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Use of non-formulary high-cost medicines in an Australian public hospital.
- Source :
- International Journal of Clinical Pharmacy; Aug2019, Vol. 41 Issue 4, p920-931, 12p
- Publication Year :
- 2019
-
Abstract
- Background Clinicians prescribe high-cost medicines for rare diseases and nonapproved indications when conventional therapies have failed. Objective To examine the use of non-formulary high-cost medicines at an Australian public hospital. Methods Retrospective audit of individual patient use applications for nonformulary medicines costing more than $5000 AUD per year at a large tertiary referral hospital in Adelaide, South Australia over a 12-month study period from January 2015 to December 2015. Main outcome measures Total cost of non-formulary high-cost medicines, medication class, indications for use, level of supporting evidence and proposed monitoring outcomes. Results Eighty-seven individual patient use applications were examined. All except one were approved, at a total cost of $1,339,203 AUD. The most common drug classes were anti-CD20 (n = 33, 38%), combined antiretrovirals (n = 10, 11%) and TNF-alpha antagonists (n = 10, 11%). There were 56 indications for these medicines with the majority being inflammatory conditions (n = 52, 60%), followed by infections (n = 14, 16%) and malignancies (n = 14, 16%). Of the first-time individual patient use applications (n = 63), there were 25 applications (40%) that provided a case series as supporting evidence. Approximately half of new individual patient use applications (n = 32) proposed an objective monitoring outcome, but few (n = 13, 21%) contained sufficient information to allow a third party to determine efficacy of the medication. Conclusions Non-formulary high-cost medicines are being used for a broad range of indications based largely on low levels of evidence. Prospective definition of an adequate response to treatment and reporting of these outcomes is required to improve the evidence-base and to aid decision-making for subsequent treatment courses. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 22107703
- Volume :
- 41
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- International Journal of Clinical Pharmacy
- Publication Type :
- Academic Journal
- Accession number :
- 137871066
- Full Text :
- https://doi.org/10.1007/s11096-019-00853-z