Pharmaceutical Expenses Research Articles

Determination of the Frequency and Direct Cost of the Adverse Drug Events in Argentina

To determine the frequency and the direct costs of adverse drug reactions, in an ambulatory population of the City of Buenos Aires, Argentina and its area of influence. A retrospective study was done during a period of three months on approximately 300.000 residents of the Buenos Aires area, gathering data according to the selected variables by means of the electronic capture of prescriptions dispensed in pharmacies of the area. This method enables the detection and registration of potential conflicts that may arise between a prescribed drug and factors such as: patient's demographic, clinical and drug profile. The analysis unit was defined as the happening of a moderate or severe adverse event reported by the system. The selected variables were the incidence of these effects and the direct cost was calculated as the value of the drugs that induced the adverse event. The events were classified according to the following interactions: a) drug-drug, b) drug-pediatrics, c) drug-gender, d) drug-pregnancy and abuse of controlled substances. The observed frequency shows great variability and the shortage of available data for ambulatory populations. We found 6.74% of reported events over the total of processed items, which generated an additional cost equivalent to 4.58% of the total pharmaceutical expenses. This study has only evaluated the cost occurred by the use of a drug that will lead to an adverse reaction. Moderate and severe reactions were included regardless of the important indirect costs, hospitalization costs, tests, physician fees, etc.

Differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations in Lleida, (Spain): A 6-months prospective observational study

BackgroundThere are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations.MethodsProspective observational study in 1,630 immigrants and 4,154 Spanish-born individuals visited by fifteen primary care physicians at five public Primary Care Clinics (PCC) during 2005 in the city of Lleida, Catalonia (Spain). Data on pharmaceutical consumption and expenses was obtained from a comprehensive computerized data-collection system. Multinomial regression models were used to estimate relative risks and confidence intervals of pharmaceutical expenditure, adjusting for age and sex.ResultsThe percentage of individuals that purchased medications during a six-month period was 53.7% in the immigrant group and 79.2% in the autochthonous group. Pharmaceutical expenses and consumption were lower in immigrants than in autochthonous patients in all age groups and both genders. The relative risks of being in the highest quartile of expenditure, for Spanish-born versus immigrants, were 6.9, 95% CI = (4.2, 11.5) in men and 5.3, 95% CI = (3.5, 8.0) in women, with the reference category being not having any pharmaceutical expenditure.ConclusionPharmaceutical expenses are much lower for immigrants with respect to autochthonous patients, both in the percentage of prescriptions filled at pharmacies and the number of containers of medication obtained, as well as the prices of the medications used. Future studies should explore which factors explain the observed differences in pharmaceutical expenses and if these disparities produce health inequalities.

Prevalencia de prescripción-indicación de protectores gástricos en pacientes hospitalizados

Prescription rates of antiulcer drugs in hospitals and their spill-over to general practice have risen over the last few years, increasing pharmaceutical expenses. The aim of this study was to analyze gastroprotective drug prescription habits in our hospital by assessing both prevalence and adherence to approved indications. An observational study of prescription-indication was performed with 2 cross sections separated by 6 months to avoid selection bias. We found overprescription of gastroprotective drugs, mainly proton pump inhibitors for the prevention of non-steroidal antiinflammatory drug-induced ulcer (17.1%). Overall, 77.6% of prescriptions had no acceptable indication, despite the availability of a specific protocol produced by the Pharmacy and Therapeutics Committee in our center. There was a high prevalence of prescriptions for non-approved indications such as prophylaxis in patients administered cor-ticosteroids without non-steroidal anti-inflammatory agents (25.7%). New programs to train clinicians and clinical mana-gers in rational drug use are required.

A 10-Point Billing Office Check-Up.

Because medical oncologists provide evaluation and management services as well as expensive chemotherapy drugs and infusion services to their patients, and usually do so without the help of a large hospital or other organization, it’s important to get the billing part right. Although the basic processes are similar to that of other specialties, a great deal more is at stake. Failure to fully and accurately bill for oncology drugs and their administration not only means the oncologist isn’t being paid for services rendered, it means staff time and pharmaceutical expenses already paid by the physician will not be reimbursed.

Relative Cost of a Line of Vision in Age-Related Macular Degeneration

To quantitate the relative cost of new therapies for age-related macular degeneration (AMD) versus saved vision. Systematic review. Landmark AMD treatment studies were reviewed to quantitate the visual benefit. For comparison, representative treatment studies for common retinal conditions including retinal detachment, macular hole (MH), epiretinal membrane (ERM), and diabetic retinopathy were also reviewed. Several parameters to estimate Snellen lines of vision saved were defined and tabulated for each condition. A regimen of office visits, ancillary testing, and treatments was outlined. Costs for this were tabulated using Medicare-allowable costs, and costs of visual benefit (per line of vision) for each condition were calculated. Life expectancy was factored in to calculate the cost of a line of vision for each year (line-year). The proportions of costs allocated to professional, technical, and pharmaceutical expenses were tabulated for each therapy. The cost per line of vision saved for AMD therapies ranged from $997 for laser for extrafoveal choroidal neovascularization, to $5509 for photodynamic therapy for occult lesions, to $12 482 for pegaptanib injections. This compares to $651 for retinal detachment repair, $1658 for MH repair, $2411 for ERM peeling, $5458 for diabetic macular edema laser, $594 for panretinal photocoagulation, and $2984 to $4178 for diabetic vitrectomy. The costs per line-years ranged from $77 to $1248 for AMD, and $21 to $194 for the comparison conditions. The proportion of costs for pegaptanib treatment was 17% for professional fees and 70% for pharmaceutical fees. Assumptions incorporated in estimating costs for pegaptanib could easily have doubled because second-year costs might approximate first-year costs and the maintenance of treatment effect has not been well established. Although correctly heralded as a breakthrough in macular degeneration treatment, new pharmacologic therapies for AMD are extremely expensive and some yield marginal visual dividends. As in all fields of medicine that provide care to elderly patients, these costs should be considered as they relate to health care costs for the individual patient and payors, and must be considered in a larger perspective of health care benefit apportionment.

Screening for unmet psycho-social needs in cancer care

8633 Background: Persons receiving cancer care are at risk for undiagnosed depression, but the burden of anxiety symptoms and social work needs is not well described. The objectives of the clinical intervention were: 1) to describe the burden of depression, anxiety and social distress; and 2) to determine whether an unmet need for psycho-social services existed in a sample of cancer patients at a university cancer center with an active psycho-social referral program. Methods: We developed a survey composed of the Memorial Distress Thermometer (MDT), specific social work needs, and the depression and anxiety modules from the Patient Health Questionnaire (PHQ). The clinical survey was administered to a convenience sample presenting for either referral visits or ongoing cancer treatment at the Indiana University Cancer Center for a four month period. Patient request for services, indicated need, and standardized threshold scores were used to determine need for referral (MDT ≥ 4; PHQ depression ≥ 10; PHQ anxiety ≥ 10). Descriptive statistics were calculated. Results: 184 patients (70% male) completed the survey. One-third of those screened met criteria for social work referral. 78% reported at least some distress (mean score 3.6) on the MDT, with 46% (n=81) scoring 4 or above. Social work needs included helping children cope with parental illness (11%), pharmaceutical expenses (11%), insurance assistance (6%), discussing illness with spouse (6%), and lodging during treatment (5%). Mental health distress was common. 34% met criteria for referral to psychological or psychiatric services. The mean PHQ depression score was 4.7, with moderate to severe depression (score ≥ 10) in 13%. Symptoms of generalized anxiety were also common, with a mean score of (5.0) and 11% scoring ≥ 10. Conclusions: In persons receiving cancer care, previously unknown distress, social work needs, depression, and anxiety were common. The burden of symptoms resulted in a markedly increased need for psycho-social services. These data reflect upon the significant need for regular screening and integration of psycho-social services with cancer treatment. No significant financial relationships to disclose.

Proton Pump Inhibitors and Acute Interstitial Nephritis

Proton pump inhibitors (PPIs) are a widely prescribed class of drugs, and their usage worldwide is increasing. Although well-tolerated, there have been case reports and a recent case series implicating these drugs in acute interstitial nephritis (AIN) and progression to acute renal failure (ARF). The aim of this study was to investigate how widespread this complication is in Australia, to identify which PPIs are implicated, and to establish whether PPI-induced AIN is a class effect. We undertook a retrospective case review of potential cases at 2 teaching hospitals and a review of registry data from the Therapeutic Goods Administration of Australia (TGA). Parameters sought included the drug implicated, concurrent medications, symptoms, signs, serum creatinine, and time of onset after prescription. We identified 18 cases of biopsy-proven PPI-induced AIN causing ARF in the retrospective case review, which is the largest hospital-based case series to date. The TGA registry data identified an additional 31 cases of "biopsy proven interstitial nephritis." An additional 10 cases of "suspected interstitial nephritis," 20 cases of "unclassified acute renal failure," and 26 cases of "renal impairment" were also identified. All 5 commercially available PPIs were implicated in these cases. With the ever more widespread use of this class of medications, PPI-induced AIN is likely to become more frequent. There is now evidence to incriminate all the commercially available PPIs, suggesting there is a class effect. Failure to recognize this entity might have catastrophic long-term consequences including chronic kidney disease. Increased awareness might facilitate more rapid diagnosis and management of this potentially reversible condition.

A Cost Analysis of the Iowa Medicaid Primary Care Case Management Program

To determine the cost savings attributable to the implementation and expansion of a primary care case management (PCCM) program on Medicaid costs per member in Iowa from 1989 to 1997. Medicaid administrative data from Iowa aggregated at the county level. Longitudinal analysis of costs per member per month, analyzed by category of medical expense using weighted least squares. We compared the actual costs with the expected costs (in the absence of the PCCM program) to estimate cost savings attributable to the PCCM program. We estimated that the PCCM program was associated with a savings of US dollars 66 million to the state of Iowa over the study period. Medicaid expenses were 3.8 percent less than what they would have been in the absence of the PCCM program. Effects of the PCCM program appeared to grow stronger over time. Use of the PCCM program was associated with increases in outpatient care and pharmaceutical expenses, but a decrease in hospital and physician expenses. Use of a Medicaid PCCM program was associated with substantial aggregate cost savings over an 8-year period, and this effect became stronger over time. Cost reductions appear to have been mediated by substituting outpatient care for inpatient care.

Pharmacoeconomic Research: The Price of Success

To the Editor: I have seen our specialty make an impressive impact on the lives of cancer patients in my 20 years of medical oncology practice in my multiethnic, working-class Southern California community. We have both prolonged and improved patient survival. Nationally and locally, oncology professionals have facilitated these improvements and developed and supported the clinical trials methodology to develop and evaluate new cancer treatments. In this same period, however, newly underinsured patients have emerged as part of a disturbing national economic trend. As oncology's pharmacologic arsenal has grown in efficacy, there also has been an unprecedented growth of pharmaceutical costs. In my practice, pharmaceutical expenses have increased from less than 10% to 60% of monthly expenses, mirroring national trends.1 Increasing numbers of my patients are unable to afford their copayments, deductibles, and pharmacy bills. In spite of our best efforts to mitigate the effect, between May and September 2005, 34 of 179 patients screened by our practice's business office declined all or part of recommended therapy for reasons of cost. We are now encountering many of the Institute of Medicine's concerns about uninsured patients' health in this population.2 There is less likelihood of patients' receiving professionally recommended standard care, less likelihood of receiving medications that are standard treatments, diminished health-related quality of life, and increased risk for adverse health events and health care cost–related bankruptcy. In other words, medical oncology professionals and patients are facing a critical point at which financial circumstances may overwhelm our ability to care for patients. How can we solve this problem? Jacque Sokolov, MD, the medical futurist, has offered a solution to many of the health economic dilemmas facing the United States in the 21st century. He proposed that this solution can be accomplished through a business process known as clarification. The goal is economic transparency (defined as knowledge of the economic value of goods and services before they are purchased).3 The U.S. health care industry and its customers need to understand prospectively the true economic value of our services and medications. In my opinion, the most logical way to accomplish this is by designing all clinical trials to specifically answer questions regarding the real dollar costs and benefits of each therapeutic option. On the basis of this information, we can make more rational decisions about oncologic health care expenditures. Until now, most segments of this industry have assiduously avoided asking and answering these questions. A PubMed search in August 2005 yielded 1,203 citations for “breast cancer, phase III,” but only six citations for “breast cancer, phase III, pharmacoeconomics.” The reasons for this avoidance are overwhelmingly complex, and it would be counterproductive to attempt to review this. Instead, the crucial issue should be how to start this transition process. The best way for this transition to happen is for all stakeholders to adopt this change in orientation with oncology health care professionals acting as catalysts. All involved interest groups will need to contribute to the effort. However, oncology professionals must take an advocacy position that maintains financial neutrality without compromising patient care. Only experienced cancer specialists can ensure both optimal patient benefit and transparency. This will also ensure that medical oncologists' primary focus will remain the health and well-being of the residents of the United States in this arena of economic uncertainty. Successes in treating cancer have created terrible economic dilemmas for our patients. Oncology professionals are in a unique position to facilitate needed change by pharmacoeconomic approaches. Unless we lead the way, our entire cancer care delivery system is at risk.

Strategic Issues in the Development of a Generics Market: Lessons from Spain and the Netherlands

The authors have carried out a comparative study between two countries with a huge difference in terms of development of the generics market: Spain and the Netherlands. The main conclusion of this paper is that, currently, the most important factor for the development of a generics market is the existence of a suitable regulatory structure (explicit and implicit, formal and informal rules) adapted to the characteristics of each country and limited by the arguments that the pharmaceutical industry (branded and generics companies) can support in order to control the pharmaceutical invoice and, as a consequence, healthcare expenditure. The current development models are expensive and complex and, moreover, do not contribute to the consolidation of their development, given that they are influenced by agents and variables that are certainly difficult to control. If the objective is to develop a generics market because it will contribute in a positive way to reducing the public pharmaceutical expenses there is an urgent need to act on end consumers, eg patients, to enrich their perception of generic medicines.

EUROPEAN COURT OF HUMAN RIGHTS

ABSTRACT The applicant was born in 1948 as a male child. In 1990, the applicant instituted proceedings before the Schoneberg District Court, asking it to change the first name Bernhard Friedrich into Carola Brenda. The District Court granted this request and considered the applicant as a male to female transsexual. In 1992 Van Kuck brought an action with the Berlin Regional Court against a private health insurance company. Having been affiliated to this company since 1975, she claimed reimbursement of pharmaceutical expenses for hormone treatment. Furthermore she requested a declaratory judgment to the effect that the company was liable to reimburse 50% of the expenses for gender reassignment operations and further hormone treatment. The Regional Court dismissed her claims. She then lodged an appeal with the Berlin Court of Appeal but unsuccessfully; in 1995 the Court of Appeal dismissed her appeal on two grounds: first, she could not prove the necessity of the gender re-assignment measures - Ms Van Kuck had undergone a gender re-assignment surgery in November 1994 - and, secondly, she herself had deliberately caused her disease of transsexuality. Ultimately, she went to the European Court of Human Rights, and claimed that the German courts had violated her right to a fair hearing of article 6 §1 of the Convention, next to her right to respect for her private life within the meaning of article 8 of the Convention. The Court agreed with Van Kuck that there has been a violation of article 6 §1 as well as of article 8 of the Convention. What follows is the judgment of the European Court of Human Rights, as far as relevant (the dissenting opinion of Judges Cabral Barrreto, Hedigan and Greve and the concurring opinion of Judge Ress are also omitted):

The cultural shift in Italy's pharmaceutical policy in 1994: a case history.

The advent of the National Health Service in 1978 in Italy also resulted in the compilation of a formulary of pharmaceutical products to be distributed free of charge. During the subsequent years the formulary increased in size with the introduction of new drugs and consequently pharmaceutical expenses increased steadily, reaching a peak in 1992. The years preceding this peak of expenses were characterized by pervasive corruption that involved several government civil servants and even the Minister of Health, as well as several members of the national committees responsible for the approval and pricing of medicinal products. The present article summarizes the events from 1992 in Italy when the revelation of corruption in the healthcare system and the pressure of public opinion obliged the authorities to make drastic changes in the pharmaceutical policy, and also introduces and discusses the reactions and the impact of such changes on pharmaceutical expenses and drug utilization over the following years.

Elaboración de un cuadro de mandos para la gestión clínica en un hospital

ObjectiveTo develop a series of clinical indicators on the performance of a hospital and its clinical departments for the purpose of creating a useful tool for clinical management. Material and MethodsA working group was set up with representatives from the departments of clinical documentation, hospital pharmacy, preventive medicine, clinical epidemiology, biostatistics, and quality assurance. The group proposed a draft of indicators for each hospital department, which included both department indicators and overall hospital indicators, with their corresponding comparisons with the indicators from the previous year and indicators from similar hospitals. The draft was sent to all clinical departments coordinated by the Medical Directorate and was modified following the suggestions made by clinicians. ResultsThe department indicators (codification, clinical performance, re-admission rates, pre-surgery length of stay, drug prescription, pharmaceutical expenses, and surgical infection by type of surgery) and hospital indicators (preventable mortality, deaths from acute myocardial infarction as the principal diagnosis, mortality within 48 hours of elective surgery, prevalence rates of patients with pressure ulcers, and prevalence rates of nosocomial infections) that ultimately made up the control panel are described. ConclusionsThe indicators included in the control panel convey the information that departments need for clinical management and are a useful tool for quality improvement.

Storia naturale dell’infiammazione allergica

Allergic pathologies are the most common immunologic diseases and their prevalence and severity show a constantly increasing trend in industrialized countries. The present article presents some recent epidemiological data, the natural development of the allergic inflammation and its pathophysiology, focusing on the recent concept of a “minimal persistent inflammation”, with particular regard to its long term treatment with antiallergic drugs. In fact, according to the most recent interpretations, allergy has to be considered as a complex phenomenon, characterized by a inflammatory response to allergenic stimuli. The complicated interrelation between cells, cytokines and affected structures is described. Very often allergic diseases of the upper airways are associated with and complicate asthma, and data that support the benefits of treating these diseases as a whole are presented. Long-term treatment of allergies with antiflogistic/antiallergic molecules is capable of reducing tissutal damage, besides improving the quality of life of the patient and lowering the frequency of acute episodes. The chronic treatment with antiallergic drugs appears to be favorable also from a pharmacoeconomical point of view, as it is associated with a reduction of overall pharmaceutical expenses and of lost working/school days, as well as determining an improved quality of life for the patient and its relatives, particularly in pediatric age. The management of the allergic patient has always to be approached with an integrated multidisciplinary attitude, in which the efforts tend to the identification of all concurrent diseases, because the optimal treatment may be achieved only with the recognition and the resolution of all underlying diseases.

The Shortage of Anesthesiologists—and Other Medical Specialists

To the Editor: The article on the shortfall in anesthesia care providers raised many unanswered questions for other specialists, including internists and surgeons, most importantly how to implement an effective national system that addresses the number of specialists required to provide optimal health care.1Schubert A Eckhout G Cooperider T Kuhel A Evidence of a current and lasting national anesthesia personnel shortfall: scope and implications.Mayo Clin Proc. 2001; 76: 995-1010Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar In contrast to the oversimplified approach highlighted by Schubert et al,1Schubert A Eckhout G Cooperider T Kuhel A Evidence of a current and lasting national anesthesia personnel shortfall: scope and implications.Mayo Clin Proc. 2001; 76: 995-1010Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar which was based on a single snapshot analysis of data driven by incomplete economic analysis, we propose the establishment of a series of standing interdisciplinary committees to reevaluate specialty training needs on an ongoing basis. Specifically, we recommend a core group of statisticians, health economists, legislators, regulators, and insurers be established and funded to serve as a permanent oversight committee. This committee would convene on a regular basis with academic and community physician representatives from individual specialties (eg, internal medicine, anesthesiology, or surgery) and subspecialty groups (eg, gastroenterology, critical care, or urology). Together, they would be charged with identifying supply/demand economic factors that have an impact on specialty personnel needs such as reimbursement, cost of training, and insurer and governmental expenditures. The group would establish criteria to address manpower requirements from a broader, more rational, and more realistic perspective. These experts would meet to reevaluate and redefine their recommendations based on the rapid and continuous changes taking place in our health systems environment. Demand for physician services is ever increasing with our growing and aging population. The need is not specialty specific. With ever-expanding pharmaceutical and technologic innovation and expenses, the delivery of care by a specific specialty becomes a dynamic process, such as the shift in demand for a specific specialty created by interventional cardiology vs cardiac surgery. The supply side of physician manpower availability necessitates a preemptive and ongoing perspective to allow compensation for the time required to train additional specialists to meet a specific patient demand.2Pingleton SK Committee on Manpower of Pulmonary and Critical Care Societies: a report to membership.Chest. 2001; 120: 327-328Crossref PubMed Scopus (6) Google Scholar, 3The Leapfrog Group Available at: www.leapfroggroup.org/purchase1.htmGoogle Scholar In addition, if reimbursement issues are not addressed, specific care providers will not be available. Various specialties, most recently critical care medicine, have been directly affected by the absence of comprehensive reimbursement despite a demonstrated need and benefit. Meanwhile, the fear of inadequate reimbursement by Medicare for physician services has altered generalist and specialist physician training and may continue to impact this dramatically in the future. We need to look no further than the current Medicare reimbursement proposals that call for an overall 5.4% cut in physician payments to see hard evidence of factors that will directly affect physician numbers, specialization, and training.4Grassroots Action Center Congress fails to fix Medicare physician cut.Available at: capwiz.com/ama/issues/alert/?alertid=26171&type=COGoogle Scholar If we fail to address physician manpower needs, do not provide appropriate and attractive training and practice opportunities, and allow reimbursement to be inequitable or inadequate, future quality American practitioners may follow more appealing paths into nonmedical fields. Such a scenario presents a lose-lose situation for clinicians, patients, and society. The Shortage of Anesthesiologists—and Other Medical Specialists: In ResponseMayo Clinic ProceedingsVol. 77Issue 2PreviewWe appreciate the thoughtful letter by Drs Coursin and Vender regarding our article. We agree that personnel fluctuations need to be minimized. The issue is how to accomplish such a complex and never-ending objective. A comprehensive approach across all medical specialties may be too cumbersome to establish and fund de novo. As Coursin and Vender point out, changes in the health care sector occur rapidly. In addition, personnel supply considerations differ across specialties. For example, surgical specialties control training positions more tightly than does anesthesiology. Full-Text PDF The Shortage of Anesthesiologists—and Other Medical SpecialistsMayo Clinic ProceedingsVol. 77Issue 2PreviewIn reply: The recommendations to form an interdisciplinary group to provide advice and/or oversight regarding physician manpower requirements and availability are logical at first glance. The concept that physician availability is not just a “medical profession” problem but clearly a major societal issue is obviously appropriate. Therefore, a committee to represent the intellectual and pragmatic framework of physician availability is an excellent recommendation. Full-Text PDF

Bacteriemia nosocomial en el paciente adulto. Estudio de costes asociados

Nosocomial infection causes a prolonged hospital stay and an increase in care costs. The objective of this study was to determine the length of stay excess and costs attributable to nosocomial bacteremia. Retrospective study of clinical records of 148 patients with nosocomial bacteremia during 1996. A matched case-control study was performed. For matching, the following parameters were used: RDG, year of admission, age 10 years, main diagnosis and number of secondary diagnoses. Costs were determined by excess length of hospital stay and calculating alternative costs. Matching was obtained for 100 cases (67.5%) and cost estimation was performed. Compared with cases, non-matched cases showed differences regarding significant issues for cost, such as hospital stay ( p = 0.01), number of empirical (p = 0.001) or definitive antibiotics (p = 0.03). The median hospital stay for cases was longer than for controls (35 vs 15.5 days, respectively; p = 0.000). When only survivor case-control pairs were considered (n = 75), cases remained in hospital for a median of 36 vs 15 days for controls (p = 0.000). Hospital stay days attributable to nosocomial bacteremia were 19.5 for all matched and 21 for matched survivor cases. Only 76% of cases had stay days attributable to bacteremia. Significant differences between cases and controls included: the mean total costs of admission (p = 0.000), cost of stay (p = 0.001), pharmaceutical expenses (p = 0.000), and cost of microbiological studies (p = 0.000), laboratory work-up (p = 0.001) and radiological studies (p = 0.000). Hospital stay represented more than 60% of costs, followed by pharmaceutical expenses. Cost differences between bacteremic patients and controls, calculated in function of stay median, was 4.424 euros (p = 0.000) and 4.744 euros (p = 0.000) for alternative costs. Ten cases showed a difference that represented more than half of the total difference. Nosocomial bacteremia represent a stay prolongation and a significant economical burden. Hospital stay and pharmaceutical expenses accounted for the most part of the associated costs. The differences in costs obtained with both methods were small. Since not all selected cases were matched, there may be an error in the appreciation of the difference between cases and controls.

Evolución del consumo de fármacos antiparkinsonianos en España

In recent years new anti Parkinson drugs have been marketed and there has been controversy over the safety of some drugs. To analyze the evolution of the consumption of anti Parkinson drugs and the effect of the newer drugs. A study of the consumption of anti Parkinson drugs (1989 1998). Data were obtained from the ECOM database of the Ministry of Health and TEMPUS of the National Statistics Institute. The drugs were classified using the Anatomo Therapeutic Clinical Classification (ATC). Consumption was expressed in defined daily dosage (DDD) and the costs in euros. The drugs marketed since 1990 were classified as new drugs and the others as classical drugs. The total consumption of drugs increased from 1.92 DDD/1,000 inhabitants/day in 1989 to 3.64 DDD/1,000 inhabitants/day in 1998. The drugs showing the greatest increase were selegiline, pergolide and levodopa. The total pharmaceutical expenses tripled. There was a smaller increase in the consumption of new drugs (1.2% of the total in 1991 and 6.6% in 1998) than in their costs (6.7% of the total in 1991 and 38.8% in 1998). The cost per DDD of the new drugs increased five times (1989: 2.55 euros and 1998: 13.59 euros) and that of the classical drugs was similar (1989: 0.54 euros and 1998: 0.62 euros). The total consumption of anti Parkinson drugs has progressively increased. The consumption of selegiline has also increased in spite of controversy over its safety. The new drugs have a major economic effect.

Strategic management of pharmaceutical expenses

Strategic management of pharmaceutical expenses

Distribution of pharmaceuticals--a Norwegian logistic perspective.

There is a general concern about rising costs of pharmaceutical expenses. One political measure is a more efficient distribution system, which can take the form of new channels for retailing. In Norway mail-order pharmacy (MOP) has been brought to the agenda due to the recently proposed law regulating pharmacies ("Apoteklov"), market developments abroad, demand for self-medication, the increase in OTC-products and advances in information technology. Mail-order pharmacy involves direct delivery of medications through postal mail to patients or those responsible for dispensing medication. With reference to the USA, mail-order pharmacy has filled a niche in the market and several other countries are following. We are convinced that it is possible to maintain a high level of service quality in the sense of safety, counselling and compliance, and that there is a potential to develop a model for this distribution form in Norway. We believe that the actors in the Norwegian pharmaceutical market are better served in taking a more active role in this area and where possible initiating pilot projects in mail-order distribution. The pharmacists will continue to play an important role as a retail outlet and should, with their influence over patients, their knowledge and experience, contribute towards developing MOP to be a safe and complementary sales outlet. Developing such a solution demands the right balance between performance and quality on the one hand and efficiency on the other; two criteria, which we believe, do not contradict each other.

Occupational Asthma: A Longitudinal Study on the Clinical and Socioeconomic Outcome After Diagnosis

To evaluate the clinical outcome and socioeconomic consequences of occupational asthma (OA). Twenty-five patients with OA both to high- and low-molecular-weight agents (3 and 22, respectively) confirmed by specific inhalation challenge were followed up for 12 months after the diagnosis. Upon diagnosis, each patient received a diary on which to report peak expiratory flow rate (PEFR), symptoms, drug consumption, expenses directly or indirectly related to the disease, as well as information regarding personal socioeconomic status. At each follow-up visit (1, 3, 6, and 12 months), the patients underwent clinical examination, spirometry, methacholine (Mch) challenge, and assessment of diary-derived parameters and socioeconomic status. Asthma severity (AS) was classified into four levels, based on symptoms, drug consumption, and PEFR variability. At 12 months, 13 patients (group A) had ceased exposure; the remaining 12 patients (group B) continued to be exposed. At diagnosis, FEV1 percent and provocative dose causing a 20% fall in FEV1 (PD20) of Mch were lower in group A than in group B; patients of group A were also characterized by significantly higher basal AS levels. At 12 months, no significant variation in FEV1 percent or PD20 was found for either group, while AS levels improved in both groups, the change being more marked for group A than group B. Pharmaceutical expense at 12 months significantly (p < 0.05) decreased, as compared with the first month, in group A, whereas it tended to increase in group B. In group A, 9 of 13 subjects had reported a deterioration of their socioeconomic status as compared with 2 of 12 in group B (p < 0.01). A significant loss of income was registered in patients of group A (median 21.45, 25th to 75th percentiles 16.9 to 25.8 Italian liras x 10(6) on the year preceding diagnosis and 15.498, 10.65 to 21.087 Italian liras x 10(6) on the year after diagnosis; p < 0.01), whereas no significant change was seen for patients in group B. In OA, cessation of exposure to the offending agent results in a decrease in asthma severity and in pharmaceutical expenses, but it is associated with a deterioration of the individual's socioeconomic status (professional downgrading and loss of work-derived income). There appears to be a great need for legislation that facilitates the relocation of these patients.