Drug Expenses Research Articles

Focusing on DNA Repair and Damage Tolerance Mechanisms in Mycobacterium tuberculosis: An Emerging Therapeutic Theme.

Tuberculosis (TB) is one such disease that has become a nuisance in the world scenario and one of the most deadly diseases of the current times. The etiological agent of tuberculosis, Mycobacterium tuberculosis (M. tb) kills millions of people each year. Not only 1.7 million people worldwide are estimated to harbor M. tb in the latent form but also 5 to 15 percent of which are expected to acquire an infection during a lifetime. Though curable, a long duration of drug regimen and expense leads to low patient adherence. The emergence of multi-, extensive- and total- drug-resistant strains of M. tb further complicates the situation. Owing to high TB burden, scientists worldwide are trying to design novel therapeutics to combat this disease. Therefore, to identify new drug targets, there is a growing interest in targeting DNA repair pathways to fight this infection. Thus, this review aims to explore DNA repair and damage tolerance as an efficient target for drug development by understanding M. tb DNA repair and tolerance machinery and its regulation, its role in pathogenesis and survival, mutagenesis, and consequently, in the development of drug resistance.

Real-World Budget Impact of Listing a Biosimilar of Rituximab

The approval of new biosimilars by national health agencies is expected to generate significant cost savings for health care systems. This is particularly the case with the biosimilar of rituximab approved for the Canadian market in 2019. However, several uncertainties remain regarding utilization of this agent. To determine the proportion of total annual drug expenses for each indication for rituximab in the hospital setting and to determine potential savings related to introduction of a biosimilar. A budget impact analysis was performed through 3 real-world scenarios, based on data obtained from a large university teaching hospital for a 12-month period. This study involved data for 420 patients. Annual expenses for rituximab for all indications represented 7.7% of total annual drug spending for the hospital, of which 5.0% was related specifically to indications approved by Health Canada. More than 6% of the annual drug expenses was attributable to the use of rituximab for oncologic indications, including 1.8% for uses not approved by Health Canada. Overall, each 10% reduction in the price of a biosimilar of rituximab (relative to the reference rituximab) would result in annual savings of about 0.8% of total drug expenses in the hospital if a biosimilar was used for all real-world indications, whether approved by Health Canada or not. The introduction of a biosimilar of rituximab to the Canadian market would generate significant savings. To properly assess the potential savings that this agent could generate in the limited budget environment of a hospital, it seems important to consider all of the indications for which it could be used.

Impact of 'Chief-Pharmacist System' on drug expenditures and rational drug use.

Background Over the last few years, pharmacists in China have been searching for effective strategies to expand their roles in pharmaceutical care. In September 2012, the Beijing Chaoyang Hospital was the first in China to establish the Chief-Pharmacist System aimed to let pharmacists be a responsible part of the multi-disciplinary care team. Objective To describe the Chief-Pharmacist System and explore its impact on drug expenditures and rational drug use. Setting A tertiary hospital in Beijing, China. Method Chief-Pharmacist System oriented specific measures were implemented and evaluated. Data on medical services quantity, quality and drug expenses during the periods of pre-implementation (from September 1, 2011 to August 31, 2012) and post implementation (from September 1, 2012 to August 31, 2016) were collected. Main outcome measure Healthcare quality indicators, drug expenditures, selected drug use indicators of outpatientand antibiotic use. Results With the implementation of the Chief-Pharmacist System and the participation of pharmacists in pharmaceutical care, drug expenses were reduced significantly. The total drug expenses, outpatient drug expenses per visit and inpatient drug expenses per admission decreased by an average of US $34.3 million, US $8.9 and US $ 303.9, respectively, compared to the pre-implementation period. Meanwhile, selected drug use indicatorsin post-implementation period were significantly improved. All results were achieved without sacrificing clinical quality and quantity. Conclusion The study illustrates that the Chief-Pharmacist System achieves substantial reductions in drug expenditures and promotion of rational drug use. It provides a model for other hospitals in China and other low- and middle-income countries.

The Risk of High Out-of-Pocket Health Spending among Older Americans

Traditional Medicare imposes significant cost-sharing on beneficiaries. Most but not all beneficiaries obtain supplemental insurance through Medigap, Medicare Advantage, Medicaid, or employer-sponsored retiree coverage, which may vary in how well they protect against the risk of high spending. This paper uses data from the Health and Retirement Study for the years 2002 through 2016 to document how supplemental coverage for Medicare beneficiaries 65 and older has changed over time, and to estimate the distribution of out-of-pocket spending for enrollees with different coverage types. I find that the shares of beneficiaries with employer-sponsored supplemental coverage or Medigap declined between 2002 and 2016, whereas the shares with Medicare Advantage or no supplemental coverage for doctor and hospital bills have increased. The majority of those with no supplemental coverage for doctor and hospital bills have Medicare Part D, which covers prescription drug expenses. I find that all supplemental coverage types are associated with lower observed dispersion in out-of-pocket medical care spending, measuring dispersion as the ratio of the 90th to the 50th percentile or the standard deviation. All supplemental insurance types are associated with a lower probability that out-of-pocket medical care spending exceeds 10% of household income, while all but Medicaid are associated with a significantly higher probability that total out-of-pocket health spending (that is, medical care plus health insurance premiums) exceeds this threshold. Thus, all supplemental insurance forms effectively function as insurance, translating uncertain medical costs into more predictable — although still potentially burdensome — premiums.

"4+7" city drug volume-based purchasing and using pilot program in China and its impact.

In order to deepen the health system reform and improve the mechanism for the formation of drug prices, in January 2019, the General Office of the State Council of the People's Republic of China issued the "National centralized drug purchasing and using pilot program", selected 11 cities in mainland China to carry out "4+7" city drug volume based purchasing pilot work. This paper introduces the specific implementation plan, organizational structure and drug selection process of China's "4+7" city drug volume-based purchasing pilot work, and expounds the initial effects, existing problems and policy development after the implementation of the policy. After the implementation of the policy, the prices of 25 selected drugs were significantly lower, compared with the minimum purchase price of the same drugs in 11 pilot cities in 2017, the average drop was 52%. After the pilot scope was extended to the nation, compared with the minimum purchase price of the Union in 2018, the proposed price of the 25 drugs have an average price drop of 59%, compared with the selected price of the "4+7" pilot cities, the average price drop was 25%, and the price of drugs dropped further. By the end of August 2019, the implementation progress of 25 selected drugs in the "4+7" city drug volume-based purchasing was better than expected, the burden of patients' drug expenses was reduced, and the pilot work was beginning to bear fruit. The long-term influence and effect of the "4+7" city drug volume-based purchasing and policy implementation after the expansion needs to be further observed.

Efficiency Fast-Moving Drug Plan with Reorder Point Intervention at a Private Hospital in Bandung

Drug supplies are the major portion of the hospital expenses. The rising of drugs cost directly affect the total expenses of the hospital. Thus, their procurement, especially for fast-moving drugs, should be managed effectively. This study aimed to examine the efficiency of fast-moving drug plan after reorder point (ROP) intervention at a private hospital in Bandung. We conducted a pre-experimental study and used turn-over ratio (TOR) as a parameter. Data were taken from the stock of antibiotics in May-June of 2013 and May-June 2014. Cost components were collected; included the amount of stock, the cost of goods sold, and daily drug use. We did pre-test and post-test analysis to check the efficiency of intervention. The results showed that ROP intervention increased the efficiency of fast-moving drug plan. The comparison of pre- and post- intervention resulted a lower inventory value and a greater TOR value. We concluded that the increase in efficiency will eventually require a smaller budget of drug expenses.

Trend analysis of medical expenses in Shenzhen after China's new health-care reforms.

Since China initiated new health-care reforms in early 2009, a variety of measures have been implemented to slow the growth of medical expenses. This study was conducted to investigate the effect of controlling medical expenses. Based on inpatients' medical expenses at the largest tertiary hospital in Shenzhen, China, from 2009 to 2017, this study analyzed the changes in medical expenses and expense structures according to payment sources (insured or self-financed), stratifying the medical expenses according to the ICD-10 classification chapters of the principal diagnoses of the inpatients in two years (2009 and 2017) in order to control for confounding diseases. The results showed that mean inpatient expenses continued to rise from 2009 to 2017, and the expenses of the self-financed group began to exceed those of the insured group after 2011. Drug and consumable expenses were still the main factors that affected inpatient expenses, and consumable expenses remarkably increased, becoming the highest proportion of expenses. New health-care reforms were effective in controlling growing medical expenses for insured patients but did not make a significant difference in the expenses of self-financed patients. The excessive use of consumables has become a new driver of growing medical expenses.

A new method for pharmaceutical compounding and storage of anti-VEGF biologics for intravitreal use in silicone oil-free prefilled plastic syringes

Intravitreal injections of antibody-based biologics targeting vascular endothelial growth factor (VEGF) are highly effective and have markedly decreased the risk of visual impairment associated with prevalent retinal diseases, such as neovascular age-related macular degeneration and diabetes macular oedema. The diseases are chronic in their nature, and most patients need long-term therapy to suppress disease activity. We previously reported a compounding method for repackaging and storage of aflibercept (Eylea), a commonly used anti-VEGF biologic, in silicone oil-coated plastic syringes without compromising drug stability or activity. In addition to improving safety and time spent per patient, compounding of anti-VEGF biologics enables single-dose vials to be split into multiple syringes, thereby considerably reducing waste and drug expenses. However, symptomatic silicone oil droplets may deposit in the eye’s vitreous body after repetitive injections. To fully avoid this complication, we here report on a novel pharmaceutical compounding method using silicone oil-free syringes and a 33 G × 9 mm Low Dead Space Needle hub injection needle. We evaluate the method for three anti-VEGF biologics commonly used in ophthalmology: aflibercept, ranibizumab (Lucentis) and bevacizumab (Avastin). Our results show that compounding and storage for one week does not compromise the functional activity of the biologics and allows for safe and cost-effective compounding of anti-VEGF biologics for intravitreal injections in prefilled silicone oil-free syringes.

Prescription Drug Insurance Plans: Potential Cost Reductions and the Pass-Through of Manufacturer Pharmaceutical Rebates to Premiums

In response to the recent moves to reduce prescription drug expenses and eliminate manufacturer pharmaceutical rebates for Medicare and Medicaid, this research investigates the pass-through of manufacturer pharmaceutical rebates to premiums and examines the potential prescription drug cost reductions through efficiency improvement. The results indicate that eliminating all pharmaceutical rebates but using 50% of the eliminated rebates to lower prescription drug list prices, the premium per member month would increase by $8.6 for the whole comprehensive line, and $19.1 for Medicare Advantage. Using the median efficiency as the efficiency goal, the total cost reductions on hospital/medical expenses, prescription drug expenses, and other expenses are always more than enough to offset any potential premium increases due to the elimination of pharmaceutical rebates, no matter how much of the eliminated rebates are used to lower prescription drug list prices.

PSS9 DRUG UTILIZATION AND COSTS OF INTRAVITREAL INJECTED ANTIVEGFS IN ITALY

To investigate drug utilization and drug-related costs of intravitreal injected anti-VEGF drugs in ophthalmology hospital setting, 2013 to 2015 An observational cohort study based on secondary data from hospital pharmacy databases was performed. Patients with intravitreal anti-VEGFs for: wet age-related macular degeneration, diabetic macular edema, macular edema secondary to retinal vein occlusion, choroidal neovascularization secondary to pathologic myopia in the period 2013 to 2015 were included. Anti VEGF drugs reimbursed by the national healthcare system were ranibizumab and aflibercept. During 2013-2015, in San Raffaele hospital 2,117 patients started anti-VEGF therapies. Median duration of follow-up for these patients was 224 days (0-1448). Majority of patients was female and mean age was higher for age-related maculopathy (74,9± 9,6). During follow up 138 patients changed medication. The 1,979 that have not changed it were followed for 12 months. A total of 2,279 eyes were treated. There was high prevalence of patients with single administration of drug, mainly in the pathologic myopia group. Patients treated on both eyes were most in diabetic maculopathy (39%); a large amount of patients treated bilaterally received a more intensive treatment on the higher-severity eye. Of the 1,979 patient-years examined, more than half of the spending on drugs (3.3Mil €) was absorbed by age-related macular degeneration, due to the higher prevalence and to the greater mean number of injection. Our study pointed out in Real World environment the followings: a high prevalence of patients who had a single administration of anti VEGF; a suboptimal adherence as compared with drug prescribing information; most of the drug expense was absorbed by age-related maculopathy; a difference in prevalence between the various diseases in terms of patients treated on the second eye; a difference in treatment intensity between the two eyes in cases of patients treated bilaterally.

The direct-medical costs associated with interferon-based treatment for Hepatitis C in Vietnam.

Background: Injectable interferon-based therapies have been used to treat hepatitis C virus (HCV) infection since 1991. International guidelines have now moved away from interferon-based therapy towards direct-acting antiviral (DAA) tablet regimens, because of their superior efficacy, excellent side-effect profiles, and ease of administration. Initially DAA drugs were prohibitively expensive for most healthcare systems. Access is now improving through the procurement of low-cost, generic DAAs acquired through voluntary licenses. However, HCV treatment costs vary widely, and many countries are struggling with DAA treatment scale-up. This is not helped by the limited cost data and economic evaluations from low- and middle-income countries to support HCV policy decisions. We conducted a detailed analysis of the costs of treating chronic HCV infection with interferon-based therapy in Vietnam. Understanding these costs is important for performing necessary economic evaluations of novel treatment strategies. Methods: We conducted an analysis of the direct medical costs of treating HCV infection with interferon alpha (IFN) and pegylated-interferon alpha (Peg-IFN), in combination with ribavirin, from the health sector perspective at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, in 2017. Results: The total cost of the IFN treatment regimen was estimated to range between US$1,120 and US$1,962. The total cost of the Peg-IFN treatment regimen was between US$2,156 and US$5,887. Drug expenses were the biggest contributor to the total treatment cost (54-89%) and were much higher for the Peg-IFN regimen. Conclusions: We found that treating HCV with IFN or Peg-IFN resulted in significant direct medical costs. Of concern, we found that all patients incurred substantial out-of-pocket costs, including those receiving the maximum level of support from the national health insurance programme. This cost data highlights the potential savings and importance of increased access to generic DAAs in low- and middle-income countries and will be useful within future economic evaluations.

Clinical pharmacists in palliative care: effects on drug therapy and drug expenses

The effect of integrating clinical pharmacists in German palliative care units with regard to the quality of drug therapy and drug costs has yet not been evaluated. This work aims to assess the number of pharmaceutical interventions (PI) and the cost-benefit ratio of aclinical pharmacist taking part in the interprofessional patient care team on an inpatient palliative care unit in Germany. The number of and underlying reasons for the pharmacist-led recommendations were recorded and analyzed over a1-year period. In addition, the respective drugs and the acceptance rate of recommendations were assessed. To evaluate the cost-benefit ratio, the financial savings in the provision of drugs were recorded and compared with the expenses for the clinical pharmacy service. A total of 245 PI were performed. Most frequently, the pharmacist advised physicians on drug choices and drug dosages. The acceptance rate was 93%. The cost savings in the provision of drugs covered 83% of the expenses for the clinical pharmacy service. The results indicate that the integration of aclinical pharmacist is well suited to optimizing the interprofessional treatment of distressing symptoms with abeneficial economic outcome in palliative care. Consequently, the permanent integration of aclinical pharmacist on an inpatient palliative care unit seems to be beneficial and advisable.

Impact of capitation on outpatient expenses among patients with diabetes mellitus in Tianjin, China: a natural experiment

ObjectivesCapitation policy, a new medical insurance settlement method implemented on 1 January 2014 in Tianjin, China, aimed to control unreasonable increases in medical costs. The goal of the current study...

Subjective expectations regarding ageing: a cross-sectional online population survey in Hungary

BackgroundWe aimed to investigate individuals’ subjective expectations regarding health and happiness alongside their provisions on life circumstances for older ages.MethodsA cross-sectional online survey was performed involving a representative sample (N = 1000; mean age 50.9, SD = 15.4; female 54.5%) in Hungary. Subjective expectations on health status (EQ-5D-3L/-5L, GALI, WHO-5), happiness (0–10 VAS), employment status, care time, and forms of care for ages 60, 70, 80, and 90 were surveyed.ResultsCurrent mean EQ-5D-5L was 0.869 (SD = 0.164) and happiness was 6.7 (SD = 2.4). Subjective life expectancy was 80.9 (SD = 11.1), and median expected retirement age was 65. Mean expected EQ-5D-5L for ages 60/70/80/90 was 0.761/0.684/0.554/0.402, and no activity limitations (GALI) were expected by 64%/40%/18%/14%, respectively. Expected happiness score was 6.8/6.7/6.2/5.7, and a decrease in mental well-being (WHO-5) was provisioned. A substantial increase in drug expenses and care time was anticipated, but only 52% thought to have extra income besides pension. The great majority expected to be helped by the family (77%/72%/53%/40%) if needed. Educational level, GALI, and longevity expectations were significant predictors of EQ-5D-5L expectations using a standard 5% significance level of decision. Current happiness was major determinant of expected future happiness.ConclusionsIndividuals expect a significant deterioration of health with age but only a moderate decrease in happiness. Overestimation of future activity limitations suggests a gap between statistical and subjective healthy life expectancy. The majority expects to rely on informal care in the elderly. Raise in retirement age is underestimated. Our results can be used as inputs for economic modelling of labor force participation and ageing.

Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: a nested case–control study

ObjectiveOlder patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to...

PCN215 EFFECTS OF MULTIPLE CHRONIC CONDITIONS ON HEALTH CARE EXPENSES IN US ADULTS WITH CANCER

Cancer increases the risk of multiple chronic conditions. This study examined the pattern of multiple chronic conditions and associated health care expenses in US adults with cancer. Data from the US Medical Expenditure Panel Survey (MEPS) household component (2010-2015) sampled adults (age ≥ 18 years) diagnosed with cancer and one or more of 18 selected chronic conditions. ICD-9-CM codes from the MEPS medical event files identified diagnoses. Outcomes measured: prevalence and distribution of chronic conditions, total health expenses (per-person per-year) including medical and prescription drug expenses. A generalized linear model (with log link and gamma distribution) assessed the effects of chronic conditions (yes vs. no) and number of chronic condition(s) (0, 1, 2, 3, >3) on total health expenses respectively while controlling for sample characteristics. All analyses and statistical procedures applied longitudinal weights for national estimates. Among 3,657 eligible adults with cancer (representing 19.1 million individuals in US), 83.9% (n = 3,040) had at least one chronic condition. Hypertension (59.7%), hyperlipidemia (53.6%), arthritis (25.6%), diabetes (22.2%), and coronary artery disease (18.2%) were the most prevalent chronic conditions. Nearly 30% reported 4 or more chronic conditions. Total health expenses were $6,388 higher in those with chronic conditions vs. without (p<0.001). One, two, three, and greater than three chronic conditions showed 35% (p=0.028), 36.3% (p=0.005), 41.9% (p=0.001), and 111.7% (p<0.001) higher total expenses vs. those without chronic conditions after adjusting for the study sample characteristics. The prevalence and total health expenses of chronic conditions in US adults with cancer are high. A holistic treatment plan is needed to improve cost outcomes.

Impact of frailty status on the cost of drugs and dietary supplements prescribed to nursing home residents: the SENIOR cohort.

The financial impact associated with drug consumption has been poorly investigated among frail subjects and, specifically, in nursing home settings. To determine the association of the average monthly cost of the drugs and dietary supplements consumed by nursing home residents with their frailty status. This is an analysis of the first follow-up year of the SENIOR cohort. All participants were classified into "frail" or "non-frail" categories according to Fried's criteria at baseline. Monthly bills from the pharmacy were analysed to determine the association between the average monthly cost of the drugs and dietary supplements consumed and frailty status. A sample of 87 residents (83.8 ± 9.33years and 75.9% women) from the SENIOR cohort was included. The prevalence of frailty was 28%. The median number of medications consumed each day was 9 (6-12) (no difference between frail and non-frail subjects; p = 0.15). The overall median monthly cost was € 109.6, of which 49% was covered by Belgian social security and the remaining balance was paid by the patient. When comparing the drug expenses of the frail subjects and the non-frail subjects, the overall average monthly cost did not differ between the 2 groups (p = 0.057). Nevertheless, the expenditure remaining to be paid by the residents, after the Belgian social security intervention, was significantly higher among the frail residents (€ 65.7) than among the non-frail residents (€ 47.6; p = 0.017). Frailty status has an impact on the expenditures related to the consumption of drugs.

Using LeDock as a docking tool for computational drug design

Computer-aided drug design (CADD) is an emerging tool for research and drug development process as it reduces the time taken for the process of drug development and expense. Molecular docking technology, as one of the main method, has been widely used in many fields of drug development. Based on the dopamine D3 receptor target, this paper describes the method of molecular docking using LeDock software (Windows version) in combination with the docking process of eticlopride ligand and D3 receptor. This method can predict the binding mode of ligands to proteins, including binding energy, binding sites and attractive interactions types. Four representative D3 receptor ligands, including BP897, NGB2904, FAUC365 and SB277011A, were respectively docked with D3 receptor by this method. By analyzing the docking results, we can conclude that the molecular docking method using LeDock software plays an important role in the drug design process.

The Physical Exercise as a Strategy of Reduce Costs with Medicine for Aged.

Background:To provide a critical reflection from the literature review to describe the current panorama on the importance of physical exercises in the improvement of the quality of life of the aged, besides the use of medications. While aging brings a high cost to health and demographic pyramid changes, so does the disease. As aging is a biological process and many diseases develop at this time of life, the aged are the fastest growing segment of the Brazilian population due to the natural susceptibility of the organism. With this increase, health costs in the country also increase. In everyday practice, medicine has often been characterized as a therapeutic intervention instrument for the first choice, and a consequence, generates significant and significant economic and social damages.Methods:Search in databases using analysis descriptors as exercises and medicine for the aged.Results:The involvement of the aged in physical exercise programs is an important adjunct to reduce the progressive degeneration associated with natural aging, becoming a powerful instrument to guarantee a healthy, active and independent lifestyle.Conclusions:The physical activity was inversely associated with the number of medications, the more physical activity and fewer drug expenses. The need to implement programs for orientation and for the promotion of health through physical activity was also verified.

Prescription Drug Insurance Plans: Potential Cost Reductions and the Pass-Through of Manufacturer Pharmaceutical Rebates to Premiums.

In response to the recent moves to reduce prescription drug expenses and eliminate manufacturer pharmaceutical rebates for Medicare and Medicaid, this research investigates the pass-through of manufacturer pharmaceutical rebates to premiums and examines the potential prescription drug cost reductions through efficiency improvement. The results indicate that eliminating all pharmaceutical rebates but using 50% of the eliminated rebates to lower prescription drug list prices, the premium per member month would increase by $8.6 for the whole comprehensive line, and $19.1 for Medicare Advantage. Using the median efficiency as the efficiency goal, the total cost reductions on hospital/medical expenses, prescription drug expenses, and other expenses are always more than enough to offset any potential premium increases due to the elimination of pharmaceutical rebates, no matter how much of the eliminated rebates are used to lower prescription drug list prices.