Cost Of Medicines Research Articles

Could the Inflation Reduction Act Maximum Fair Price Hurt Patients?

Background: The Inflation Reduction Act's Medicare Drug Price Negotiation Program allows the federal government to negotiate caps for select medications. These price caps may reduce revenue for the pharmacy benefit managers (PBMs) that negotiate the actual price paid for medicines in the U.S. To offset the resulting pressure on their profit margins, it is possible that PBMs would, in turn, increase patients' out-of-pocket costs for medicines with capped prices. The model presented here evaluates how increased out-of-pocket costs for the anticoagulants apixaban (Eliquis) and rivaroxaban (Xarelto) could impact patients financially and clinically. Methods: Copay distributions for all 2023 prescription fills for apixaban and rivaroxaban managed by the 3 largest PBMs, CVS Caremark, Express Scripts International, and Optum Rx, were used to approximate current copay costs. Increased out-of-pocket costs were modeled as a shift of all apixaban and rivaroxaban prescriptions to the highest copay tier. The known linear relationship between copay costs and treatment abandonment was used to calculate the potential resulting increase in treatment abandonment. Known rates of morbidity and mortality due to abandoning anticoagulants were used to estimate resulting increases in morbidity and mortality. Results: If the 3 largest PBMs all shifted costs onto patients by moving all apixaban and rivaroxaban prescriptions to the highest formulary tier, Tier 6, patients' copay amount would increase by 482 million for apixaban and 206 million for rivaroxaban. Such an increase could lead to 169 000 to 228 000 patients abandoning apixaban and 71 000 to 93 000 abandoning rivaroxaban. The resulting morbidity and mortality could include up to an additional 145 000 major cardiovascular events and up to 97 000 more deaths. Conclusion: The Medicare Price Negotiation Program could impact patients negatively if it causes PBMs to increase patients' out-of-pocket costs for medicines. Policymakers should closely monitor changes in overall affordability, including all patient out-of-pocket expenditures, for medications in the program. Preemptive measures should be considered to ensure that the most vulnerable citizens are not placed in precarious situations, leading to poorer health outcomes.

Impacts of economic sanctions on population health and health system: a study at national and sub-national levels from 2000 to 2020 in Iran

BackgroundFormal evidence regarding the effects of sanctions on population health status and the health system is scarse in Iran. Given the intricate and multifaceted nature of sanctions, a nuanced understanding of their impact is imperative. We aimed to investigate the magnitude and effects of sanctions on population health and healthcare system during the last two decades in Iran.DesignThis is a mixed-methods research. We quantified the impact of sanctions using 28 indicators, i.e. macroeconomic, healthcare resources and health outcomes indicators from 2000 to 2020. The concurrent qualitative study aimed to explore the pathway of the effect by considering perceptions of both patients and health policy makers towards sanctions; Interview data was analyzed using content analysis.SettingThis study was conducted in Iran at both national and sub-national levels.ResultsOur findings revealed that the trend of 11 indicators (39.2%) had changed after the change point in 2009; four indicators (14.2%) significantly deteriorated after the change point. Further, five indicators revealed significant increases during the sanctions period: Out-of-Pocket payment (OOP), household expenditure on food and mortality rates due to Chronic Obstructive Pulmonary Disease (COPD), thalassemia and hypertension. Our qualitative analysis revealed that patients identified availability, cost and quality of medicines and healthcare services as the most significant challenges that compromised population’s health. From the policy makers’ perspective, the effect of sanctions on health system functions and infrastructures, i.e. economic, political, social, educational and research had significant repercussions on population health.ConclusionWe could not find compelling evidence to establish significant associations between the imposition of sanctions and the trend of population health. Nevertheless, our qualitative study revealed people’s deteriorating life experiences, e.g. increasing catastrophic health expenditure, limited access to necessary medicine, medical equipment, procedures and interventions, imposed by sanctions, with ultimate reducing impact on the overall quality of life. It seems that sanctions have negatively affected financial and physical access to medication and healthcare services. Nonetheless, Iran has demonstrated remarkable resilience against their highly detrimental effects, maybe due to its established economic infrastructure and healthcare system.

PERANCANGAN SISTEM INFORMASI ANALIS BREAK EVEN POINT DAN STOK PADA BUDIDAYA AYAM POTONG BERBASIS WEB

Although broiler chicken farming offers many benefits, there are also risks of losses, especially when production costs are not accurately recorded, leading to inaccurate per-unit pricing that can harm farmers. To assist farmers in accurately determining the Break Even Point (BEP) price for each chicken, a web-based cost and stock management information system for broiler farming has been developed. To provide a clear and sequential software lifecycle approach, this system was built using the waterfall method, which includes the stages of requirements analysis, design specifications, coding, testing, and maintenance. Each stage produces measurable outcomes before proceeding to the next. The development results indicate that the system successfully records the total production costs, including detailed costs for feed, medicine, operational expenses, and chicken stock. By using the formula BEP = total production cost/number of live chickens, the system achieves accurate pricing for broiler chickens. Based on these findings, future research is suggested to improve the user interface for greater appeal, optimize system accessibility on mobile devices, and integrate this system with other systems.

Content and cost of waste pharmaceuticals collected by pharmacies for disposal

ABSTRACT Background The research aims to the costs and contents of waste pharmaceuticals collected through pharmacies for disposal. This study adds significant value to the country’s economy in terms of cost and number of medicines. Methods The study was conducted with waste pharmaceuticals collected from 29 pharmacies in Erbaa district of Tokat province in Turkey. In the study, the total of waste pharmaceuticals, ATC classification and cost data of these medicines were obtained from the Eczanem automation program. Microsoft Office Excel and IBM SPSS programs were used in the analysis of the data. Results In the study, 1178 waste pharmaceuticals were evaluated. It was determined that approximately 88% of the waste pharmaceuticals were never used and 30% of them had not expired. Finally, it was determined that the total monthly cost of the collected waste pharmaceuticals was 4,908.88 USD. When this amount is calculated nationwide, the annual estimated cost of waste pharmaceuticals is 58,281,272.36 USD. Conclusion As a result of the research, it was revealed that waste pharmaceuticals constitute a serious national burden and waste in terms of both number and cost. Therefore, it is important to investigate the causes of waste pharmaceuticals in detail and take measures against them.

Solutions for reducing the severe economic burden of musculoskeletal diseases

Abstract Issue In Slovenia the big group of over 150 musculoskeletal and connective tissue diseases (MSCTD) constitute a serious public health problem, a major burden on health systems and society as a whole. Patients with these diseases have a poorer quality of life and often retire early. Any early retirement that could have been prevented represents a loss of human capital, which is a major social and economic cost to society. The aim of this study was to analyze the economic burden of the six most common MSCTD in Slovenia for the period from 2020 to 2022, to contribute to a better understanding of this problem and suggest solutions. Methods At the Slovenian National Institute of Public Health, in collaboration with the Faculty of Economics at the University of Ljubljana, we calculated the burden of six most common MSCTD for the period 2020-2022. We used the National Transfer Accounts (NTA) methodology to calculate the indirect costs; direct costs were calculated based on the national routine health data. Results The calculated economic burden of the six most common diagnoses of MSCTD represents 5% of total health expenditure or 0.4% of Slovenian gross domestic product on average. Direct costs amounted to 2% of total health expenditure (hospitalizations 22.5%, costs for medicines 9.3%, first curative visits at the primary level and visits to the outpatient clinic at the secondary level 2.7%). Indirect costs amounted to 3% of total health expenditure. Conclusions Despite the reduced access to the health system due to COVID-19 the economic burden of MSCTD is high in Slovenia and would be significantly higher considering all diagnoses from this group of diseases. The research requires interdisciplinary cooperation between medicine and economics regarding demanding NTA methodology which is innovative in our country. Key messages • One of the main public health priorities in Slovenia should be to raise awareness of MSCTD. • In the light of the aging population prevention activities with focus on MSCTD should be intensified as soon as possible.

Budget Impact Analysis of Implementing Antenatal Care Recommendations for Positive Pregnancy Outcomes at Public Primary Facilities in Tanzania.

Tanzania recently changed its antenatal care (ANC) guidelines to reduce perinatal mortality and improve the experience of pregnancy care. The new guideline recommends increasing the number of ANC visits from four to eight and introducing one routine ultrasound scan, among other recommendations. We estimated the budget impact of implementing the new guideline compared to the previous focused ANC guideline at public dispensaries and health centers. In a dynamic Markov model, we prospectively followed annual cohorts of between 2.3 and 2.6 million pregnant women who will be attending ANC at dispensaries and health centers for 5years. We allowed a population of pregnant women into the model every year and women exit the model at delivery. We calculated the cost of medicines, medical supplies, and laboratory supplies required to produce services from a public health system perspective. Our model neither estimated condition-related costs nor health effects. The budget impact was calculated as the difference in the estimated costs between the two guidelines. We conducted scenario analyses to explore attending more visits and different assumptions to calculate the target population. We estimated that implementing the new ANC guideline would have a cumulative budget impact of around US$154 million over 5years. The budget required will increase from US$137 million under the focused ANC guideline to US$291 million under the new guideline. Laboratory supplies will consume 47% of the estimated budget under the new guideline. We expect the annual budget impact to be US$38 million in the first year of implementation and US$32 million in the fifth year. We assumed that by the fifth year, 82% of all pregnant women would have had four or more visits. The budget impact would increase to US$214 million, with the proportion of pregnant women attending four or more ANC visits reaching 90% within 5years. Scaling up the implementation of the new ANC guideline at public dispensaries and health centers may substantially increase the supplies required to produce ANC services, particularly laboratory supplies. Studies on the health impact of the new guideline are warranted to estimate the value for money.

The economic costs of precision medicine for clinical translational research among children with high-risk cancer

Embedding precision medicine in paediatric oncology shows promise to have a positive impact on how children with cancer will be treated in the future. While there are a number of studies of precision medicine in childhood cancer, there is limited evidence available on the cost of implementing the related testing. This is the first Australian study that systematically measures the cost of using precision medicine in the care of high-risk childhood cancers, through the Zero Childhood Cancer Precision Medicine Programme. In 2021 Australian dollars, the estimated costs inclusive of genomic and preclinical testing were: (A) $12,743 per patient for access; (B) $14,262 per identification of molecular cause; and (C) $21,769 per MTB recommendation. The information gained supports the understanding of the cost of reporting clinically significant outcomes relevant to the biology of the tumour, diagnosis, prognosis and potentially improving clinical management for a child.

Innovative Approaches to Strengthening Preventative Care in Contemporary Healthcare: A Systematic Review

Preventative care plays a critical role in reducing disease burden, improving patient outcomes, and lowering healthcare costs in contemporary medicine. However, the effective implementation of preventative care strategies faces numerous challenges, including technological, financial, and social barriers. This systematic review explores innovative approaches aimed at strengthening preventative care in modern healthcare systems. Key innovations include the use of telemedicine, artificial intelligence (AI), personalized medicine, and community-based public health initiatives. Telemedicine and AI have revolutionized early detection and risk assessment, while personalized medicine and genomic screening allow for tailored preventative interventions. Additionally, behavioral economics and health education programs have proven effective in promoting healthier lifestyles and improving adherence to preventative measures. The review evaluates the impact of these innovations on patient outcomes and highlights both the benefits and challenges of implementing these approaches. While the advancements offer promising results, further research is needed to address issues related to equity, ethical concerns, and global applicability. This review provides valuable insights for healthcare providers, policymakers, and researchers looking to enhance the effectiveness of preventative care strategies in contemporary healthcare systems.

Burden of disease and cost of illness of infants less than 6 months of age hospitalised with respiratory syncytial virus in Denmark – a 10-year national register-based study

BackgroundRespiratory syncytial virus (RSV) is the most common cause of hospitalisation in infants aged ≤ 6 months in Western countries. Nearly 1,500 infants under six months of age are hospitalised with RSV annually in Denmark. This nationwide study describes the healthcare resource utilisation and costs related to RSV hospitalisation in this vulnerable age group.MethodsRSV cases were identified in the Danish National Patient Register. Infants were included if they at the age of 0–5 months had a (1) respiratory related hospital admission (duration > 12 h), (2) within 10 days of a positive RSV test, (3) between January 2013 and December 2022. Each case was matched with five individuals never diagnosed with RSV on age, sex, region of residence, birth (pre/full term), number of siblings < 7 years old, and parents’ education. An episode of RSV was defined as the seven days prior to hospitalisation to 30 days after initial hospitalisation. Study outcomes included contacts with hospital and primary care, and total healthcare costs defined as the sum cost of hospital care, primary care, and prescription medicine. Cost and contacts attributable to RSV was calculated in a diff-in-diff framework, as the difference between case and reference group.ResultsThe study population comprised of 8,428 RSV cases and 41,725 reference individuals. Cases generated 1.58 (p < 0.001) attributable inpatient contacts, 0.84 (p < 0.001) outpatient contacts, and 1.19 (p < 0.001) primary care contacts during their RSV episode. An additional 0.6 (p < 0.001) inpatient, 1.08 (p < 0.001) outpatient and 2.42 (p < 0.001) primary care contacts were attributed to RSV in the year following the RSV episode. Total cost of an RSV episode was EUR 2,997 (p < 0.001) with an additional EUR 1,428 (p < 0.001) in the following year.ConclusionRSV hospitalisations of infants are associated with substantial healthcare utilisation and costs. The same pattern was observed in the year following the RSV episode. If the new RSV prevention options are introduced nationwide, the overall burden of RSV is expected to be substantially reduced in the future.

Cost-effectiveness and postoperative outcomes of spontaneous vs. mechanical ventilation during video-assisted thoracoscopic surgery: a retrospective study.

Video-assisted thoracoscopic surgery (VATS) is known to have the advantages of being minimally invasive, reducing complications, and shortening hospitalization time. However, related cost surveys have been inconsistent. In recent years, a new concept of tubeless anesthesia has been introduced, but its impact on the cost-effectiveness of VATS is unclear. This study compared the hospitalization costs and postoperative outcomes in patients undergoing spontaneous ventilation VATS (SV-VATS) and mechanical ventilation VATS (MV-VATS). We retrospectively analyzed data on the VATS procedures performed at the Shaoxing People's Hospital from June 2022 to July 2023. Overall, 386 patients who met the inclusion criteria were treated with SV-VATS (n=57) or MV-VATS (n=329). Comprehensive cost comparisons were performed between the groups. The two groups shared comparable clinical characteristics, such as age (P=0.64), sex (P=0.72), body mass index (BMI) (P=0.68), and type of procedure (P=0.43). All costs are expressed in U.S. dollars ($). The overall, diagnostic, operation, and material costs of SV-VATS and MV-VATS were $3,858.71±$746.32 vs. $3,870.26±$990.69 (P=0.94), $911.83 vs. $908.73 (P=0.51), $875.58 vs. $875.58 (P=0.51), and $1,560.5 vs. $1,596.91±$727.18 (P=0.31), respectively. In addition, the median costs of anesthesia materials and total medications were $233.51 vs. $324.02 and $290.63 vs. $364.14, respectively (P<0.001). Among medications, the cost of anesthesia medicine was $179.6±$45.48 vs. $224.12±$54.67, respectively (P<0.001). Postoperative complications, including sore throat, hoarseness, and expectoration, did not occur in the SV-VATS group, whereas 13, 11, and 10 cases were noted, respectively, in the MV-VATS group (13.5%, 11.5%, and 10.4%, respectively; P=0.01, P=0.03, P=0.041). The time to extubation in the SV-VATS and MV-VATS groups was 4 and 10 min, respectively (P<0.001). No intermediate surgery was performed in either group. Compared with SV-VATS, MV-VATS can reduce patients' anesthesia and medicine costs and has similar postoperative adverse event rates in VATS patients, which is conducive to accelerating patient recovery. Therefore, tubeless anesthesia is recommended for future VATS.

WHO Model list of essential medicines: visions for the future.

The first version of the World Health Organization Model list of essential medicines contained 186 medicines in 1977 and has evolved to include 502 medicines in 2023. Over time, different articles criticized the methods and process for decisions; however, the list holds global relevance as a model list to over 150 national lists. Given the global use of the model list, reflecting on its future role is imperative to understand how the list should evolve and respond to the needs of Member States. In 2023, the model list Expert Committee recommended the World Health Organization (WHO) to initiate a process to revise the procedures for updating the model list and the criteria guiding decisions. Here, we offer an agenda outlining priority areas and a vision for an authoritative model list. The main areas include improving transparency and trustworthiness of the recommendations; strengthening connection to national lists; and continuing the debate on the principles that should guide the model list, in particular the role of cost and price of essential medicines. These reflections are intended to support efforts ensuring the continued impact of this policy tool.

Barriers and Facilitators to Accessing Care and Adhering to Medications in People With Epilepsy in India: Healthcare Workers' Perspectives.

Introduction Exploring the barriers and facilitators that people with epilepsy face in accessing care and adhering to medications could enable a better understanding of how India's epilepsy treatment gap could be addressed. Furthermore, there is a paucity of research on the topic, and we could not find any studies exploring these barriers from the perspective of healthcare workers. Aim The study aimedto explore the barriers and facilitators to accessing care and adhering to medicationsfaced by people with epilepsy in India. Methodology Purposive sampling was used to recruit healthcare workers at a private hospital and a non-governmental organization in Pune, India. A total of 13 participants were interviewed, with all of these interviews being audio-recorded. Findings were transcribedand then analyzed by thematic analysis. Findings Several barriers to accessing care were identified, with misconceptions surrounding epilepsy being the most frequently mentioned barrier. Facilitators to accessing carementioned by participants included higher symptom severityand a higher level of education. Several barriers to medication adherence were discussed, with misconceptions and finances being key themes in participants' responses. Finally, four key themes arose from exploring facilitators to adherence, namely the low cost of medicines, counselling, a good doctor-patient relationship, and a higher education level. Discussion The barriers and facilitators in this study were similar to the barriers and facilitators identified in similar studies. However, some key differences were seen too. For example, this study found financial difficulties to be a key barrier to adherence, but a similar study in South India did not find financial difficulties to be a barrier. Several recommendations can be madebased on the findings of this studyon how to address India's epilepsy treatment gap. Conclusion People with epilepsy in India face several barriersand facilitators to accessing care and adhering to medications.India's epilepsy treatment gap is a complex and multifactorial issueand will therefore be challenging to address.

Escalating costs of innovative medicines: perspective and proposals.

Public healthcare systems are challenged by the soaring costs of medications that require increasing resources, often at the expense of other investments. The increasing pharmaceutical budget poses a threat to the allocation of funds for essential preventive and primary healthcare services while also raising concerns about equitable access, particularly in models where patients bear part of the costs out of their own pockets. Proposals on how to ensure ongoing and long-term accessibility, efficiency, and financial stability are required. The escalating costs of medicines may be explained in part by the mismatch between the traditional value-based pricing and reimbursement frameworks and the type of clinical development of targeted therapies and precision medicine in clinical practice. New appraisal methods and managed access strategies should be adapted to therapies targeting small populations and addressing increased uncertainty. Fair pricing strategies, transparent healthcare investments based on problems and outcomes, regulatory reforms, international cooperation, and critically examining the drug acquisition model are potential solutions. Transitioning from an industry-driven pricing approach to a health-driven payment model can help align the cost of treatments with actual health outcomes, establishing a foundation for a healthcare system that addresses immediate challenges and fosters long-term well-being. Acknowledging the lack of a universally applicable solution, the practical implementation of interventions requires a reframing of the pricing and access system and adaption to the targeted therapeutic approaches. Balancing innovation with financial sustainability necessitates a collaborative, adaptive, and transparent approach, as well as transitioning toward health-driven payment models, moving the focus from the cost of medications to the well-being of populations worldwide.

Adoption of clinical pharmacist roles in primary care: Longitudinal evidence from English general practice.

Over the last decade, the number of clinical pharmacists working within multidisciplinary teams in English general practice has expanded Aim: This study examines changes in quality of prescribing after the adoption of clinical pharmacists in English general practices. Two-way fixed effects regression was used to compare differences in prescribing indicators in general practices in England with and without pharmacists following implementation between September 2015 and December 2019 Results: Between September 2015 and December 2019, the proportion of practices employing a clinical pharmacist increased from 236/ 7,623 (3.10%) to 1,402/ 6,836 (20.51%). Clinical pharmacist implementation resulted in statistically significant reductions in total costs of medicines per 1,000 patients (-0.85% ,95% CI -1.50%, -0.21%), the total number of opioid prescriptions per 1,000 patients (- 1.06%, 95% CI -1.82%, -0.29%), and the average daily quantity (ADQs) of anxiolytics per 1,000 patients (-1.26%, 95% CI -2.40%, -0.12%). Clinical pharmacist implementation also resulted in reductions in the total number of prescriptions per 1,000 patients (-0.58%, 95% CI -1.30%, 0.13%), and the total number of antibiotic prescriptions per 1,000 patients (-0.51%, 95% CI -1.30%, 0.27%) that trended towards statistical significance. There were no statistically significant differences in the share of broad-spectrum versus narrow-spectrum antibiotics (0.02%, 95% CI -0.07%, 0.11%) and the oral morphine equivalence of high-dose opioids (>120mg per 24 hours) per 1,000 patients (1.19%, 95% CI -0.46%, 2.85%). Our analysis is limited by aggregate data at the practice-level but supports the hypothesis that clinical pharmacist implementation results in improvements in prescribing quality.

Better Care, Same Cost - Reducing Unplanned Care for Multi-visit Patients: A Payer-Provider Model.

Many interventions implemented for multi-visit patients (MVP) have been developed to address patient-centric needs of these individuals and reduce unplanned care for ambulatory-sensitive conditions. More rigorous research is needed to better understand the impact of these interventions on changes in care utilization including unplanned care. To evaluate the impact of the Enhanced Care Program (ECP), a payer-provider collaborative model, on unplanned care use and cost of care. Using propensity methods, a comparison group was constructed using insurer membership files. Comparisons were performed using a difference-in-differences analysis. Patients enrolled in ECP through December 2019 were considered eligible for the study (n = 357). All patients had five or more ED visits in the past year or two or more inpatient hospitalizations in the past year prior to enrollment. ECP is a high-intensity outpatient intervention intended to reduce avoidable unplanned care such as ED visits and inpatient hospital stays through home visits, chronic/acute disease management, and intensive care coordination. The primary outcomes of interest were events per 100 members per year of ED use with return to home, unplanned inpatient and observational status admissions, and unplanned behavioral health inpatient admission, and cost of care per member per month. Overall total unplanned care encounters were significantly reduced with a difference-in-difference of 320 unplanned care encounters per 100 members per year in the intervention group (p < 0.05). The ECP group showed statistically significant decreases in costs of unplanned ED, unplanned observation admission, and unplanned inpatient behavioral medicine costs, but statistically significant increases in overall pharmacy costs and lab costs. Changes in total costs of care for the ECP group were not statistically different than the control group (p = 0.55). ECP showed significant reduction of unplanned care for MVP patients.

New Evidence of the Impact of the National Drug Price Negotiation Policy on the Availability, Utilization, and Cost of Anticancer Medicines in China: An Interrupted Time Series Study.

The increasing global burden of cancer has become a significant challenge for public health. The Chinese government introduced the National Drug Price Negotiation (NDPN) policy with the goal of lowering the prices of innovative drugs and enhancing their accessibility. This study aims to evaluate the impact of the 2021 NDPN policy on the availability, utilization, and cost of anticancer medicines in China. Data was gathered from 1519hospitals between April 2021 and December 2022, with a focus on eight anticancer drugs affected by the 2021 NDPN policy. The availability, Defined Daily Doses (DDDs), and cost per Defined Daily Dose (DDDc) before and after the intervention were evaluated through interrupted time series analysis. The NDPN policy resulted in a substantial 5.10% increase in the availability of anticancer drugs (p < 0.001). Utilization also experienced a significant surge, with an immediate increase of 11,254.36 DDDs (p < 0.001) and a monthly increase of 1208.28 DDDs (p < 0.001) following policy implementation. The DDDc decreased by US$ 111.00 (p < 0.001) immediately after the policy. Disparities in regional drug utilization were evident, with higher usage in the eastern region. The 2021 NDPN policy has notably enhanced the availability and utilization of anticancer medications in China while reducing their cost, in line with the policy's objectives. However, continuous monitoring is essential to ensure sustained access and to tackle regional disparities in drug utilization.

Value for money of medicine sampling and quality testing: evidence from Indonesia

BackgroundSubstandard and falsified medicines (SFMs) are a public health concern of global importance. Postmarket surveillance in the form of medicine sampling and quality testing can prevent and detect SFM, however,...

Evaluations of the in vitro and in vivo antidiabetic activity of 70 % ethanolic fruit extracts of Rosa abyssinica

BackgroundDiabetes mellitus is becoming major health challenge with continually increasing burden. High costs of conventional medicines and numerous side effects associated with them, on the other hand, easy availability and accessibility of traditional herbal medicines calls upon experimental investigations to validate their effect on lowering blood glucose level. MethodsThe dried fruit of Rosa abyssinica was macerated with 70 % ethanol and the extract's in vitro antidiabetic activity was investigated using dinitrosalisylic acid method for alpha amylase inhibitory activity. Furthermore, the in vivo hypoglycemic and Antihyperglycemic effects of various doses of the extract (100, 200 and 400 mg/kg) was determined on normoglycemic, glucose loaded (1500 mg/kg) and Streptozotocine (180 mg/kg)-induced diabetic mice models. ResultsThe acute oral toxicity study revealed the plant showed no toxic effect on swiss albino mice at 2000 mg/kg. The in vitro alpha amylase inhibitory activity study showed that the extract has comparable IC50 value of 21.37 ± 4.252 μg/ml with the standard drug acarbose (IC50 value of 26.72 ± 3.59 μg/ml). On the other hand, in normal mice, none of the dose levels except at 400 mg/kg significantly reduces blood glucose level. This is in contrast to the oral glucose tolerance test, which the extract produced significant reduction at 60, 90 and 120 min following glucose challenge. The 70 % ethanolic fruit extracts of Rosa abyssinica also experienced profound antidiabetic activity in streptozotocin-induced diabetic model. In the single-dose study, both RAFE200 and RAFE400 demonstrated a significant (P˂0.05) reduction in blood glucose levels at 1, 2, 3, and 4 h. Similarly, in the repeated-dose study, RAFE200 and RAFE400 not only significantly reduced blood glucose levels but also produced a notable improvement in animal body weight. ConclusionThe 70 % ethanolic fruit extracts of Rosa abyssinica have shown significant in vitro alpha amylase inhibition effect and an in vivo blood glucose level lowering effects in diabetic mice.Therefore, this study supports the traditional use of Rosa abyssinica in the management of diabetes mellitus.

The Australian Team Approach to Polypharmacy Evaluation and Reduction (AusTAPER) hospital study: effect of a collaborative medication review on the number of current regular medicines for older hospital inpatients.

Potentially harmful polypharmacy is a growing public health concern. This article aims to evaluate the effectiveness of a structured Team Approach to Polypharmacy Evaluation and Reduction (AusTAPER) framework. We recruited patients at metropolitan hospitals for a randomised controlled trial with 12 months of follow-up. The intervention included a comprehensive medicines history, multidisciplinary meeting and medicines review prior to discharge, with engagement with the participants' general practitioner extending after discharge. The primary outcome was the change in the number of regular medicines used at 12 months from baseline. A cost consequence was performed to estimate costs per participant during the study period. There were 98 participants enrolled in the study. The number of regular medicines was significantly reduced from baseline in both groups (-1.7 ± 4.3, t = 2.38, P = 0.02 in the control group vs -2.7 ± 3.6, t = 4.48, P = 0.0001 in the intervention group), although there was no statistical difference detected between the two groups (1.0 (SE 0.9), t = 1.03, P = 0.31). The intervention was estimated to cost AU$644.17 and was associated with cost savings of AU$552.53 per participant in sustained reduced medicines cost. Health outcomes and healthcare costs were similar in both groups. Medicines were significantly reduced in both groups, with a trend to a larger reduction in medicines at 12 months in the intervention group. The intervention cost was approximately offset by sustained reduced medicines cost, although these results should be regarded cautiously because of the absence of significance in the differences in outcomes between groups.

Pharmacological and ethical comparisons of lung cancer medicine accessibility in Australia and New Zealand

Gaps in funded cancer medicines between New Zealand and Australia can have significant implications for patients and their families. Pharmac, the New Zealand pharmaceutical funding agency, has been criticised for...