Pharmaceutical Costs Research Articles

Prescription of Gastric Acid Secretion Inhibitors before and after the Withdrawal of Ranitidine

Background: In September 2019, ranitidine, the largest share in the gastric acid secretion inhibitor market, was identified as a carcinogen, and sales were banned. The purpose of this study was to investigate how the gastric acid secretion inhibitor market changed after ranitidine withdrawal.Methods: From January 2010 to December 2021, the prescription dose and cost of gastric acid secretion inhibitors were calculated monthly. To investigate the effect of ranitidine withdrawal on the gastric acid secretion inhibitor market, we developed a time-series autoregressive model using data from January 2010 to October 2019. In addition, the P-value was calculated by interrupted time series analysis using the data dating between 2010 and 2021 (interrupted time: October 2019).Results: Since 2010, proton pump inhibitors have increased their market share in terms of prescription volume and drug costs. This trend accelerated since ranitidine was withdrawn from the market in September 2019. In 2021, it was estimated that ranitidine prescriptions would be transferred as follows: famotidine's increased prescription volume was estimated at 323 million (pharmaceutical cost, 53.2 billion won), proton pump inhibitors (PPIs) at 223 million (89.9 billion won), and lafutidine at 137 million (20.5 billion won).Conclusions: The market share expansion of PPIs accelerated due to the withdrawal of ranitidine. The ranitidine prescription was partially transferred to the same H <sub>2</sub> blockers, such as famotidine and lafutidine, and there was also a significant transfer to PPIs.

Comparative Study of Nutraceutical Products Authorization Requirements in Singapore, Malaysia & Cambodia

The high cost of branded name pharmaceuticals in the nutraceuticals sector is a problem in Asian countries such as Singapore, Malaysia, and Cambodia. Generic medications, which are less expensive and more competitive than branded drugs, play an important role in boosting drug access and lowering drug costs. The pharmaceutical market in Southeast Asia is rapidly expanding. There are ten countries in the Asian region. All countries have a comparable regulatory environment. However, the registration requirements and procedures differ from country to country throughout the Asian region. Despite the fact that ACTD is harmonized for all ten nations, various local criteria, such as administrative, technical, clinical, and non-clinical papers, GMP, and ICH standards vary by country. This review article will provide an overview of the drug registration regulations of nutraceuticals in three key player ASEAN member states such as Singapore, Malaysia & Cambodia.

Generic switching: Do future physicians in Jordan have enough knowledge and a positive attitude?

Background: Generic switching is a policy that has shown success in minimising pharmaceutical costs. It has also been used to mitigate recurrent and sudden drug shortages. Not all countries have policies that allow pharmacists to switch to generic drugs independently. In Jordan, only pharmacists at Ministry of Health hospitals automatically switch to generics if doctors had not already done INN prescribing. Objectives: This study targeted medical students to assess their experience with generic switching as patients, their knowledge of the subject as students, and their attitude towards it as future prescribers and policymakers. Methods: This is a descriptive, cross-sectional study conducted online. Eligibility criteria were being a fourth, fifth, or sixth-year medical school student enrolled at any of the six Jordanian universities. The questionnaire was developed by the researchers after a careful review of the relevant literature. Results: Three hundred and ninety students responded to the online questionnaire. Most participants were females (244, 62.6%), senior students in their final (6th)year (162, 41.5%) and with very good academic achievement (166, 42.6%). The highest knowledge scores concerned patient rights (0.73/1.00), followed by knowledge about monitoring after generic switching (0.66/1.00), and patients with known drug allergies (0.66/1.00). Almost half of the participants believe that pharmacists should not be given the right to do generic switching and only 16% stated that they would choose generic drugs if they needed treatment in the future. Multivariate linear regression analysis showed that significant predictors of knowledge were gender, GPA, and family income. No correlations were found between participants' knowledge scores and their attitudes towards giving pharmacists the right to independently switch drugs, or whether they would accept a substitute from pharmacists rather than having to refer to the physician. Conclusion: Medical students in Jordan lack sufficient knowledge about generic switching. Students need to be more aware of the current policies and regulations of this practice, and the role of each healthcare worker involved in it. They also need to have a more positive attitude toward generic drugs and generic switching practice to facilitate its future implementation.

Cost-Effectiveness of the Early Arthritis Clinic Organizational Model.

Early diagnosis and tight control improve outcomes of rheumatoid arthritis (RA). However, whether establishing an early arthritis clinic (EAC) is sustainable for national health systems is not known. This analysis aimed to compare effectiveness and costs of an EAC compared to patients followed by the current standard of care. A retrospective study on administrative health databases of patients with a new diagnosis of RA was conducted: 430 patients followed in an EAC were enrolled, and 4 non-EAC controls were randomly matched for each. During 2 years of follow-up, the mean health care costs (outpatient, inpatient, pharmaceutical, and global) and 3 effectiveness measures (number and length of hospitalization and quality of care) of the EAC and non-EAC were estimated. The incremental cost-effectiveness ratio was calculated as well as the cost-effectiveness acceptability curve. The cohorts included patients with a mean age of 55.4 years, and 1,506 patients (70%) were female. The mean pharmaceutical (2,602 versus 1,945 euros) and outpatient (2,447 versus 1,778 euros) costs were higher in the EAC cohort. Conversely, a higher rate of non-EAC patients had a low adherence to quality-of-care indicators. The expected number of hospitalizations and the length of stay were statistically significantly higher in the non-EAC versus EAC. Despite an expected increase in outpatient costs (visits and diagnostic tests) and pharmaceutical costs, the reduction in terms of number and length of hospitalizations and the higher adherence to international quality-of-care guidelines support the effectiveness of the EAC model.

PP123 Fair Drug Pricing: Review Of Literature And Models

IntroductionConstantly rising costs of pharmaceuticals and biologics spurred a debate in recent years leading to increasingly persistent public calls to overhaul the existing system of pricing and distributing health technologies. The COVID-19 pandemic exposed the controversies of the current model of access to health commodities in all evidence when the existing discrepancy between the global supply and the global demand in health technology can be viewed as an illustration of a conflict between the neoliberal free market ideal of health innovation genesis and ownership and the original democratic principles of what would now be called sustainable human development.MethodsPresented here is an integrative literature review of over 265 publications in peer-reviewed journals on Pubmed and Web of Science, academic and “grey” literature, mainly publicism, published in English. We reviewed and analyzed included literature for the purposes of identifying leading ideas with regards to ethical frameworks for evaluating or referencing value for pricing health commodities.ResultsSeven drug pricing models were analyzed in terms of them satisfying the three most common criteria of price adequacy – its fairness (viewed from the point of view of main schools of ethical thought), accountability-for-reasonableness (including transparency of decisions, relevance, existing mechanisms of revisions and governance to ensure compliance), and price functionality. One of the central ideas under controversy is value, its relative character for different contexts due to the high weight of the willingness-to-pay in the value-based health technology assessment (HTA) decisions and the relative value of money, and the attempts to quantify value in a universal way for institutions, patients, and originators.ConclusionsWhile the review scored the pricing models on their “public fairness” with volume-based rather than value-based pricing models leading the rating, the main conclusion of the review is that the main meaningful divide is between value creation and value extraction when pricing health innovation.

Healthcare costs associated with comorbid cardiovascular and renal conditions among persons with diabetes, 2008–2019

BackgroundThere is paucity of data examining healthcare costs among persons with comorbid diabetes and cardiorenal conditions.ObjectiveTo elucidate the longitudinal trends and quantify the incremental healthcare costs associated with the following cardiorenal conditions: atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and kidney disease, among persons with diabetes.MethodsMedical Expenditure Panel Survey data (2008–2019) were used to identify adults with diabetes and comorbid cardiorenal conditions. Overall, medical and pharmaceutical costs were ascertained (in 2019 US dollars). Analyses were adjusted for 14 variables using a two-part regression model.ResultsAmong 32,519 adults with diabetes, the mean (standard error [SE]) annual healthcare costs were $13,829 ($213), with medical and prescription components contributing $9301 ($172) and $4528 ($98), respectively. Overall healthcare costs rose by 26.8% from $12,791 (2008–2009) to $16,215 (2018–2019) over the study period, driven by 42.5% and 20.3% increase in pharmaceutical and medical spending, respectively. Similar trends were observed for subgroup of persons with cardiorenal conditions. Compared to their counterparts without cardiorenal conditions and prior to adjustment, persons with ASCVD, HF and kidney disease incurred healthcare costs that were approximately 2.2, 3.3, and 2.7 times greater. After adjustment, comorbid ASCVD, HF and kidney disease were associated with annual excess spending of $8651 (95% CI $7729–$9573), $9373 (95% CI $9010–$9736), and $9995 (95% CI $8781–$11,209), respectively.ConclusionsStudy results are generalizable to non-institutionalized US persons. Healthcare costs associated with the management of diabetes are high—especially among those with comorbid cardiorenal conditions, and have risen in recent years.

Pharmaceutical cost implications for oral healthcare interventions at a dental clinic in Windhoek, Namibia

Half of the world’s 7.9 billion population suffers from oral health conditions. Most are largely preventable and treatable but costs are often unaffordable especially in developing countries. The World Health Organization (WHO) resolved in 2021 to include oral healthcare interventions in universal healthcare coverage (UHC) programmes. Although the general expenditure on oral healthcare services has been reported by some countries, amounts spent on particularly pharmaceuticals have not been reported. This study aimed to report on the prevalence of different types of oral health diseases in patients attending a dental clinic in Windhoek (Namibia) and quantify the pharmaceutical expenditure incurred. Records for all patients who visited the dental clinic at KIRH during a six-month period (1 January 2021 to 30 June 2021) were reviewed. Costs associated with the respective pharmaceutical management options for the most common oral conditions were calculated based on the approximated cost for a single treatment course per patient.Pharmaceutical expenditure on oral diseases was approximately 0.4% of the hospital’s annual budget. From this, 94.6% was due to treatment of dental caries which had a 90.1% prevalence. Prevalence of dental caries among 13-19 years age group (9.5%) was lower than for 1-12 years (18.6%) and 20-64 years (68.2%). Cases for dental caries were fewer for the 65+ years age group (3.8% of total cases) but had the highest prevalence (95.2%) of dental caries then other age groups. The proportion of the pharmaceutical budget spent on treating oral diseases was 0.4%, of which 94.6% was due to dental caries. Promotion of oral healthcare among children may be instrumental in reducing the pharmaceutical costs associated with treatment of dental carries.

Influence of COVID-19 on the 10-year carbon footprint of the Nagoya University Hospital and medical research centre

Background:Amidst the climate crisis, a key goal of the medical sector is to reduce its large carbon footprint. Although the Coronavirus disease 2019 (COVID-19) pandemic greatly impacted the medical sector, its influence on carbon footprints remains unknown. Therefore, the aim of this study was to evaluate changes in the carbon footprint of a university hospital with a medical research centre over the past 10 years.Methods:Data on electricity, gas, and water usage, pharmaceutical and medical supply costs, and waste amounts were recorded for Nagoya University Hospital from April 2010 to March 2021. The relevant emission factors were obtained from the Japanese government and the overall monthly carbon footprint was reported according to the Greenhouse Gas Protocol. The effect of the COVID-19 pandemic on the carbon footprint was then compared for three types of emission sources. Moreover, a regression model was used to plot quadratic functions as approximate functions using monthly carbon emissions and monthly average external temperatures. Finally, the monthly carbon footprint was calculated per hospital admission.Results:The overall carbon footprint of the hospital was 73,546 tCO2e in 2020, revealing an increase of 26.60% over the last 10 years. Carbon emissions from electricity consumption represented 26% of total emissions. The individual carbon footprints of pharmaceuticals, medical supplies, waste, and water usage also increased from 2010 to 2020. The overall monthly carbon footprint was positively correlated with the average monthly temperature (R2 = 0.7566, p < 0.001). Compared with 2019, the overall carbon footprint decreased by 2.19% in 2020. Moreover, the monthly carbon footprint per hospital admission increased significantly between 2018 (0.24 tCO2e/admission) and 2020 (0.26 tCO2e/admission) (p = 0.002).Conclusion:The overall carbon footprint of the hospital generally increased over the last decade. During the COVID-19 epidemic in 2020, the carbon footprint decreased slightly, likely because of the reduced number of patients. However, the carbon footprint per admission increased, which was attributed to more complicated patient backgrounds because of the ageing population. Therefore, evaluation of carbon emissions in the medical sector is urgently required in order to act on the climate crisis as soon as possible.

Failure to Launch: Why Some Generics Don’t Take

Prescription drug affordability is a growing health policy concern. In 2019, pharmaceutical spending accounted for an estimated 12.6% of overall health spending in the United States.1 The annual rise in US pharmaceutical costs consistently outpaces the consumer price index. In this context, much attention has been devoted to various strategies to mitigate or reign in pharmaceutical expenditures.2 Newer prescription drugs are inherently immune to free market competition on price owing to lengthy patent protections, which pose a considerable barrier to the entry of competitors.

Economic Effects of Fixed-Dose Versus Loose-Dose Combination Therapy for Type 2 Diabetes Patients.

We examined the effects of fixe-dose combinations (FDCs) versus loose-dose combinations (LDCs) on costs from the payer and patient perspective and investigated potential channels contributing to differences in costs between the two modes of treatment. We investigated administrative data from 2017 to 2020 on diabetes patients in Germany. After using prospensity-score matching to remove dissimilarities between FDC and LDC patients, we compared changes in costs with a difference-in-differences approach. We analyzed pharmaceutical costs, inpatient and outpatient costs, other costs and total healthcare costs from the payer perspective, and co-payments from the patient perspective. The sample comprised 1117 FDC and 1272 LDC patients. Regression analysis revealed that FDC therapy significantly increased antidiabetic pharmaceutical spending in the first year by 5.5% (p<0.01), but decreased co-payments by 33% (p<0.01) in the first and 44% (p<0.01) in the second year. We also observed a trend towards higher outpatient spending in the first year. No significant differences were found with respect to inpatient or other costs. The increase in antidiabetic pharmaceutical spending did not contribute to a significant increase in total healthcare expenditure. We identified a shift of co-payments to the payer and higher adherence as possible mechanisms behind the increase in antidiabetic pharmaceutical spending. Although FDC therapy increased disease-specific pharmaceutical spending in the short term, this increase did not lead to differences in total healthcare costs from the payer perspective. From the patient perspective, FDC therapy may be the preferred treatment approach, because of significant saving in co-payments, which is likely attributable to the elimination of one co-payment and therefore a shift in costs to the payer.

Wellness Program Participation and its Association With Reduction in Health Risks and Health Care Costs: One University's Story.

Evaluate if there is a(n): 1) reduction in health risk behaviors and 2) association between health and wellness initiative participation and claims costs decreases overtime. Health risk behavior change consisted of the analysis of pre (2009) - post (2019) measures of health questionnaire participants. The medical and pharmaceutical claims costs evaluation consisted of a time-series (2016-2019) design with a comparison group. A large mid-western university with a health system. The health risk behavior sample ranged from 5215-5399, depending on the variable of interest. The medical and pharmaceutical costs sample used a cohort of participants (participating all 4 years, n=11114) and non-participants (not participating all 4 years, n=4776). Comprehensive employee health and well-being initiative. McNemar's tests were used to identify bivariate associations between 2009 and 2019 health risks. The claims cost analysis used propensity score matching based on select demographics and linear mixed-effects regression modeling. Results show statistically significant (P > .001) improvements (ranging from -2.1% to -12.5%) in 7 of 8 health risk behaviors. 2016 and 2019 claims costs have a lower statistically significant (P > .001) percent increase for participants (32.6%) compared to non-participants (47.5%). Employers, may consider implementing a comprehensive health and wellness program as part of their strategy to assist in health behavior risk reduction and health care cost containment.

Evaluations of Funerals and Health Trajectories in the Second Year After Bereavement-The Ongoing Japan National Survey.

Our nationwide postal survey analyzing 190 responses from Japanese bereaved who had responded a year earlier found that funeral dissatisfaction rose during the second year after the funeral. Controverting previous research advocating participation in funeral planning, elderly bereaved spouses forced to decide about and/or pay for the funeral showed elevated grief as much as 2years later. While not reaching levels diagnosed as prolonged, traumatic, or complicated grief, nevertheless one out of three of our bereaved sample showed continuing daily symptoms of grief from 14 to 24months after their bereavement, with continued or increasing use of tranquillizers or antidepressants. The medical and pharmaceutical costs incurred by mourners more than a year after bereavement warrant further research into what factors improve or exacerbate the health of grieving bereaved, not limited to a single year after the bereavement.

The Human Cost: Patient Contribution to Clinical Trials in Neurology.

Drug development abounds with corporate pharmaceutical capital investment and expenditure costs for new therapeutics. However, there is little data on the human investment, in particular, the number of participants required or the potential burden on and cost to individual trial participants so instrumental to this endeavor. Indeed, the human participant burden in clinical trials is poorly, if at all, described in the literature and we could identify no reports that have detailed the participant burden unique to neurology trials. The cost of clinical trials to participants, including the unique circumstances affecting enrollment of diverse participant populations, has only begun to be reflected in the wider clinical trial literature. Additionally, details of the indirect costs, including time commitment, out-of-pocket expenses, emotional expenditure, and potential loss of enrollment into a more successful trial by participants in trials that fail - the majority in the field - is also particularly striking in the lack of representation in the literature. Even in successful clinical trials, participants in the placebo group face both an emotional burden and medical risk of morbidity and mortality without potential offsetting therapeutic benefit.

Lifetime health costs of intimate partner violence: A prospective longitudinal cohort study with linked data for out-of-hospital and pharmaceutical costs

The health effects of intimate partner violence (IPV) can be long term, developing years after the IPV began and persisting after it has ceased. We aim to quantify the excess lifetime out-of-hospital and pharmaceutical health costs of women who experience IPV in Australia by applying a novel combination of econometric and actuarial techniques to a large and unique dataset. We find that women with a history of IPV have AUD48,413 (2020) higher lifetime health costs per person than women who do not experience IPV. This suggests that the adverse health impact of IPV leads to increased health costs over one's lifetime regardless of whether the initial IPV experience is early or later in life, and policies reducing the incidence of IPV will have long-term impacts on the healthcare system.

Evaluating the anti-arthritic potential of walnut (Juglans regia L.) in FCA induced Sprague Dawley rats.

Rheumatoid arthritis (RA) is an autoimmune progressive disease, associated with many pathophysiological consequences. Owing to the adverse effects and higher costs of pharmaceuticals, people are now looking for complementary and alternative remedies. In this milieu, the present study was designed to explore the therapeutic potential of walnuts against FCA-induced arthritis in rat models. Purposely, 50 Sprague Dawley rats were housed in a well-ventilated animal room and separated into 5 groups of 10 rats each. The rats were categorized as G0 (negative control), G1 (positive control, i.e., FCA induced untreated arthritic rats), G2 (arthritic rats treated with MTX), G3 (arthritic rats treated with walnut feed), and G4 (arthritic rats treated with walnut extract), with an efficacy trial lasting for 42 days. The physical analysis explicated that paw swelling was significantly improved by 10%-12.8% in treatment groups after the intervention when compared with positive control. Moreover, biochemical analyses revealed significantly lower levels of ESR, CRP, and RF in rats treated with walnut-based interventions when compared to positive control. ESR values were decreased by 62.4% and 69.92% in G3 and G4 , whereas CRP levels were improved by 56.20% and 77.78% in G3 and G4 when compared with G1 . Likewise, RF values decreased in G2 , G3 , and G4 by 64.71%, 55.88%, and 69.24%, respectively when compared to G1 . The histological examination demonstrated the potential role of walnut-based interventions in reducing the severity of disease by decreasing cell infiltration, bone erosion, and paw inflammation. Meanwhile, the gene expression analysis revealed that walnut-based interventions protected the paw joints from damage by downregulating the RANKL-OPG pathway. Conclusively, walnut feed and extract may serve as potent anti-arthritic interventions with no side effects. PRACTICAL APPLICATIONS: Plant-based therapeutics are effective in the prevention and management of various chronic diseases. The current research explored the anti-arthritic potential of walnuts. Walnut feed and extract effectively reduced the serum arthritic biomarkers as well as downregulated the genes involved in bone destruction. Thus, the inclusion of dietary ingredients having therapeutic potential such as walnuts may be synchronized in clinical practices to ameliorate arthritis.

Multicentre study revealed significant gaps between evidence-based recommendations for using corticosteroids for croup and clinical practice.

Adherence to croup management recommendations has been poorly investigated. This study aimed to describe the treatment patterns in two paediatric emergency departments and analyse the adherence to recommendations. We conducted a retrospective chart review of children diagnosed with croup in two Italian paediatric emergency departments in 2017. Data on clinical presentation, corticosteroid administration and home therapy were collected. Length of stay, hospitalisation and re-access rates were compared among different corticosteroid treatment groups. We enrolled 632 patients (61.1% males) with a mean age of 42.8± 55.1 months. Corticosteroids were administered to 403 (63.8%) children in the emergency departments. Dexamethasone was administered to 1 (0.4%) patient. Inhaled and oral corticosteroids were given to 342 (54.1%) and 226 (35.8%) patients, respectively. Home therapy was prescribed for 603 (95.4%) patients, either with inhaled (86.2%) and/or oral (43.8%) corticosteroids. The re-access rate was 2.8%. The actual pharmaceutical costs were an estimated 10 times higher than they would have been if the recommendations had been followed. A significant gap between the evidence and clinical practice for croup treatment was observed. Improving adherence to the recommendations could lead to clinical and economic benefits.

ANALYSIS OF TOTAL COSTS OF BREAST CANCER CEMOTHERAPY PATIENTS BASED ON USE OF CHEMOTHERAPY REGIMEN ON JKN PATIENTS IN SANGLAH RSUP

&#x0D; Breast cancer is the first sequence of most attacking women in Indonesia. The high cost of care and old services is a major problem in the prevention of breast cancer. This study aims to determine the relationship between the total cost of the Sanglah Denpasar hospital with the chemotherapy regimen of breast cancer of JKN patients at Sanglah Hospital Denpasar. Test homogeneity using Levene test method. Test normality using Kolmogorov-Smirnov. One way ANOVA test results showed a significant relationship between chemotherapy therapy regimen (FAC, FAC + PAXUS, FEC, AC, AC + PAXUS) with total real cost in breast cancer chemotherapy patients (p = 0.001). The total rill cost was greater in the group receiving FAC + PAXUS, FEC, and AC + PAXUS regimens than the group receiving FAC and AC therapy regimens. This can be caused by a large pharmaceutical cost component in the FAC + PAXUS, FEC, and AC + PAXUS groups. Pharmaceutical costs account for 76.84-85.80% of the total real cost of breast cancer patients receiving chemotherapy. More drug combination factors can lead to higher total rill costs in patients receiving FAC + PAXUS, FEC, and AC + PAXUS.&#x0D;

Does health technology assessment compromise access to pharmaceuticals?

In response to rapidly rising pharmaceutical costs, many countries have introduced health technology assessment (HTA) as a ‘fourth hurdle’. We evaluated the causal effect of HTA based regulation on access to pharmaceuticals by using the introduction of Germany’s HTA system (AMNOG) in 2011. We obtained launch data on pharmaceuticals for 30 European countries from the IQVIA (formerly IMS) database. Using difference-in-difference models, we estimated the effect of AMNOG on launch delay, the ranking order of launch delays, and the availability of pharmaceuticals. We then compared the results for Germany to Austria, Czechia, Italy, Portugal, and the UK. Across all six countries, launch delays decreased from the pre-AMNOG period (25.01 months) to the post-AMNOG period (14.34 months). However, the introduction of AMNOG consistently reduced the magnitude of the decrease in launch delay in Germany compared to the comparator countries (staggered DiD: + 4.31 months, p = 0.05). Our logit results indicate that the availability of pharmaceuticals in Germany increased as a result of AMNOG (staggered logit: + 5.78%, p = 0.009). We provide evidence on the trade-off between regulation and access. This can help policymakers make better-informed decisions to strike the right balance between cost savings achieved through HTA based regulation and access to pharmaceuticals.

Utilization and cost of drugs for diabetes and its comorbidities and complications in Kuwait.

BackgroundDiabetes imposes a large burden on countries’ healthcare expenditures. In Kuwait, diabetes prevalence in adults is estimated at 22.0%%—double the worldwide prevalence (9.3%). There is little current data on pharmaceutical costs in Kuwait of managing diabetes and diabetes-related complications and comorbidities.ObjectivesEstimate the utilization and cost of drugs for diabetes and diabetes-related complications and comorbidities in Kuwait for year 2018, as well determinants of costs.MethodsThis cross-sectional study used a multi-stage stratified sampling method. Patients were Kuwaiti citizens with diabetes, aged 18–80, recruited from all six governorates. Physicians collected demographic data, clinical data, and current drug prescription for each patient which was extrapolated for the full year of 2018. A prevalence-based approach and bottom-up costing were used. Data were described according to facility type (primary care vs. hospital). A generalized linear model with log function and normal distribution compared drug costs for patients with and without comorbidities/complications after adjustments for demographic and health confounders (gender, age group, disease duration, and obesity).ResultsOf 1182 diabetes patients, 64.0% had dyslipidemia and 57.7% had hypertension. Additionally, 40.7% had diabetes-related complications, most commonly neuropathy (19.7%). Of all diabetes patients, 85.9% used oral antidiabetics (alone or in combinations), 49.5% used insulin alone or in combinations, and 29.3% used both oral antidiabetics and insulin. The most frequently used oral drug was metformin (75.7%), followed by DPP4 inhibitors (40.2%) and SGLT2 inhibitors (23.8%). The most frequently used injectables were insulin glargine (36.6%), followed by GLP-1 receptor agonists (15.4%). Total annual drug cost for Kuwait’s diabetic population for year 2018 was US$201 million (US$1,236.30 per patient for antidiabetics plus drugs for comorbidities/complications).ConclusionsDrug costs for treating diabetes and comorbidities/complications accounted for an estimated 22.8% of Kuwait’s 2018 drug expenditures. Comorbidities and complications add 44.7% to the average drug cost per diabetes patient.

The Clinical and Economic Benefit of CMV Matching in Kidney Transplant: A Decision Analysis.

The development of cytomegalovirus (CMV) infection after kidney transplant remains a significant cause of posttransplant morbidity, graft loss, and mortality. Despite appropriate antiviral therapy, recipients without previous CMV exposure can currently be allocated a kidney from a donor with previous CMV infection (D+R-) that carries the greatest risk of posttransplant CMV infection and associated complications. Preferential placement of CMV D- organs in negative recipients (R-) has been shown to reduce the risk of viral infection and associated complications. To assess the long-term survival and economic benefits of allocation policy reforms, a decision-analytic model was constructed to compare receipt of CMV D- with CMV D+ organ in CMV R- recipients using data from transplant registry, Medicare claims, and pharmaceutical costs. For CMV R- patients, receipt of a CMV D- organ was associated with greater average survival (14.3 versus 12.6 y), superior quality-adjusted life years (12.6 versus 9.8), and lower costs ($529 512 versus $542 963). One-way sensitivity analysis demonstrated a survival advantage for patients waiting as long as 30 mo for a CMV D- kidney. Altering national allocation policy to preferentially offer CMV D- organs to CMV R- recipients could improve survival and lower costs after transplant if appropriately implemented.