Cost Of Pharmaceutical Services Research Articles

Challenges of patients with multiple sclerosis in receiving health care services in Iran.

Background: Multiple sclerosis (MS) is a debilitating, non-traumatic, neurological disorder in young adults and can reduce quality of life (QoL) by interfering with the ability to work, leisure activities, and routine living tasks. Various studies have shown the dissatisfaction of people with MS in different areas of care services. Regarding the patients' weakness with care and services, we sought to identify the challenges for patients with MS in receiving care and services in Iran. Methods: This cross-sectional study was conducted in 2016-2018 using a researcher-made questionnaire (designed by MS Specialists in an MS research center). The questionnaire examined the care challenges in four areas: 1) costs of medication, hospitalization, and rehabilitation services, 2) family support, insurance system, and job protection, 3) access to transportation system and treatment team, 4) quality of the provided care and services. Results: Completed questionnaires were received from 945 respondents. The mean age of responders was 35.92 years. In total, 731 (77.8) participants were women and 208 (22.2) were men. Academic education was reported among 615 (65.3) participants and 367 (40.2) were employed during the study, while 99 (10.5) of the subjects were not able to walk a minimum of 20 meters. The prioritization of care services challenges was as follows: the cost of pharmaceutical services (49.1), lack of telephone counseling (47.4), uninsured home rehabilitation (44.7), lack of qualified care centers (41.2), and rehabilitation costs (40.2). Conclusion: We found that patients who could not walk at least 20 meters and unemployed individuals had more problems and lower QoL. The patients who had non-academic education had more challenges with the cost of medication, transportation, and lack of familial support. This study shows the challenges of MS patients in receiving health care in Iran that vary in age, education, employment, and ability to walk. As the abovementioned challenges are of great importance in determining the QoL of people with MS, an appropriate solution is provided in this study to overcome these challenges.

PRM3 Standard Cost List for Economic Evaluation in Thailand

To develop standard unit costs of medical services provided by different health facilities, cost of patients coming for treatments, and reference values used in the economic evaluation. The project was conducted as a number of sub-projects. Analysis of unit cost of medical services was conducted in 5 hospitals employing the relative value unit method. Cost of health center services was calculated in 19 health centers employing standard costing and micro-costing methods. Cost of pharmaceutical services was analysed in 11 hospitals. Logistics cost of vaccines under the national vaccination program covered the supply chain from the central supplier to provincial health offices. Cost of patients coming to have treatments was collected by interviewing 900 patients from 6 health centers, 3 district hospitals and 3 provincial/regional hospitals. Reference values were obtained from documentary research. The results were published in a book, and can be accessed via the Health Intervention and Technology Assessment (HITAP) website (http://db.hitap.net/). They are composed of 3091 items of hospital medical services in two categories of hospitals: district and provincial/regional hospitals. Services of hospital pharmacy departments, and health services provided by health centers, include 9 and 68 items, respectively. Logistics cost of vaccines is presented as cost per dose of the vaccine supplied. Cost of patients is composed of distance, time, transportation cost and meal cost. Reference values are useful years of capital assets (i.e. buildings, vehicles, furniture and equipment), minimum wage, and gross domestic product per capita. This standard cost menu and reference values should make economic evaluations faster and more convenient. This is the first standard cost menu to be developed for Thailand. Some limitations exist, which will be improved upon in the next revision.

PHP14: COST ANALYSIS OF PHARMACEUTICAL SERVICES IN A TEACHING INSTITUTION

OBJECTIVES: The study purpose was to describe and quantify annual costs of pharmaceutical services per category (5) and clienteles (5) in a 452 bed mother and child teaching institution. METHODS: Based on a daily diary completed by each pharmacist, we calculated costs of pharmaceutical services in five categories in 1999–2000: distribution, management, clinical, teaching and research. Pharmacists were requested to provide a description of their activities, including the number of new patients/follow-up, verbal and written requests and number/type of interventions. Costs ratios were calculated. RESULTS: 1999–2000 fiscal year showed 21,330 admissions, 115,961 patient-days and 275,000 outpatient visits. Pharmacists represented 47% of total worked hours. Pharmacists' total hours reported represented 89,6 % of accounting data. Hours were dedicated to distribution (53%), clinical (29%), management (12%), teaching (5%) and research (1%) services. Pharmacists answered 26 491 questions while providing 26 065 interventions among 5 clienteles (intensive care, pediatrics, multi-specialties, mother and child and haematology/oncology). We calculated a ratio of interventions/worked hours with an average of 0,61 (min 0,015–max 1,35). An analysis of these differences will be provided. Pharmacists' total annual costs represented $1,453,000.00 CDN including social benefits. Assuming our pharmacy model optimizes the number of potential interventions in our setting and that 100 % of pharmacist's paid time is required to materialize them, we calculated an average cost of $54.92 CDN/intervention (min $24.80 CDN–max $2,233.00 CDN). Differences were calculated between 1998–1999 and 1999–2000 showing an average of 104% difference (min 68%–max 197%). Differences can be explained by pharmacist expertise evolution, management decisions and changes in activity volumes. CONCLUSION: There are little data available to allow benchmarking in the costs of pharmaceutical services. Further studies are required to identify the most useful ratios to monitor such costs as well as relevant outcomes.

P8. A payer perspective cost-benefit analysis of felbamate in a managed-care setting

Louisiana’s Intermediate Care Facilities I during 1994. Inappropriate drugs were identified using explicit criteria. The study was retrospective, observational, and crosssectional. Relevant data on the study population (19,932 patients) were extracted from the Medicaid files and analyzed using regression procedures. A beneficiary’s geographic region and the number of different drugs prescribed influenced the number of different inappropriate drugs prescribed. Costs of pharmaceutical services for a beneficiary were positively correlated with the number of different inappropriate drugs prescribed, number of physicians and pharmacies used, and the urban region, and were negatively correlated with beneficiary age. Probability of the beneficiary’s mortality was positively correlated with the number of pharmacies used. Minimizing numbers of prescribers and dispensers, as well as the number of different inappropriate drugs prescribed, may reduce drug utilization problems and may be cost-effective.

Cost of pharmaceutical services in U.S. hospitals in 1992

The results of a 1992 national survey of hospital-based pharmaceutical services are reported and compared with data collected during a similar survey in 1989. A questionnaire was mailed to pharmacy directors at all 3756 medical-surgical hospitals in the United States that had 50 or more licensed beds. Cost results were evaluated both as unadjusted data and as data adjusted for severity of illness with the case mix index. The response rate was 43% (1597 usable responses). Mean +/- S.D. unadjusted medication costs per occupied bed were $9850 +/- 4744 (a 46% increase over 1989 costs); significant differences were observed for geographic region, hospital ownership, drug delivery system, and pharmacy director's education. Mean +/- S.D. unadjusted total pharmacy costs per occupied bed were $16,550 +/- 6,249 (a 40% increase over 1989 costs); significant differences were observed for geographic region, hospital ownership, drug delivery system, and pharmacy director's education. Other mean +/- S.D. unadjusted pharmacy cost components were as follows: injectable solution costs, $2627 +/- 2191 (a 38% increase over 1989 costs); inventory costs, $2029 +/- 2593 (70% increase); pharmacist salary costs per occupied bed, $2997 +/- 1267 (33% increase); pharmacy technician costs per occupied bed, $995 +/- 876 (24% increase); pharmacist salary costs per full-time equivalent (FTE), $43,791 +/- 12,206 (14% increase); pharmacy technician salary costs per FTE, $18,953 +/- 6,154 (15% increase); and pharmacy staff development costs per occupied bed, $45 +/- 41 (29% increase). Pharmacist salary costs associated with centrally based clinical pharmacy services ranged from a high of $361 per occupied bed per year for drug-use evaluation to a low of $15 per occupied bed per year for inservice education. Pharmacist salary costs for patient-specific pharmaceutical services ranged from $3 per patient for medical rounds to $8 per patient for cardiopulmonary resuscitation team participation and drug protocol management. A 1992 survey provided comprehensive data on the cost structure of hospital-based pharmaceutical services and a basis for comparison with 1989 cost data.

Cost of pharmaceutical services.

Cost of pharmaceutical services.

Recent developments in organizing and financing health-care services

Recent developments in the organization and financing of health-care services are described. All recent developments reflect an effort by both private and public payers to restrict use of health-care services, as well as to control price. Private use-review programs, such as second-surgical-opinion services and case-management services, are increasingly being used. The number of hospital admissions and length of patient stay continue to decline, but, because of increasing complexity of care, the cost of pharmaceutical services has not decreased proportionately. Points relating to health-care financing in the federal reconciliation budget effective May 1, 1986, are reviewed, as are other new federal regulations affecting the structure of services and terms of reimbursement under the Medicare and Medicaid programs. For Medicare, these include new scope objectives for professional review organizations, decreased return-on-equity payments to for-profit hospitals for outpatient services and to skilled nursing facilities, and elimination of waiver-of-liability presumptions for hospitals. Also, physicians must now identify specific services provided during each inpatient hospital visit. Most developments related to home health-care services pertain to limiting the cost of durable medical equipment. Alternative types of health care based on capitation funding, such as health maintenance organizations, competitive medical plans, and preferred provider organizations, will continue to grow in both the public and private sectors, and the use of private use-review programs for controlling costs is expected to accelerate in the next year.