Patient Drug Costs Research Articles

Number needed to treat and cost per remitter for biologic treatments of Crohn’s disease in Japan

Aims: Adalimumab, infliximab, and ustekinumab have been approved for patients with moderate-to-severe Crohn’s disease in Japan. This study compared the relative efficacy and cost-effectiveness of adalimumab, infliximab, and ustekinumab in patients with Crohn’s disease based on data from randomized controlled trials.Methods: Data were extracted from four phase 3 clinical trials: CHARM, NCT00445432, ACCENT I, and IM-UNITI. A network meta-analysis (NMA) compared 1-year clinical remission rates in patients who responded to treatment during an induction phase. Remission was defined as a Crohn’s Disease Activity Index score <150. The number needed to treat (NNT) was defined as the inverse of the risk reduction (compared with placebo) estimated from the NMA among initial responders. Cost per incremental remitter was calculated based on the projected per patient drug cost (2018 Japanese Yen [¥]) and the NNT.Results: Among initial responders, the remission rates were 45.2%, 31.9%, 27.4%, 24.1%, and 15.6% for adalimumab 40 mg every other week (EOW), infliximab 5 mg/kg every 8 weeks, ustekinumab 90 mg every 8 weeks, ustekinumab 90 mg every 12 weeks, and placebo, respectively. The NNT was the lowest for adalimumab 40 mg EOW. Compared with adalimumab, the incremental cost per remitter was numerically higher for infliximab (¥5,375,470) and statistically higher for ustekinumab 90 mg every 8 weeks and ustekinumab 90 mg every 12 weeks (¥42,788,597 and ¥41,495,543, respectively).Limitations: Indirect comparisons are limited by the availability of suitable clinical evidence and there may be residual heterogeneity that could not be adjusted for.Conclusion: Adalimumab was associated with a numerically lower cost per remitter compared with infliximab and a statistically lower cost per remitter compared with ustekinumab in patients with moderate-to-severe Crohn’s disease in Japan.

Frontline Physicians Flex Medicine’s Muscle on Capitol Hill Regarding Patient Care

A coalition of physician organizations, including APA, presented a united front on Capitol Hill to encourage reforms important to physicians and their patients.

PRS12 - A Budget Impact Analysis of The Inclusion of Fluticasone Propionate/Formoterol On A Government Subsidy List in Singapore For The Treatment of Moderate-To-Severe Asthma

A report by the Global Asthma Network (2014) ranked Singapore as an intermediate risk country for asthma prevalence. However, subsidy on asthma medication is limited to only a few selected inhaled corticosteroids and long-acting β2-agonists fixed dose combinations. The purpose of this model was to show the potential budgetary impact of the inclusion of fluticasone propionate/formoterol (FP/FORM) on a government subsidy list in Singapore, for treatment of patients with moderate-to-severe asthma. A budget impact model was built to show the change to annual drug costs for patients with moderate-to-severe asthma in Singapore following the inclusion of FP/FORM on a government subsidy list. The relevant prevalent population that requires treatment was identified, and the different treatment costs pertaining to this population were applied according to the market shares (IQVIA R03F Singapore National Sales Data) for different scenarios. The focus was on drug costs over five years, and publicly available non-subsidised patient prices obtained from pharmacies of local restructured hospitals were used in the model. An additional analysis was conducted examining the difference in exacerbation costs if uncontrolled patients were switched from fluticasone propionate/salmaterol (FP/SAL, Evohaler®) to FP/FORM. Assumptions based on published literature were validated by clinicians. The budget impact analysis showed that inclusion of FP/FORM on a government subsidy list, and the increase in market share as a result, could lead to drug cost savings of S$1,022,937 in the scenario where patients switch from FP/SAL (Evohaler®), and drug cost savings of S$2,561,917 in the scenario where patients switch from budesonide/formoterol (BUD/FORM, Turbuhaler®), over five years. Inclusion of FP/FORM on a government subsidy list in Singapore could lead to significant drug cost savings. FP/FORM is also associated with clinical benefits, such as low exacerbation rates, compared to FP/SAL and BUD/FORM, which could lead to further cost savings for uncontrolled asthma patients.

Are Shorter Durations of Dual Antiplatelet Therapy Acceptable Following Percutaneous Coronary Intervention?

Much debate has centered on whether or not the standard 12-month duration of dual antiplatelet therapy (DAPT) is still necessary postpercutaneous coronary intervention, given recent improvements in stent technology. The benefits of shorter (3-6 months) durations of DAPT include a potential lower risk for bleeding and less patient drug cost and pill burden. Although randomized clinical trials have shown noninferiority for shorter versus longer DAPT regimens in many regards, some endpoints (e.g., myocardial infarction) may still occur less frequently with longer DAPT regimens, particularly in higher risk populations (e.g., acute coronary syndromes). Bleeding risk is either comparable or less with shorter versus longer DAPT regimens. Given the lack of unequivocal data regarding the equality of shorter versus longer DAPT regimens in all patients, there is a growing consensus that an individualized approach is advisable for determining DAPT duration postpercutaneous coronary intervention. Clinical decision aids and updated clinical practice guidelines are available that consider risk:benefit ratios and clinical trial data to assist the clinician in developing a personalized DAPT regimen.

PBMs blame pharmacies for high patient drug costs

PBMs blame pharmacies for high patient drug costs

Comparison of the Pharmacoeconomics of Calfactant and Poractant Alfa in Surfactant Replacement erapy.

To compare the pharmacy costs of calfactant (Infasurf, ONY, Inc.) and poractant alfa (Curosurf, Chiesi USA, Inc., Cary, NC). The University of South Alabama Children's and Women's Hospital switched from calfactant to poractant alfa in 2013 and back to calfactant in 2015. Retrospectively, we used deidentified data from pharmacy records that provided type of surfactant administered, gestational age, birth weight, and number of doses on each patient. We examined differences in the number of doses by gestational ages and the differences in costs by birth weight cohorts because cost per dose is based on weight. There were 762 patients who received calfactant and 432 patients who received poractant alfa. The average number of doses required per patient was 1.6 administrations for calfactant-treated patients and 1.7 administrations for poractant alfa-treated patients, p = 0.03. A higher percentage of calfactant patients needed only 1 dose (53%) than poractant alfa patients (47%). The distribution of the number of doses for calfactant-treated patients was significantly lower than for the poractant alfa-patients, p < 0.001. Gestational age had no consistent effect on the number of doses required for either calfactant or poractant alfa. Per patient cost was higher for poractant alfa than for calfactant in all birth weight cohorts. Average per patient cost was $1160.62 for poractant alfa, 38% higher than the average per patient cost for calfactant ($838.34). Using poractant alfa for 22 months is estimated to have cost $202,732.75 more than it would have cost if the hospital had continued using calfactant. Our experience showed a strong pharmacoeconomic advantage for the use of calfactant compared to the use of poractant alfa because of similar average dosing and lower per patient drug costs.

Costs of dose escalation among ulcerative colitis patients treated with adalimumab in Germany.

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

PCN247 - Is utilization of Adjuvant Endocrine Therapy Affected Mainly by Patient Drug Costs? An Analysis of Two Databases

Although adjuvant endocrine therapy (AET) is becoming an important cornerstone of treatment in Medicare breast cancer survivors, few studies have examined variations in the use of this treatment by potentially important sociodemographic influences like patient race and geography are independent of economic drivers such as patient costs associated with these medications. To test our hypotheses that utilization may be driven by sociodemographics independent of drug costs, we compared and contrasted AET therapy use in two survivor populations with breast cancer, those enrolled in Medicare Part D (with significant copayment and medication cost issues) with survivor populations enrolled in the Medicaid program (with little to no copayments for these medications). We compared 18,075 Medicare breast cancer survivors enrolled in Part D plans with 1,307 Medicaid survivors in three states (West Virginia, Maryland and Ohio) over a 5 year period. Similar to what we found in the SEER-Medicare data, white patients had significantly higher use rate of AET than African American patients (6.6% vs. 4.6%, p<0.0001), while other minorities had significantly higher use rate of AET than white patients (8.5% vs. 6.6%, p = 0.02). These were consistent with what we found in the SEER-Medicare data. We also identified significant differences in the use rate of AET among the three states, which have different geographies (use rate of AET in WV, MD, and OH were 10.8%, 7.0%, and 4.7%, respectively (p<0.0001). These findings were confirmed in multivariate models. Our analyses of data from two different insurance programs with differential patient economic cost burden for AET therapy finds evidence that there are distinct sociodemographic factors such as patient race and rural status that affect the use of AET therapy, and these effects are independent of patient cost-sharing for these medication therapies.

GOTMeDS?: Development and Evaluation of an Interactive Module for Trainees on Reducing Patient's Drug Costs

GOTMeDS?: Development and Evaluation of an Interactive Module for Trainees on Reducing Patient's Drug Costs

Usage and cost of first-line drugs for patients referred to inpatient anthroposophic integrative care or inpatient conventional care for stress-related mental disorders--a register based study.

BackgroundStress-related mental disorders (SRMD) are common and costly. Rehabilitation strategies, including pharmacotherapy, may be complicated to evaluate. Previous research has indicated increased quality of life and self-rated health for SRMD patients that receive a combination of conventional and complementary therapies, i.e. integrative care. The aim of this retrospective registry study was to explore and contrast the prescription of first-line drugs for SRMD patients referred to hospital inpatient anthroposophic integrative care (AIC) or inpatient conventional care (CC).MethodsSRMD patients that had received AIC or CC were identified through high-quality inpatient registry data from Stockholm County Council and matched by available background characteristics including diagnosis (ICD-10: F43), age, gender and socio-economics. General disease load was estimated by analysis of ICD-10 chapter data. The Swedish Prescribed Drug Register was then used to investigate purchased defined daily doses (DDD) and cost of drugs from 90-days before/after, and 180-days before/after, the first visits (index) to AIC and CC respectively. First-line drug categories were Anatomical Therapeutic Chemical classification codes N05A (antipsychotics), N05B (anxiolytics), N05C (hypnotics and sedatives) and N06A (antidepressants).ResultsThere were no statistically significant differences between the AIC (n = 161) and the CC (n = 1571) cohorts in terms of background characteristics and the overall disease loads were similar between the groups the preceding year. At baseline, the prescription of first-line anxiolytics and antidepressants were not statistically different between groups whereas the prescription of antipsychotics and hypnotics/sedatives were lower for the AIC cohort. The overall change in drug prescriptions and costs during the investigated periods, both for the 90-days before/after and for the 180-days before/after the index visit, showed a general decrease within the AIC cohort with significantly less prescribed anxiolytics and hypnotics/sedatives. During the same time periods there was a general increase in prescriptions and costs of first-line drugs within the CC cohort. The overall disease loads were generally stable within both cohorts over time, except that the CC cohort had increased visits registered with an ICD-10 F-chapter diagnosis the year after index.ConclusionsThe results suggests that there may be different drug utilization patterns for SRMD patients referred to AIC or CC. Different management strategies between AIC and CC providers, different SRMD disease severities and different preferences of patients referred to AIC and CC are hypothetical differentiating factors that may influence drug outcomes over time. Additional studies including prospective and randomized clinical trials are warranted to determine if there is a causal link between inpatient AIC and reduced drug utilization.

Patient costs of breast cancer endocrine therapy agents under Medicare Part D vs with generic formulations.

PurposeThe high expense of newer, more effective adjuvant endocrine therapy agents (aromatase inhibitors [AIs]) for postmenopausal breast cancer contributes to socioeconomic disparities in breast cancer outcomes. This study compares endocrine therapy costs for breast cancer patients during the first five years of Medicare Part D implementation, and when generic alternatives became available.MethodsThe out of pocket patient costs for AIs and tamoxifen under Medicare Part D drug plans were determined for 2006–2011 from the CMS Website for the 50 US states and District of Columbia.ResultsBetween 2006 and 2010, the mean annual patient drug cost under Medicare Part D in the median state rose 19% for tamoxifen, 113% for anastrozole, 89% for exemestane, and 129% for letrozole, resulting in median annual out of pocket costs in 2010 of $701, $3050, $2804, and $3664 respectively. However, the 2011 availability of generic AI preparations led to median annual costs in 2011 of $804, $872, $1837, and $2217 respectively. Not included in the reported patient costs, the mean monthly drug premiums in the median state increased 58% in 2011 compared to 2007.ConclusionsThe more effective AI agents became considerably more expensive during the first several years of the Medicare Part D program. Cost decreased with the introduction of generic agents, an intervention that was independent of the Part D program. It is unlikely that the Part D program ameliorated existing socioeconomic disparities in survival among breast cancer patients, but the availability of generic agents may do so.

Abstract 259: Identifying Predictors of Cumulative Health Care Costs in Incident Atrial Fibrillation: a Population-Based Study

Background: The dramatic increase in the incidence of atrial fibrillation (AF) has substantial impacts on health care resource utilization. Our objective was to understand the pattern and predictors of cumulative health care costs in patients with incident AF. Methods: All patients discharged after a first presentation of AF to the emergency department (ED) in Ontario, Canada were identified from April 1st, 2005 to March 31st, 2010. Per patient cumulative health care costs were determined until death or March 31st 2012. The cost sectors included were acute and chronic hospitalizations, same-day surgeries, emergency room visits, physician fee-for-service billings, home care, long term care and drug costs for patients over the age of 65 years. All costs were adjusted to 2013 Canadian dollars. Join-point analyses identified clinically relevant phases of health care costs. Hierarchical generalized linear models with a logarithmic link and gamma distribution determined predictors of cost per phase. Results: There were a total of 61,112 ED visits for AF over the period of interest. Our cohort consisted of 17,980 patients with new onset AF who were discharged from the ED. Mean age was 65.7 and 45.8% were female. Over the mean follow-up period of 3.9 years, 17.1% of patients died. Three distinct phases of cumulative cost were identified: 2 month phase post index ED visit; 12 month phase pre-death and a stable/chronic phase. The mean cost per patient in the 1st month post-index was $1,876 (95% CI 1,822-1,931), while the mean cost per patient in the month prior to death was $8,050 (95% CI 7,666-8,434), compared to $640 (95% CI 624-655) per month for the stable/chronic phase. The main component of costs in the post-index and stable/chronic phases were physician services (67% of all costs for 1-month post-index; 44% of all costs for stable/chronic phase). In contrast, acute-hospitalizations represented the largest component of costs in the pre-death phase at 72%. The CHA2DS2VASC clinical risk score was the strongest predictor of increasing costs, with a gradient of increasing per patient cost with increasing score (Rate ratio (RR) of 6.8 and 2.06 for score of 9 versus score of 0 in pre-death phase and post-index phase respectively) Conclusion: There are distinct phases of resource utilization after the diagnosis of AF, with highest costs in the pre-death phase. Cumulative costs are driven by patient co-morbidities, as captured by the CHA2DS2VASC risk score.

Evaluation of Anti-Retroviral Combination Therapy In Patients With HIV/Aids Injecting Drug Users

HIV stands for ‘Human Immunodeficiency Virus’. HIV is a retrovirus that infects cells of the human immune system (mainly CD4), and destroys or impairs their function. This viral infection results in a constant decrease in human immune system and eventually results in immunodeficiency. Indonesia is one of the countries that show increasing number of HIV/AIDS cases. By June 2011, 26.483 cumulative HIV/AIDS cases were reported in Indonesia. Drug users are a major factor in the spread of HIV/AIDS infections. Antiretroviral (ARV) therapy in patients with HIV infection aims at suppressing replication in a maximum way for a long period, restoring and maintaining the body’s immune. It is important to extend and improve the quality of life to reduce the morbidity and mortality. Efficacy of the combination of three of antiretroviral drugs was better than the combination of two types of antiretroviral, where there is a decrease in viral load to undetectable level and increased CD4 lymphocyte count. This study was conducted compare several combinations of antiretroviral, that is Lamivudine +Zidovudine+ Nevirapine, Lamivudine+ Zidovudine +Efavirenz, Lamivudine +Stavudine +Nevirapine and Lamivudine+Stavudine+Efavirenz, in terms of effectiveness, side effects, adherence and antiretroviral drug costs in patients HIV/AIDS drug users in Drug Dependence Hospital Jakarta. The study was conducted in a retrospective way, using data obtained from medical records of patients from January 2005 to December 2010 in patients with CD4 ≤ 350 cells/mmɜ and a minimum of 6-12 months of antiretroviral treatment. Of the 333 patients, 100 patients had antiretroviral treatment and met the inclusion criteria. The results showed effectiveness of combination antiretroviral therapy in that there was an increase in the number of CD4; the increase was found to be different in each antiretroviral combination. However, statistical test with ANOVA showed that the increases in CD4 had no significant difference. Nausea is a common side effect in HIV/AIDS patients who received antiretroviral therapy. Of the 100 patients, 94% adhered to the therapy and the combination of Lamivudine+Zidovudine +Efavirenz required the highest cost, compared to the other combinations.

Cost Per Responder Associated with Biologic Therapies for Crohn’s Disease, Psoriasis, and Rheumatoid Arthritis

Biologic therapies have demonstrated efficacy and safety in several chronic systemic disorders. The authors indirectly compared response rates and costs per responder associated with biologic treatments for moderate-to-severe Crohn's disease (CD), psoriasis (Ps), and/or rheumatoid arthritis (RA). A systematic literature search was performed to identify phase 3 randomized controlled trials of biologics for CD (adalimumab, infliximab), Ps (adalimumab, etanercept, infliximab, ustekinumab 45 mg, ustekinumab 90 mg), or methotrexate-refractory RA (abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab). Food and Drug Administration-approved dosing schedules were evaluated. Published response rates were extracted, with response defined in CD, Ps, and RA as: ≥70-point reduction in CD Activity Index at 12 months; ≥75% improvement in Psoriasis Area and Severity Index at 3 months; and ≥50% improvement in American College of Rheumatology component scores at 6 months. Within each indication, mixed-treatment comparison meta-analyses were conducted to derive pooled estimates and 95% CIs of response rate difference versus placebo for each biologic, adjusting for cross-trial variation in control-arm response rates. Cost per responder was estimated for each biologic as projected per patient drug costs (2011 US$) divided by response rate difference. Altogether, 23 publications were selected. In CD, 12-month cost per responder was estimated at $116,291 (95% CI $71,637-208,348) for adalimumab and $125,169 (95% CI $60,532-267,101) for infliximab. Among biologics approved in Ps, 3-month cost per responder was lowest for adalimumab ($9,756; 95% CI $8,668-11,131), infliximab ($12,828; 95% CI $11,772-13,922), and ustekinumab 45 mg ($13,821; 95% CI $12,599-15,167). In RA, biologics with the lowest 6-month cost per responder were adalimumab ($27,853; 95% CI $19,284-40,270), etanercept ($29,140; 95% CI $14,170-61,030), and tocilizumab ($31,363; 95% CI $14,713-64,232). Meta-analyses of clinical trials found considerable variation in cost-effectiveness of biologic therapies for CD, Ps, and RA. These results may help determine biologic utilization in these chronic diseases.

Tu1014 Real-World Evaluation of the Economic Impact of Duration of Drug Therapy in the Treatment of Hepatitis C Virus (HCV): an Update

Background: New therapies for hepatitis C [HCV] are under development which will likely augment the standard treatment regimen of pegylated interferon-alpha plus ribavirin [P/R] to improve patient outcomes and possibly shorten P/R duration. However, few studies have evaluated the economic implications associated with P/R treatment duration in real world practice. Objective: To estimate the impact of P/R treatment duration on health care costs in real-world clinical practice. Methods: Paid claims data for 2003-2010 were retrieved from a large U.S. health insurance company and 148, 176 HCV patients were identified. Only 7,840 HCV patients received P/R treatment [5.3%]. Patients were then screened for a minimum of 6 months of data prior and 24 months of data after the start of P/R drug therapy. Patients with a pre-treatment diagnosis for HIV, hepatitis B, cirrhosis, liver cancer or a liver transplantation were also excluded. The impact of treatment duration on cost and adverse event risk was estimated by comparing patients with 24-48 weeks and 48+ weeks of therapy to patients with 0.05]. First year drug costs for patients with 48+ weeks of treatment were +$27,116 [p 48 weeks were not sufficient to offset drug costs, these results were reversed in year 2. This suggests that a full course of P/R therapy may reduce total cost over time. More research is needed to determine if year 2 savings associated with compliance with drug therapy continues on beyond year 2.

Abstract P12: Medication Therapy Management Services - A Requirement for Medicare Part D Plans: Are Your Patients Eligible?

Background: Medication Therapy Management (MTM) is a mandated component of Medicare Part D whereby a pharmacist-patient encounter identifies, resolves and prevents medication-related problems. MTM programs have been shown to improve drug therapy goal attainment while reducing overall costs in cardiac patients; however, MTM has been greatly underutilized. The purpose of this study is to identify the proportion of patients eligible for MTM from those enrolled in the NCDR's outpatient PINNACLE Registry. Methods: MTM eligibility is based on the presence of multiple chronic diseases and medications plus the likelihood of exceeding an annual drug cost threshold ($4000 in 2009 and $3000 in 2010). Patients from PINNACLE (5/1/08 to 9/30/10) with 3 or more of the following diseases were identified: HTN, HF, dyslipidemia, DM, CAD. Patient demographics, cardiac diseases, and cardiac drug classes prescribed (individual drugs not available) were captured. To estimate individual patient drug costs to determine MTM eligibility, a weighted average cost was calculated using nationally representative drug utilization data and average wholesale prices (AWP). Sensitivity analyses for determining MTM eligibility were performed by varying drug costs using AWP for the highest cost and clinician-defined most frequently prescribed drugs in each class. Results: Of the 160,593 Medicare patients enrolled in PINNACLE, 93,089 (58%) were identified with ≥ 3 cardiac diseases. The cohort’s mean age was 74.4 ± 9.2 yrs, 54.4% were male and 86.5% were white. Patients were prescribed a mean of 3.5 cardiac drugs. The table displays drug costs and MTM eligibility results. Conclusions: A substantial number of patients met MTM eligibility requirements with this conservative approach using only cardiac drug costs, although variability existed based on cost method. These data serve to raise cardiologists' awareness of their patients' potential eligibility to receive the benefits of MTM services. Cost Methodology Median Annual Cost (IQR) 2009 MTM Eligibility [N (%)] 2010 MTM Eligibility [N (%)] Weighed average cost $1329 (915,2609) 6,202 (6.7% ) 19,903 (21.4%) Frequently prescribed cost $366 (193,1361) 1084 (1.2% ) 7326 (7.9%) High cost $3,958 (2406,5358) 46,477 (49.9% ) 59,619 (64%) 2009 and 2010 MTM eligibility based on likelihood of exceeding drug cost threshold of $4000 and $3000, respectively. IQR - interquartile range; MTM - medication therapy management.

Pharmacy resource management — three methods to assess individual patient drug costs

Abstract Resource management has important implications for pharmacy, and methods of costing drugs to individual patients require evaluation as part of this approach. Three systems of allocating medication costs to individual patients have been examined in a study over a year on one medical and one surgical ward at Freeman hospital, Newcastle upon Tyne. These systems were investigated in three phases: (i) calculation of average cost per bed occupied day, using existing data; (ii) retrospective collection of data from prescription charts; (iii) data capture at the time of administration. The first approach gave variable and insensitive data about medication costs. Although having little effect on workload, it had no clear potential for resource management. The second phase evaluated two methods for calculation of drug costs from medication records after discharge. The system accounted for less than 70 per cent of drug costs, and poor staff acceptability, and was time-consuming to administer with no additional benefits. The third phase captured data via lightpens, with bar codes identifying patient and drug. Between 66 per cent and 93 per cent of issues were recorded accurately by this system. Advantages included computerised ordering with subsequent time-savings and improvement in stock control. The system has clear potential for use in clinical audit and drug utilisation review

A randomised controlled trial of structured nurse-led outpatient clinic follow-up for dyspeptic patients after direct access gastroscopy

BackgroundDyspepsia is a common disorder in the community, with many patients referred for diagnostic gastroscopy by their General Practitioner (GP). The National Institute of Clinical Excellence (NICE) recommends follow-up after investigation for cost effective management, including lifestyle advice and drug use. An alternative strategy may be the use of a gastro-intestinal nurse practitioner (GNP) instead of the GP. The objective of this study is to compare the effectiveness and costs of systematic GNP led follow-up to usual care by GPs in dyspeptic patients following gastroscopy.ResultsDirect access adult dyspeptic patients referred for gastroscopy; without serious pathology, were followed-up in a structured nurse-led outpatient clinic. Outcome measurement used to compare the two study cohorts (GNP versus GP) included Glasgow dyspepsia severity (Gladys) score, Health Status Short Form 12 (SF12), ulcer healing drug (UHD) use and costs. One hundred and seventy five patients were eligible after gastroscopy, 89 were randomised to GNP follow-up and 86 to GP follow-up. Follow-up at 6 months was 81/89 (91%) in the GNP arm and 79/86 (92%) in the GP arm. On an intention to treat analysis, adjusted mean differences (95%CI) at follow-up between Nurse and GP follow-up were: Gladys score 2.30 (1.4–3.2) p < 0.001, SF12 140.6 (96.5–184.8) p =< 0.001 and UHD costs £39.60 (£24.20–£55.10) p =< 0.001, all in favour of nurse follow-up.ConclusionA standardised and structured follow-up by one gastrointestinal nurse practitioner was effective and may save drug costs in patients after gastroscopy. These findings need replication in other centres.

Cost-Efficient Treatment Options for Uninsured or Underinsured Patients For Five Common Conditions

The nurse practitioner's (NP's) role in providing quality care continues to evolve, concurrent with the ever-evolving health care system. With an influx of uninsured and underinsured patients, NPs must not only provide high-quality health care, they must also address cost-efficient treatment options for patients who cannot afford expensive medications. Familiarity with the cost of medications and prescribing cost-efficient medications are valuable tools NPs can use to encourage patient compliance with a specific care regimen, consequently improving the overall health of uninsured or underinsured individuals. Knowledge of patient assistance programs may also assist NPs in decreasing prescription drug costs for patients. Cost-efficient treatment options for upper respiratory infection, migraine headache, eczema, trichomoniasis, and polycystic ovarian syndrome are presented.

Impact of Splitting Risperidone Tablets on Medication Adherence and on Clinical Outcomes for Patients With Schizophrenia

Impact of Splitting Risperidone Tablets on Medication Adherence and on Clinical Outcomes for Patients With Schizophrenia