Pharmaceutical Expenditure Research Articles

FÁRMACOS NA PANDEMIA DA COVID-19: UMA TEMÁTICA PARA A EDUCAÇÃO AMBIENTAL CRÍTICA NO ENSINO DE QUÍMICA ANALÍTICA

PHARMACEUTICALS IN THE COVID-19 PANDEMIC: A THEME TO CRITICAL ENVIRONMENTAL EDUCATION ON ANALYTICAL CHEMISTRY TEACHING. During the COVID-19 pandemic, the pursuit of a cure for the disease resulted in an excessive consumption of various pharmaceuticals, even after their inefficacy had been scientifically demonstrated. This scenario highlights the urgency of educational initiatives that improve students’ critical thinking and promote awareness of indiscriminate use of pharmaceuticals and its environmental and social implications. This research described the educational initiative “Pharmaceuticals in the COVID-19 pandemic” based on the study case method, implemented at an analytical chemistry class, and analyzed its potential on promoting Critical Environmental Education through a content analysis guided by the indicators proposed by Luz and Tonso. Students were divided into groups and studied different cases about pharmaceuticals featured in the media during the pandemic. They were expected to gather relevant data regarding the case scenario; to take a position on a socio-environmental dilemma; propose an analytical chromatographic methodology for the pharmaceutical in the case and present their results in a final report. The educational initiative was considered aligned with Critical Environmental Education principals due to the presence of six out of the seven indicators. As a future perspective, we aim to optimize the educational initiative in order to include all the indicators and students’ suggestions.

Psychoactive substance consumption after the Fundão dam mine tailing disaster in Minas Gerais State, Brazil.

Disasters cause changes in morbidity, mortality, and medicine use. Brazil is one of the main producers of mineral ores at great environmental cost. Mine tailings are stored in dams and ruptures have led to major disasters. We investigated the consumption of psychoactive medicines in the municipalities affected by the Fundão dam disaster in Minas Gerais State. An ecological study was carried out on drug consumption, estimated using public purchases in Minas Gerais and dispensing data from private retail pharmacies. Consumption (in number of defined daily doses/100,000 inhabitants per day) was analyzed descriptively in eight municipalities, stratified according to consumption level during a 25-month period. Six comparisons of mean consumption values for both data sets were done for pre- and post-disaster periods. The means of medicine consumption before and after the event were plotted and linear trends were added. Public purchase data evinced high consumption levels. Only pharmaceutical retail showed significant differences between the strata in the pre-disaster versus two post-disaster periods. Smaller municipalities showed an increase in consumption 15 months after the disaster. Clonazepam led the way in pharmaceutical retail consumption, followed by fluoxetine. Medicines showed an upward trend after the disaster. The high public provision may have stifled significant consumption patterns of psychoactive drugs; however, peak consumption were observed in private retail, suggesting a modification in use patterns after the disaster. The decrease in consumption immediately after the event was probably related to lower care-seeking behavior on the part of the population, and significant peaks after the disaster may reflect economic consequences of it.

고가 의약품 건강보험 급여 현황 분석

In recent years, the introduction of high-priced innovative pharmaceuticals has been on the rise, placing a burden on the national pharmaceutical expenditure. This study aimed to analyze the spending trends of high-priced drugs in South Korea over the past ten years and derive policy implications for the management of pharmaceutical expenditure. The claims data of National Health Insurance (NHI) were used as the data source, and drugs with annual per-patient costs exceeding ten million KRW were defined as 'high-priced drugs.' The study selected the each year’s list of high-priced drugs from 2010 to 2021 and analyzed the trends considering their spending size, manufacturer types, therapeutic groups, Risk-Sharing Agreements, and Economic Evaluation Exemption. The spending on high-priced drugs accounted for 8.0% of the NHI pharmaceutical expenditure in 2021, and it has been increasing annually by 14.3% since 2010. The expenditure on high-priced drugs introduced through the RSA (Risk-Sharing Agreement) rapidly increased, especially for oncology drugs and immunosuppressants. This study defined high-priced drugs based on per-patient costs and observed the trends in the expenditure of these drugs according to pharmaceutical characteristics. Based on this, it is significant in proposing issues and policy implications for noteworthy drug categories.

Financial Outcomes of Managed Entry Agreements for Pharmaceuticals in Italy

Most countries in the Organisation for Economic Co-operation and Development apply managed entry agreements (MEAs), reimbursement arrangements between manufacturers and payers, to pharmaceuticals. Few data exist regarding their ability to lower expenditures. To analyze the financial outcomes of MEAs for pharmaceuticals from 2019 to 2021 in Italy. In this observational study of MEAs and pharmaceutical spending in Italy, medications that were monitored through individually collected data and generated paybacks from manufacturers during the 2019 to 2021 study period were included in the analysis. Payback data were collected through pharmaceutical spending monitoring activities conducted by the Agenzia Italiana del Farmaco (Italian Medicines Agency). Expenditure data were collected through the Italian Drug Traceability System. Products were categorized by type of MEA: financial-based, outcome-based, or mixed. The main outcome was median payback as a proportion of expenditure by category of MEA. Results were also provided by subtype: cost sharing or capping models for financial-based MEAs and risk-sharing or payment-by-result models for outcome-based MEAs. Mixed MEAs were considered when medications had multiple indications with different MEA types. A total of 73 medications with MEAs generated a payback by manufacturers during the study period. Six were either not reimbursable or delivered within the Italian National Health Service, and 5 had incomplete data. Of the 62 medications analyzed, 24 (38.7%) had financial-based MEAs, 30 (48.4%) had outcome-based MEAs, and 8 (12.9%) had mixed MEAs. A total payback amount of €327.5 million was calculated during the 3 years, corresponding to 0.9% of the €41.1 billion of total expenditures for medications purchased by public health facilities in Italy. Financial-based MEAs returned the highest payback revenues, €158.1 million; the outcome-based MEAs and mixed MEAs generated smaller paybacks of €74.5 million and €94.9 million, respectively. Overall, the median proportion of payback to expenditure on the medications analyzed was 3.8%. For mixed MEAs, the payback-to-expenditure proportion was 6.7%; for outcome-based MEAs, 3.3%; and for financial-based MEAs, 3.7%. This observational study found limited evidence that MEAs lower pharmaceutical expenditures. Determining criteria for prioritizing MEA use, identifying potential design changes, and improving implementation may be needed in the future.

Therapeutic Substitution in Response to Patent Expiry? Statins in Australia*

This study aims to investigate the effects of generic entry on the market share of different statins. We use administrative records from a representative sample of Australians between 2003 and 2014 and analyse over 21 million prescriptions to quantify the change in the total market share of each statin after experiencing generic entry for the first time. With detailed information on patients' benefits and prices, we also estimate potential savings from increasing the use of statins where generics became available. Our results indicate that despite the price decrease, the market share of the molecule experiencing generic entry does not significantly increase, and there is some evidence of substitution away from statins with generic availability. For the most commonly used molecules, this association is stronger in patients receiving higher government subsidies. We calculate potential savings of A\$17 million if patients had initiated treatment with the most prescribed off‐patent statin rather than a patent‐protected statin. Generic entry after patent expiry presents an opportunity for a significant reduction in pharmaceutical expenditure if these are preferred. This study highlights the importance of improving prescription systems that help doctors recommend lower cost, clinically appropriate alternatives and enhance the effectiveness of policies promoting generic substitution.

Trends in cost and consumption of essential medicines for non-communicable diseases in Azerbaijan, Georgia, and Uzbekistan, from 2019 to 2021.

Access to medicines is a global priority. Azerbaijan, Georgia, and Uzbekistan have different approaches to pricing policies for pharmaceuticals. The aim of this study was to analyze recent trends in the consumption and prices of non-communicable disease (NCD) medicines in Azerbaijan, Georgia, and Uzbekistan, in the outpatient setting. We included medicines for asthma and COPD, cancer, cardiovascular disease, diabetes, epilepsy, and mental disorders. Sales data for pharmaceutical products in community pharmacies were extracted from a commercial database. Changes in consumption and prices were analyzed across all included NCD medicines, by disease category and pharmacological group. Consumption of NCD medicines was highest in Georgia, at twice the levels in Azerbaijan, and four times levels in Uzbekistan. Average prices of NCD medicines, weighted by consumption, increased by 26% in Georgia, but decreased by 3% in Azerbaijan and by 0.1% in Uzbekistan. Prices increased for all disease groups in Georgia (from +13% for epilepsy medicines to +86% for cancer), varied by group in Uzbekistan (from -22% for epilepsy medicines to +47% for cancer), while changes in Azerbaijan were smaller in magnitude (from -4% for medicines for cardiovascular disease to +11% for cancer). Cancer medicines had markedly higher prices in Uzbekistan, and asthma and COPD medicines had markedly higher prices in Azerbaijan and Uzbekistan. Georgia showed the highest outpatient consumption of NCD medicines, suggesting the broadest access to treatment. However, Georgia also saw marked price increases, greater than in the other countries. In Georgia, where there was no price regulation, widespread price increases and increases in consumption both contribute to increasing pharmaceutical expenditures. In Azerbaijan and Uzbekistan, increases in outpatient pharmaceutical expenditures were primarily driven by increases in consumption, rather than increases in price. Comparing trends in consumption and pricing can identify gaps in access and inform future policy approaches.

The Influence Of Marketing, Pricing And Promotion On Gen Z’s Purchase Behavior Of Halal Cosmetics In Indonesia

As This study investigates the influence of marketing mix (product, price, place, and promotion), on purchasing behavior of Indonesian Gen Z when buying Halal cosmetics. The objective of this study was to enhance the current understanding and bridge the gaps in existing literature by examining the marketing effects and cognitive factors associated with Gen Z’s purchasing behavior, as previous studies in Indonesia have mainly focused on Halal food and pharmaceutical consumption. There is a need to enter this Halal sector because cosmetics are now regarded as a primary requirement, and the Halal cosmetics business's growth will affect any country's GDP. The study sets out to investigate the impact of TPB constructs on purchasing behavior of Gen Z regarding Halal cosmetics products. The proposed model identifies the factors that shape the purchase intention of Gen Z towards Halal cosmetics and analyze how these marketing mix factors impact their attitude. The quantitative study was conducted on the island of Java, with data obtained from 500 respondents. The data was analyzed using Structural Equation Modeling (SEM) with the PLS (Partial Least Square) approach with the SmartPLS application. The study found that marketing mix elements exert influence on the purchasing behavior of Indonesian Gen Z when purchasing Halal cosmetics. These findings contribute not only to advancing theoretical knowledge but also provide practical implications for the industry players.

Response of lipid metabolism, energy supply, and cell fate in yellowstripe goby (Mugilogobius chulae) exposed to environmentally relevant concentrations atorvastatin

The usage of typical pharmaceuticals and personal care products (PPCPs) such as cardiovascular and lipid-modulating drugs in clinical care accounts for the largest share of pharmaceutical consumption in most countries. Atorvastatin (ATV), one of the most commonly used lipid-lowering drugs, is frequently detected with lower concentrations in aquatic environments owing to its wide application, low removal, and degradation rates. However, the adverse effects of ATV on non-target aquatic organisms, especially the molecular mechanisms behind the toxic effects, still remain unclear. Therefore, this study investigated the potentially toxic effects of ATV exposure (including environmental concentrations) on yellowstripe goby (Mugilogobius chulae) and addressed the multi-dimensional responses. The results showed that ATV caused typical hepatotoxicity to M. chulae. ATV interfered with lipid metabolism by blocking fatty acid β-oxidation and led to the over-consumption of lipids. Thus, the exposed organism was obliged to alter the energy supply patterns and substrates utilization pathways to keep the normal energy supply. In addition, the higher concentration of ATV exposure caused oxidative stress to the organism. Subsequently, M. chulae triggered the autophagy and apoptosis processes with the help of key stress-related transcriptional regulators FOXOs and Sestrins to degrade the damaged organelles and proteins to maintain intracellular homeostasis.

THE INVESTIGATION OF THE RELATIONSHIP BETWEEN PHARMACEUTICAL CONSUMPTION AND HEALTH STATUS

It is thought that it is important to reveal the contribution of pharmaceutical consumption to health outcomes because the share of pharmaceutical expenditures in health expenditures is quite high and the debate about controlling healthcare costs. The study aims to examine the relationship between pharmaceutical consumption and the health status of EFPIA member countries with canonical correlation analysis. It was found that the health status of the EFPIA member countries and their pharmaceutical consumption were strongly correlated (rc=75.9). According to canonical cross loadings, the variable of life expectancy at birth (0.846), which has the strongest relationship with its own set, also establishes the strongest relationship with pharmaceutical consumption (0.642). The pharmaceutical consumption dataset remarkably correlates with antidepressant use and lipid use, respectively. According to canonical cross loadings, antidepressant use, which had the strongest association with its own set, had the strongest association with the health status dataset (0.592). This research provides evidence that pharmaceutical consumption and the health status of EFPIA member countries are positive associated. It is thought that the potential of pharmaceutical-related interventions can be exploited as a way to improve the health status.

Exploring the Evolution of Statin Pricing in Australia: Observations of Price Disclosure Effects on Pharmaceutical Benefits Scheme Expenditure

ObjectivesThe high cardiovascular disease burden globally and in Australia necessitates attention on statin expenditure, the primary pharmacological intervention for cardiovascular disease risk factors. The Pharmaceutical Benefits Scheme (PBS) subsidies approved statins for Australians. Managing PBS government expenditure occurs through price control strategies of statutory price decreases upon first generic entry and price disclosure. This study investigates the impact price control measures had on statin price evolution and government expenditure between 2010 and 2022. MethodsPrescription and pricing data were obtained from Services Australia Medicare Statistics, and price reduction strategies from the PBS. Summary statistics compared and described statin price, prescription, number of brands, market share, and government expenditure to atorvastatin, fluvastatin, pravastatin, rosuvastatin, and simvastatin price control timelines. ResultsStatin prices exposed to price control measures decreased irrespective of dosage and correlated with reductions in government expenditure, with a comparison of 2010 and 2022 showing annual statin expenditure declined by AU$833.5 million (83.25%) whereas prescriptions reduced by 3.0 million (15.7%). Effects of price disclosure on atorvastatin and rosuvastatin market share suggest industry-prompted price reductions may arise from market share loss, whereas reasons external to pricing prompted rosuvastatin to gain market share. ConclusionsLimited publications on contemporary effects of statin price control measures exist. This investigation found these measures reduced government expenditure for statins by AU$949.1 million, with the price reduction correlating with price control measures. In addition to affirming price control mechanisms remain effective in contemporary times, this investigation provides data for key insights into the Australian statin industry.

Evolution of Pharmacological Treatments and Associated Costs for Multiple Myeloma in the Public Healthcare System of Catalonia: A Retrospective Observational Study.

(1) Background: Our understanding of and treatment for multiple myeloma (MM) has advanced significantly, and new pharmacological treatments have promising benefits but high price tags. This study analyzes prescription patterns and pharmaceutical expenditure for MM treatments in Catalonia's public healthcare system over eight years. (2) Methods: A retrospective observational study examined MM treatment data from 2015 to 2022 in Catalonia, using healthcare registries from the Catalan Health Service to collect information on patients, medicines used, and treatment costs. (3) Results: A total of 4556 MM patients received treatment, with a rising trend in the number of treated patients each year from 902 in 2015 to 1899 in 2022. The mean age was 68.9 years, and patients were almost evenly distributed by gender (51.5% male). Most patients were treated with bortezomib (3338 patients), lenalidomide (2952), and/or daratumumab (1093). Most drugs showed increased utilization annually, most significantly for lenalidomide and daratumumab. The total pharmacological treatment cost throughout the entire study period was EUR 321,811,249, with lenalidomide leading with the highest total cost (EUR 157,236,784), and daratumumab exhibiting the highest increase in annual expenditure. (5) Conclusions: The study reveals a progressive increase in the number of MM patients treated and rising pharmaceutical costs. Lenalidomide and daratumumab incurred the highest costs. The findings highlight MM treatment's economic impact and the need to monitor prescription patterns and expenditures to optimize healthcare resources and decision making. Understanding these trends can guide resource allocation effectively.

The State of Pharmacoeconomics Education in the Doctor of Pharmacy Curriculum amid the Changing Face of Pharmacy Practice.

(1) Background: Continuous growth in pharmaceutical expenditure indicates the need for more advanced pharmacoeconomics evaluations to optimize healthcare outcomes and resource allocation. This study assesses the extent to which accredited pharmacy colleges in the United States cover pharmacoeconomics content within the didactic curriculum of their Doctor of Pharmacy (PharmD) programs. (2) Methods: We conducted a systematic search of the websites of accredited professional-degree programs in pharmacy schools located in the United States to identify pertinent content related to pharmacoeconomics. (3) Results: Out of 141 pharmacy programs, a total of 111 programs of varying sizes were found to have publicly accessible information regarding the content of their pharmacoeconomic curricula on their websites. All these programs required the inclusion of pharmacoeconomics content in their curricula. An examination of course syllabi revealed that the goals and descriptions were broad, aiming to provide students with an introductory understanding of the principles of pharmacoeconomics. The number of credit hours allocated to pharmacoeconomics education ranged from one to seven across the programs. The approach to delivering pharmacoeconomics content varied among the programs. (4) Conclusions: Advanced knowledge of the principles of pharmacoeconomics must be an integral component of all PharmD curricula to prepare pharmacists to assess the rational use of pharmacy products and services, improve clinical outcomes, and mitigate healthcare expenditures.

National service is free, not cancer disease: Financial toxicity in a public universal coverage healthcare system.

32 Background: Italian National Health Service provide regional control on clinical pathways to be cost-free. ASL Napoli 1 centralized model of Palliative Care Unit ensure free multidisciplinary medical and nursing assistance, beyond aids and devices. Since healthcare costs are rising and private spending is becoming necessary, our aim is screening financial toxicity in the most densely populated area in Europe. Methods: From January to April 2023 we performed simple random sampling to select 27 home care patients. From the richest neighborhoods to poorest ones, patients answered the COST-FACIT questionnaire. We collected information about medical history, sociodemographic characteristics (employment status or retired, family composition, if benefiting from state allowances) and, above all, out-of-pocket costs. Results: Data highlight that wealthiest and middle-class patients are afraid about out of control medical expenses and their satisfaction about economic status is declining. Patients from a lower socioeconomic background are deeply concerned about not being able to work and not being of financial support to often single income families. Score analysis reveals significant variation among the different items, and the average score is 12.4. Highest scores count 28 and 29, respectively, suggesting that these patients are more able to manage the costs of treatment or access financial resources to cope with medical expenses. Three scores of 0 suggest higher financial toxicity in the realm of palliative oncology care. These patients face greater difficulty in handling treatment costs, encounter barriers in accessing financial resources, or experience high expenses. Patients have highlighted that purchase of non-reimbursable drugs is the most onerous out-of-pocket cost in home care setting. Conclusions: Our centralized Palliative Care Unit organizational model coordinates by adapting purchasing and providing holistic sanitary approach beyond patients' economic abilities. Our centralized Palliative Care Unit provides health services to endure equity across all the city. However, score analysis suggests a range financial suffering for home care patients. Low average score 12.4 suggests how much financial suffering in palliative care impacts, even in a model of centralization of health care with global coverage. So, screening for financial toxicity plays a key role in directing health policies on pharmaceutical expenditure.

Determinants of Pharmaceutical Expenditure in OECD Countries: Evidence from Panel Data

Purpose –The objective of this study is to identify the main factors affecting pharmaceutical expenditures in the Organization for Economic Cooperation and Development (OECD) countries.Design/methodology/approach –In this study, it was investigated whether the university graduate rate(UNI), the unemployment rate(UNEMP), gross domestic productper capita (GDP) in Purchasing Power Parity (PPP $),and the number of physicians per 1,000 people (PHY) affected per capita pharmaceutical expenditures (PHAR)(PPP $) by using panel data analysis. The population of the study was 33 OECD countries whose data were available. The data consisted of the time period of 2013-2016. Results –GDP and UNIstatistically significantly increased PHAR (p<0.05). The UNEMPand PHYalso increased PHAR, but the effects of these variables were not found to be statistically significant (p>0.05). The variables included in the model explained 22% of the variance in PHAR.Conclusion –PHAR are affected by economic factors and sociodemographic factors as well as health systems' structure. Therefore, governments wishing to control pharmaceutical expenditures should also focus on these variables.

Fate of pharmaceuticals in the Ebro River Delta region: The combined evaluation of water, sediment, plastic litter, and biomonitoring

The increasing consumption of pharmaceuticals, alongside their limited removal in wastewater treatment plants (WWTPs), have led to their ubiquitous occurrence in receiving aquatic environments. This study addresses the occurrence of 68 pharmaceuticals (PhACs) in the Ebro River Delta region (NE Spain), as well as their distribution in different environmental compartments, including surface water, sediments, biota (river biofilm and fish tissues), and field-collected plastic litter. In addition, their concentrations in serving WWTPs, as possible sources of environmental contamination, were also determined.Our study confirmed the widespread occurrence of PhACs in riverine and, to a more limited extent, coastal environments. Most frequently detected PhACs belonged to analgesics/anti-inflammatories (e.g., ibuprofen) and psychiatric drugs (e.g., venlafaxine) therapeutic groups, followed by antihypertensives (e.g., valsartan) and antibiotics (e.g., azithromycin). Seasonal differences in cumulative levels of PhACs were reported for water and sediments (winter>summer). Despite spatial gradients were not clear along the river, a non-negligible contribution of upstream Ebro sites (reference area) was highlighted, which was unexpected based on the low anthropogenic pressure. Sediments represented a minor attenuation pathway for the selected PhACs, whereas they were more heavily accumulated in biota: fish liver (up to 166 ng/g dw), river biofilms (up to 108 ng/g dw), fish plasma (up to 63 ng/mL), and fish muscle (up to 31 ng/g dw).These findings highlight the importance of biomonitoring in the characterization of polluted areas and prioritization of hazardous substances (e.g., psychiatric drugs) in aquatic systems, and a particular interest of fish plasma as non-destructive biomonitoring matrix. PhACs were also detected on plastic litter, demonstrating their role as environmental sinks for certain PhACs (e.g., analgesics/anti-inflammatories, psychiatric drugs). Overall, the widespread detection of PhACs in a variety of biotic and abiotic matrices from the lower Ebro River and Delta warns about their possible environmental implications.

A systematic review of policies regulating or removing mark-ups in the pharmaceutical supply and distribution chain

The regulation of mark-ups throughout the pharmaceutical supply and distribution chain may be a valuable approach to control prices of medicines and to achieve broader access to medicines. As part of a wider review, we aimed to systematically determine whether policies regulating mark-ups are effective in managing the prices of pharmaceutical products. We searched for studies published between January 1, 2004 and October 10, 2019, comparing policies on regulating mark-ups against other interventions or a counterfactual. Eligible study designs included randomized trials, and non-randomized or quasi-experimental studies such as interrupted time-series (ITS), repeated measures (RM), and controlled before-after studies. Studies were eligible if they included at least one of the following outcomes: price (or expenditure as a proxy for price and volume), volume, availability or affordability of pharmaceutical products. The quality of the evidence was assessed using the GRADE methodology. A total of 32,011 records were retrieved, seven of which were eligible for inclusion for this review. The limited body of evidence cautiously suggests that policies regulating mark-ups may be effective in reducing medicine prices and pharmaceutical expenditures. However, the design of mark-up regulations is a critical factor for their potential success. Additional research is required to confirm the effects of these policies on the availability, affordability or usage patterns of medicines and in low- and middle-income countries.

Bioactive Components of Myracrodruon urundeuva against SARS-CoV-2: A Computational Study

SARS-CoV-2 (severe acute respiratory distress syndrome coronavirus 2) is the causative agent for the novel coronavirus disease 2019 (COVID-19). It raises serious biosecurity questions due to its high contagious potential, thereby triggering rapid and efficient responses by the scientific community to take necessary actions against viral infections. Cumulative scientific evidence suggests that natural products remain one of the main sources for pharmaceutical consumption. It is due to their wide chemical diversity that they are able to fight against almost all kinds of diseases and disorders in humans and other animals. Knowing the overall facts, this study was carried out to investigate the chemical interactions between the active constituents of a promising medicinal plant, Myracrodruon urundeuva, and some specific proteins of SARS-CoV-2. For this, we used molecular docking to predict the most appropriate orientation by binding a molecule (a ligand) to its receptor (a protein). The best results were evaluated by screening their pharmacokinetic properties using the online tool pkCSM. Findings suggest that among 44 chemical compounds of M. urundeuva, agathisflavone, which is abundantly present in its leaf, exhibited excellent molecular affinity (−9.3 to −9.7 kcal.mol−1) with three functional proteins, namely, Spike, MPro, and RBD of SARS-CoV-2. In conclusion, M. urundeuva might be a good source of antiviral agents. Further studies are required to elucidate the exact mechanism of action of the bioactive compounds of M. urundeuva acting against SARS-CoV-2.

Prices of Orphan Drugs in Four Western European Countries Before and After Market Exclusivity Expiry: A Cross-Country Comparison of List Prices and Purchase Prices.

Increasing pharmaceutical expenditure challenges the sustainability and accessibility of healthcare systems across Europe. Confidentiality restraints hinder assessment of actual prices of Orphan Medicinal Products (OMPs). Hence, we assessed the real prices of brand-name OMPs around market exclusivity expiry (MEE). We aimed to explore developments in published list prices (LPs) and confidential hospital purchase prices (PPs) of brand-name OMPs relative to their market exclusivity status in Western European countries with similar GDPs. We analyzed LPs and PPs of 13 selected OMPs purchased by university hospitals in Western European countries between 2000 and 2020. For confidentially reasons, proportions were used, with the Dutch LPs of the selected OMPs at the year of MEE serving as reference values. PPs included pre-purchase discounts. Rebates were not considered. Data were analyzed from hospitals in Denmark (DK) (n=1), France (FR) (n=1), Germany (DE) (n=2), and the Netherlands (NL) (n=1). Average LPs and PPs of included OMPs dropped gradually but limited over time, with no explicit price drop after MEE. LP levels differed more per country than PP levels: LP range before MEE was 164% (DE)-101% (FR) and after MEE was 135% (DE)-82% (FR); PP range before MEE was 150% (DE)-102% (FR) and after MEE was 107% (DE)-80% (FR). Overall differences between LPs and PPs were <3% in all countries, except for Denmark. No evident price drops of included brand-name OMPs were observed around MEE and differences in purchase prices are modest in the selected Western European countries. Results were not subject to significance testing. More robust data are needed to strengthen negotiations with suppliers.

Seasonal behavior of pharmaceuticals and personal care products within Chilean rural WWTPs under COVID-19 pandemic conditions

During the COVID-19 pandemic, the consumption of pharmaceuticals and personal care products (PPCPs) increased exponentially. There is an associated risk concerning the presence of PPCPs from wastewater, mainly in rural zones of emerging countries, where sanitation tends to be poor or inefficient. Therefore, this study aimed to evaluate the seasonal behavior of PPCPs within Chilean rural wastewater treatment plants (WWTPs) under COVID-19 pandemic conditions. Ten Chilean rural WWTPs were monitored during 2021, both in the cold (May–September) and warm (November – December) months, being collected semi-composite samples (influent/effluent). WWTPs were based on activated sludge, aerobic lagoons, rotatory discs, activated sludge + bio discs, constructed wetlands, and vermifilter. Physicochemical parameters and PPCPs (azithromycin, ciprofloxacin, caffeine, ibuprofen, losartan, and triclosan) compounds were monitored. Results showed that PPCPs, such as antibiotics (azithromycin, ciprofloxacin: 14.7 – 100%), stimulants (caffeine: 41.5 – 100%), NSAIDs (ibuprofen: 32.9–100%), β-blockers (losartan: 43.5–100%), and disinfectants (triclosan: 45.9–100%) were variably removed. Non-significant differences (p > 0.05) of the PPPCs (effluent concentrations/efficiencies) were reported regarding seasonality and treatment typologies. Moreover, azithromycin, ciprofloxacin and triclosan reported positive correlations (Ɵ ≈ 0 °) with solids. Finally, this study evidenced that COVID-19 pandemic conditioned seasonally variability of PPCPs from wastewater.

Antimicrobial Susceptibility from a One Health Perspective Regarding Porcine Escherichia coli from Bavaria, Germany.

Antimicrobial resistance is one of the most crucial One Health topics worldwide. Consequently, various national and international surveillance programs collect data and report trends regularly. Ceftiofur, colistin and enrofloxacin belong to the most important and critical class of anti-infective medications in both human and veterinary medicine. In the present study, antimicrobial resistance was analyzed using the epidemiological cut-off (ECOFF) value on 6569 Escherichia coli isolated from pigs in Bavaria, Germany, during five years, from 2016 to 2020. The statistically relevant results regarding antimicrobial resistance revealed a decrease for colistin, an increase for enrofloxacin, and a constant level for ceftiofur. In Germany, the usage of all three antimicrobial substances in livestock has fallen by 43.6% for polypeptides, 59.0% for fluoroquinolones and 57.8% for the 3rd + 4th generation cephalosporines during this time. Despite the decline in antimicrobial usage, a reduction regarding antimicrobial resistance was solely observed for colistin. This finding illustrates that in addition to the restriction of pharmaceutical consumption, further measures should be considered. Improved biosecurity concepts, a reduction in crowding, and controlled animal movements on farms may play a key role in finally containing the resistance mechanisms of bacteria in farm animals.