Drug Utilization Analysis Research Articles

Analysis of Prescription Pattern of Anti-diabetic Medications in a Teaching Hospital in North India.

This retrospective observational study aimedto comprehensively analyse the clinical profile and treatment modalities of patients diagnosed with type 2 diabetes mellitus (T2DM) who were treatedat a tertiary care centre. The study included a cohort of 300 individuals who sought medical care at the hospital from January 2023 to January 2024. The analysis primarily examined parameters such as the mean number of anti-diabetic medications per prescription, the proportion of various categories of anti-diabetic medications prescribed, the predominant class and type of anti-diabetic medications prescribed, and the proportion of anti-diabetic medications prescribed from the essential drug lists. The age distribution demonstrated that 52.0% of participants were above 60 years old, showcasing a substantial elderly representation. Gender distribution emphasized a male predominance at 65.0%, highlighting potential gender-specific implications in type II diabetes. The blood profile analysis of patients with T2DM revealed a range of values for key parameters. Fasting blood glucose levels ranged from a minimum of 101 mg/dL to a maximum of 359 mg/dL, with a mean of 180.01 mg/dl. The comprehensive analysis of anti-diabetic drug utilization, based on the total number of units prescribed, sheds light on the diverse treatment approaches employed for managing diabetes mellitus (DM). Insulin, comprising 31.3% of the total units, plays a pivotal role in glycemic control, with both regular and biphasic formulations contributing significantly at 26.3% and 9.3%, respectively. Among the 300 patients, the overall utilization of anti-diabetic drugs reveals that 38.7% of individuals are using a combination of insulin with oral anti-diabetic drugs, while 61.3% are relying on oral anti-diabetic drugs alone. The most frequently prescribed drug combinations for diabetes management include sulphonylurea with biguanides, emerging as the most prevalent combination with 22 occurrences. The study's findings contribute valuable insights into the socio-demographic profiles and anti-diabetic drug utilization patterns among diabetes patients.

Sedative load and anticholinergic burden among older adults in Slovenia over a decade: Potential for optimization of pharmacotherapy.

This study investigates the 10-year trend in the sedative and anticholinergic burden among older adults in Slovenia, with the aim of identifying opportunities to optimize pharmacotherapy in this population. A retrospective drug utilization analysis was conducted based on a national anonymized database of dispensed prescriptions from 2009 to 2019. The study employed the sedative load model and the anticholinergic cognitive burden scale to assess the sedative and anti cholinergic burden, respectively. The findings indicate that in 2019, 45.6 % and 40.8 % of older adults (≥ 65 years) used sedative and anticholinergic medications, respectively. A high sedative load and a clinically significant anticholinergic burden were observed in a considerable proportion of older adults (13.2 % and 11.2 %, respectively, in 2019). The age-standardized prevalence of sedative load and anti-cholinergic burden significantly decreased over the 10-year study period by 5.6 % and 1.7 %, respectively (absolute difference), while the prevalence of clinically significant anticholinergic burden remained stable. Notably, the age groups 85-89 years and above 90 years had an increase in the proportion of individuals with a clinically significant anticholinergic burden over the years. These results emphasize the need for targeted interventions, particularly in the oldest age groups, to promote safe and effective medication use among older adults.

Analysis of the availability of bronchodilators and anti-inflammatory drugs for patients with chronic obstructive pulmonary disease

Background. The study of drug availability for patients with chronic obstructive pulmonary disease (COPD) represents one of the priority tasks in the organization of effective counteraction to COPD in the Russian Federation.Objective: to assess drug prices, affordability, and availability for COPD patients.Material and methods. The analysis of drug availability for COPD patients was carried out according to the methodology of the World Health Organization and Health Action International (WHO/HAI). Bronchodilator and anti-inflammatory therapy of originator brands and lowestpriced generics was evaluated. The consumption volume of the studied drugs was also analyzed using the ATC/DDD (Anatomical Therapeutic Chemical classification / defined daily dose) pharmacoepidemiologic methodology over a three-year period (from 2020 to 2022), taking into account their share of total DDD (drug utilization analysis, DU90%).Results. According to the results of DU90% analysis, the most purchased drugs for bronchodilator and anti-inflammatory therapy for all the years under study were drugs from the groups of short-acting bronchodilators (salbutamol, fenoterol, ipratropium bromide + fenoterol) and inhaled glucocorticoids (budesonide, beclomethasone). The obtained data were confirmed by the results of the physical availability study. Thus, the highest percentage of physical availability was for short-acting inhaled beta-2-agonists (SABA) (salbutamol). Analysis of drug affordability also revealed a tendential superiority of SABA and short-acting anticholinergics over baseline bronchodilators and antiinflammatory drugs.Conclusion. Low affordability of the main drugs of baseline therapy contributes to the burden of COPD and necessitates improvement of drug supply mechanisms for individuals, especially those with low material income, which in the long term will significantly reduce the costs of the healthcare system for the treatment of these patients by decreasing the severity and frequency of exacerbations.

Drug utilization analysis of osteoporosis medications in seven European electronic health databases

SummaryWe studied the characteristics of patients prescribed osteoporosis medication and patterns of use in European databases. Patients were mostly female, older, had hypertension. There was suboptimal persistence particularly for oral medications. Our findings would be useful to healthcare providers to focus their resources on improving persistence to specific osteoporosis treatments.PurposeTo characterise the patients prescribed osteoporosis therapy and describe the drug utilization patterns.MethodsWe investigated the treatment patterns of bisphosphonates, denosumab, teriparatide, and selective estrogen receptor modulators (SERMs) in seven European databases in the United Kingdom, Italy, the Netherlands, Denmark, Spain, and Germany. In this cohort study, we included adults aged ≥ 18 years, with ≥ 1 year of registration in the respective databases, who were new users of the osteoporosis medications. The study period was between 01 January 2018 to 31 January 2022.ResultsOverall, patients were most commonly initiated on alendronate. Persistence decreased over time across all medications and databases, ranging from 52–73% at 6 months to 29–53% at 12 months for alendronate. For other oral bisphosphonates, the proportion of persistent users was 50–66% at 6 months and decreased to 30–44% at 12 months. For SERMs, the proportion of persistent users at 6 months was 40–73% and decreased to 25–59% at 12 months. For parenteral treatment groups, the proportions of persistence with denosumab were 50–85% (6 month), 30–63% (12 month) and with teriparatide 40–75% (6 month) decreasing to 21–54% (12 month). Switching occurred most frequently in the alendronate group (2.8–5.8%) and in the teriparatide group (7.1–14%). Switching typically occurred in the first 6 months and decreased over time. Patients in the alendronate group most often switched to other oral or intravenous bisphosphonates and denosumab.ConclusionOur results show suboptimal persistence to medications that varied across different databases and treatment switching was relatively rare.

Analysis of Drug Utilization in Patients with Psoriasis: A Real-World Retrospective Study Among the Italian Population.

An Italian real-world retrospective study was conducted in patients with psoriasis (PSO) to evaluate their characteristics, treatment patterns, and biological/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) drug utilization. The retrospective analysis was carried out on real-world data collected from administrative databases of selected Italian health-departments; the dataset covered approximately 22% of the Italian population. PSO patients (identified by PSO hospitalization, and/or active exemption code and/or a topical anti-psoriatic medication prescription) were included. In prevalent patients identified during 2017-2018-2019-2020, baseline characteristics and treatment patterns were investigated. Moreover, b/tsDMARD drug utilization (focusing on persistence, monthly dosage, and mean duration between prescriptions) was evaluated in bionaïve patients included during 2015 and 2018. PSO was diagnosed in 241,552 (in 2017), 269,856 (in 2018), 293,905 (in 2019) and 301,639 (in 2020) patients. At the index date, almost 50% of patients had not received systemic medications, and 2% had received biological treatment. Among the b/tsDMARD-treated patients, a decrease in the use of tumour necrosis factor (TNF) inhibitors (60.0-36.4%, from 2017 to 2020) and an increase in the use of interleukin (IL) inhibitors (36.3-50.6%, from 2017 to 2020) were observed. In 2018, the persistence rates of TNF inhibitors and IL inhibitors in bionaïve patients ranged from 60.8-79.7% and 83.3-87.9%, respectively. This real-world study of PSO drug utilization in Italy showed that a significant number of patients were not treated with systemic medications and only 2% of patients were treated with biologics. An increase in the use of IL inhibitors and a decrease in the prescription of TNF inhibitors over years were found. Patients treated with biologics were highly persistent with treatment. These data provide insight into routine clinical practice for PSO patients in Italy, suggesting that the optimization of treatment for PSO still represents an unmet medical need.

Clinicoetiological Profile of Acute Ischemic Stroke Patients in the Therapeutic Window in a Tertiary Care Hospital in Northern India

Background: A stroke is defined by the rapid emergence of clinical symptoms and focuses on evidence (applicable to individuals in a deep coma and those with subarachnoid hemorrhage) or widespread brain damage. The study aimed to evaluate the clinical characteristics of patients with acute ischemic stroke in a tertiary care hospital in North India. Methods: By analyzing case files and conducting patient interviews, information on the patients was gathered and evaluated. The study's inclusion and exclusion criteria were based on the 2018 American Heart Association and American Stroke Association (AHA/ASA) thrombolysis guidelines for acute ischemic stroke. Recent major trauma or major surgery within 14 days not involving the head, seizure at the onset of stroke, systemic malignancy, and pregnancy were excluded. Results: The study enlisted the participation of 76 patients who were divided into two groups. Patients in the one group were given tenecteplase, whereas the other group were given alteplase. Patients in the tenecteplase and alteplase groups were of different ages and had various other risk factors for hypertension, atrial fibrillation, diabetes, smoking, and previous stroke or transient ischemic attack. The risk factor distribution in both the groups was statistically significant for variables such as hypertension and diastolic blood pressure (P < 0.05). Stroke in internal carotid artery territory was present in 3 out of 42 in the tenecteplase group and 2 out of 32 in the alteplase group. Most patients in both the groups had a stroke of undetermined cause. Small vessel and large vessel strokes were found in 9.5% and 14.7%, respectively. Conclusion: In the development of stroke, there is a definite relationship between age and gender. A sedentary lifestyle, food, and obesity are risk factors for stroke. According to an AHA/ASA drug utilization analysis, most medicines were appropriate for stroke patients.

Neuropsychiatric Comorbidity in Primary Hyperparathyroidism Before and After Parathyroidectomy: A Population Study

BackgroundPrimary hyperparathyroidism (PHPT) is often accompanied by neuropsychiatric symptoms. This study aimed to map out psychiatric comorbidity as reflected by medical treatment for psychiatric symptoms.MethodsA retrospective case–control analysis and a prospective cohort analysis of psychotropic drug utilization before and after PTX. A total of 8279 PHPT patients treated with parathyroidectomy in Sweden between July 1, 2008 and December 31, 2017 compared to a matched control cohort from the total population (n = 82,790). Information on filled prescriptions was collected from the Swedish Prescribed Drug Register (SDR). Socioeconomic data and diagnoses were added by linkage to national patient and population registers. Regression analyses were used to calculate relative drug utilization (OR) within 3 years prior to PTX and relative incidence of drug treatment (RR) within 3 years postoperatively.ResultsUtilization of antidepressant, anxiolytic and sleep medication was more comprehensive in PHPT patients compared with the controls prior to PTX. The most common were benzodiazepines [OR 1.40 (95% CI: 1.31–1.50)] and selective serotonin reuptake inhibitors [SSRI; OR 1.38 (95% CI: 1.30–1.47)]. Postoperatively, the excess prescription rate for anxiolytic benzodiazepines decreased within three years from a 30 to 19% excess and for benzodiazepines for sleep from 31 to 14%. No corresponding decrease in excess prescription rate was observed for SSRI.ConclusionPHPT is associated with increased utilization of antidepressive medications and benzodiazepines before PTX. This study implies that psychiatric symptoms should be considered in PHPT patients and continuous medication should be reevaluated after PTX.

Drug Utilization Analysis of Anticoagulant and Antiplatelet Drugs in Cardiology Department of a Tertiary Care Hospital

<p style="text-align: justify;"><strong>Background: </strong>The current study was planned to estimate the usage of antiplatelet drugs and anticoagulant drugs patients in the teaching hospital. <strong>Methods: </strong>The records were composed through the Cardiology ward / Cardiac care unit (CCU) on regular basis after receiving agreement from the Institutional Ethics Committee (IEC). The documents pooling layout was generated and validated by giving inclination to drugs used by Coronary artery disease (CAD), Ischemic heart disease (IHD), Angina pectoris, Arterial fibrillation. Data of patient&rsquo;s identical inclusion criteria were noted. <strong>Results:</strong> An overall of 210 patients was included in the study giving an overview of the characteristics of the patients and prescriptions. In this study, the total number of male patients was found to be 118, and the number of female patients was 92. Coronary artery disease was observed to be more common in males (56.2%) than in females (43.8%). A total of 210 patients were taken for the study and patients were categorized according to their age group and gender. <strong>Conclusion:</strong> It was concluded that drug utilization of antiplatelet and anticoagulant drugs was 92.8% and 63.80% respectively achieved in the tertiary care hospital in Northern India Jan-June 2021. Aspirin and Ticagrelor were the frequently used antiplatelet drugs whereas Heparin and Enoxaparin were the most used anticoagulant drugs in MMIMSR, Ambala. This study gives an idea for conducting Drug utilization review on antiplatelet and anticoagulants drugs with improved and better understanding. <p style="text-align: justify;"><strong>Key words:</strong> Drug utilization review, Anticoagulant, Antiplatelet, Cardiovascular disease, Single-dual-triple antiplatelet therapy, Single dual anticoagulant therapy, Antiplatelet and anticoagulant therapy.

Retrospective analysis of drug utilization and rational drug use in treatment of essential arterial hypertension in Bulgaria: Generic perception

Aim: To analyze drug utilization and rational drug use in treatment of essential arterial hypertension in Bulgaria by using quantitative and qualitative parameters at national level. To assess generic penetration as a part of rational drug use. Materials and methods: Design: retrospective study of publicly accessible data from registries of National health insurance fund for the period January–December 2017. The analyses are in accordance with ATC/DDD methodology of WHO. The data was processed via descriptive statistical methods. Results: The analyzed population includes 185 671 patients with essential arterial hypertension—13.33% of all hypertensive patients. The expenses for 2017 are 9 796 940.12 BGN (Bulgarian leva; 1 Euro=1.95,585 BGN). The expense per patient per year is 52.76 BGN, monthly expense is 4.40 BGN and daily expense is 0.14 BGN. The sum of 9 796 940.12 BGN is divided into two groups—expenses for monoproducts 65.88% and expenses for combined products 34.12%. Blockbusters are INNs lercanidipine and nebivolol. The total expenses for uncomplicated essential arterial hypertension are 1.22% of the total expenses. With this resource, 1.6 DDD/Patient/Day is provided. Discussion: In Bulgarian therapeutic practice, the most prescribed products are beta-blockers nebivolol and bisoprolol, calcium antagonist lercanidipine, and centrally acting antiadrenergic agents rilmenidine and moxonidine. Sartanes are represented mainly by valsartan. In all section analyses, the considerable use of lercanidipine is evident. Reference (original) medicinal products are mainly prescribed, while the market share of generic products, both in terms of costs and DDD, is significantly lower. Obtained results are inconsistent with European recommendation, while lack of national pharmacotherapeutic guideline poses a serious challenge.

Free combination of dutasteride plus tamsulosin for the treatment of benign prostatic hyperplasia in South Korea: analysis of drug utilization and adverse events using the National Health Insurance Review and Assessment Service database

ObjectiveTo assess the use and safety of free combination therapy (dutasteride and tamsulosin), dutasteride monotherapy, or tamsulosin monotherapy in patients with benign prostatic hyperplasia (BPH).MethodsThis non-interventional retrospective cohort study used claims data from the Korea Health Insurance Review and Assessment-National Patient Sample database. Patients with BPH ≥ 40 years of age receiving combination therapy (dutasteride 0.5 mg and tamsulosin 0.4 mg daily) or dutasteride 0.5 mg, or tamsulosin 0.4 mg daily dose between 2012 and 2017 were included. The frequency, duration of treatment and risk of any adverse event (AE) or serious AE (SAE) was compared for combination therapy versus each monotherapy using non-inferiority testing.ResultsOf 14,755 eligible patients, 1529 (10.4%) received combination therapy, 6660 (45.1%) dutasteride monotherapy, and 6566 (44.5%) tamsulosin monotherapy. The proportion of patients treated with combination therapy exceeded the pre-specified 3% threshold for ‘frequent’ use. Safety results indicated a similar risk of any AE and SAE irrespective of treatment group. The adjusted relative risk for any AE over the treatment observation period comparing combination therapy with dutasteride monotherapy was 1.07 (95% confidence interval [CI] 1.03, 1.12), and with tamsulosin monotherapy was 0.98 (95% CI 0.95, 1.02) demonstrating non-inferiority. The adjusted relative risk for any SAE was 1.07 (95% CI 0.66, 1.74) and 0.90 (95% CI 0.56, 1.45), compared with dutasteride and tamsulosin monotherapy, respectively. Although the SAE results did not statistically demonstrate non-inferiority of combination therapy based on pre-specified margins, the 95% CI for the risk ratio estimates included the null with a lower limit below the non-inferiority margins, indicating no meaningful differences in SAE risk between groups. Absolute SAE risks were low.ConclusionCombination therapy with dutasteride and tamsulosin is frequently used in real-world practice in South Korea for treatment of BPH and demonstrates a safety profile similar to either monotherapy.

Analysis of Prescription Drug Utilization with Beta Regression Models

The health care sector in the United States is complex and is also a large sector that generates about 20% of the country’s gross domestic product. Health care analytics has been used by researchers and practitioners to better understand the industry. In this article, we examine and demonstrate the use of Beta regression models to study the utilization of brand name drugs in the United States to understand the variability of brand name drug utilization across different areas. The models are fitted to public datasets obtained from the Medicare & Medicaid Services and the Internal Revenue Service. Integrated nested Laplace approximation (INLA) is used to perform the inference. The numerical results show that Beta regression models can fit the brand name drug claim rates well and including spatial dependence improves the performance of the Beta regression models. Such models can be used to reflect the effect of prescription drug utilization when updating an insured’s health risk in a risk scoring model.

Analysis of drug utilization in government tertiary care institution of South India

Background: Drug is an active chemical molecule used for diagnosis, prevention, and treatment of a disease. Drug utilization study is a potential tool in the evaluating the health-care system of a country since drug therapy accounts for major health expenditure. These studies also facilitate rational use of drugs among people of various age groups. Aims and Objectives: This study aims to analyze the utilization pattern of drugs in the pediatric outpatient department (OPD) and also to analyze drug prescribing indicators of the World Health Organization. Materials and Methods: A prospective observational study was conducted in the pediatric outpatient department (OPD) of Government Kilpauk Medical College Hospital, Chennai for one month during October 2014. A total of 600 prescriptions were collected. Patient-related information and drug-related information were analyzed. Drug prescribing indicators of the World Health Organization were also analyzed. Results: The most common age group was 1–6 years. Average number of drug per prescription was 1.96. Antimicrobial agents were most commonly prescribed drugs. About 93.6% of them were generic drugs. About 90.33% of drugs were from National Essential Medicine List 2011. Conclusion: This study helps us to identify potential targets so as to make improvement in prescribing and dispensing policies of drugs in the hospital.

PMS36 Real-World Analysis of Prevalence, Treatment Patterns and Drug Utilization Among Patients Affected By Axial Spondyloarthritis (AXSPA) in Italy

To evaluate prevalence of patients with axSpA diagnosis and their treatment patterns and drug utilization in real-world settings. This observational study was performed using administrative databases of selected Italian settings and included patients with axSpA diagnosis identified by ICD-9-CM or exemption code. A cross-sectional analysis was performed for years 2016-2018 to evaluate treatment patterns. Patients prescribed drugs indicated for axSpA were defined “treated”, otherwise “untreated”. A longitudinal analysis was conducted to investigate biological disease-modifying antirheumatic drugs (bDMARDs) utilization among axSpA patients receiving their first bDMARD (index-therapy) during years 2014 and 2017. Follow-up was from index-therapy prescription date to end of data availability. Switch was defined when bDMARDs administered during follow-up were different than index-therapy. Treatment discontinuation was defined as absence of bDMARDs prescriptions during last trimester of follow-up. In the sample analysed, AxSpA prevalence was 0.076% (0.088% in adult population). Cross-sectional analysis: patients with axSpA diagnosis were 5,942 in 2016, 6,554 in 2017, 7,146 in 2018. Proportion of untreated patients was 34.1% (2016), 36.6% (2017) and 51.5% (2018), that of bDMARDs-treated patients was 21.4% (2016), 22.0% (2017), 16.9% (2018). In 2016 the only class of biologic prescribed was anti-TNF; in 2017 bDMARDs-treated patients started receiving anti-IL-17A agents (7.9% in 2017, 12.9% in 2018). Longitudinal analysis: in 2014, of 349 patients included, 9.5% switched therapy; 13.8% discontinued their bDMARDs treatment after a mean time of 84.9±72.7 days. In 2017, 262 patients were considered: 12.2% switched therapy and 27.1% had a treatment discontinuation after a mean time of 107.0±81.9 days. In this real-world study, we provided axSpA prevalence in an unselected Italian population under clinical practice settings. Preliminary results showed significant proportions of untreated patients. In 2017, around one-fourth of patients receiving first bDMARD discontinued their treatment. Our findings suggest an unmet therapeutic need exists for axSpA patients.

Traceability of Pediatric Antibiotic Purchasing Pathways in Italy: A Nationwide Real-World Drug Utilization Analysis.

PurposeThe aim of the present study was to describe the purchasing patterns of a set of antibiotics used exclusively in an out-patient pediatric setting in Italy using the Farma360 wholesale drug database (IQVIA Solutions Italy), identifying the proportion of medications which are not captured by Italian National Health Service (NHS) pharmacy claims databases and examining the implications of such findings from a public health and pharmaceutical policy perspective.MethodsUsing a systematic approach, sixty-six antibiotic pediatric formulations were selected for the 5 most commonly used antibiotics in Italy in children and adolescents: amoxicillin in combination with clavulanic acid, amoxicillin, azithromycin, clarithromycin and cefixime. The Farma360 wholesale drug purchasing database was used to identify the yearly proportion of antibiotics not purchased based on NHS reimbursement in primary care from 2015–2017 at the national level. The relationship between product cost and purchase outside the NHS was assessed by a scatterplot. All analyses were stratified by geographic area: Northwest, Northeast, Central and Southern Italy.ResultsThe proportion of antibiotics not reimbursed by the NHS increased nationally from 24% in 2015 to 29% in 2017. The antibiotic with the highest proportion of purchases outside the NHS was amoxicillin, with almost two-thirds of all amoxicillin purchases in Southern Italy being made in this way in 2017. The relationship between antibiotic price and antibiotic purchase outside the NHS was almost linear for many geographic areas.ConclusionsThis study showed that a large proportion of antibiotics with a pediatric formulation is purchased outside the NHS drug purchasing pathway, especially in Southern Italy, indicating that it is not possible to fully monitor drug utilization, including appropriateness, for these antibiotics. A better strategy is needed to improve drug utilization monitoring, such as better data collection or data linkage.

Real-World Experience With Apremilast in the Treatment of Adults With Moderate to Severe Plaque Psoriasis in Québec: A Claims-Based Analysis of Drug Utilization and Healthcare Resource Utilization.

In Québec, targeted biologic therapies for moderate to severe plaque psoriasis are restricted to patients who have not responded to phototherapy or conventional systemic treatment, primarily due to high drug costs. Apremilast, an oral treatment for plaque psoriasis, was added to the Québec provincial health insurance plan (Régie de l'assurance maladie du Québec; RAMQ) formulary in 2015, making this the only province in Canada with public drug plan reimbursement for apremilast. The aim of this study is to describe patients' characteristics, treatment patterns, healthcare resource utilization (HCRU), and associated costs and to measure real-world budget impact of using apremilast before biologics in plaque psoriasis. This study was performed using RAMQ drug claims and medical services data. Patients diagnosed with psoriasis between January 2015 and December 2017 were identified. Medical services and prescription claims were categorized as all-cause and psoriasis-related. Using RAMQ database estimates, a 3-year budget impact analysis was developed comparing treatment cost with and without the addition of apremilast to the formulary. In all, 540 patients were identified (apremilast: n = 92; biologics: n = 448). Comorbidity burden and treatment persistence and adherence were comparable between apremilast and biologic users. The year following the index date, all-cause HCRU was lower for apremilast versus biologic users (CAN$19 763 vs CAN$28 025; P < .01), mainly driven by drug cost. Using apremilast before biologics resulted in an estimated RAMQ net savings of CAN$49 290 (2015), CAN$746 856 (2016), and CAN$1 216 512 (2017), and a total savings of CAN$2 012 658 since apremilast's addition to the formulary. Adding apremilast to the drug formulary of other Canadian provinces could result in significant healthcare savings.

Impact of out-of-pocket costs on patient initiation, adherence and persistence rates for patients treated with anti-vascular endothelial growth factor medicines.

Out-of-pocket costs are a key driver of patient decisions to access, adhere and persist with anti-vascular endothelial growth factor (VEGF) therapy. The Medicare Benefits Schedule Review Taskforce proposes a 69% reduction in the scheduled fee for intravitreal injections (item 42 738) which risks increasing out-of-pocket costs for patients and worsening visual outcomes. To determine the impact of out-of-pocket costs on current anti-VEGF utilization rates in patients with neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO). This is a retrospective cohort drug-utilization analysis. This study involved 11 592 patients in Australia diagnosed with nAMD or DMO. A retrospective analysis of electronic, de-identified dispensing records of patients diagnosed with nAMD or DMO who initiated anti-VEGF therapy between January 1, 2016 and December 2018 across Australia. Patients were categorized by treatment facility type: bulk-billing clinics (BBCs) and "rest of market" clinics (ROMCs). Dispensing quantities, intervals and persistence rates. For patients with nAMD who initiated therapy between 2016 and 2018 the mean number of medicines dispensed up to September 30, 2019 was 17.0 for BBC and 13.8 for ROMC patients. For patients with DMO, the mean number of medicines dispensed was 16.5 for BBC patients and 12.5 for ROMC patients. Patients treated at BBCs had higher persistence rates than those treated at ROMCs. DMO patients had higher initiation rates BBCs (46%) vs ROMCs (25%). Lower out-of-pocket costs are associated with higher adherence and persistence rates for anti-VEGF therapy in patients with AMD and DMO and higher initiation rates for DMO patients.

Drug utilization, rationality, and cost analysis of antimicrobial medicines in a tertiary care teaching hospital of Northern India: A prospective, observational study.

BACKGROUND:The burden of bacterial infections is huge and grossly under-represented in the current health-care system. Inappropriate use of antimicrobial medicines (AMMs) poses a potential hazard to patients by causing antibiotic resistance. This study was conducted to assess the: (i) AMM consumption and use patterns in patients attending the outpatients and inpatients of Medicine and Surgery departments of the hospital. (ii) Appropriateness of the AMM in the treatment prescribed, and (iii) cost incurred on their use in admitted patients.MATERIALS AND METHODS:An observational, prospective study was conducted among inpatients and outpatients of the Medicine and Surgery departments of a tertiary care hospital of northern India. Analysis of 2128 prescriptions and 200 inpatient records was performed using a predesigned format. The use of AMMs was reviewed using anatomical therapeutic chemical classification and defined daily doses (DDDs). To evaluate the expenditure incurred on AMMs, ABC analysis was performed.RESULTS:AMMs were prescribed to 37.9% outpatients and 73% of admitted patients. The percentage encounters with AMMs was 40.6% (medicine) and 25.6% (surgery) outpatients. The total DDDs/100 patient days of AMMs in medicine and surgery were 3369 and 2247. Bacteriological evidence of infection and AMM sensitivity was present in only 8.5% of cases. Over 90% of AMMs were prescribed from the hospital essential medicines list. Most of the AMMs were administered parenterally (64.9%). Multiple AMMs were prescribed more to inpatients (84.2% vs. 4.2% outpatients). Overall, expenditure on AMM was 33% of the total cost of treatment on medicine. ABC analysis showed that 74% of the expenditure was due to newer, expensive AMM, which constituted only 9% of the AMM used. The AMM therapy was found to be appropriate in 88% of cases as per Kunin's criteria for rationality.CONCLUSION:AMMs are being commonly prescribed without confirmation of AMM sensitivity in the hospital. A large proportion of expenditure is being incurred on expensive AMM used in a few number of patients. There is a need for developing a policy for rational use of AMM in the health facility.

Drug prescribing patterns in pediatric urinary tract infections: A retrospective drug utilization analysis in an urban tertiary care hospital

ABSTRACTIntroduction:A constant update of antibiotic sensitivity of pathogens of the area, country, or institution helps in interventions that would improve the prescribing pattern and rational use of drugs in children. This study aimed to assess prescribing trends for urinary tract infection (UTI), a common distressful pediatric infection in a tertiary care teaching hospital.Materials and Methods:This study was a descriptive, retrospective, cross-sectional, and record-based analysis including pediatric patients aged <18 years of either gender diagnosed with UTI. The case record files retrieved from medical records department based on the International Classification of Diseases, 10th Revision (ICD-10) disease coding were analyzed for demographics, and details of drugs including dose and route of administration, frequency, and duration of treatment with antimicrobial used and other concurrent drugs were recorded.Results:Of 42 patients included in the study, 14 (33.3%) were males and 28 (66.67%) were females. Third-generation cephalosporins were the most commonly used antibiotics (71.4%) followed by aminoglycosides (35.7%), amoxicillin clavulanate (11.9%), fluoroquinolones (7.1%), and miscellaneous (doxycycline, metronidazole, and nitrofurantoin) (9.5%). Ceftriaxone among the cephalosporins and amikacin among the aminoglycosides were the most commonly used drugs. Intravenous route was the most commonly used route of administration followed by patients who received by both intravenous and oral routes. The average duration of therapy was 4.43 ± 1.9 days.Conclusion:This study concludes that third-generation cephalosporin is used as first-line drugs irrespective of the causative agent for UTI which should ideally be reserved for complicated UTIs. Moreover, existing guidelines also indicate that the duration of antimicrobial therapy should be seven to 14 days. These results highlight the necessity for a remedial education program within the health care system designed to improve pharmacotherapy of UTI.

Combined hormonal contraceptive use in Europe before and after the European Commission mandated changes in product information

ObjectivesWe investigated combined hormonal contraceptives (CHC) prescribing patterns (focusing on combined oral contraceptives; COC) in three countries (Netherlands, Denmark, United Kingdom) in a time period preceding and in a time period following the European Commission's decision to update product information, and we estimated changes in incidence of venous thromboembolism (VTE) between the two periods. Study designWe conducted a drug utilization analysis and a cohort study using routinely collected data. We calculated number, proportion and incidence rate of new users, switchers, and stoppers of COC in both time periods. VTE incidence was calculated in new users of COC and in all women aged 18–49 years. ResultsIn all countries, the largest proportion (>75%) of new users used COC containing levonorgestrel, norethisterone, or norgestimate, (i.e., indicated by European Medicines Agency (EMA) as the safest preparations) in both time periods. Switching did not demonstrate a clear pattern towards these types of COC and distribution of stoppers was similar in both time periods. While the proportion of new users initiating COC containing levonorgestrel, norethisterone, or norgestimate increased slightly, this did not translate to a decrease in the overall VTE incidence. ConclusionAll three countries had the greatest proportion of women initiating a COC containing levonorgestrel, norethisterone, or norgestimate, and this proportion increased in the period after the European Commission decision albeit the increase was small due to the high percentage of use before the decision. This did not translate into a measureable change in the incidence of VTE. ImplicationsBoth before and after the European Commission's decision, the largest proportion of new users started with combined oral contraceptives containing levonorgestrel, norethisterone, or norgestimate. Earlier studies had already indicated an increased risk of VTE associated with COC containing other progestogens compared with these preparations, so it is possible that physicians were already preferentially prescribing COC containing levonorgestrel, norethisterone, or norgestimate to new users.

Prescription Pattern and Drug Utilization Analysis in Patients with Acute Coronary Syndrome

Prescription Pattern and Drug Utilization Analysis in Patients with Acute Coronary Syndrome