Prescription Costs Research Articles

Proton-pump inhibitor use in older adults: Public vs. Private Prescribing in Portugal

Abstract Background Proton pump inhibitors (PPI) are frequently overprescribed, posing challenges to patients and healthcare systems. In Portugal, the publicly funded National Health Service (NHS) provides universal coverage and reimburses the cost of medications regardless of the prescription origin. If private practices may benefit from longer consultation times allowing better prescription, they do not face any incentive to avoid over-prescription. We aimed to compare outpatient prescription trends, patterns, and costs of PPI among older adults in private and public sectors. Methods Nationwide retrospective ecological study on PPI prescribed for older adults in Portugal 2020-2022. Data on defined daily doses (DDD) and costs were obtained from a national public database by healthcare sector, sex (female/male), and age group (65-74, ≥75). We analysed trends, market share of DDD per 1000 older adults per day (DID), and mean cost per DDD (€/DDD) for all PPI substances. Results We observed a decrease in prescribed PPI from 349.0 DID in 2020 to 341.9 DID in 2022. Omeprazole (reference and cheaper substance) was the most prescribed drug for females and pantoprazole for males in the public sector. Similar pattern was observed among those aged ≥75 in the private sector while for those aged 65-74, esomeprazole was the most prescribed drug. Overall, the private sector prescribed PPI with a 20% higher price (0.126 €/DDD) than the public (0.106 €/DDD), with greater differences among the most expensive substances (rabeprazole +0.032 €/DDD; lansoprazole +0.029 €/DDD; esomeprazole +0.021 €/DDD). Conclusions PPI prescription followed similar trends in both sectors, but private practitioners tend to prescribe more expensive drugs, because their patients can afford them and because there is no incentive for more rational prescription. Since the NHS financially supports drugs prescribed in private practices, financial incentives towards rationale prescription should also fall in this sector. Key messages • Overall, the private sector prescribed PPI with a 20% higher price (0.126 €/DDD) than the public (0.106 €/DDD), with greater differences among the most expensive substances. • Since the National Health Service financially supports drugs prescribed in private practices, financial incentives towards rationale prescription should also fall in this sector.

Unravelling the shift: exploring consumers’ adoption or resistance of E-Pharmacy through behavioural reasoning theory

In the ever-evolving nature of the healthcare sector, the advent of electronic-Pharmacy introduces a dynamic shift in how consumers acquire and access medical and pharmaceutical products. The research utilized the behaviour reasoning theory. The study evaluated the reasons for adopting and against adopting electronic-Pharmacy. By employing the qualitative approach, this study unravels rich contextual and narrative insights, shedding light on the complexities of individual decision-making processes. The study received responses from 28 through an in-depth interview, and thematic data analysis was employed for the data analysis. The outcome of the research is summarized as follows. The respondents indicated that essential reasons for adopting electronic pharmacy services include convenience and accessibility, prescription management, cost and affordability, logistics, and timely delivery. On the other hand, the reasons against adoption include trust and security concerns, regulatory challenges and legal uncertainties, lack of internet access and privacy concerns. As technology changes healthcare delivery, this research closes the knowledge gap between theory and practice by offering crucial insights into the behavioural aspects influencing electronic-Pharmacy adoption or resistance. The findings are anticipated to significantly impact the academic discourse surrounding electronic-health and the practical implementation of strategies to enhance the integration of electronic-Pharmacy services into conventional healthcare systems.

Budget impact of resmetirom for the treatment of adults with non-cirrhotic non-alcoholic steatohepatitis (NASH) with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis)

Aims This study assessed the budget impact of resmetirom as a treatment for adults with non-cirrhotic non-alcoholic steatohepatitis (NASH) with moderate-to-advanced liver fibrosis and estimated total costs for a hypothetical private payer in the United States. Materials and methods A three-year budget impact analysis based on an open cohort state transition model was developed for a hypothetical one-million-member private health plan. The comparator was Standard of Care (SOC), defined as routine care for non-cirrhotic NASH patients with moderate-to-advanced liver fibrosis. Each year, the number of resmetirom treatment-eligible patients was estimated through prevalent, incident, and diagnostic rate estimates. Costs included resources incurred by the medical and pharmacy benefits of private payers, including resmetirom drug acquisition costs, diagnosis and monitoring, other medical and other prescription costs stratified by disease progression status (i.e. non-cirrhotic vs. cirrhotic/advanced liver diseases). Resmetirom adverse event management costs were included in sensitivity analysis. Drug costs were estimated based on the average wholesale acquisition cost as of March 2024. Other costs were based on published sources and inflated to 2023 US dollars. Budget impact outcomes were presented in aggregate, net, and on a per-member per-month (PMPM) basis. Results Compared with a scenario without resmetirom, the introduction of resmetirom yielded results ranging from 50 to 238 treated patients, net budget impact of $2.2 to $9.5 million, and PMPM from $0.19 to $0.80 over years one and three. Net costs excluding resmetirom declined over time. In sensitivity analyses, results were most sensitive to diagnostic and epidemiologic inputs. Limitations Market shares are based on internal forecasts, a short time horizon, average treatment effects, and other limitations common to BIMs. Conclusion The adoption of resmetirom on the formulary for the treatment of non-cirrhotic NASH with moderate-to-advanced liver fibrosis resulted in a moderate increase in budget impact with declining costs related to NASH progression.

Opioid Use and Healthcare Utilization in Adults With Psoriatic Arthritis and Ankylosing Spondylitis.

Opioid use among individuals with spondyloarthritis is common; however, data on whether these individuals have higher utilization of the healthcare system are lacking. We examined the association between opioid use and healthcare utilization and costs among patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS). We included adults with PsA or AS enrolled in the FORWARD registry, with ≥ 1 completed disease activity or disability questionnaire between 2010 and 2019. The exposure was patient-reported opioid use, and the outcomes were annualized healthcare utilization and prescription costs. We used negative binomial regression to assess the association between opioid use and the utilization outcomes, and generalized linear models with γ-distribution and log link function for the association between opioid use and costs. Models were adjusted for age, sex, and hospitalization. AS and PsA were studied separately. Among 828 patients with PsA, 21.4% used opioids; for those with AS, 27.2% of 334 patients reported opioid use. Opioid users had higher healthcare utilization and costs, including increased medical visits, diagnostic tests, direct medical costs, and pharmacy expenses. Opioid users had 32-33% more medical visits annually vs nonusers. Patients using opioids spent more on medical visits annually compared to nonusers (US $3464 vs $2706 for PsA; US $4500 vs $3660 for AS). Compared to patients not using opioids, patients with PsA and AS who used opioids had higher healthcare utilization and higher health-related costs. New care pathways are needed to improve care and reduce costs.

Health Outcome Changes in Individuals With Type 1 Diabetes After a State-Level Insulin Copayment Cap

Many insulin users ration doses due to high out-of-pocket costs. Starting January 2020 with Colorado, 25 states and the District of Columbia enacted laws that cap insulin copayments. To estimate the association of Colorado's $100 copayment cap with out-of-pocket spending, medication adherence, and health care services utilization for diabetes-related complications. In this cohort study using Colorado's All-Payer Claims Database, nonelderly insulin users with type 1 diabetes were analyzed from January 2019 to December 2020. Outcome changes were compared in the prepolicy and postpolicy period among individuals continuously enrolled in state-regulated and non-state-regulated plans using difference-in-differences regressions. Subgroup analyses were conducted based on individuals' prepolicy spending (low: never ≥$100 out-of-pocket vs high: ≥$100 out-of-pocket cost at least once). Data were analyzed from June 2023 to May 2024. Enrollment in state-regulated health insurance plans subject to the copayment cap legislation. Adherence to basal and bolus insulin treatment was evaluated using the proportion of days covered measure, out-of-pocket spending reflected prescription cost for a 30-day supply, and health care utilization for diabetes-related complications was identified using primary diagnosis codes from medical claims data. The panel included 1629 individuals with type 1 diabetes (39 096 person-months), of which 924 were male (56.7%), 540 (33.1%) had 1 or more comorbidities, and the mean (SD) age was 40.6 (15.9) years. Overall, the copayment cap was associated with out-of-pocket spending declines of $17.3 (95% CI, -$27.3 to -$7.3) for basal and $11.5 (95% CI, -$24.7 to $1.7) for bolus insulins and increases in adherence of 3.2 (95% CI, 0.0 to 6.5) percentage points for basal and 3.3 (95% CI, 0.3 to 6.4) percentage points for bolus insulins. Changes in adherence were associated with increases within the prepolicy high-spending group (basal, 9.9; 95% CI, 2.4 to 17.4 percentage points; bolus, 13.0; 95% CI, 5.1 to 20.9 percentage points). The policy was also associated with a mean reduction of -0.09 (95% CI, -0.16 to -0.02) medical claims for diabetes-related complications per person per month among high spenders, a 30% decrease. In this cohort study of Colorado's insulin copayment cap among individuals with type 1 diabetes, the policy was associated with an overall decline in out-of-pocket spending, an increase in medication adherence, and a decline in claims for diabetes-related complications only among insulin users who spent more than $100 in the prepolicy period at least once.

Delay and Pay? Healthcare Costs Associated with Late Oral Anti-coagulant Prescribing in People with Atrial Fibrillation.

Atrial fibrillation (AF) is associated with increased morbidity and mortality and exerts an increasingly significant burden on global healthcare resources, with its prevalence rising with an ageing population. Despite a substantial thromboembolic risk, particularly in the period immediately following diagnosis, oral anti-coagulation is frequently not initiated or is delayed. The aim of this study was to evaluate healthcare costs in people with AF, comparing those who were commenced on oral anti-coagulation in the immediate period following the index diagnosis date with those in whom initiation was late and those who never started anti-coagulation. This retrospective cost analysis used linked Scottish health data to identify adults newly diagnosed with AF between January 1st 2012 and April 30th 2019 with a baseline CHA2DS2-VASc score of ≥2. This AF population was sub-divided according to timing of the first prescription of oral anti-coagulant (OAC) during a 2-year follow-up period: never started (OAC never initiated), immediate OAC (OAC prescribed within 60 days of incident AF diagnosis), and delayed OAC (OAC prescribed more than 60 days after incident AF diagnosis). A two-part model was developed, adjusted for key covariates, including age, sex, and frailty, to estimate costs for inpatient admissions, outpatient care, prescriptions, and care home admissions, and overall costs. Of an overall AF population of 54,385, 26,805 (49.3%) never commenced OAC, 7654 (14.1%) initiated an OAC late, and 19,926 (36.6%) were prescribed anti-coagulation immediately. The mean adjusted cost for the overall AF population was £7807 per person per year (unadjusted: £8491). Delayed OAC initiation was associated with the greatest adjusted estimated mean annual cost (unadjusted: £13,983; adjusted: £9763), compared to those that never started (unadjusted: £10,433; adjusted: £7981) and those that received an immediate OAC prescription (unadjusted: £3976; adjusted: £6621). Increasing frailty, mortality, and female sex were associated with greater healthcare costs. AF is associated with significant healthcare resource utilisation and costs, particularly in the context of delayed or non-initiation of anti-coagulation. Indeed, there exists substantial opportunity to improve the utilisation and prompt initiation in people newly diagnosed with AF in Scotland. Interventions to mitigate against the growing economic burden of AF should focus on reducing admissions to hospitals and care homes, which are the principal drivers of costs; prescriptions and outpatient appointments account for a relatively small proportion of overall costs for AF.

Reprint of: Impact of outpatient pharmacist dispensing in an opioid use disorder clinic

BackgroundMedications for opioid use disorder are effective in reducing opioid deaths, but access can be an issue. Relocating an outpatient pharmacist for weekly buprenorphine dispensing in an outpatient clinic may facilitate coverage for buprenorphine and mitigate access and counseling barriers. ObjectivesThis study aimed to evaluate whether staffing an outpatient resident pharmacist to dispense in the buprenorphine clinic had a positive impact on (1) mean cost per prescription charged to charity care and (2) basic elements of patient satisfaction with the on-site pharmacist. MethodsPatient demographics, buprenorphine formulation, insurance type, and uncovered costs were abstracted from dispensing records in the 16 weeks before the pharmacist clinic presence and 16 weeks with the pharmacist present. The difference in insurance types across the 2 periods was tested using a chi-square test, and the mean uncovered prescription costs charged to charity care for the 2 periods was compared using an independent-samples t test. A brief survey was administered while the pharmacist was on-site to evaluate satisfaction, which was analyzed with frequencies of “yes” responses and free-text comments. ResultsA total of 38 patients received buprenorphine during both the pre- and postperiods. Once the pharmacist was on-site, more patients used Medicaid or private insurance, decreasing the mean uncovered cost per prescription from $55.00 (SD 68.7) to $36.97 (SD 60.1) (P = 0.002). Patients reported high levels of satisfaction with most reporting they were more likely to ask questions, pick up their prescriptions, and take their medicine with the pharmacist in the clinic. ConclusionsThe pharmacist successfully transitioned a portion of prescriptions previously covered by charity care to Medicaid or private insurance. This shift led to a decrease in charity care costs by $2950.20 and a reduction in the average uncovered cost per prescription. The pharmacist’s presence in the clinic seemed to reduce barriers especially related to inconvenience.

Med Money: The Effects of Prescription Cost on Patients with Kidney Disease.

Med Money: The Effects of Prescription Cost on Patients with Kidney Disease.

Real-world comparison of health care costs of venetoclax-obinutuzumab vs Bruton's tyrosine kinase inhibitor use among US Medicare beneficiaries with chronic lymphocytic leukemia in the frontline setting.

Bruton's tyrosine kinase inhibitors (BTKis) and the BCL-2 inhibitor venetoclax in combination with obinutuzumab (VEN-O) are both recommended as frontline therapy in chronic lymphocytic leukemia (CLL). However, VEN-O is a 12-month fixed-duration therapy generating durable remissions whereas BTKis are continuous treat-to-progression treatments. To examine costs before and after the fixed-duration treatment period for VEN-O relative to that observed for BTKis in a national sample of older US adults with CLL in the frontline setting. This retrospective analysis used Medicare Parts A, B, and D claims from 2016 to 2021. Fee-for-service Medicare beneficiaries aged 66 years or older initiating frontline CLL treatment with VEN-O or a BTKi treatment between June 1, 2019, and June 30, 2020 (index date = first prescription fill date), were included in the sample. Mean cost measures were captured for both groups over 2 fixed time periods calculated from the index date: Month 0 to 12 (proxy for VEN-O on-treatment period) and Month 13 to 18 (proxy for VEN-O off-treatment period). A difference-in-difference approach was used. Multivariate generalized linear models estimated changes in adjusted mean monthly costs during Month 0 to 12 vs Month 13 to 18, for the VEN-O group relative to the BTKi group. The final sample contained 193 beneficiaries treated with VEN-O and 1,577 beneficiaries treated with BTKis. Risk-adjusted all-cause monthly total costs were similar for VEN-O patients ($13,887) and BTKi patients ($14,492) between Month 0 and 12. Moreover, during Month 13 to 18, the mean monthly all-cause total costs declined by 67% for VEN-O ($13,887 to $4,462) but only by 10% for BTKi ($14,492 to $13,051). Hence, the relative reduction in costs across the 2 periods was significantly larger for VEN-O (-$9,425) vs BTKi (-$1,441) patients (ie, difference in difference = -$7,984; P < 0.001). Similar patterns were observed for CLL-related costs, with the substantially larger reductions in CLL-related total monthly costs (-$9,880 VEN-O vs -$1,753 BTKi; P < 0.001) for the VEN-O group primarily driven by the larger reduction in CLL-related monthly prescription costs (-$9,437 VEN-O vs -$2,020 BTKi; P < 0.001). This real-world study of older adults with CLL found a large reduction in monthly Medicare costs in the 6 months after completion of the fixed-duration treatment period of VEN-O, largely driven by the reduction in CLL-related prescription drug costs. A similar decline in costs was not observed among those treated with BTKis. Our study highlights the substantial economic benefits of fixed-duration VEN-O relative to treat-to-progression therapies like BTKis in the first-line CLL setting.

National patterns of paroxetine use among US Medicare patients from 2015-2020.

Paroxetine is an older "selective" serotonin reuptake inhibitor (SSRI) that is notable for its lack of selectivity, resulting in an anticholinergic adverse-effect profile, especially among older adults (65+). Paroxetine prescription rates and costs per state were ascertained from the Medicare Specialty Utilization and Payment Data. States' annual prescription rate, corrected per thousand Part D enrollees, outside a 95% confidence interval were considered significantly different from the average. Nationally, there was a steady decrease in population-corrected paroxetine prescriptions (-34.52%) and spending (-29.55%) from 2015-2020 but a consistent, five-fold state-level difference. From 2015-2020, Kentucky (194.9, 195.3, 182.7, 165.1, 143.3, 132.5) showed significantly higher prescriptions rates relative to the national average, and Hawaii (42.1, 37.9, 34.3, 31.7, 27.7, 26.6) showed significantly lower prescription rates. North Dakota was often a frequently elevated prescriber of paroxetine (2016: 170.7, 2018: 143.3), relative to the average. Neuropsychiatry and geriatric medicine frequently prescribed the most paroxetine, relative to the number of providers in that specialty, from 2015-2020. Despite the American Geriatrics Society's prohibition against paroxetine use in older adults and many effective treatment alternatives, paroxetine was still commonly used in the US in this population, especially in Kentucky and North Dakota and by neuropsychiatry and geriatric medicine. These findings provide information on the specialty types and states where education and policy reform would likely have the greatest impact on improving adherence to the paroxetine prescription recommendations.

Impact of COVID-19 pandemic on the utilization and quality of antibiotic use in the primary care setting in England, March 2019–March 2023: a segmented interrupted time series analysis of over 53 million individuals

ABSTRACT Background Amid the COVID-19 pandemic, we evaluated the short-term impact of COVID-19 on antibiotic use in primary care in England, focusing on both antibiotic quantity (overuse) and quality (misuse) of use. Research design and methods A population-based segmented interrupted analysis was applied on monthly dispensed antibiotics prescriptions using the Prescription Cost Analysis dataset (March/2019–March/2023). The quantity was assessed using number of items dispensed per 1000 inhabitants (NTI) and defined daily doses per 1000 inhabitants per day (DID), while quality was evaluated using WHO’s Access Watch Reserve (AWaRe) classification, the proportion of ‘4C’ antibiotics and the percentage of broad- to narrow-spectrum antibiotics. Results Findings indicate 8.6 (17.2%) and 0.4 (2.6%) increase in the NTI and DID, respectively, with a statistically significant uptick in trend noted after the second lockdown (β5) for ‘total antibiotics’ for NTI only (β5 = 1.6; 95% CI:0.17, 3.1). Quality assessment showed an increase in ‘Access’ antibiotics from 77% in March/2019 to 86% in March/2023; however, COVID-19 had no significant impact on WHO AWaRe classes. Conclusion COVID-19’s impact on antibiotic use quality and quantity appeared to be minimal, though an increase in utilization post-second lockdown coincided with healthcare system recovery. This suggests a nuanced impact of the pandemic, highlighting the importance of continued antimicrobial stewardship.

Patient out-of-pocket costs for guideline-recommended treatments for erectile dysfunction: a medicare cost modeling analysis.

Patient out-of-pocket (OOP) cost represents an access barrier to erectile dysfunction (ED) treatment. We determined OOP cost for men with ED covered by Fee-for-Service Medicare. Coverage policies were obtained from the Medicare Coverage Database for treatments recommended by the 2018 American Urological Association (AUA) guidelines. OOP cost was retrieved from the 2023 Centers for Medicare & Medicaid Services Final Rule. OOP cost for treatments without Medicare coverage were extracted from GoodRx® or literature and inflated to 2022 dollars. Annual prescription costs were calculated using the published estimate of 52.2 yearly instances of sexual intercourse. Medicare has coverage for inflatable penile prostheses (IPP; strong recommendation), non-coverage for vacuum erection devices (VED; moderate recommendation) and phosphodiesterase type-5 inhibitors (PDE5i; strong recommendation), and no policies for intracavernosal injections (ICI; moderate recommendation), intraurethral alprostadil (IA; conditional recommendation), or low-intensity extracorporeal shock wave therapy (ESWT; conditional recommendation). Annual IA prescription is most costly ($4022), followed by ICI prescription ($3947), one ESWT course ($3445), IPP ($1600), PDE5i prescription ($696), and one VED ($213). PDE5i and IPP, both strongly recommended by AUA guidelines, are associated with lower OOP cost. Better understanding of patient financial burden may inform healthcare decision-making.

Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the Scottish primary care setting: a population-based segmented interrupted time-series analysis

ABSTRACT Background Inappropriate use of antibiotics is expected to increase during the COVID-19 pandemic, but there are limited data on COVID-19’s long-term impact. We assessed the impact of COVID-19 on the quantity and quality of antibiotic use in Scotland. Research design and methods A segmented interrupted time series was applied to monthly dispensed antibiotics using prescription cost analysis data from March/2019 to March/2023. Antibiotic use was quantified using the number of items dispensed/1000 inhabitants (TIDs) and defined daily dose/1000 inhabitants/day (DIDs). The quality of antibiotic use was assessed using key quality indicators including the WHO AWaRe classification, proportion of broad-spectrum and ”4C”-antibiotics. Results Overall, for all antibiotics, there was a non-significant increase in TIDs and DIDs before the first lockdown (March/2020) (β1), but a decline in the level immediately after the first (β2) and second lockdowns (β4) (November/2020), albeit non-significant. However, a significant increase in the time trend after the second lockdown (β5) for all antibiotic classes was observed. COVID-19 had no negative impact on AWaRe utilisation, with the proportion of all antibiotics from the Access group increasing from 76% in March/2019 to 90% in March/2023. The proportion of ”4C” antibiotic reduced significantly after the second lockdown. Conclusions Neither the utilisation nor the quality of total antibiotic use appeared to have been significantly affected by COVID-19.

RWD159 Assessing the Relationship between Initial Opioid Prescription and Subsequent Pain-Related Healthcare Resource Utilization and Costs Among Patients with Chronic Pain

RWD159 Assessing the Relationship between Initial Opioid Prescription and Subsequent Pain-Related Healthcare Resource Utilization and Costs Among Patients with Chronic Pain

Cost-Effectiveness of Test-and-Treat Strategies to Reduce the Antibiotic Prescription Rate for Acute Febrile Illness in Primary Healthcare Clinics in Africa.

Inappropriate antibiotic use increases selective pressure, contributing to antimicrobial resistance. Point-of-care rapid diagnostic tests (RDTs) would be instrumental to better target antibiotic prescriptions, but widespread implementation of diagnostics for improved management of febrile illnesses is limited. Our study aims to contribute to evidence-based guidance to inform policymakers on investment decisions regarding interventions that foster more appropriate antibiotic prescriptions, as well as to address the evidence gap on the potential clinical and economic impact of RDTs on antibiotic prescription. A country-based cost-effectiveness model was developed for Burkina Faso, Ghana and Uganda. The decision tree model simulated seven test strategies for patients with febrile illness to assess the effect of different RDT combinations on antibiotic prescription rate (APR), costs and clinical outcomes. The incremental cost-effectiveness ratio (ICER) was expressed as the incremental cost per percentage point (ppt) reduction in APR. For Burkina Faso and Uganda, testing all patients with a malaria RDT was dominant compared to standard-of-care (SoC) (which included malaria testing). Expanding the test panel with a C-reactive protein (CRP) test resulted in an ICER of $0.03 and $0.08 per ppt reduction in APR for Burkina Faso and Uganda, respectively. For Ghana, the pairwise comparison with SoC-including malaria and complete blood count testing-indicates that both testing with malaria RDT only and malaria RDT + CRP are dominant. The use of RDTs for patients with febrile illness could effectively reduce APR at minimal additional costs, provided diagnostic algorithms are adhered to. Complementing SoC with CRP testing may increase clinicians' confidence in prescribing decisions and is a favourable strategy.

Trends in prescription and cost of Sativex, a cannabinoid-based medicine, in treating patients with multiple sclerosis in England.

Cannabis-based medication has recently been made available in the NHS for reducing pain and spasticity in patients with multiple sclerosis (MS). The currently available preparation of Sativex (nabiximols) contains a combination of botanical cannabis extracts with cannabidiol (CBD) and tetrahydrocannabinol (THC) with almost equal amounts in addition to minor cannabinoids and terpenoids and is delivered via an oro-mucosal spray. The present study aims to examine the use and trends in prescribing cannabinoid-based Sativex to control pain in patients diagnosed with MS. Primary care prescribing data for cannabinoid-based Sativex (2013-2022) from the Prescription Cost Analysis were extracted and analysed. Linear regression analyses were performed to examine prescription trends and prescription costs (average change per year). There was a general increasing trend in the number of prescriptions each year, from 4.42 items dispensed per 100,000 people in 2013 to 5.15 in 2022. Overall, prescription items for cannabinoid-based Sativex increased by 0.34% per year (95% CI:-3.98, 4.67, p = 0.860) on average between 2013 and 2022. On average, a 2.43% (95% CI: -5.78, 0.92, p = 0.133) increase per year was observed for the costs of cannabinoid-based Sativex from 2013 to 2022. The results suggested that cannabinoid-based Sativex should be considered an option due to its effectiveness, acceptable tolerance, and safety profile in the prescribing of Sativex.

Price transparency at the point of prescribing with real-time prescription benefits.

Real-time prescription benefits (RTPB) shows prescribers patient-, medication-, and pharmacy-specific information on medication pricing, prior authorization requirements, and lower-cost alternatives. RTPB is intended to improve patient satisfaction and prescription fill rates by decreasing out-of-pocket costs for prescriptions. Therefore, we evaluated how RTPB affects prescribing patterns by examining acceptance and subsequent fill rates for RTPB alternative suggestions. RTPB was implemented in February 2022 using external vendor interfaces. Prescribing data from March 2022 to March 2023 were analyzed. RTPB displayed alerts for medications requiring prior authorization or when alternative medications would result in cost savings. Patients were included if their prescription received an RTPB response and they had a subsequent encounter with pharmacy fill data. Primary outcomes were alert acceptance rates and prescription fill rates across RTPB alert groups, with a secondary outcome of monthly copay savings for accepted alerts. RTPB requests received a response for 88% of prescriptions, with price estimates provided for 77.9% of them. Lower-cost alternatives accounted for 67.2% of alerts, while prior authorization requirements represented 15% of alerts. Prescribers selected a lower-cost alternative 32% of the time. For those with an RTPB alert, patients filled prescriptions 68% of the time when an alternative was chosen, compared to 59% of the time when the original prescription was retained (odds ratio, 1.5; 95% confidence interval, 1.5-1.6; P < 0.001). Patients saved an average of $27.77 per month on copay costs when alternatives were selected. Implementation of RTPB was found to result in significant improvements in prescription fill rates and decrease patient copay costs, despite low alert acceptance rates.

Assessment of antibiotic prescribing pattern and cost for hospitalized patients: A study from Palestine.

One of the largest problems facing the world today is the morbidity and mortality caused by antibiotic resistance in bacterial infections. A major factor in antimicrobial resistance (AMR) is the irrational use of antibiotics. The objective of this study was to assess the prescribing pattern and cost of antibiotics in two major governmental hospitals in the West Bank of Palestine. A retrospective cohort study was conducted on 428 inpatient prescriptions containing antibiotics from two major governmental hospitals, they were evaluated by some drug use indicators. The cost of antibiotics in these prescriptions was calculated based on the local cost. Descriptive statistics were performed using IBM-SPSS version 21. The mean ± SD number of drugs per prescription (NDPP) was 6.72 ± 4.37. Of these medicines, 38.9% were antibiotics. The mean ± SD number of antibiotics per prescription (NAPP) was 2.61 ± 1.54. The average ± SD cost per prescription (CPP) was 392 ± 744 USD. The average ± SD antibiotic cost per prescription (ACPP) was 276 ± 553 USD. The most commonly prescribed antibiotics were ceftriaxone (52.8%), metronidazole (24.8%), and vancomycin (21.0%). About 19% of the antibiotics were prescribed for intra-abdominal infections; followed by 16% used as prophylactics to prevent infections. Almost all antibiotics prescribed were administered intravenously (IV) 94.63%. In general, the average duration of antibiotic therapy was 7.33 ± 8.19 days. The study indicated that the number of antibiotics per prescription was statistically different between the hospitals (p = 0.022), and it was also affected by other variables like the diagnosis (p = 0.006), the duration of hospitalization (p < 0.001), and the NDPP (p < 0.001). The most commonly prescribed antibiotics and the cost of antibiotics per prescription were significantly different between the two hospitals (p < 0.001); The cost was much higher in the Palestinian Medical Complex. The practice of prescribing antibiotics in Palestine's public hospitals may be unnecessary and expensive. This has to be improved through education, adherence to recommendations, yearly immunization, and stewardship programs; intra-abdominal infections were the most commonly seen infection in inpatients and ceftriaxone was the most frequently administered antibiotic.

Abstract PS04-08: Sociodemographic Risk Factors and Prediction of Aromatase Inhibitor Non-Adherence in Women with Breast Cancer Enrolled in SWOG S1105

Abstract Background: Non-adherence to aromatase inhibitors (AIs) for breast cancer is common and increases risk of recurrence. Few prospective studies have systematically evaluated non-adherence and non-clinical factors associated with it. We analyzed baseline sociodemographic characteristics and financial factors associated with non-adherence to create a baseline composite risk-score for AI non-adherence. Methods: Patients enrolled in S1105 were required to have been on an AI for ≥30 days at enrollment. Patients were assessed for non-adherence of AIs every 3 months for 36 months, with non-adherence defined as urine AI metabolite assay results satisfying any of the following: &amp;lt; 10 ng/mL, undetectable, specimen submitted outside of the ± 21-day follow-up appointment window, or no submitted specimen. Factors included race, Hispanic ethnicity, age, education, income, health insurance type, and prescription cost. We also included socioeconomic deprivation and rural or urban residence using trial participants’ residential zip codes linked to the Area Deprivation Index (ADI) and Rural Urban Continuum codes (RUCC) respectively. For numeric factors and categorical factors with more than two levels, we used cutpoint analysis to determine the highest risk range by optimizing the Chi-squared statistic. For each resulting binary factor, we performed a logistic regression, adjusting for the study stratification factors and stratifying by treatment arm. Factors associated with adherence at the alpha=0.10 level were combined into a composite risk score, with study participants given one point for each baseline adverse risk factor. Secondarily, we examined a composite risk score including all factors, regardless of statistical significance. Results: In total, 724 patients were registered from 40 institutions between May 2012 and September 2013. The median age was 60.9 years, and 64.5% were on AI &amp;lt; 12 months prior to registration. Only 8% had out of pocket (OOP) cost &amp;gt;$30. Observed adherence at 36 months was 35.9%. Patients living in metro areas with populations ≥ 250,000 (RUCC ≤ 3) were more likely to be non-adherent (37.5% vs 28.3%, OR=1.50, p=.08); as were those who were younger, those without a college education, and those with limited (≤$5) OOP cost. ADI, race and ethnicity were not associated with non-adherence. The composite risk score was strongly associated with 36-month adherence. For each 1 unit increase in risk level, the risk of non-adherence increased 47% (OR=1.47, p&amp;lt; .001); the risk increased 64% for those with &amp;gt;2 vs. ≤2 risk factors (OR=1.64, p=.002). Results using all factors regardless of statistical significance were consistent. Conclusions: A composite model comprised of sociodemographic risk factors can identify patients on AI’s at much greater risk of long-term AI non-adherence. In addition to mitigating side effects, targeted interventions to improve adherence should focus on structural barriers among those at highest risk. Non-adherence (+/- 6 months) = factor + AI duration + AI type, stratified by arm Citation Format: Dawn Hershman, Anna Moseley, Kathryn Arnold, Julie Gralow, Alfred Neugut, Scott Ramsey, N. Lynn Henry, Joseph Unger. Sociodemographic Risk Factors and Prediction of Aromatase Inhibitor Non-Adherence in Women with Breast Cancer Enrolled in SWOG S1105 [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS04-08.

Paediatric off-label use of drugs in Gansu, China: a multicentre cross-sectional study

ObjectiveTo examine the current prevalence and cost of paediatric off-label drug prescriptions in Gansu, China, and the potential influencing factors.DesignThe prevalence of off-label prescriptions in paediatrics was evaluated according to...