Drug Purchases Research Articles

Analysis of drug provision for patients with broncho-obstructive diseases in the Russian Federation

Introduction. The article presents data from an analysis of drug provision for patients with bronchial asthma and chronic obstructive pulmonary disease, both in inpatient conditions and at the stage of outpatient treatment. The object of the study was the provision of medications to patients with broncho-obstructive diseases in the constituent entities of the Russian Federation. The purpose of our study was to study drug provision for patients with broncho-obstructive diseases. Why the following research methods were used: purchases of medicines in federal districts and some constituent entities of the Russian Federation in 2019–2022 were analyzed, the amount of funds per patient diagnosed with bronchial asthma or chronic obstructive pulmonary disease was calculated. Separately, we analyzed the purchases of short- and long-acting bronchodilators, as well as mono- and combination drugs and monoclonal antibody drugs for the treatment of patients with bronchial asthma. Data on drug purchases were analyzed using the website zakupki.gov.ru; information on the number of patients in federal districts and constituent entities of the Russian Federation was taken from statistical materials of the Russian Ministry of Health. Results. We found a multiple difference between federal districts in the amount of funds per patient in both 2019 and 2022, and differentiation between federal districts also turned out to be the case when analyzing preferential drug coverage. The dynamics of the amounts of funds spent by entities on the purchase of drugs for the treatment of patients in outpatient settings turned out to be multidirectional: some entities not only did not increase these amounts in 2012 compared to 2019, but, on the contrary, decreased them. At the same time, the difference between the subjects of the same federal district reaches tenfold values. Conclusion. Patients with broncho-obstructive diseases living in different federal districts of the country have different drug coverage both in outpatient and inpatient treatment settings. To improve the drug supply for these patients, it is necessary to introduce a unified methodology for calculating the planned need for drugs and oblige the subjects to provide patients with chronic obstructive pulmonary disease with drugs at the expense of the budgets of the subjects.

Response Aggregation to Obtain Truthful Answers to Sensitive Questions: Estimating the Prevalence of Illegal Purchases of Prescription Drugs

This research proposes a simple, new technique to obtain truthful answers to sensitive, categorical questions. The paired response technique (PRT) asks participants to merely report the sum of the answers to two paired questions, one baseline and one sensitive, with the answers to each question known only to the participants. The technique then statistically infers the prevalence of the sensitive characteristic and its potential drivers from the association of the baseline question with other questions in the survey. Monte Carlo simulations demonstrate the performance of the PRT under varying conditions. A representative survey (n = 4,649) in the Netherlands about legal and illegal purchases of prescription drugs to enhance sexual performance reveals that 17.4% of the target population has purchased medication to enhance sexual performance at least once. In contrast, in a control group surveyed with direct questioning, only 5.1% admit having done so. The great majority of these individuals opt to purchase illegally. Two further empirical applications, respectively, in the United States and the United Kingdom, show that the PRT reduces cognitive and affective costs of survey participation compared with a state-of-the-art randomized response technique for categorical questions.

“I Don’t Go Overboard”: Perceptions of Overdose Risk and Risk Reduction Strategies among People Who Use Drugs in Rhode Island

Background : North America experiencing an unprecedented overdose epidemic, with data estimating almost 110,000 overdose deaths occurring in 2022 in the United States (US). To address fatal overdoses in the US, community organizations and local health departments in some jurisdictions have expanded community distribution of naloxone, and increased overdose prevention education, and other harm reduction supplies and services (e.g., fentanyl test strips, drug checking programs) to reduce harm for people who use drugs (PWUD). Objectives : Understanding how PWUD manage overdose risk within the context of these expanded services is important for ensuring public health services are meeting their needs. Semi-structured qualitative interviews were conducted with 25 PWUD who were accessing harm reduction services in Rhode Island. Data were imported into NVivo where they were coded and analyzed thematically. Results : Our findings demonstrate the complexity of managing overdose risk in the context of a fentanyl drug supply. While most participants were concerned about overdosing, they sought to manage overdose risk through their own harm reduction practices (e.g., testing their drugs, going slow) and drug purchasing dynamics, even when using alone. Conclusions : Study findings point to the need to implement and scale-up community-level interventions to better support PWUD within the context of the current US overdose crisis.

The relationship between cryptomarket drug purchase, social networks and adverse drug events: A cross-sectional study

The relationship between cryptomarket drug purchase, social networks and adverse drug events: A cross-sectional study

Downsizing and purchases of psychotropic drugs: A longitudinal study of stayers, changers and unemployed.

The evidence is insufficient regarding the association between organizational downsizing and employee mental health. Our aim was to analyze trajectories of prescribed sedatives and anxiolytics with a sufficiently long follow-up time to capture anticipation, implementation and adaption to a downsizing event among stayers, changers and those who become unemployed compared to unexposed employees. Residents in Sweden aged 20-54 years in 2007, with stable employment between 2004 and 2007, were followed between 2005 and 2013 (n = 2,305,795). Employment at a workplace with staff reductions ≥18% between two subsequent years in 2007-2011 (n = 915,461) indicated exposure to, and timing of, downsizing. The unexposed (n = 1,390,334) were randomized into four corresponding sub-cohorts. With generalized estimating equations, we calculated the odds ratios (OR) of purchasing prescribed anxiolytics or sedatives within nine 12-month periods, from four years before to four years after downsizing. In order to investigate whether the groups changed their probability of purchases over time, odds ratios (OR) and their 95% confidence intervals (95% CI) were calculated contrasting the prevalence of purchases during the first and the last 12-month period within four time periods for each exposure group. The odds of purchasing psychotropic drugs increased more for changers (sedatives OR 1.08, 95% CI 1.05-1.11) and unemployed (anxiolytics OR 1.08, 95% CI 1.03-1.14), compared to unexposed before downsizing, while for stayers purchases increased more than for unexposed during and after downsizing. Among those without previous sickness absence, stayers increased their purchases of psychotropic drugs from the year before the event up to four years after the event. This study indicates that being exposed to downsizing is associated with increased use of sedatives and anxiolytics, before the event among those who leave, but especially thereafter for employees who stay in the organization.

Interruptions in Insurance Coverage and Prescription Drug Utilization: Evidence from Kentucky.

This study examined how interruptions in insurance coverage affect purchases of prescription drugs for young adults. It used data spanning 2014 to 2018 from Kentucky's prescription drug monitoring program, which tracked the universe of federally-regulated (Schedule II-V) prescription drugs dispensed in the state. The study employed a regression discontinuity design based on the age limit at 26 for dependent insurance coverage for children. At age 26, the probability of purchasing a prescription decreased by 5%, with all subcategories of prescriptions affected. The share of generic prescriptions increased for stimulants (the only category observed with substantial branded prescriptions). By age 27, prescription purchases returned to levels observed at 25, but the share purchased with public insurance and the generic share for stimulants remained higher. The findings suggest that interruptions in insurance coverage decrease prescription drug utilization by young adults and that public insurance programs such as Medicaid are important for resuming treatment.

The relationship between cryptomarket drug purchase, social networks and adverse drug events: A cross-sectional study

IntroductionDrug use and trading are typically social activities; however, supply through cryptomarkets can occur without any in-person social contact. People who use drugs alone may be at higher risk of experiencing harms, for example, due to lack of others who may call for emergency assistance. Alternatively, cryptomarkets may be a source of harm reduction information and drugs with better-known content and dose, potentially reducing the risk of adverse events. This study examines relationships between cryptomarket use, drug-using social networks and adverse drug events for MDMA, cocaine and LSD. MethodA subsample of 23,053 respondents from over 70 countries was collected in the 2018 Global Drug Survey. People who reported using MDMA, cocaine or LSD were asked about using cryptomarkets to purchase these drugs; any adverse drug events requiring medical treatment (combining seeking treatment and should have sought treatment but did not); and social networks who they had used the specific drug with. All measures referred to the last 12 months, hereon referred to as ‘recent’. Binary logistic regressions examined relationships between cryptomarket use, drug-using social networks, and adverse drug events, controlling for age, gender, and frequency of drug use. ResultsAdverse events from any drug type were low (5.2%) and for each drug; MDMA (3.5%); cocaine (3.3%); and LSD (3.5%). After controlling for covariates, recent cryptomarket use was associated with increased likelihood of having no drug-using network for each drug type. People who recently used cryptomarkets were more likely to report adverse cocaine (AOR = 1.70 (1.22-2.37)) and LSD (AOR = 1.58 (1.12-2.09)) events. For those reporting a network size >1, network characteristics did not differ with recent cryptomarket use; however, those reporting recent cryptomarket use were more likely to report adverse LSD events (AOR = 1.86 (0.99-3.51)). ConclusionPeople who reported purchasing drugs from cryptomarkets more commonly reported having no drug-using network, and cryptomarket purchase was associated with reported adverse events. Our results support the notion that cryptomarket use increases drug-related harm, but further disentanglement of multiple complex mechanisms is needed in future research.

Cyber Crime Classification and Analysis of Various Indian States and Union Territories During 2011 to 2022 Using Data Mining Techniques

This paper attempts to identify the performance and to classify the cybercrime rate in Indian states during the period of 2022 with twenty-seven states and seven union teritories. The secondary source of data were collected from National Crime Records Bureau in India. Intially, the researchers selected 27 parameters related to crime. After data mining few variables are discarded from the analysis. The discarded variables are considered as outliers. The remaing twenty parameters were considered for further analysis, the variables like hacking the system, sexual exploitation, business, personal emotion, purchase of illegal drugs, spreading piracy, motives of blackmailing, etc. In this connection the main objectives are (i) to identify in which states crime rate is more, (ii) to identify which factors influence more for cybercrime, and (iii) to classify the performance based on the k-means clustering techniques. The results are classifed and are labelled as High Cyber Crime Rate States (HCCRS), Moderate Cyber Crime Rate States (MCCRS) and Low Cyber Crime Rate States (LCCRS)

Antimicrobial stewardship in private pharmacies in Wakiso district, Uganda: a qualitative study

BackgroundPrivate pharmacies are the first point of contact for the public regarding acquisition of medicines and other pharmaceuticals in many low- and middle-income countries including Uganda. Most antimicrobial stewardship (AMS) programmes in Uganda have targeted pharmacies in public health facilities, with little known about private pharmacies. This study explored knowledge and practices related to AMS in private pharmacies in Wakiso district, central Uganda.MethodsThis was a qualitative study that involved 31 in-depth interviews to explore AMS among retail private pharmacy staff including pharmacists, pharmacy technicians/dispensers, and nurses. Participants were asked about antimicrobial resistance (AMR) and AMS practices at their pharmacy. The audio-recorded interviews were transcribed verbatim and imported to NVivo 2020 (QSR International) for thematic analysis.ResultsFive major themes emerged from the study: commonly sold antimicrobials; knowledge on AMR and AMS; potential contributors to AMR; practices related to AMS; and challenges to AMS. The commonly sold antimicrobials in the pharmacies with or without prescriptions were oral azithromycin, Ampiclox® (ampicillin and cloxacillin), amoxicillin, ciprofloxacin, Septrin® (co-trimoxazole), metronidazole, Flucamox® (amoxicillin and flucloxacillin), Augmentin® (amoxicillin and clavulanic acid), cephalexin, doxycycline, and chloramphenicol. Participants had heard about AMR but not AMS, although only a few correctly defined AMR. Lack of knowledge among health workers and local communities; the overuse, misuse, and abuse of antimicrobials such as non-adherence to dosage; self-medication; and purchase of drugs without prescription were identified as potential accelerators to the emergence of AMR. Current practices related to AMS in private pharmacies were limited to meetings, antimicrobial dispensing, providing client advice, record keeping, and monitoring of drugs. Cost of healthcare, client satisfaction and retention, outdated guidelines, and the business orientation of pharmacies were the main challenges related to AMS.ConclusionThere was poor knowledge of AMR and AMS, and limited AMS practices in private pharmacies. Private pharmacies have the potential to contribute to Uganda’s fight against AMR if motivated and equipped with adequate knowledge to enhance their practices related to AMS.

Anticoagulation therapy in patients with atrial fibrillation and active cancer

Abstract Background Atrial fibrillation (AF) is common among cancer patients. Oral anticoagulation therapy (OAT) is important to prevent stroke in AF patients, but active cancer may also predispose to bleeding. Current knowledge on the use of OAT among AF patients with active cancer is scarce. Purpose To assess the influence of active cancer on the initiation of OAT in patients with AF and to explore cancer features predicting withholding OAT. Methods The nationwide FinACAF registry linked data from several registries covering all levels of care as well as drug purchases and included all 123 618 patients diagnosed with incident AF in Finland during 2011- 2018 with an indication for OAT (≥1 non-sex CHA2DS2-VASc point). Patients were considered to have active cancer if they had received a new cancer diagnosis or treatment for cancer during the preceding year from AF diagnosis. The primary outcome was the initiation of OAT (including non-vitamin K oral anticoagulants (NOAC) and warfarin) and the secondary outcome the initiation of any anticoagulation therapy (AAT; including OAT and low molecular-weight heparin) during the first year from AF diagnosis. Results The mean age of the patients was 73.9 (standard deviation 11.5) years and 62 955 (50.9%) of them were women. Altogether, 7015 (5.7%) patients had active cancer at AF diagnosis. The median CHA2DS2-VASc (3 [interquartile range 2-4] for both groups) and HAS-BLED (2 [interquartile range 2-3] for both groups) scores were similar in patients with active cancer and those without cancer history. Patients with active cancer, compared to those without cancer history, less often initiated OAT (47.7% vs. 70.5 %) or AAT (61.8% vs. 71.8%) (Figure). In Fine-Gray regression analyses with all-cause mortality as a competing risk, after adjusting for confounding factors, active cancer remained associated with lower likelihood of OAT (adjusted subdistribution hazard ratio (aSHR 0.501) (95% confidence interval (CI): 0.485-0.518), p<0.001) as well as AAT (aSHR 0.745 (95%-CI 0.723-0.769, p<0.001) initiation. Among cancer patients, metastases, gastrointestinal cancer and radiotherapy were associated with lower likelihood of OAT initiation, while only metastases predicted lower likelihood of AAT initiation (Table). Among patients initiating OAT, active cancer was associated with lesser likelihood of choosing a NOAC over warfarin compared to those without cancer (36.0% vs. 39.2%; adjusted hazard ratio 0.712 (95%-CI: 0.640-0.792), p<0.001). Conclusion AF patients with active cancer are less likely to initiate anticoagulation therapy, and those starting OAT are less likely to initiate with NOACs, compared to patients without cancer history. Metastases are the most important predictor of withholding anticoagulation therapy among AF patients with cancer.

Analyzing Black Market Sales of the Second-Line ADHD Medication Atomoxetine

Research Question and Objective: While the number of pharmacoepidemiological studies on stimulant-based ADHD medications has expanded rapidly in recent years, likely due to the stimulant shortage, few studies have analyzed non-stimulant ADHD medications from a pharmacoepidemiological perspective. Such research is important because a significant number of individuals with ADHD have medical or psychiatric conditions that preclude stimulant use. Furthermore, no studies, to our knowledge, have analyzed atomoxetine exchanges on the black market. In this report, we seek to fill both these gaps in the research by analyzing black market diversions of atomoxetine, a non-stimulant medication for ADHD. As ADHD medication diversion is a growing issue, we also hypothesize the pharmacoepidemiologic contributors to and implications of such diversion. Method: This study analyzed black market atomoxetine purchases entered on the web-based platform StreetRx between January 2015 and July 2019. Data included the generic drug name, dosage, purchase price, date, and location in the United States. The mean price per milligram was determined and a heatmap was generated. Results: The average price per milligram of 113 diverted atomoxetine submissions was USD 1.35 (±USD 2.76 SD) (Median = USD 0.05, Min = USD 0.01, Max = USD 20.00). The states with the most submissions included Michigan (11), Pennsylvania (9), Indiana (8), and Ohio (8). Conclusion: The cost per milligram of atomoxetine on the black market is over 50 times the cost per milligram of the generic prescribed form. Future qualitative studies should investigate reasons why individuals are motivated to purchase atomoxetine, a non-stimulant medication, on the black market (recreational vs. nootropic vs. other clinical uses).

Streptococcus salivarius Probiotics to Prevent Acute Otitis Media in Children

New approaches for the prevention of acute otitis media (AOM), the most common reason for antibiotic use in children, are needed. To assess the efficacy of the Streptococcus salivarius K12 oral probiotics in the primary prevention of AOM. This double-blind, randomized placebo-controlled clinical trial was conducted from August 1, 2020, to May 31, 2021, at 50 day care centers in the Oulu region of Finland. A total of 827 children aged 1 to 6 years attending day care were included. The exclusion criteria consisted of ongoing antimicrobial prophylaxis or immunodeficiency. The follow-up time was 6 months and was completed on May 31, 2021. Data were analyzed from October 24, 2022, to September 16, 2023, based on intention to treat. Eligible participants were randomly allocated to receive 1 daily dose of a S salivarius K12 product or placebo every evening for 6 months. A daily dose was defined as 1 sachet of soluble oral powder for children younger than 3 years or 1 chewable tablet for children 3 years or older containing 1 × 109 colony-forming units of S salivarius K12. The primary outcome was the proportion of children with at least 1 episode of AOM requiring antimicrobial therapy within 6 months of randomization. All physician visits and purchases of antimicrobial drugs were retrieved from the electronic national medical record and prescription register. The primary outcome was met if the legal guardian had purchased an antimicrobial prescription for AOM. A total of 827 children with a mean (SD) age of 4.1 (1.6) years (433 boys [52.4%]) were randomized to S salivarius K12 oral products (n = 413) or placebo (n = 414). Thirty-four children (8.2%) in the S salivarius group and 24 children (5.8%) in the placebo group experienced at least 1 episode of AOM requiring antimicrobial therapy during the 6-month follow-up period (relative risk, 1.42 [95% CI, 0.86-2.34]; proportion difference, -2.44% [95% CI, -5.94% to 1.09%]; P = .17). Time to first AOM episode did not differ between the groups (174 [95% CI, 171-177] days in the S salivarius group vs 176 [95% CI, 173-179] days in the placebo group; P = .18). In this randomized placebo-controlled clinical trial, the daily use of the S salivarius K12 products for 6 months did not reduce the occurrence of AOM. New approaches for primary prevention of AOM among children are needed. ClinicalTrialsRegister.eu Identifier: 2020-001076-14.

Should the Carbon Footprint of Care be Taken into Account When Choosing a Treatment for Lymphoma? a Case Application on Mantle Cell Lymphoma

OBJECTIVE While climate change represents the greatest threat of the current century on human health, the carbon footprint of the healthcare sector represents 7-10% of occidental countries green house gas (GHG) emissions. Purchases, mostly of drugs and medical devices, represent about 50% of emissions. Oncology and hematology are suspected to be particularly carbon intensive, as they require long term and frequent consumption of healthcare resources. Here, we estimate the carbon footprint associated with different therapeutic strategies (including chemo-free or high dose chemotherapy) in patients with Mantle Cell Lymphoma (MCL) and discuss their future health impacts. METHODS Standard immunochemotherapy based versus chemo-free strategies were compared both in 1) the ≤65 years old/fit and 2) in the >65 years old/unfit populations. Namely, we compared 1) immunochemotherapy induction (rituximab, dexamethasone, cytarabine, and a platinum derivative) followed by autologous stem-cell transplantation and 3-year rituximab maintenance (LyMa) to obinituzumab, ibrutinib, venetoclax combination (OIV), and 2) rituximab, bendamustine combination (RB) to rituximab, ibrutinib combination (RI). These treatment schemes were considered to have similar clinical efficacy in each sub-group of patients. Carbon footprints were estimated by considering drugs, medical devices, hospital stays, car journeys, medical biology and imaging consumption in the French context. Drug specific method (including production, packaging and transport with or without R&D, sales, general and administrative costs), and non-drug specific methods using mean emission factors based on their costs (kgCO2eq/€ from the French Environment Agency (ADEME) and the US Environmentally-Extended Input-Output (USEEIO) models) were applied to estimate drug carbon footprints and were compared in a sensitivity analysis. Carbon footprints were translated into future disability adjusted life years (DALY, a metric similar to quality adjusted life years QALY) expected to be lost in the future using the ReCiPe 2016 model. RESULTS The carbon footprint of each therapeutic strategy varied from 6.6 to 69.1 tCO2eq. In each, >70% of the total carbon footprint was related to drug purchase. A larger fraction (10-70%) of the carbon footprint of biotherapies (rituximab, obinituzumab) and low-cost small molecules (cotrimoxazole, valaciclovir) is related to their production while it is smaller (<10%) for high-cost small molecules (ibrutinib, venetoclax) that require higher R&D, sales, general and administrative costs. In the ≤65 years old/fit population, treating a patient with LyMa leads to the emission of 16.8 tCO2eq corresponding to an estimated 0.21 [95%CI 0.08-0.51] induced DALY. Treating a patient with OIV for 5 years leads to the emission of 69.1 t CO2eq (0.86 [0.35-2.09] DALY) whereas stopping the treatment at 2 years leads to the emission of 36.6 tCO2eq (0.46 [0.19-1.11] DALY). In the >65 years old/unfit population, treating a patient with RB leads to the emission of 6.6 tCO2eq (0.08 [0.03-0.2] DALY) while treating a patient with RI for 5 years leads to the emission of 41.1 tCO2eq (0.51 [0.21-1.25] DALY) whereas stopping the treatment at 2 years leads to the emission of 22.7 tCO2eq (0.28 [0.12-0.69] DALY). These estimates have to be taken with caution, as they are highly dependent on the method chosen. Using non-drug specific ADEME or USEEIO mean emission factors increase the carbon footprint of 2 year OIV from 36.6 tCO2eq to 164 tCO2eq and 313 tCO2eq, respectively. On the contrary, only accounting for drug production, packaging and transport diminishes its carbon footprint to 10.8 tCO2eq. Detailed discussion on the models, on the impact of R&D and on the use of generic/biosimilar drugs will be provided at the congress. CONCLUSIONS Treatment of patients with MCL is associated with a significant carbon footprint. Integrating their carbon footprint in the therapeutic decisions (such as length of treatment) could lead to significant decreases in carbon emissions that could translate into less health damages to future generations. Drug specific carbon accounting methods seem more adapted than nonspecific ones to estimate the carbon footprint of high cost drugs . Future research is required to determine more precisely the carbon footprint of drugs and therapeutic strategies in patients with hematological malignancies.

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.

Ifema hospital model. Implementation and start-up of the Pharmacy Department

On the 20th of March 2020, triggered by the public health emergency declared, the Health Authorities in Madrid reported a legal instruction (Orden 371/2020) indicating the organization of a provisional hospital to admit patients with COVID-19 at the Trade Fair Institution (IFEMA).Several pharmacists working in the Pharmacy and Medical Devices Department of the Madrid Regional Health Service were called to manage the Pharmacy Department of the abovementioned hospital. Required permissions to set up a PD were here authorized urgently.Tackling human and material resources, and computer systems for drug purchase and electronic prescription, were some of the initial issues that hindered the pharmaceutical provision required for patients from the very day one.Once the purchase was assured, mainly by direct purchase from suppliers, drug dispensing up to 1,250 hospitalized patients (25 nursing units) and 8 ICU patients was taken on. Dispensing was carried out through either drug stocks in the nursing units or individual patient dispensing for certain drugs.Moreover, safety issues related to prescription were considered, and as the electronic prescription was implemented we attained 100% prescriptions review and validation. The constitution of a multidisciplinary Pharmacy and Therapeutics Committee let agree to a pharmacotherapy guide, prescription protocols, therapeutic equivalences, interactions, and drug dispensing circuits.The Pharmacy Department strategy was to ensure a very quick response to basic tasks keeping the aim to offer a pharmaceutical care of the highest quality whenever possible.Working under a health emergency situation, with many uncertainties and continuous pressure was a plight. However, the spirit of collaboration in and out of the Pharmacy Department was aligned with the whole hospital motivation to offer the highest quality of healthcare. These were possibly the keys to allow caring for almost 4,000 patients during the 42 days that the hospital lasted.

Collusion and price-fixing of drugs in Mexico: The case of metformin (2008-2018)

Objective. This study aims to analyze the collusion of pharmaceutical companies that hinders competition in the pharmaceutical market and if this phenomenon leads to an increase in overpricing in government drug purchases and a decrease in social welfare. Design and setting. A descriptive analysis was carried out based on drug purchase data by the Mexican Social Security Institute (MSSI) to the leading companies in the pharmaceutical sector, and a well-being changes analysis was carried out using the Harberger triangle method. Results. The data shows that a consortium of drug suppliers sold metformin at a premium to one of the prominent public health institutes in the country. Furthermore, there was a highly significant decrease in well-being indices. Conclusion. Industry executives and government officials were acting during that period as a cartel, colluding to set high prices during 2008-2018. Collusion hinders competition between companies; consequently, the consumer does not always have access to the lowest available drug price.

Prevalence of pre-eclampsia in 265 patients with an intracranial aneurysm, 393 female relatives versus a control cohort: Acase-control study.

There is emerging evidence on the connection between pre-eclampsia and saccular intracranial aneurysms (sIAs). Our aim was to study the prevalence of pre-eclampsia in sIA patients, their female relatives, and matched controls, and to examine familial sIA disease and familial pre-eclampsia in sIA patients' families. We included all female sIA patients in the Kuopio Intracranial Aneurysm Patient and Family Database from 1995 to 2018. First, we identified the sIA patients, their female relatives, and matched population controls with the first birth in 1987 or later and studied the prevalence of pre-eclampsia. Second, all female sIA patients and all female relatives were analyzed for familial sIA disease and familial pre-eclampsia. Using the Finnish nationwide health registries, we obtained data on drug purchases, hospital diagnoses, and causes of death. In total, 265 sIA patients, 57 daughters, 167 sisters, 169 nieces, and 546 matched controls had the first birth in 1987 or later. Among them, 29 (11%) sIA patients, 5 (9%) daughters, 10 (6%) sisters, 10 (6%) nieces, and 32 (6%) controls had pre-eclampsia. Of all the 1895 female sIA patients and 12,141 female relatives, 68 sIA patients and 375 relatives had pre-eclampsia, including 32 families with familial pre-eclampsia. Pre-eclampsia was significantly more common in the sIA patients than in their matched controls. Familial sIA disease and familial pre-eclampsia co-occurred in seven families. Further studies of the mechanisms by which pre-eclampsia could affect the walls of brain arteries and increase the rupture risk in sIA disease are indicated.

Analisis Efektivitas Penggunaan System Console pharmacy terhadap Pembelian Obat Rawat Jalan Non Racikan di RS Premier Jatinegara

Hospital pharmacies are responsible for managing and monitoring the drug use process and ensuring the safe, effective, economical and timely availability of drugs to patients and hospital staff. The waiting times indikator set by the Hospital for non-compound drugs is less than 20 minutes with a target delay less than 10%. However, during the period July 2021 to June 2022, 56,77% of the drugs were prepared beyond 20 minutes. The Pharmacy Department and hospital manajemen decided to improve the manajemen of outpatient drug purchase queues by using an automated prescription queuing system (pharmacy console). Analyze the effect of using the console pharmacy system for outpatients purchase of non-compound drugs in terms of decreasing the percentage of delays when non- compound drugs are received by patients exceeding 20 minutes and increasing the number of line itemss in outpatient pharmacy. Analysis data of non-compound drugs delay report and the number of line itemss report in outpatient pharmacy in the period July-December 2022 after using the console pharmacy system. The number of prescriptions delayed more than 20 minutes decreased from a monthly average of 56.77% to 36.54%, a decrease of 20.23% per month. The number of Pharmacy line itemss also increased from the average per month in the previous period of 45,415 to 53,945 or an increase of 8,531 per month. Even though it still has not reached the target, the console pharmacy system has proven to be effective in providing many advantages for Premier Jatinegara Hospital in reducing waiting times and increasing the purchase of non-compound drugs in outpatients pharmacy. Pharmacy Departments and hospital manajemen must continue to work together for continuous improvement.
 

Economic burden of advanced lung cancer patients treated by gefitinib alone and combined with chemotherapy in two regions of China

AimTo assess the economic burden of different chemotherapies for lung cancer patients and influencing factors in China.Materials and methodsThe economic burden of lung cancer, including direct, indirect and intangible costs was measured within three months after diagnosis and treatment. Direct cost included the cost of hospitalization, outpatient visits, out-of-pocket drug purchases, costs of transportation, accommodation and meal expenses while seeking treatments in hospitals. Cost information was attained from questionnaire and patients’ medical record. Indirect cost was measured by the patients’ and their caregivers’ productive days lost due to outpatient visits and hospitalization for lung cancer treatment. Intangible cost was obtained through the willingness-to-pay method from a questionnaire completed by the patient.ResultsAmong the total cost of CNY71,401.92, direct cost, indirect cost and intangible cost constituted 89.02%, 4.29%, and 6.69% respectively. Educational level, occupation, family income, lung cancer classification, and the city of residence significantly influenced the total cost.LimitationsLimitations in our study included: First, our follow-up period of three months was relatively short compared to the whole survival period of lung cancer patients. Second, the sample size of the chemotherapy combined with targeted therapy group was not large enough, and the cost data obtained would need confirmation in future studies. Third, participants came from only two localities, which may somewhat limit the representativeness of the study results for the whole of China.ConclusionsThe economic burden of lung cancer treatment mainly came from the cost of the drugs. Patients taking chemotherapy had significantly higher cost compared to patients using targeted therapy. The cost was generally higher for those with higher educational level, those with higher family income, and those living in an economically more developed city. Patients with NSCLC had higher cost compared to patients with SCLC.

The Asymmetry of Embeddedness: Illegal Trade Networks and Drug Purchasing Diversity on an Online Illegal Drug Market

Abstract While economic sociology research and theory argue that excessive network embeddedness depresses competition in illegal markets, prior research does not examine how distinct types of embeddedness may have asymmetric effects on the diversity of purchasing behavior—the range of illegal goods that buyers typically purchase. This study considers how network embeddedness can positively or negatively affect drug purchasing diversity in online drug markets by referring buyers to new vendors or “locking” buyers into recurrent trade for the same products. We analyze novel network data on 16,847 illegal drug exchanges between 7205 actors on one online illegal drug market. Consistent with hypothesized network asymmetry, buyers are more likely to purchase a new type of drug when the transaction is part of an indirect network referral. Although histories of exchange increase the overall frequency of drug purchasing, they are associated with decreases in new drug-type purchases. In the aggregate, these processes either contribute to an integrated market where buyers purchase multiple drugs from multiple vendors (in the case of referrals) or a fragmented market characterized by recurrent trade from the same vendors for the same substances (in the case of repeated trade). We discuss the implications of these findings for research on embeddedness, illegal markets, risky exchange, and drug policy.