Reduce Drug Costs Research Articles

Optimizing Cefiderocol Dosing Through Population Pharmacokinetic/Pharmacodynamic Simulation: An Assessment of Drug Cost Reductions.

Cefiderocol is a siderophore cephalosporin antibiotic with bactericidal activity against carbapenem-resistant Enterobacterales. However, an efficient dosing strategy is yet to be developed. This study aimed to evaluate efficient lower-dose regimens and estimate potential drug cost reductions. This simulation study used a virtual population of 10,000 resampled individuals based on a reported population pharmacokinetic model. The target index for maximal bactericidal activity was the time for the unbound cefiderocol concentration to be above the minimum inhibitory concentration (TAM_unbound) of 100%, which was determined using a minimum inhibitory concentration distribution or specific value. The probability of achieving 100% TAM_unbound with the standard, low- (reduced by 1 g or one dose), and extended low- (reduced by 2 g or 2 doses) dose regimens was nearly 100%. The lowest probability of achieving 100% TAM_unbound with the extended low-dose regimen at a creatinine clearance range of 90-120 mL/min was 86.4%. The probability of achieving TAM_unbound of 100% was more than 90% for MIC of ≤0.5 mcg/mL with the extended low-dosing regimen. Furthermore, using an efficient dosing regimen reduced the medical costs over a 10-day treatment period for 10 patients, from $122,826.50 to $62,665.69 $ and ¥12,598,187 $ to ¥5,451,173 in the United States and Japan, respectively. A lower dosing regimen for cefiderocol could result in substantial reductions in drug costs while still achieving 100% TAM_unbound.

De-simplifying antiretroviral therapy from a single-tablet to a two-tablet regimen: Acceptance, patient-reported outcomes, and cost savings in a multicentre study.

Antiretroviral therapy (ART), which is increasingly used by people with HIV, accounts for significant care costs, particularly because of single-tablet regimens (STRs). This study explored de-simplification to a two-tablet regimen (TTR) for cost reduction. The objectives of this study were: (1) acceptance of de-simplification, (2) patient-reported outcomes, and (3) cost savings. All individuals on Triumeq®, Atripla® or Eviplera® in five HIV clinics in the Netherlands were eligible. Healthcare providers informed individuals of this study. After inclusion, individuals were free to de-simplify. An electronic questionnaire was sent to assess study acceptance, adherence, quality of life (SF12) and treatment satisfaction (HIVTSQ). After 3 and 12 months, questionnaires were repeated. Cost savings were calculated using Dutch drug prices. In total, 283 individuals were included, of whom 55.5% agreed to de-simplify their ART, with a large variability between treatment centres: 41.1-74.2%. Individuals who were willing to de-simplify tended to be older, had a longer history of HIV diagnosis, and used more co-medication than those who preferred to remain on an STR regimen. Patient-reported outcomes, including quality of life and treatment satisfaction, showed no significant difference between people with HIV who switched to a TTR and those who remained on an STR regimen. Furthermore, we observed a 17.8% reduction in drug costs in our cohort of people with HIV who were initially on an STR. De-simplification from an STR to a TTR within the Dutch healthcare setting has been demonstrated as feasible, leads to significant cost reductions and should be discussed with every eligible person with HIV in the Netherlands.

Dosage Adjustment as an Efficiency in Treatment Costs for Chronic Kidney Disease Patients

Introduction: Chronic Kidney Disease (CKD) treatment, in all stages, has been shown to impose a big economic burden. To reduce drug costs, dose adjustment can be used in CKD treatment. Apart from saving costs, dose adjustments can also reduce the risk of side effects due to excessive doses. This research aimed to identify the dose suitability of CKD patient treatment and calculate the difference in treatment costs before and after the dose adjustments. Method: This research was a cross-sectional study using descriptive analysis. Data was collected from medical records in UGM Academic Hospital using purposive nonrandom sampling in inpatient CKD patients with decreased creatinine clearance and serum creatinine who underwent hospitalization for at least one year. Result: There were 58.14% male patients and 41.86% female patients. Most of the patients have stage 5 CKD (46.51%) and hypertension comorbidities (59.30%). Around 69.14% of drugs used in treatment required dose adjustment and only 52.33% of them had appropriate doses based on the Lexicomp Drug Information Handbook. The class of drugs that required the most dose adjustments was antibiotics with 14 occurrences. After the dose adjustment, the saved cost from patients with inappropriate doses was IDR 1,766,330. The biggest cost difference after the dose adjustment was IDR 1,090,865, which comes from the antibiotic group. Conclusion: Dosage adjustments can reduce the incidence of medication errors, improve clinical outcomes, and increase the effectiveness of clinical outcomes and cost-effectiveness.

Проблемы комплаенса в кардиологической практике

Cardiovascular diseases are the leading cause of death worldwide. Despite the achievements of pharmacotherapy, which leads to a decrease in morbidity and mortality associated with cardiovascular diseases, non-compliance with prescribed treatment remains a significant problem for improving the prognosis of the disease. The research purpose is to study the features of compliance in patients with chronic cardiovascular diseases, to find ways to improve adherence to treatment. Materials and methods. The study was carried out on the basis of a systematic approach to the violation of treatment processes, due to the low level of compliance. The methods were analysis of scientific literature, comparison, generalization, systematization. Results. The systematic approach is the most promising in increasing the level of compliance in patients with a cardiological profile. Presented various strategies for improving adherence to medication include the following categories: improving patient education, introducing medication reminders, management tactics for people with cognitive emotional disorders, reducing drug costs, involving family members to comply with medical prescriptions, optimizing drug dosing regimens. We consider the influence of compliance on the prognosis of the course of diseases, trends in improving compliance. Conclusions. The practical application of the obtained theoretical results makes it possible to identify the relationship between the prognosis of the course of the disease and compliance with the treatment regimen. We determine new technologies and patient management strategies contributing to an increase in the level of compliance.

Recently Proposed Federal and State Legislation To Constrain Pharmacy Benefit Managers Would Not Reduce Drug Costs

Recently Proposed Federal and State Legislation To Constrain Pharmacy Benefit Managers Would Not Reduce Drug Costs

Evaluation of the Leftover Capecitabine Tablets in Adjuvant CAPOX Chemotherapy for Gastric Cancer

Since it is important that patients take their oral anticancer therapy as prescribed, pharmacists need to assess adherence. In addition, oral anticancer drugs are expensive, and reuse of leftover drugs at outpatient pharmacy clinics is useful in reducing drug costs. The present study aimed to clarify when and why patients have leftover capecitabine tablets, and the cost of leftover capecitabine tablets reused at an outpatient pharmacy clinic, focusing on adjuvant capecitabine plus oxaliplatin (CAPOX) chemotherapy for gastric cancer. We retrospectively studied patients who received adjuvant CAPOX chemotherapy for gastric cancer between November 1, 2015, and April 30, 2021, at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research. The cost of leftover capecitabine reused by pharmacists was calculated based on the National Health Insurance drug price standard for the study period. This study included 64 patients who received adjuvant CAPOX chemotherapy. Thirty-seven patients had 152 leftover capecitabine tablets. The most common reasons for leftover capecitabine tablets were nausea and vomiting (21.7%), missed doses (18.4%), and diarrhea (13.2%). The leftover capecitabine tablets for 25 patients were reused at the outpatient pharmacy clinic at a cost of JPY 604142.8 (JPY 24165.7 per patient). The study results suggest that evaluating capecitabine adherence and the reasons for leftover capecitabine tablets at outpatient pharmacy clinics as well as reusing leftover medication can contribute to reducing drug costs.

Positioning System of Working Bodies in Differential Spraying of Plants

The paper highlights that the escalation in the use of pesticides and agrochemicals poses a significant risk to human health, environmental integrity, and food safety. The predominant method of pesticide application is crop spraying. Improved efficiency and quality of spraying, coupled with a reduction in drug costs, can be achieved by transitioning to differential treatment of agricultural land and precision dose regulation. The incorporation of robotic devices offers a promising solution to facilitate the process of plant protection. (Research purpose) The research aims to develop a positioning system for a robotic differential spraying device. (Materials and methods) were subjected to chemical treatment by an autonomous field robot, and the quality of spraying was assessed using a nozzle. (Results and discussion) The research established a relationship between calculating the nozzle capture angle of an individual plant and the angle of lever lift. Subsequently, a computerized spraying model was developed, enabling the adjustment of various parameters and benchmarking the proposed differential spraying method against the traditional one. The variation coefficient, reflecting the uniformity of droplet distribution on the plant surface, was calculated. The results indicate that the variation coefficient is dependent on the speed and distance of spraying in different operating modes, including individual plant spraying and row spraying. (Conclusions) The variation coefficient for the traditional spray method was 46 percent. With the adoption of differential spraying methods, this variation coefficient decreased to 25-28 percent for individual plant spraying and 33-40 percent for row spraying. Field studies further demonstrated a variation coefficient of 19-24 percent for individual plant spraying in contrast to 30-35 percent for row-spray treatments.

Tailored doses, tailored savings: Optimizing dosing strategies of immune checkpoint inhibitors.

68 Background: While immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, their high cost and limited global supply pose major challenges. Optimizing ICI dosing to achieve a minimum effective dose that has shown to maintain clinical benefit may be a potential solution with significant savings to the health system. We investigated potential savings in Medicare that could be attained from alternative ICI dosing. Methods: We conducted a literature review including original Phase 1/2 trials describing the minimal effective dose of three commonly used ICIs: Pembrolizumab (P), Nivolumab (N) and Atezolizumab (A). Alternate dosing strategies based on existing data for Pembrolizumab (2 mg/kg), Nivolumab (1 mg/kg) and Atezolizumab (4 mg/kg) were proposed. Publicly available CMS data on Medicare Part B expenditure for these therapies was utilized to obtain average cost per dosage unit, mg/dosage unit, and number of Medicare beneficiaries between 2018-2021. Average cost per dose and total cost per ICI was calculated based on current FDA approved dosing and alternate dosing strategies. Results: The average wholesale cost per fixed dose for P (200 mg), N (480 mg), and A were $9,242.00, $12,460.80, and $8,616.00, respectively. Implementing the proposed alternate dosing strategies led to a substantial reduction in drug costs: P ($7,393.60), N ($2,076.80), and A ($2,297.60). The ensuing cost savings were calculated based on the annual number of Medicare beneficiaries. From 2018-2021, the average total savings were estimated to be $95,545,182 for Pembrolizumab, $294,734,264 for Nivolumab, and $62,937,582 for Atezolizumab (Table). The cumulative average total cost savings from 2018-2021 exceeded $453 million. Conclusions: We demonstrate potential savings in Medicare with implementation of an alternative ICI dosing strategy. Our study underscores an urgent need to better understand clinical efficacy and cost savings from a patient perspective, and feasibility from a regulatory standpoint. This perspective may hold considerable global implications, providing a roadmap for cost-effective care in the domain of immunotherapy. [Table: see text]

Real-World Cost Effectiveness of a Policy of KRAS Testing to Inform Cetuximab or Panitumumab for Third-Line Therapy of Metastatic Colorectal Cancer in British Columbia, Canada.

Cetuximab and panitumumab, two anti-EGFR therapies, are widely used for third-line therapy of metastatic colorectal cancer (mCRC) with wild-type KRAS, but there remains uncertainty around their cost effectiveness. The objective of this analysis was to conduct a real-world cost-effectiveness analysis of the policy change introducing KRAS testing and third-line anti-EGFR therapy mCRC in British Columbia (BC), Canada. We conducted secondary analysis of administrative data for a cohort of mCRC patients treated in BC in 2006-2015. Patients potentially eligible for KRAS testing and third-line therapy after the policy change (July 2009) were matched 2:1 to pre-policy patients using genetic matching on propensity score and baseline covariates. Costs and survival time were calculated over an 8-year time horizon, with bootstrapping to characterize uncertainty around endpoints. Cost effectiveness was expressed using incremental cost-effectiveness ratios (ICER) and the probability of cost effectiveness at a range of thresholds. The cohort included 1757 mCRC patients (n=456 pre-policy and n=1304 post-policy; of those, n=420 received cetuximab or panitumumab). There was a significant increase in survival and cost following the policy change. Adoption of KRAS testing and anti-EGFR therapy had an ICER of CA$73,759 per life-year gained (LYG) (95% CI 46,133-186,446). In scenario analysis, a reduction in cetuximab and panitumumab cost of at least 50% was required to make the policy change cost effective at a threshold of CA$50,000/LYG. A policy of third-line anti-EGFR therapy informed by KRAS testing may be considered cost effective at thresholds above CA$70,000/LYG. Reduction in drug costs, through price discounts or potential future biosimilars, would make anti-EGFR therapy considerably more cost effective. By using real-world data for a large cohort with long follow-up we can assess the value of a policy of KRAS testing and anti-EGFR therapy achieved in practice.

Cost-Effectiveness Analysis of Long-acting Injectable Once-monthly of Aripiprazole Compared with Long-acting Injectable Once-monthly Paliperidone Palmitate for the Treatment of Stable Schizophrenia Patients in Thailand

Objective: Long-acting injectable (LAI)-aripiprazole and LAI-paliperidone palmitate are both second-generation antipsychotics that have been introduced to increase drug compliance in patients. These attributes are expected to enhance drug compliance, particularly in stable patients. The previous studies demonstrated that the efficacy of LAI-aripiprazole and LAI-paliperidone palmitate is controversial. Nevertheless, the costs of treatments and adverse events of both LAI-aripiprazole and LAI-paliperidone palmitate are unlikeness. As there had been no previous cost-effectiveness studies comparing the use of LAI-aripiprazole and LAI-paliperidone palmitate in Thailand, this study was carried out to investigate the matter. Materials and Methods: This study analysed the cost-effectiveness of LAI-aripiprazole compared with LAI-paliperidone palmitate in the treatment of stable schizophrenia, by using the Markov model from a societal perspective. Results: The total cost of treatment with LAI-aripiprazole and LAI-paliperidone palmitate was 1,334,919.05 baht and 1,329,818.79 baht, respectively, while the quality-adjusted life years (QALYs) were both 16.35 years. Life-year of the treatment with LAI-aripiprazole and LAI-paliperidone was 24.27 years and 24.25 years, respectively. The cost-effectiveness ratios (CER) of the treatment with LAI-aripiprazole and LAI-paliperidone palmitate were 81,652.85 baht/QALY gained and 81,330.94 baht/QALY gained, respectively. Conclusion: In Thailand, the treatment of stable schizophrenia with LAI-aripiprazole was shown to provide similar benefits to LAI-paliperidone palmitate in terms of QALYs, despite being more costly. Comparatively, LAI-aripiprazole exhibited better clinical efficacy and led to a longer average life expectancy than LAI-paliperidone. Treatment with LAI-aripiprazole may be dominant strategy, especially with a 2% reduction in drug cost. The results could contribute to appropriate decision-making by policymakers.

Economic Advantages of Domestic Production of Biosimilar Medicines in Iran

Background: Biosimilars can be considered generic versions of branded biologic medicines. Substituting branded biologic medicines with biosimilars is important to reduce medication costs. In addition to reducing drug costs, the domestic production of biosimilars can provide many other economic benefits. Therefore, this study aimed to investigate the economic benefits of producing biosimilar medicines in Iran.
 Methods: This study was done in 2021 through 2 qualitative and quantitative steps. In the first step, after literature review, the interview guide was designed and semi-structured interviews with experts continued until reaching the saturation point, after interviewing 9 experts from different fields (imports, production, and policy making). The data were coded and analyzed by thematic analysis using MaxQDA software and the economic benefits of producing the biosimilars in Iran were extracted. In the quantitative step, the price advantage of producing domestic biosimilars was analyzed as one of their most important economic advantages compared to its equivalent in reference countries. In addition, the same comparison was done for the main imported branded medicines.
 Results: From the experts’ viewpoints, the most important economic effect of the domestic production of biosimilars was the reduction of medication costs through access to lower-priced medicines. The employment of professionals, development of new technologies, expansion of the pharmaceutical market, the reduction of foreign currency outflows, increased affordability and access to drugs, and ultimately the improvement of the health level of the society were the other economic aspects of these medicines. In the quantitative step, after comparing the prices of 23 domestic biosimilars with the prices of the equivalent medicines in reference countries, the prices of 21 medicines were lower than the average prices of equivalent biosimilars and the prices of 18 medicines were even lower than the minimum price of the equivalent biosimilars in the reference countries. In addition, the production of these drugs in the country is indirectly effective in reducing the price of the main branded drugs in the country, so that in the case of imported branded biologic medicines, out of 28 medicines, the prices of 26 medicines were lower than the average prices in the reference countries and the prices of 23 medicines were even lower than the minimum of prices in the reference countries. 
 Conclusion: Based on the results of the study, it was concluded that the domestic production of biosimilar medicines in Iran, in addition to increasing access to biological drugs and promoting public health, provides many economic benefits, including saving drug costs.

The cost-effectiveness of pegcetacoplan in complement treatment-naïve adults with paroxysmal nocturnal hemoglobinuria in the USA.

Aim: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare blood disorder characterized by hemolytic anemia, bone marrow failure and thrombosis, and is associated with high healthcare burden. We evaluated the cost-effectiveness of pegcetacoplan, a proximal complement-3 inhibitor (C3i), compared with the C5i, eculizumab and ravulizumab, in complement treatment-naive adults with PNH, from the UShealthcare payer perspective. Materials & methods: A de novo cost-effectiveness model based on a Markov cohort structure evaluated lifetime (55-year) PNH costs and outcomes. The 6-month cycles of the model reflected the follow-up period of PRINCE (NCT04085601), an open-label trial of pegcetacoplan compared with eculizumab in C5i-naive patients. Data from PRINCE informed the clinical, safety and health-related quality of life outcomes in the model. Results: Pegcetacoplan was associated with lifetime cost savings of USD1,176,808 and USD213,062 relative to eculizumab and ravulizumab, respectively (largely attributed to reduced drug costs and blood transfusions), and additional quality-adjusted life years (QALYs) of 0.25 and 0.24. Conclusion: In patients with PNH who are treatment-naive, the base-case cost-effectiveness analysis, scenario analysis and sensitivity analysis showed both lifetime cost savings and increased QALYs associated with pegcetacoplan compared with eculizumab or ravulizumab in the USA.

P66 Uptake of biosimilars for psoriasis: a drug utilization study from the British Association of Dermatologists Biologics and Immunomodulators Register

Abstract Tumour necrosis factor-α inhibitors (TNFi) have revolutionized the treatment of moderate-to-severe psoriasis. Following patent expirations of TNFi originators, TNFi biosimilars became available, presenting the opportunity for significant reductions in drug costs. This observational cohort study aimed to describe the uptake of TNFi biosimilars for psoriasis treatment in the UK and Republic of Ireland (RoI). This study utilized data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), a national pharmacovigilance register for patients with psoriasis on systemic treatments. We analysed biosimilar uptake trends over time in nine geographical regions of England, along with Wales, Scotland, Northern Ireland and the RoI. We assessed the incidence of switching to biosimilars in an originator-user cohort (switchers). Patients on originator infliximab, etanercept and adalimumab at the time originator patents expired entered the cohort on 1 February 2015, August 2015 and October 2018, respectively, and were followed up until 31 October 2021. Trends in biosimilar initiations were assessed in an adalimumab-naïve cohort who started adalimumab between 1 October 2018 and 31 July 2019 (starters). We assessed the associations between patient factors and originator-to-biosimilar switching and biosimilar initiation using a multivariable Cox regression model and a multivariable logistic regression model. In total, 4202 patients (209 on infliximab, 742 on etanercept and 3251 on adalimumab) were included in the originator-user cohort. For infliximab, etanercept and adalimumab, the cumulative incidence of originator-to-biosimilar switching increased with time to 14.8%, 23.6% and 66.6% after 3 years, respectively. Across geographical regions, 3-year switching rates varied from 0% (North East England, London, Scotland, Northern Ireland, RoI) to 43.7% (East Midlands) for infliximab; from 0% (RoI) to 40.4% (South West England) for etanercept; and from 12.5% (London) to 84.3% (North East England) for adalimumab. After switching to biosimilars, 2.8% of switchers cross-switched to other biosimilars, 1.1% switched back to the originator and 17.1% discontinued or switched to other biologic medicines. In total, 528 patients were included in the adalimumab-naïve cohort, of whom 67.8% started on biosimilars. Amgevita® and Imraldi® were the most commonly used biosimilars among adalimumab biosimilar switchers (56.8% and 39.1%, respectively) and starters (53.6% and 34.4%, respectively). Originator-to-biosimilar switching and biosimilar initiation were more common in patients who were male or had lower a Psoriasis Area and Severity Index at cohort entry. The uptake of biosimilars increased over time and varied considerably across the UK and RoI; adalimumab had the highest biosimilar uptake rate compared with other TNFi.

Experiment of Reducing Drug Costs through the Concurrent Listing of Drug Prices in the Prescribing System:

Experiment of Reducing Drug Costs through the Concurrent Listing of Drug Prices in the Prescribing System:

PCR246 Patient Perspectives on Non-Medical Switching

Non-Medical Switching (NMS) occurs when a patient has their medication changed for reasons other than efficacy, side effects, or adherence, and often relates to drug formulary policies aimed at reducing drug costs. Physicians have raised concerns on how these policies impact patient care. We explored patient perspectives of NMS regarding awareness, impact on their treatment and relationship with their provider, challenging NMS decisions, and support needs. Participants were invited from Janssen’s Patient Engagement Research Councils (PERCs) and were consented and compensated for their time.

Pharmacist-Driven Dosing Services and Pharmaceutical Care Increase Probability of Teicoplanin Target Concentration Attainment and Improve Clinical and Economic Outcomes in Non-Critically Ill Patients.

Pharmacist-driven (PD) dosing and monitoring services have been shown to improve the clinical and economic outcomes in patients treated with different antibiotics, other than teicoplanin. This study investigates the impact of PD dosing and monitoring services on the clinical and economic outcomes of non-critically ill patients receiving teicoplanin treatment. A single-center retrospective study was conducted. Patients were divided into the PD group and the non-PD (NPD) group. Primary outcomes included the achievement of target serum concentration, and a composite endpoint of all-cause mortality, intensive care unit (ICU) admission, and sepsis or septic shock development during hospitalization or within 30days of hospital admission. The cost of teicoplanin, overall medication cost, and total cost during hospital stay were also compared. A total of 163 patients from January to December 2019 were included and assessed. Seventy patients were assigned to the PD group and 93 to the NPD group. The PD group had a higher percentage of patients reaching the target trough concentration (54% versus 16%, p < 0.001). Around 26% of the patients in the PD group and 50% of the patients in the NPD group met the composite endpoint during their hospital stay (p = 0.002). The PD group exhibited a significantly lower incidence of sepsis or septic shock, shorter hospital stays, reduced drug costs, and lower total expenses. Our study demonstrates that pharmacist-driven teicoplanin therapy can improve the clinical and economic outcomes for non-critically ill patients. https://www.chictr.org.cn ; identifier, ChiCTR2000033521.

Abstract P4-07-06: Implementation of A Bone Modifying Agent Pathway at UChicago Medicine for Metastatic Breast Cancer Patients

Abstract Background: In 2019, a quality improvement (QI) research project was conducted at UChicago Medicine (UCM) to evaluate bone modifying agent (BMA) use for skeletal-related event (SRE) prevention in patients with metastatic breast cancer and metastatic castration-resistant prostate cancer. Denosumab was the preferred BMA agent at UCM in this setting. Compared to zoledronic acid (ZA), denosumab was associated with higher drug cost and lower adherence rate mainly due to the difficulty of maintaining the 4-weekly frequency. Studies have shown that ZA can be de-escalated from 4-weekly to 12-weekly for SRE prevention. There is still no convincing evidence to show that this de-escalated schedule can be applied to denosumab. One study evaluated the noninferiority of 12-weekly compared with 4-weekly denosumab suggested that the health-related quality of life was non-inferior (Clemons et al., 2021). However, the study was not powered to evaluate the statistical difference in SRE rates. Based on the results of the 2019 QI project, a BMA pathway was generated at UCM in September 2020 with the purpose of guiding physician prescribing patterns, improving adherence rate, and reducing drug costs. This pathway recommended using ZA as the preferred agent for SRE prevention instead of denosumab. Methods: This was a retrospective study that included 198 patients who had metastatic breast cancer and received at least one dose of ZA or denosumab from UCM outpatient oncology clinic for SRE prevention. All included patients must have bone metastases. 107 patients from the pre-implementation study period (July 1st, 2018 to June 30th, 2019) and 91 patients from the post-implementation study period (November 10th, 2020 to November 10th, 2021) were included. Patients were divided into four groups based on study time (pre- or post-implementation period) and BMA agent (ZA and denosumab). The primary outcome was BMA therapy adherence rate, which was defined by those who received greater than or equal to 80% of appropriately scheduled doses. Secondary outcomes included the percentage of patients on ZA or denosumab, SREs, BMA-associated adverse effects, and BMA cost. Descriptive statistics were used SREs and BMA-associated adverse effects. Results: The percentage of patients on ZA significantly increased from 12% to 64% after BMA pathway implementation (P&amp;lt; 0.0001). Denosumab use decreased from 88% to 36% (P&amp;lt; 0.0001). The overall BMA adherence rate including both ZA and denosumab patients during the post-implementation period was 68%, which was not significantly different compared to the overall adherence rate of 74% during the pre-implementation period (P=0.5461). The adherence rates in denosumab groups (63% in pre and 30% in post) were lower than in ZA groups (100% in pre and 90% in post). The most common reason for the lower adherence rates in denosumab groups was scheduling convenience. During the study period, there were 2, 0, 3, and 3 patients who had SREs in the above four groups respectively. The predominant adverse events among all groups were hypocalcemia and hypophosphatemia. The cost analysis showed using ZA as the primary BMA agent saved 1.1 million dollars of drug costs during the post-implementation study period at UCM. Conclusion: Implementing a BMA pathway encouraged the providers to choose ZA as the preferred agent for SRE prevention in metastatic breast cancer patients with bone metastasis, which dramatically reduced drug costs. The overall BMA adherence rate was not significantly improved with the implementation. The difficulty of maintaining a 4-weekly denosumab frequency continued to exist. Citation Format: Kun Lin, Jordan Baur, Sandeep Parsad, Heng Yang. Implementation of A Bone Modifying Agent Pathway at UChicago Medicine for Metastatic Breast Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-06.

P428 Pharmacist led clinic in Inflammatory Bowel Disease

Abstract Background Only 13% of IBD teams across the UK have a specialist pharmacist within the MDT (1). Pharmacists have a crucial role in safe and effective medication prescribing and monitoring (2). Studies have shown that pharmacist led clinics are acceptable to clinicians and patients (2). At our trust we set up a pharmacist led biologic switch clinic where a specialist pharmacist counselled regarding biologic therapy switch from intravenous (IV) to subcutaneous (SC) medication and assessed disease burden at baseline and follow up. We set up thiopurine clinic where the specialist pharmacist arranges monitoring and facilitates pre-emptive switch of stable patients to shared care prescribing with the GP, in line with the national commitment of providing convenient and easy access to services. We analysed patient feedback, biologic and shared care prescribing data to assess the impact of our pharmacist-led clinics. Methods Patients who had been scheduled in thiopurine and biologic switch clinic were sent with questionnaires either by post or email. Both paper and electronic data were collected and analysed using Microsoft ExCel. Biologic therapy and thiopurine prescribing and monitoring databases were setup and data were captured and analysed retrospectively. Results 112 patients were switched from IV biologic therapy to SC therapy of which 8 patients needed to be switched back to IV due to either an adverse reaction or uncontrolled IBD. By reducing drug cost and increasing hospital CIU capacity, the biologic switch clinic has generated significant financial savings to the organisation (estimated £333,666 per annum). In thiopurine clinic, 80 patients were identified as suitable candidates for shared care agreement with primary care. 88% patients have been successfully transferred to primary care and the remaining 12% remained under secondary care because the GP opted-out. 88% of patients who had been scheduled in pharmacist led clinic were happy with the service and the remainder had a neutral opinion regarding the service (see chart). Some patients fed-back that the telephone consultation did not happen at scheduled time or they preferred face to face clinic. Conclusion Pharmacist led clinic led to significant cost savings, increased accessibility to thiopurines and was acceptable to patients. In response to patient feedback we amended our appointment letters to clarify appointment time frames and give pharmacist contact details for further patient queries. We have also set up face to face clinics for patients preferring this option.

Pharmaceutical enterprises drug quality strategy Moran analysis considering government supervision and new media participation.

The improvement of drug quality requires not only the supervision of government, but also the participation of new media. Therefore, this paper considers the impact of government regulation and new media reports on pharmaceutical enterprises, constructs a Moran Process evolutionary game model, and analyzes the evolution trajectory of pharmaceutical enterprises' choice of drug quality improvement strategy and drug cost reduction strategy. We obtain the conditions for the two strategies to achieve evolutionary stability under the dominance of external factors and the dominance of expected returns. To verify the theoretical results, we conduct a numerical simulation by the software MATLAB 2021b. The results show that, first of all, when the government penalty is high, the drug quality improvement strategy tends to become an evolutionary stable solution, increasing the penalty amount will help promote the improvement of drug quality. What's more, when the government penalty is low and the new media influence is low, the drug cost reduction strategy is easier to dominate. The higher the new media influence, the higher the probability that pharmaceutical enterprises choose the drug quality improvement strategy. Thirdly, when the number of pharmaceutical enterprises is lower than a threshold, the drug quality improvement strategy is easier to dominate. Finally, the drug quality improvement strategy is dominant when the quality cost factor is low and the government penalty is high, the drug cost reduction strategy is dominant when the quality cost factor is high and the government penalty is low. Above all, this paper provides countermeasures and suggestions for the drug quality improvement of pharmaceutical enterprises in practice.

Study of Factors to Increase the Usage Rate of Generic Drugs in Platelet Aggregation Inhibitors.

To reduce pharmacy-related medical expenses, it is necessary to reduce drug costs. One way to achieve this is by increasing the usage rate of generic drugs. The purpose of this study was to identify platelet aggregation inhibitors (PAIs) that contribute to high drug costs and are sold as brand-name drugs in order to increase the usage rate of generic drugs, and to analyze the factors that affect the usage rate of generic drug. We conducted a cross-sectional study based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan (NODJ) of the Ministry of Health, Labor and Welfare and datasets containing related medical information from official statistical surveys such as the Basic Survey on Wage Structure. Monthly personal income in each prefecture were negatively correlated with outpatient out-of-hospital and outpatient in-hospital prescriptions of the PAIs clopidogrel (75 mg), cilostazol (50 mg), cilostazol (100 mg), and ticlopidine (100 mg), but not between monthly personal income and outpatient out-of-hospital prescription of ticlopidine (100 mg). For outpatient out-of-hospital prescriptions and outpatient in-hospital prescriptions, negative correlation was generally observed between the usage rate of generic drug and monthly personal income, except for ticlopidine (100 mg), which has the lowest price among the brand-name drugs. The usage rate of generic PAIs is negatively correlated with monthly personal income. Promoting the use of generic drugs among high-income earners might be necessary to further increase the usage rate of generic drug.