduced dispensing time totaled 3.75 h per month per pharmacist, equivalent to an annual labor cost savings of $15,488 NTD per pharmacist. In addition, drug loss was reduced during the prescription process, with a mean savings of $4,517 NTD per year. The combined savings adds up to a not insignificant $20,005 NTD per year per pharmacist. When taking all TCM clinics/hospitals in Taiwan into account, the total annual savings would be $77 million NTD. Conclusion: CIPS assists clinicians and pharmacists to formulate precise prescriptions in a clinical setting to simplify the dispensing process while reducing medical resource waste and labor costs. [ABSTRACT FROM AUTHOR]

Background: Opioids are commonly used to manage the pain of head and neck (HN) cancer patients. Methods: Retrospective cohort of graduates from American Head and Neck Society accredited fellowships from 1997 to 2018. The Center for Medicare and Medicaid Services Part D Provider Utilization and Payment database 2014–2019 was cross‐referenced with provider names to identify opioid prescription trends. Results: From 2014 to 2019, there was no significant difference in the average number of opioid beneficiaries per provider (18.02 vs. 18.10, p = 0.586) or opioid claims per provider (28.06 vs. 26.73, p = 0.708). The average total opioid day supply per beneficiary declined from 11.09 to 7.05 days from 2014 to 2019 (p < 0.001). In 2019, providers in the Northeast had the lowest prescribed opioid day supply (3.67 days) compared to those from the South who had the highest (10.32 days). Conclusions: Opioid prescription length has significantly declined among HN surgeons, with variations across geographic regions. [ABSTRACT FROM AUTHOR]

Objective: To describe the temporal trends in the cost and use of adrenocorticotropic hormone (ACTH), oral prednisolone, and vigabatrin, the first‐line treatments for infantile epileptic spasms syndrome (IESS). Methods: Retrospective observational study using the MarketScan Commercial database from 2006 to 2020. We identified patients with IESS diagnosed between birth and 18 months of age who received at least one of the first‐line treatments within 60 days of diagnosis. Costs were adjusted for inflation using the Gross Domestic Product Implicit Price Deflator. Results: A total of 1131 patients received at least one first‐line treatment (median [p25–p75] age: 6.3 [4.5–8.3] months, 55% male), of whom 592 patients received ACTH, 363 patients received oral prednisolone, and 355 patients received vigabatrin. After adjusting for inflation, the median average wholesale price of a 14‐day course of treatment increased for ACTH from $3718 in 2006 to $100 457 in 2020, ~2700% (by a factor of 27), whereas it decreased for oral prednisolone from $169 in 2006 to $89 in 2020, ~50% (by a factor of 0.5), and increased for vigabatrin from $1206 in 2009 (first year with data on vigabatrin used for IESS) to $4102 in 2020, ~340% (by a factor of 3.4). During the first 60 days after diagnosis, inpatient admission days and costs where higher for ACTH than for oral prednisolone and vigabatrin—5.0 (3.0–8.3) days vs 2.0 (0.0–5.0) days vs 2.0 (0.0–6.0) days, p <.0001; and $32 828 ($14 711–$67 216) vs $16 227 ($0–$35 829) vs $17 844 ($0–$47 642), p <.0001. ACTH use decreased from representing 78% of first‐line treatments in 2006 to 18% in 2020 (p <.0001). Sensitivity analyses confirmed the robustness of the results. Significance: The gap between the cost of ACTH and the cost of oral prednisolone or vigabatrin has widened markedly from 2006 to 2020, whereas the relative proportion of ACTH use has decreased. [ABSTRACT FROM AUTHOR]

Introduction: Denosumab (Xgeva®) and zoledronic acid (Zometa®) are widely utilized for prevention of skeletal related events (SREs) in oncology patients. Drug costs, renal function, ease and logistics of administration, and adverse effect profile are factors frequently considered by patients and/or providers when selecting an optimal agent. Given the significantly higher drug cost of denosumab compared to zoledronic acid, an evaluation of our institution's denosumab use and investigation into opportunities to shift denosumab administrations to zoledronic acid and/or to lower cost sites-of-care was warranted. Methods: A single-center, multi-site, retrospective, observational analysis of the electronic medical record (EMR) was conducted for adult oncology patients who received denosumab 120 mg for prevention of SREs from October 1st, 2018 to September 30th, 2019 at three institutions within our health system. Additional information was collected to characterize the patient population based on cancer diagnosis, renal function, and concomitant calcium and vitamin D supplementation. Our primary objective was to evaluate if the use of denosumab met current formulary restrictions of the health system. Results: In total, 304 adult oncology patients received 1411 doses of denosumab for the prevention of SREs. The majority of reviewed patients had a primary oncology diagnosis of breast (35%) or lung (24%) cancer. Of the patients who received denosumab, 278 (93%) met the health system's current formulary restrictions. The majority of patients who did not meet formulary restrictions were those with multiple myeloma (MM) (20/22; 91%). Of the 304 patients reviewed, 70 had the appropriate parameters in the EMR to calculate creatinine clearance (CrCl) using Cockcroft-Gault Equation. Of those 70 patients, 59 (84%) would have been eligible to receive zoledronic acid instead of denosumab given that their CrCl >30 mL/min with no documented intolerance to bisphosphonates. Concurrent use of calcium and vitamin D is recommended when using denosumab. Based on the most recent prior to admission (PTA) medication list obtained from the 304 patients evaluated, 222 (73%) had both calcium and vitamin D listed as "taking". Conclusions: Within our health system, denosumab is restricted to those who meet formulary restrictions. Additional education is recommended to help limit the use of denosumab, specifically in MM, to reduce drug costs when zoledronic acid is also an appropriate first-line agent. [ABSTRACT FROM AUTHOR]

To improve patients' welfare, governments can regulate the availability of the low‐price drugs (LPDs) through lower wholesale purchasing or retail selling of the LPD. This paper characterizes two common constrained policies from the practices of pharmaceutical markets. The first (policy P) controls the ratios of the LPD's purchasing quantity and fee. The second (policy S) controls the ratios of the LPD's selling quantity and revenue. Considering a pharmaceutical supply chain consisting of two independent manufacturers and a hospital, we investigate the impacts of two policies on the LPD's availability and the whole industry gains. Our results show that policy P dominates policy S in two aspects: (a) policy P provides a higher product availability of the LPD and (b) policy P reduces less profits for the pharmaceutical supply chain. Specifically, policy P could incur a win‐win outcome for the patient and the supply chain. We further show that the demand allocation of the LPD, the substitution degree, and the profit margins' difference can significantly affect the performances of the policies. [ABSTRACT FROM AUTHOR]

AbstractObjective To investigate the effect of an educational intervention of nursing staff on change in psychotropic use and related costs among older long-term care residents.Design A secondary analysis of a randomized controlled intervention study with 12 months of follow-up.Setting Assisted living facilities in Helsinki, Finland.Subjects Older (≥65 years) residents (N = 227) living in assisted living facility wards (N = 20) in Helsinki in 2011.Intervention The wards were randomized into two groups. In one group, the nursing staff received training on appropriate medication therapy and guidance to recognize potentially harmful medications and adverse effects (intervention group); in the other group, the nursing staff did not receive any additional training (control group).Main outcome measures Change of psychotropic use counted as relative proportions of WHO ATC-defined daily doses (rDDDs) among older long-term care residents. In addition, the change in drug costs was considered. Comparable assessments were performed at 0, 6, and 12 months.Results A significant decrease in both rDDDs and the cost of psychotropics was observed in the intervention group at 6 months follow-up. However, at 12 months, the difference between the intervention and control group had diminished.Conclusions Educational training can be effective in reducing the doses and costs of psychotropics. Further studies are warranted to investigate whether long-term effects can also be achieved by various educational interventions.Registration number ACTRN 12611001078943 KEY POINTSWe explored the effect of staff training on psychotropic use and associated costs among older long-term care residents.Educational training of nursing staff was beneficial as regards the actual drug doses of psychotropics, and cost savings in psychotropic medication were achieved.Educational training was efficient in the short-term, but further research is warranted to achieve long-term effects.

Background: Major disparities have been reported in recombinant tissue plasminogen activator (rtPA) availability among countries of different socioeconomic status. Aims: To characterize variability of rtPA price, its availability, and its association with and impact on each country's health expenditure (HE) resources. Methods: We conducted a global survey to obtain information on rtPA price (50 mg vial, 2020 US Dollars) and availability. Country-specific data, including low, lower middle (LMIC), upper middle (UMIC), and high-income country (HIC) classifications, and gross domestic product (GDP) and HE, both nominally and adjusted for purchasing power parity (PPP), were obtained from World Bank Open Data. To assess the impact of rtPA cost, we computed the rtPA price as percentage of per capita GDP and HE and examined its association with the country income classification. Results: rtPA is approved and available in 109 countries. We received surveys from 59 countries: 27 (46%) HIC, 20 (34%) UMIC, and 12 (20%) LMIC. Although HIC have significantly higher per capita GDP and HE compared to UMIC and LMIC (p < 0.0001), the median price of rtPA is non-significantly higher in LMICs (USD 755, interquartile range, IQR (575–1300)) compared to UMICs (USD 544, IQR (400–815)) and HICs (USD 600, IQR (526–1000)). In LMIC, rtPA cost accounts for 217.4% (IQR, 27.1–340.6%) of PPP-adjusted per capita HE, compared to 17.6% (IQR (11.2–28.7%), p < 0.0001) for HICs. Conclusion: We documented significant variability in rtPA availability and price among countries. Relative costs are higher in lower income countries, exceeding the available HE. Concerted efforts to improve rtPA affordability in low-income settings are necessary. [ABSTRACT FROM AUTHOR]

Objective The aim of this study is to investigate the clinical use of 17 antineoplastic drugs passing national medical insurance negotiation in Peking Union Medical College Hospital before and after the implementation of national policies about promoting the inclusion of antineoplastic drugs in health insurance, and to provide reference for the optimization and adjustment of hospital formulary. Methods The prescription data of 17 antineoplastic drugs of outpatients and inpatients in our hospital from December 1, 2017 to November 30, 2019(December 1, 2017 to November 30, 2018 for the year 2018, December 1, 2018 to November 30, 2019 for the year 2019) were collected. The basic information of patients, the usage amount and cost, defined daily doses (DDDs), and defined daily cost (DDC) were analyzed. Results A total of 6881 patients used the 17 antineoplastic drugs in 2019. Among them, there were 4713(68.5%) outpatients and 2168(31.5%) inpatients. The proportions of the cost of 17 antineoplastic drugs to that of all antineoplastic drugs and all formulary drugs in our hospital were 16.3% and 3.8%, respectively. The 17 antineoplastic drugs were mainly used for thorax, hematologic, and urologic malignancies. The top three antineoplastic drugs in terms of cost were osimertinib, octreotide acetate microspheres and crizotinib, with good synchronization between drug cost and DDDs. The top three drugs in terms of DDC were vemurafenib, cetuximab and ibrutinib. The total cost and prescription of the six drugs that had already been included in the formulary of our hospital before the implementation of the policy increased by 78.2% and 89.8%, respectively in 2019 compared with those in 2018, and the proportions of the cost of six antineoplastic drugs to that of all antineoplastic drugs and all formulary drugs in the hospital increased by 54.4% and 78.6%, respectively. After the implementation of national policies, the quantity and cost of osimertinib increased significantly, and the drugs increased in quantity but decreased in cost were cetuximab, axitinib, and sunitinib in sequence. Both the quantity and the cost of pegaspargase decreased significantly. Conclusions The national health insurance negotiation policy promoted the use of 17 antineoplastic drugs in the hospital and improved the accessibility of these drugs to patients significantly. At the same time, the total cost of the involved drugs had a sharp rise. It is necessary to strengthen the monitoring and dynamic evaluation of the clinical application of related drugs, so as to promote rational drug use while meeting patients' needs.

Abstract Objective To examine neurotologists' 2013 to 2016 Medicare Part‐D data and evaluate commonly prescribed medications, longitudinal changes in prescribing patterns, presumed associated pathologies, and cost distribution across United States. Methods Comprehensive prescription data of Part‐D‐participating neurotologists was quiered from the 2013 to 2016 Medicare Part‐D database. Outcome variables consisted of the 25 most commonly prescribed + refilled medications, cost distribution per medication, presumed associated pathologies, and standardized prescription cost across United States. Results Of the 594 available U.S. neurotologists, 336 (57%) were found in the Medicare Part‐D database. In 2016, total prescription costs were $4 483 268 with an averaged $13 343 ± $18 698 per neurotologist. The three most frequently filled drugs were fluticasone propionate, ciprofloxacin, and triamterene‐hydrochlorothiazide. From 2013 to 2016, the greatest change in prescription pattern was observed with azelastine (+188%), montelukast sodium (+104%), mupirocin (+63%), and mometasone (−91%), whereas the greatest change in relative drug cost distribution was seen in ofloxacin, (+695.7%) neomycin‐polymyxin‐hydrocortisone (+262.1%), and mometasone (−83%). Triamterene‐hydrochlorothiazide, prednisone, montelukast, amoxicillin‐clavulanate, azelastine, spironolactone, and mupirocin had statistically significant increases in average number of prescriptions per physician, whereas ofloxacin and mometasone had significant decreases. Medications presumably treating Eustachian tube dysfunction, Meniere's disease, and vestibular migraine had the greatest percent changes across years. Cost distribution of four drugs increased upwards of 100%. Geographic analysis demonstrated that Southern and Midwest regions had higher standardized prescription costs. Conclusions This study is the first to analyze neurotologists' trends in prescribing patterns, regional prescription cost distributions, and commonly treated pathologies. This can lead to better standardization of prescribing patterns and cost in the future.

Cost can be a barrier to achieving health equity for guideline‐directed medical therapy; however, ambulatory care pharmacists who provide services in primary care settings can assist in reducing these barriers. Strategies to reduce drug cost should be tailored to patient‐specific factors including insurance type, drugs being prescribed, and availability of local and national assistance programs. Pharmacists can use a team‐based approach, when possible, to promote health equity in drug access due to cost. The authors provide recommendations that can be incorporated into clinical practice and improve health equity. [ABSTRACT FROM AUTHOR]

To investigate the effect of an educational intervention of nursing staff on change in psychotropic use and related costs among older long-term care residents. A secondary analysis of a randomized controlled intervention study with 12 months of follow-up. Assisted living facilities in Helsinki, Finland. Older (≥65 years) residents (N = 227) living in assisted living facility wards (N = 20) in Helsinki in 2011. The wards were randomized into two groups. In one group, the nursing staff received training on appropriate medication therapy and guidance to recognize potentially harmful medications and adverse effects (intervention group); in the other group, the nursing staff did not receive any additional training (control group). Change of psychotropic use counted as relative proportions of WHO ATC-defined daily doses (rDDDs) among older long-term care residents. In addition, the change in drug costs was considered. Comparable assessments were performed at 0, 6, and 12 months. A significant decrease in both rDDDs and the cost of psychotropics was observed in the intervention group at 6 months follow-up. However, at 12 months, the difference between the intervention and control group had diminished. Educational training can be effective in reducing the doses and costs of psychotropics. Further studies are warranted to investigate whether long-term effects can also be achieved by various educational interventions. ACTRN 12611001078943 We explored the effect of staff training on psychotropic use and associated costs among older long-term care residents. Educational training of nursing staff was beneficial as regards the actual drug doses of psychotropics, and cost savings in psychotropic medication were achieved. Educational training was efficient in the short-term, but further research is warranted to achieve long-term effects. [ABSTRACT FROM AUTHOR]

This study aimed to standardize the clinical application of adjuvant drugs and control the unreasonable increase in drug costs. Management measures were formulated for adjuvant drug utilization by promoting the rational use of adjuvant drugs. The efficacy and economics of the same types of drugs were compared to provide a scientific reference for clinical drug selection. In 2018, the total cost of the use of adjuvant drugs decreased by 7.4117 million renminbi compared with that in 2015. In the first half of 2019, the proportion of revenue from adjuvant drugs decreased by 10.77 % from that in the same period in 2015. From 2015 to 2018, the per capita drug cost of adjuvant drugs gradually decreased and in 2018, this resulted in savings of 568.41 renminbi. Through administrative intervention, prescription review, information management and pharmacoeconomic evaluation, a scientific management system of adjuvant drugs was established to standardize the use of adjuvant drugs and to reduce their cost. The scientific management of adjuvant drugs can avoid unnecessary drug expenses for patients and provide effective reference values for the rational use of adjuvant drugs in hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare costs are increasing against the backdrop of scarce resources. Surgical procedures are an important part of healthcare spending, and the cost of anesthetic techniques is relevant as part of the total cost of care and it is a potential target for expenditure optimization. Although important economic differences have been reported internationally for general anesthesia options, there are no publications in Colombia that compare current costs and allow for informed and financially responsible decision-making. Objective: To quantify and compare direct costs associated with the various general anesthesia options most frequently used at the present time. Methods: Cost minimization analysis based on a theoretical model of balanced general anesthesia using isoflurane, sevoflurane, desflurane in combination with remifentanil, and TIVA (propofol and remifentanil). Initial results were obtained using a deterministic simulation method and a sensitivity analysis was performed using a Monte Carlo simulation. Results: The average total cost per case for the different anesthetic techniques was COP 126381 for sevoflurane, COP 97706 for isoflurane, COP 288605 for desflurane and COP 222 960 for TIVA. Conclusions: Balanced general anesthesia with desflurane is the most costly alternative, 1.2 times more expensive than TIVA, and 2 and 3 times more costly than balanced anesthesia with sevoflurane and isoflurane, respectively. TIVA ranks second with a cost 1.8 times higher than balanced anesthesia with sevoflurane and 2.5 times higher than balanced anesthesia with isoflurane. [ABSTRACT FROM AUTHOR]

To formulate a convergent and consensus expert panel to calculate normative drug cost in the top twenty diseases in primary care. Method: In the first round, the expert panel define a list of consensus statements based on data derived from non-systematic reviews of treatment standard for the top twenty disease in primary care. In the second round, experienced doctors in treatment at primary care were involved to express individual consent to the statements using questionnaire. Face-to-face meeting were held simultaneously with filling questionnaire. Consensus was defined as 75% agreement. Result: Delphi process at the first round, the expert panel consisting of 11 doctors in primary care defined a list of 60 statements from 20 diseases on the treatment standard calculated the normative cost of acute and chronic disease in primary care. The second round involved 11 doctors who are experienced in primary care with more than 6 years' experience in doing treatment in primary care. Conclusion: The identified consensus statement can help doctors to apply the normative cost calculation results on the top 20 diseases in primary care as evidence based policy study material for calculating the percentage of drug cost in the capitation system in Indonesia. [ABSTRACT FROM AUTHOR]

The objectives of this article are to describe the interventions carried out by the Strategic Fund of the Pan American Health Organization to facilitate access to and availability of antihypertensive drugs and devices for measuring blood pressure in the countries of the Region of the Americas, supporting implementation of the HEARTS initiative; and to present the preliminary results of price analyses of antihypertensive drugs. The study methodology included a review of reports made by the Strategic Fund during 2019-2020, evaluation of modalities of procurement, a review of the public procurement databases for five antihypertensive drugs, and a comparison with the price obtained by the Strategic Fund. Differences ranging from 20% to 99% were identified, indicating significant opportunities for savings. Interprogrammatic actions in support of the HEARTS initiative are also presented, such as the inclusion of antihypertensive drugs recommended by the World Health Organization; consolidation of regional demand and establishment of competitive prices with long-term agreements to manage the procurement of quality generic products; and the definition of technical specifications and regulatory requirements to support the procurement of devices to measure blood pressure. Through this mechanism, Member States can reduce their costs significantly, enabling them to extend treatment and diagnostic coverage to more people. [ABSTRACT FROM AUTHOR]

Pharmacy pharmacists are expected to contribute to the optimization of healthcare costs by reducing drug costs with a focus on remaining drugs. In this study, we investigated the interventions to reduce remaining medication at 44 of our insurance pharmacies located in six prefectures in Tohoku from November 2018 to January 2019, clarified the breakdown of reduced medications and associated pharmaceutical management fees, and verified the effectiveness of pharmacy pharmacists in reducing medical costs. The results showed a reduction in medical costs of 16,361.1 yen per store per month. Based on these results, it is estimated that if all insurance pharmacies were to achieve the same reduction effect, the approximately 1,000 pharmacies in our company would contribute to an annual reduction of 196 million yen, and the approximately 59,613 pharmacies nationwide would contribute to an annual reduction of 11.7 billion yen in medical costs. The most common reasons for the occurrence of leftover medication are forgetting to take medication, self-adjustment, and discrepancies between the date of consultation and the number of prescription days, in that order. The results suggest that pharmacy pharmacists can make a contribution to reducing medical costs by not only making adjustments after confirming leftover medication, but also intervening to prevent leftover medication. [ABSTRACT FROM AUTHOR]

Background: To reduce the burden of patients' medical care, the Xuzhou Municipal Government has initiated an exploratory study on the supply model and categorized management of nationally negotiated drugs. This study aims to understand the extent to which Xuzhou's 2021 reform of the National Drug Price Negotiation (NDPN) policy has had a positive impact on the healthcare costs of individuals with different types of health insurance., Methods: The Interrupted Time Series Analysis method was adopted, and the changes in average medical expenses per patient, average medical insurance payment cost per patient and actual reimbursement ratio were investigated by using the data of single-drug payments in Xuzhou from October 2020 to October 2022., Results: Following the implementation of the policy, there was a significant decrease in the average medical expenses per patient of national drug negotiation in Xuzhou, with a reduction of 62.42 yuan per month ( p  < 0.001). Additionally, the average medical insurance payment cost per patient decreased by 44.13 yuan per month ( p  = 0.01). Furthermore, the average medical expenses per patient of urban and rural medical insurance participants decreased by 63.45 yuan ( p  < 0.001), and the average monthly medical insurance payment cost per patient decreased by 57.56 yuan ( p  < 0.04). However, the mean total medical expenditures for individuals enrolled in employee medical insurance decreased by 63.41 yuan per month ( p  < 0.001), whereas the monthly decrease was 22.11 yuan per month ( p  = 0.21). On the other hand, there was no discernible change in the actual reimbursement ratio., Conclusion: After the adoption of the NDPN policy, a noticeable decline has been observed in the average medical expenses per patient and the mean cost of the average medical insurance payment per patient, although to a limited extent. Notably, the reduction in employee medical insurance surpasses that of urban and rural medical insurance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Qin, He, Shen, Liu, Xu and Chen.)

Introduction: The Reference Drug Program (RDP) was established to steer patients toward equally safe and cost-effective medication under British Columbia's public drug coverage. Each RDP class covers at least one reference drug, and non-reference drugs are reimbursed up to the cost of the reference drug. In 2016, the RDP updated to include proton pump inhibitors (PPIs). This study evaluated the impact on drug expenditures, prescription patterns, and health services utilization., Methods: We identified a cohort of individuals covered by Fair Pharmacare who used PPIs, and a control group of H2 Blockers users. We used interrupted time series analysis on administrative data from June 2014 to December 2019 on the following outcomes: new users, day supply, expenditures, drug costs, reference drug use, and physician visits and costs., Results: The RDP had little impact on overall PPI use patterns. We did not observe any changes in reference drug uptake, new users, physician visits, cost-savings, or significant changes to days supplied post-policy. Cost expenditure results were likely biased due to co-occurring changes to drug prices., Conclusion: Inclusion of PPIs to the RDP saw no cost-savings for the provincial drug program and had little impact on prescribing patterns. Overall, our findings are consistent with existing evidence that the RDP is safe for similar therapeutic alternatives, but the impact on PPI costs remains unclear., Competing Interests: Conflict of Interest Dr. Law has consulted for Health Canada and acted as an expert witness for the Attorney General of Canada. All other authors report no potential conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: This study aims to analyze the of drug costs for patients with chronic diseases in the capitation system in public primary health cares (Public PHCs). Materials and Methods: This research is a quantitative study with an observational cross-sectional approach at 16 Public PHCs. Data collection used the retrospective method. The total sample was 293 outpatients in 2016. Results: The results showed that 63% of patients are female. The most patients are aged between 56-65 years (37%). The average drug cost for patients receiving more than 3 types of drugs is IDR 7,726. The biggest drug cost is patients with DM type 2 with which the average cost is IDR 7.400. And the metformin treatment is 17 (6%) patients with the cost IDR 4,500,-. Chi-square analysis shows that the quantity of drug items, type of disease and prescriptions there are have significant effect on drug cost (p-value <0.05). However, gender and age group there are no significant effect on drug cost (p-value >0.05). Drug prescriptions are an important component in managing chronic diseases patients. Prescribing costs provide important information in the sustainability of the management of chronic disease programs. Conclusion: This study recommends that the prolanis policy in public PHCs is focused on the elderly age group patients and female group. [ABSTRACT FROM AUTHOR]

This study aims to estimate the theoretical excess expenditure that would be incurred by the Irish state-payer, should drugs be reimbursed at their original asking ("list") price rather than at a price at which the drug is considered cost-effective. In Ireland, all new drugs are evaluated by the National Centre for Pharmacoeconomics. For this study, drugs that were submitted by pharmaceutical companies from 2012 to 2017 and considered not cost-effective at list price were reviewed. A total of 43 such drugs met our inclusion criteria, and their pharmacoeconomic evaluations were further assessed. The price at which the drug could be considered cost-effective (cost-effective price) at the upper cost-effectiveness threshold used in Ireland (€ 45 000/quality adjusted life-year) was estimated for 18 drugs with an available cost-effectiveness model. Then, for each drug, the list price and cost-effective price (both per unit) were both individually applied to 1 year of national real-world drug utilization data. This allowed the estimation of the expected expenditures under the assumptions of list price paid and cost-effective price paid. The resulting theoretical excess expenditure, the expenditure at list price minus the expenditure at the cost-effective price, was estimated to be €108.2 million. This estimate is theoretical because of the confidentiality of actual drug prices. The estimation is calculated using the list price and likely overestimates the actual excess expenditure, which would reduce to zero if cost-effective prices are agreed. Nevertheless, this estimate illustrates the importance of a process to assess the value of new drugs so that potential excess drug expenditure is identified. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of discontinuing treatment with cholinesterase inhibitors (ChEIs) on drug costs in patients with advanced dementia. Methods: Severe dementia patients receiving ChEI treatment for over 12 months (n = 43) aged over 65 years (mean age = 82.6 ± 7.5 years) were recruited from 8 nursing homes located in Alicante, Spain. ChEI treatment was discontinued in 23 patients. Here, we report the results from a cost-minimization analysis to evaluate the drug costs with a follow-up period of three months. The drug costs were prospectively analyzed based on drug acquisition costs. Results: At the end of the follow-up, the mean monthly drug costs were €52.68 ± 22.48 in the discontinuation group and €122.54 ± 44.74 in the continuation group - a significant difference of means of -€69.86 (95 % CI, -91.24 to -48.48; p = 0.000). The monthly drug cost reduction for the ChEI discontinuation group was €1,533.35. Conclusion: ChEI discontinuation appears to be a possible option for minimizing treatment costs in institutionalized patients with advanced dementia. [ABSTRACT FROM AUTHOR]

Significant advances in drug research and development are herein reviewed first to set the background for a critical consideration of the economic sustainability of biologics and small molecules, why biologic drugs are more expensive, and how drug cost often influences patient access to one drug class over the other. Also strongly emphasized is the need for the drug-making, especially the biopharmaceutical, industry to consider a reassignment of priorities so that more patients can enjoy the great benefits that come with blockbuster drugs, many of which are of biological origin but extremely expensive. A balance between the efficacy of wonder-performing drugs and the patient's financial ability to access them must be established to obliterate the crippling effect of the high costs of drugs on the poor majority of patients – those who cannot afford them. The overarching point broadly emphasized is that the actual success in drug discovery and development and in healthcare delivery should be measured not only by the magnitude of scientific breakthroughs but also by the level to which they are affordable to patients as determined by their costs. To enhance patients' access to drugs and new and/or improved healthcare technologies, more research attention must be paid to such cheaper alternatives as small molecules generics, biosimilars, and antibody-drug conjugates; government policies must be established to encourage the commercialization of biosimilars; and pharmaceutical companies must be charitable enough to run assistance programs for eligible financially handicap patients while seeking to make profits from the drug-making business.

Poly(ADP-ribose) polymerase (PARP) inhibitors are expensive and their use is expanding. We aimed to evaluate cost sharing patterns between patients, payors, and financial assistance programs. We identified ovarian cancer patients prescribed a PARP inhibitor from 5/2015–9/2019 using our pharmacy database. Cost information was collected for patients who filled their prescription at our specialty pharmacy. We calculated descriptive statistics for monthly PARP inhibitor costs for patients, payors, and financial assistance programs. We used Wilcoxon rank sum tests to evaluate monthly costs based on insurance characteristics. Seventy-six patients filled 94 different PARP inhibitor prescriptions with 42 (45%) prescriptions obtained using any type of financial assistance program. We analyzed 232 prescription months for the 41 prescriptions with available cost data. This included 18 (44%) prescriptions for rucaparib, 18 (44%) for niraparib, and 5 (12%) for olaparib. The total monthly drug cost was average $12,422 and median $13,700. The monthly out-of-pocket (OOP) cost for patients was average $46 and median $0 (IQR $0–4). Payors had the highest monthly costs with average $12,019 and median $13,662 (IQR $9914-14,709). Financial assistance programs contributed average $358 and median $0 per month (IQR $0–150). Patients with public (p <0.01) or Medicare insurance (p<0.01) had higher OOP costs than without. OOP costs were generally low with 75% of patients paying <$5 per month. While limited by small sample size at a single institution, financial assistance programs appear to play a critical role to ensure access to PARP inhibitors as nearly 50% of patients utilized these programs. • Payors are responsible for the highest amount of PARP inhibitor costs. • Patient out of pocket costs for PARP inhibitors are low at our single institution. • Nearly 50% of patients utilized financial assistance programs for PARP inhibitors. [ABSTRACT FROM AUTHOR]

Medications form a significant portion of spending in primary health care. Angiotensin-converting enzyme inhibitors (ACE-Is) are among the most prescribed blood pressure medications in general practice. Medications within this class are considered therapeutically equivalent, but the cost of each ACE-I varies. Our aim was to explore cost and other factors that influence general practitioners (GPs) to prescribe a specific ACE-I and understand their views on therapeutic interchange within this drug class. We conducted a qualitative study of Australian GPs using thematic analysis. We found that GPs were aware of therapeutic equivalency within the ACE-I class, but unaware of the cost differences. Although GPs tended to adopt a prescribing preference, they were open to fewer prescribing options if there was a decreased cost to patients and the PBS, or potential to minimise prescribing error. Our findings have immediate relevance for national prescribing policies and the Pharmaceutical Benefits Scheme (PBS). The wide selection of ACE-Is that are available results in diverse prescribing patterns and may not be cost-effective for patients or the PBS. Restricting the number of drug options within the ACE-I class in primary care appears to be an acceptable drug cost-containment strategy according to our sample of GPs. GPs prescribe a range of medications within the commonly used blood pressure medication class, angiotensin-converting enzyme inhibitors (ACE) inhibitors. Medications within this class are considered equivalent, but the cost of each ACE inhibitor varies. We found GPs were aware of equivalence within this drug class, but unaware of cost differences. GPs were open to fewer available prescribing options if there was a decreased cost to the health system. Restricted prescribing options in primary care may be an acceptable cost-containment strategy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Drug-related problems (DRPs) are common in hospitalized patients receiving Key Monitoring Drugs. Clinical pharmacy services have the potential to minimize drug-related harm and improve patient care. The aim of this study is to standardize the clinical application of Key Monitoring Drugs and reduce drug-related problems (DRPs) and associated costs, using clinical pharmacist interventions. PATIENTS AND METHODS: Clinical pharmacists formulate management measures for Key Monitoring Drugs using evidence-based medicine and analyze the DRPs of Key Monitoring Drugs in China at the Shandong Provincial Third Hospital over a period of five years, from 2015 to 2019. RESULTS: In 2019, the total cost of the use of Key Monitoring Drugs decreased by 10.12 million CNY, in comparison with the cost in 2015. The proportion of revenue generated from Key Monitoring Drugs also decreased by 11.49% compared with 2015. In addition, the cost per capita of Key Monitoring Drugs has gradually decreased; this resulted in a saving of 580.07 CNY per capita in 2019 compared with 2015. Over this time, the DRPs associated with Key Monitoring Drugs decreased by 45.50%. Through administrative intervention, prescription review, information management, and pharmaco-economic evaluation, a scientific management system for Key Monitoring Drugs has been established over this time, which standardizes the use of Key Monitoring Drugs and reduces their associated costs. CONCLUSIONS: Clinical pharmacists' interventions can assist in the early detection of drug-related problems associated with Key Monitoring Drugs and prevent any resulting harm to patients. [ABSTRACT FROM AUTHOR]

Purpose To examine the financial impact of automatic formulary substitution of nebulization solutions for pressurized metered dose inhalers and dry powder inhalers and the effect of the automatic substitution initiative on respiratory care practitioner (RCP) workload at a community hospital. Methods A retrospective observational study was conducted in a 326-bed nonacademic community hospital. Adult patients who received respiratory medications and had an inpatient stay, were admitted for observation, or had an emergency room visit from December 2016 through February 2017 (the control group) or from December 2017 through February 2018 (the study group) were included in the analysis. The primary outcomes were the cost of respiratory medications per hospital stay and the number of RCP visits per hospital stay. The secondary outcome was the cost of wasted doses per hospital stay. Results A total of 3,766 patients were included in the study: 2,030 in the study group and 1,736 in the control group. The mean cost of respiratory medications per hospital stay was significantly lower in the study group vs the control group ($13.29 vs $36.48, P < 0.001). The mean number of RCP visits per hospital stay was also statistically lower in the study group vs the control group (11.6 vs 12.9, P = 0.04). The mean cost of wasted doses was significantly lower in study group vs the control group ($0.25 vs $22.91, P < 0.001). Conclusion Automatic formulary substitution of nebulization solutions for inhaler medications significantly decreased medication costs without increasing the average number of RCP visits per hospital stay. [ABSTRACT FROM AUTHOR]

Omalizumab (OMA) is highly effective for refractory chronic spontaneous urticaria (CSU), but its high cost exerts a great economic burden on patients and society. Current knowledge is lacking regarding the economic impact of long‐term administration of OMA on patients with CSU in the real‐world setting. We retrospectively investigated drug costs relevant to CSU treatment during the period before through to 12 months after starting OMA in actual clinical practice. This study involved 32 patients who received at least two injections of OMA (300 mg/4 weeks) and achieved good responses of urticaria control test score of 12 or more and/or weekly urticaria activity score of 6 or less within 12 weeks. Median drug costs of the overall patient cohort increased from ¥14 496/month to ¥104 522 after starting OMA, but reduced to ¥48 810 in 12 months along with reduced amount of OMA administration and concomitant medication use. In patients pretreated with antihistamine alone or plus alternative medicines such as H2 blocker and antileukotriene prior to OMA, the increased drug costs by adding OMA decreased to approximately 30% in 12 months mainly due to the OMA dose reduction and interval extension of OMA. The drug cost reduction was also observed in patients pretreated with intensive multi‐agents, due to discontinuation of expensive immunosuppressants. In conclusion, the introduction of OMA significantly increased the total drug costs relevant to CSU management, but the costs decreased to half in 12 months, along with dose‐reduced and interval‐extended OMA and discontinued concomitant drugs in patients with CSU who responded well to OMA. [ABSTRACT FROM AUTHOR]

This article endeavors to clarify the current requirements and status of regulatory approval for chemoprevention (risk reduction) drugs and discusses possible improvements to the regulatory pathway for chemoprevention. Covering a wide range of topics in as much depth as space allows, this report is written in a style to facilitate the understanding of nonscientists and to serve as a framework for informing the directions of experts engaged more deeply with this issue. Key topics we cover here are as follows: a history of definitive cancer chemoprevention trials and their influence on the evolution of regulatory assessments; a brief review of the long-standing success of pharmacologic risk reduction of cardiovascular diseases and its relevance to approval for cancer risk reduction drugs; the use and limitations of biomarkers for developing and the approval of cancer risk reduction drugs; the identification of individuals at a high(er) risk for cancer and who are appropriate candidates for risk reduction drugs; business models that should incentivize pharmaceutical industry investment in cancer risk reduction; a summary of scientific and institutional barriers to development of cancer risk reduction drugs; and a summary of major recommendations that should help facilitate the pathway to regulatory approval for pharmacologic cancer risk reduction drugs.

Drug cost, health care costs, generic Drugs, prescription drugs, health policy, pharmacoeconomics, Sovaldi, Harvoni, linezolid, truvada, medical ethics, cost-benefit analysis, practice guidelines. [Extracted from the article]

Supplemental digital content is available in the text. The aim of the study was to assess physiatrists' knowledge of the cost of medications commonly prescribed at discharge from inpatient rehabilitation units across the spectrum of practice experience from residents to attending physicians. Investigators contacted 92 pharmacies across four major regions of the United States and averaged the cash price of each medication. An electronic survey was created highlighting 17 medications in which physicians estimated the cost of a medication per pill and per month for a 30-day supply. Surveys were sent to all Accreditation Council for Graduate Medical Education–accredited programs across the United States; 43 participants responded to the survey. Most respondents overestimated the cost of the medications chosen for the survey. There was no significant difference between medication cost knowledge and practice experience (P = 0.497) or postgraduate year of training (P = 0.593). This raises awareness that physiatrists may not know the cost of medications they commonly prescribe at discharge, which may have implications on patient medication compliance, quality of care, and patient satisfaction. [ABSTRACT FROM AUTHOR]

Background Elevated blood pressure (i.e. hypertension) and diabetes (BPD) are the two major noncommunicable diseases that expose households to high out-of-pocket treatment costs in low- and middle-income countries. Medication is the biggest share of BPD treatment expenses, and households with someone suffering from BPD may need to adjust consumption of other commodities to pay for essential BPD medicines. We assess how BPD medication expenditures are associated with crowding out of other household commodities in Pakistan. Methods We analyze self-reported household consumption data from the nationally representative Pakistan Household Income and Expenditure Survey 2015–16. We estimate conditional Engel curves under the Quadratic Almost Ideal Demand System framework to examine the differences in average consumption shares between BPD medication-consuming and not-consuming households. Results We find that BPD medication expenditures are associated with crowding out of food and crowding in of other medical expenditures for all households, but the magnitudes of crowding out and crowding in are larger for the poorer households. BPD medication spending is also associated with crowding out of education and personal care for middle-class and wealthier households. Conclusions Our results indicate that allocations for essential commodities, like food and education, are lower for BPD medication–consuming households and inform policies for preventive health promotions and affordable treatment for hypertension and diabetes. [ABSTRACT FROM AUTHOR]

Introduction: In the current economic climate with continuous expenditure reviews and financial constraints, clinicians should remain conscious of making cost-effective choices on consumables and medications. In this survey, we evaluated the cost awareness amongst UK urologists. This is an observational study in which urology clinicians were asked to estimate the cost of 10 commonly used medications and consumables in urology by completing a questionnaire. Methodology: The survey was primarily conducted at the BAUS Annual Meeting 2017 with subsequent responders at local hospitals and urological courses. The costs of consumables and medications were verified with the relevant companies and the 73rd edition of the British National Formulary. Result: There were 139 responders from across the UK (46 consultants, 64 training registrars, 13 trust grades doctors and 16 senior house officers (SHOs)). In total, 16 and 60% of all estimates were within ± 25% and ± 100% of the true cost of the items respectively. Approximately 97.1, 95.7 and 97.1% overestimated the cost of a 14Ch urethral catheter, Ciprofloxacin and Sildenafil, respectively; while 78.4 and 84.9% of responders underestimated the cost of a JJ ureteric stent and Solifenacin, respectively. On multivariate analysis, SHOs significantly overestimated the cost of urethral catheters, suprapubic catheterization kits and JJ ureteric stents compared to other clinician grades. Conclusion: Cost awareness among UK urologists is poor. Expensive items (e.g. JJ ureteric stent, Solifenacin) tend to be underestimated while inexpensive items (e.g. catheter, Ciprofloxacin, Sildenafil) tend to be overestimated. This lack of appreciation of value may have an impact on drug and consumable expenditure. Level of Evidence: Level 3 [ABSTRACT FROM AUTHOR]

To explore the preferences of Spanish healthcare professionals (haematologists and hospital pharmacists) for the treatment selection of active Chronic Lymphocytic Leukaemia (CLL) patients at first relapse, condition that mainly afflicts older adults. A discrete choice experiment (DCE) was conducted among haematologists and hospital pharmacists. A literature review and a focus group informed the DCE design. CLL treatment settings were defined by seven attributes: four patient/disease-related attributes (age, functional status, comorbidities, and risk of the disease) and three treatment-related attributes (efficacy [hazard ratio of progression-free survival, HR-PFS], rate of discontinuations due to adverse events and cost). A mixed-logit model was used to determine choice-based preferences. Relative importance (RI) of attributes was calculated and compared between stakeholders. Willingness-to-pay (WTP) was estimated through the DCE. Besides, nine ad-hoc questions were posed, to explore more in depth CLL treatment decision making. A total of 130 participants (72 haematologists and 58 hospital pharmacists) answered the DCE. All attributes were significant predictors of preferences (p < 0.05) in the multinomial model. Higher RI was obtained for treatment-related attributes: the highest rated being 'cost' (23.8%) followed by 'efficacy' (20.9%). Regarding patient-related attributes, the highest RI was obtained for 'age' (18.1%). No significant differences (p > 0.05) in RI between haematologists and pharmacists were found. WTP for the treatment was higher for younger CLL patients. Ad-hoc questions showed that patient age and functional status influence treatment decisions. For healthcare professionals, 'cost' and 'efficacy' (treatment-related attributes) and age (patient-related attribute) are the main factors that determine CLL treatment selection at first relapse. WTP decreases as patient's age increases. [ABSTRACT FROM AUTHOR]

See Article by Luo et al

Case: An 81‐year‐old man who had many symptoms, including body pain, was receiving 13 different drugs. We used kampo medicine to improve his symptoms and to reduce the number of drugs he received. Outcome: Keishikajutsubuto (KSTJB) was given to the patient, and gradually the number of drugs he received was reduced. All symptoms were improved with only two drugs, KSTJB and epinastine, and the patient's condition has been improved for more than 10 years. Conclusion: By introducing kampo medicine, we were able to reduce the patient's daily regimen from 13 to 2 medications. A pharmaceutical cost estimate indicated savings of approximately ¥1m over the past 10 years. Thus, use of kampo medicine can resolve polypharmacy and potentially reduce pharmaceutical costs. [ABSTRACT FROM AUTHOR]

Purpose An ethnographic study of 3 pharmacy and therapeutics (P&T) committees was conducted to characterize the process by which evidence is weighted and decisions are made. Methods We recorded discussions and conducted an analysis of the transcripts from the 3 P&T committees for a 1-year period. We examined the content and ideas expressed during deliberations and synthesized themes to give a broader picture of the issues arising. Committee discussions were transcribed and the segments of each meeting that addressed any new formulary additions were then analyzed. Using constant comparison method, we generated a series of topic codes to characterize and classify that portion of the discussion. Results At 26 meetings across the 3 sites, 24 new drug formulary additions were discussed. A total of 1,093 discussion segments were identified and mapped to 7 broad categories related to discussion of evidence of need, efficacy/indications, safety, misuse potential, cost issues, committee decision-making issues, and discussion related to operationalizing use and implementation at the local institution. Overall, the leading category of discussion was efficacy/indications followed by evidence of need, operational issues, and cost issues, with some variation by site. The committees devoted substantially greater portions of their discussion to the logistics of using the drugs in their institutions than they did safety issues. We identified wide variations in specific drugs being considered and the relative amount of time devoted to various issues related to these drugs being discussed. We found discussions generally did not follow a systematic, standardized, rigorous, and reproducible approach. Discussions tended to be more idiosyncratic, individualized, varying from drug to drug, and at times devoted to a variety of tangential issues raised by committee members. Conclusion P&T committee discussions at all 3 sites tended to be idiosyncratic and individualized, varying from drug to drug, and at times devoted to a variety of issues more tangentially raised by committee members. All spent less time talking about drug safety, in each case roughly half the time that they devoted to discussions of efficacy. [ABSTRACT FROM AUTHOR]

Hospice is a unique environment among all clinical fields of practice. Although every other specialty aims to work toward a curative goal or prevention of mortality, hospice completely redirects focus solely on pain and symptom management and sustaining the highest quality of life possible. Addition of a clinical pharmacist to the interdisciplinary group (IDG) is not common, but Haven: Advanced Illness Care added a clinical pharmacist to the team in 2017. Substantial financial impacts were made in the first year, and clinical impacts were well regarded by physicians and nurses. A cost savings of $427,705 was observed, and the clinical pharmacist provided a great deal of expertise to the IDG. Adding a clinical pharmacist to the IDG of other hospice organizations may prove to be a worthy investment. [ABSTRACT FROM AUTHOR]

Introduction: The emergence of immune-modulating drugs such as biologics has altered the treatment landscape for psoriasis. However, their use presents high financial costs to patients and healthcare systems. Patient demographic and socioeconomic status may influence adherence to biologic medications and usage of healthcare resources.Areas Covered: We performed a systematic literature review to summarize the available evidence pertaining to biologic medication adherence and resource use. PubMed was searched using the terms 'psoriasis and adherence' and 'psoriasis biologics resource use.'Expert Commentary: Psoriasis patients utilize many healthcare resources. Adherence rates are typically higher for biologics than for other psoriasis treatment categories. However, adherence rates are still suboptimal. [ABSTRACT FROM AUTHOR]

Background: Drug prescription pattern for the treatment of falciparum malaria differs widely from place to place; but there is also some intra organizational variation of prescription pattern of anti-malarial drugs for the treatment of falciparum malaria. Aims and Objectives: The present study was planned to study the drug utilization pattern for the treatment of falciparum malaria in a tertiary care teaching hospital in eastern India. Materials and Methods: It was a hospital based study conducted in the department of medicine among the patients admitted with confirmed diagnosis of falciparum malaria. Drugs prescribed, average number of drugs per prescription, percentage of drugs prescribed in generic name, percentage of prescription with co-prescription of antibiotics, percentage of prescription having at least an injection prescribed, percentage of drugs prescribed from essential drug list or formulary and average drug cost per prescription are the parameters studied in this study. Results: Average number of drugs per prescription in the present study was 3.96. Artesunate and Mefloquine were the most common anti-malarial drugs prescribed among study subjects. 22.9% patients received oral Chloroquine as anti-malarial drug. 43.3% prescriptions had antibiotics co-prescribed. Only 16.9% drugs were prescribed in generic name. 85.4% of the prescribed drugs were from essential drug list. Average drug cost per patient was Rs. 282/- with minimum of Rs. 55/- and maximum of Rs. 1750/-. Conclusion: Though Artesunate combination therapy is getting popularized gradually but a sizable proportion of patients (22.9%) were prescribed with oral Chloroquine therapy. Generic prescription of drugs should be encouraged among the physicians. Multi-centric study regarding drug prescription can give a broader picture in changing scenario.

Highlights • The cost of antiepileptic drugs does not predict lower self-reported adverse effects scores. • Older adults with adequate health literacy are more likely to report greater number of antiepileptic drugs' adverse effects. • The self-reported antiepileptic adverse effects scores do not seem to influence older adults' health-related quality of life. Abstract The aim of this prospective questionnaire-based cross-sectional study was to examine whether the new generation of Antiepileptic drugs (AEDs) with higher acquisition cost generate lower adverse effects than the old AEDs among a sample of 102 Arabic-speaking older adults (60 years of age or older) with seizure disorders. The mean scores of the Arabic version of the Liverpool Adverse Events Profile (LAEP), which assessed the adverse effects of the AEDs, did not differ between patients taking the old and new generations of AEDs. Despite their 4-fold higher cost, the new generation of AEDs were not characterized by lower LAEP scores of adverse effects. However, higher LAEP scores were associated with better health literacy. In conclusion, the use of new AEDs was not associated with lower self-reported adverse effects scores among Arabic-speaking older adults with seizure disorders despite their higher acquisition costs. [ABSTRACT FROM AUTHOR]

Background: Assessment of drug costs for cost-effectiveness analyses (CEAs) in the United States is not straightforward because the prices paid for drugs are not publicly available and differ between payers. CEAs have relied on list prices that do not reflect the rebates and discounts known to be associated with these purchases.Objectives: To review available cost measures and propose a novel strategy that is transparent, consistent, and applicable to all CEAs taking a US health care sector perspective or a societal payer's perspective.Methods: We propose using the National Average Drug Acquisition Cost (NADAC), the Veterans Affairs Federal Supply Schedule (VAFSS), and their midpoint as the upper bound, lower bound, and base case, respectively, to estimate net drug prices for various payers. We compare this approach with wholesale acquisition cost (WAC), the most common measure observed in our literature review. The minimum WAC is used to provide the most conservative comparison.Results: Our sample consists of 1436 brand drugs and 1599 generic drugs. On average, the upper bound (NADAC) is 1% and 9.8% lower than the WAC for brand and generic drugs respectively, whereas the lower bound (VAFSS) is 48.3% and 54.2% lower than the WAC. The NADAC is less than the WAC in 89.6% of drug groups. The distributions of these relationships do not show a clear mode and have wide variation.Conclusions: Our study suggests that the WAC may be an overestimate for the base case because the minimum WAC is higher than the NADAC for most drugs. Our approach balances uncertainty and lack of data for the cost of pharmaceuticals with the need for a transparent and consistent approach for valid CEAs. [ABSTRACT FROM AUTHOR]