Retrospective Drug Utilization Study Research Articles

Trends and regional differences in antidiabetic medication use: a nationwide retrospective observational study

Background The prevalence of diabetes is increasing, and several new drug groups have been authorized and used successfully in the treatment of diabetes, while older drug groups are still in use. Our aim was to assess the utilization tendencies and regional differences in antidiabetic medication consumption in Hungary between 2015 and 2021 and to identify the possible determinants of regional differences in antidiabetic medication use.MethodsFor this retrospective drug utilization study, yearly wholesale database was used, which provides total coverage for ambulatory antidiabetic drug sales in Hungary, including both reimbursed and non-reimbursed medications. Data were expressed as Defined Daily Dose per 1000 inhabitants per day (DDD/TID), percentage of total use and the ratio of the highest and lowest utilization values among the counties (max/min ratio). To assess the potential reasons for regional differences in antidiabetic drug use, we analyzed the associations between regional drug utilization data and possible determinants.ResultsThe total national antidiabetic medication use has increased by 7.6% and reached 94.8 DDD/TID in 2021. Regarding antidiabetic subgroups, the use of metformin and novel antidiabetics (DPP4Is, GLP1As and SGLT2Is) and their combinations increased in all counties, while sulfonylurea consumption decreased, and insulin use was stable. In 2021, 19.2–24.1% of the total antidiabetic medication consumption was novel antidiabetics, 39.1–47.2% metformin, 14.8–25.8% sulfonylureas and 23.6–30.5% were insulins. Regional differences in antidiabetic medication consumption were considerable mainly in the case of GLP1As (max/min ratio:3.00), sulfonylureas (2.03) and SGLT2Is (1.92) in 2021. The association between antidiabetic medication use and possible determinants was confirmed in the case of unemployment rate and sulfonylurea use, the number of public medical card holders per ten thousand inhabitants and human insulin and sulfonylurea use. GLP1As were the only antidiabetic drug group that did not correlate with any of the investigated factors.ConclusionsAlthough novel antidiabetic drug use was growing dynamically in Hungary, sulfonylurea use is still considerable. Differences in antidiabetic drug consumption were substantial between the regions.

Assessing medication use patterns by clinical outcomes severity among inpatients with COVID-19: A retrospective drug utilization study

PurposeThis study assessed medication patterns for inpatients at a central hospital in Portugal and explored their relationships with clinical outcomes in COVID-19 cases. MethodsA retrospective study analyzed inpatient medication data, coded using the Anatomical Therapeutic Chemical classification system, from electronic patient records. It investigated the association between medications and clinical severity outcomes such as ICU admissions, respiratory/circulatory support needs, and hospital discharge status, including mortality (identified by ICD-10-CM/PCS codes). Multivariate analyses incorporating demographic data and comorbidities were used to adjust for potential confounders and understand the impact of medication patterns on disease progression and outcomes. ResultsThe analysis of 2688 hospitalized COVID-19 patients (55.3% male, average age 62.8 years) revealed a significant correlation between medication types and intensity and disease severity. Cases requiring ICU admission or ECMO support often involved blood and blood-forming organ drugs. Increased use of nervous system and genitourinary hormones was observed in nonsurvivors. Corticosteroids, like dexamethasone, were common in critically ill patients, while tocilizumab was used in ECMO cases. Medications for the alimentary tract, metabolism, and cardiovascular system, although widely prescribed, were linked to more severe cases. Invasive mechanical ventilation correlated with higher usage of systemic anti-infectives and musculoskeletal medications. Trends in co-prescribing blood-forming drugs with those for acid-related disorders, analgesics, and antibacterials were associated with intensive interventions and worse outcomes. ConclusionsThe study highlights complex medication regimens in managing severe COVID-19, underscoring specific drug patterns associated with critical health outcomes. Further research is needed to explore these patterns.

Drug utilization study in post-operative patients in obstetrics and gynecology ward of a tertiary care teaching hospital

Background: The World Health Organization (WHO) defines drug utilization as “the marketing, distribution, prescription, and use of drug in a society with special emphasis on resulting medical, social, and economic consequences.” Prescription monitoring and drug utilization patterns should be taken care, so it will provide better efficacy and reduce the adverse drug reactions. Aim and Objective: The aim of the study was to assess the prescribing pattern (using the WHO prescription Indicators). Materials and Methods: A retrospective drug utilization study was conducted in the post-operative patients of obstetrics and gynecology (OBG) department over a period of 4 months after getting approval from Institutional Ethics Committee. Name, sex, age, diagnosis, and treatment were recorded from patient’s case sheet of post-operative patients. The data were analyzed using descriptive analysis with the help of Statistical Package for the Social Sciences software. Result: A total of 238 cases were recorded. The average number of drugs per encounter was seven. Antacids, analgesics, antibiotics, and intravenous fluids were common. About 99.57% of encounters were prescribed an antibiotic. Average number of injections prescribed was 95.8% and 525 (31.47%) were prescribed by their generic name. About 99.8% were from the National list of essential medicine-2015. Conclusion: It was observed that most of the drugs were prescribed according to the national essential list of medicines. Major advantage in of the study is to prevent irrational prescription and reduce health-care burden in the community.

Drug Expenditure, Price, and Utilization in US Medicaid: A Trend Analysis for New Multiple Myeloma Medications from 2016 to 2022.

Multiple myeloma (MM) is the most common plasma cell tumor type. In late 2015, the FDA approved three new medications for MM. These medications were ixazomib, daratumumab, and elotuzumab. However, their utilization, reimbursement, and price in the Medicaid program have not been analyzed before. A retrospective drug utilization study using the national Medicaid pharmacy claims data from 2016 to 2022 in the US. The primary metrics of analysis were utilization (number of prescriptions), reimbursement (total spending), and price (reimbursement per prescription). The overall Medicaid utilization of MM medications increased from 1671 prescriptions in 2016 to 34,583 prescriptions in 2022 (1970% increase). Moreover, the overall Medicaid reimbursement for the new MM medications increased from USD 9,250,000 in 2016 to over USD 214,449,000 in 2022 (2218% increase). Daratumumab had much higher utilization, reimbursement, and market shares than its competitors. Ixazomib was the most expensive medication compared to daratumumab and elotuzumab. The results of this study demonstrate that CMS utilization and spending on MM medications have significantly grown since 2016. Daratumumab has by far the highest utilization, spending, and market share. The utilization of and spending on specific pharmaceuticals are clearly impacted by policy and clinical guideline recommendations.

GLYCOPYRRONIUM-BASED TRIPLE (ICS/LABA/LAMA) NEBULIZATION IN PATIENTS HOSPITALIZED WITH ACUTE EXACERBATING OBSTRUCTIVE AIRWAY DISEASE: DRUG UTILIZATION STUDY IN INDIA

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Nebulization therapy plays an essential role in hospitalized AEOAD patients. Primary bronchodilators used in the management are salbutamol/levosalbutamol (SABA) and ipratropium bromide (SAMA) requiring frequent dosing and with heightened cardiovascular risk. Glycopyrronium has more potent, quicker and long lasting bronchodilatory action compared to ipratropium, also it has better cardiac safety leading to its off label use for AEOAD in Indian clinical setting. Objective: To evaluate the real world use of glycopyrronium based triple nebulization in hospitalized AEOAD cases in terms of patient characteristics, treatment pattern, dosing, duration. METHODS: Retrospective drug utilization study (DUS) was conducted in 100 consecutive hospitalized AEOAD patients who received glycopyrronium based triple nebulization from single Indian centre after independent ethics committee approval. Medical records from Oct 2020 – Feb 2021 were analyzed to capture details about demography, diagnosis, co-morbidities, existing OAD treatment, nebulization therapy, discharge medications. RESULTS: Average age of 100 consecutive AEOAD patients was 64.5 + 14.5 yrs with 4:1 M:F ratio. 44% were smokers. 67% had comorbidities, commonest being DM (49%), CVD (42%) & HTN (22%) . Most common OAD diagnosis was COPD (70%), followed by asthma (27%) & ACO (3%); Median duration of OAD was 12 yrs(1-40 yrs). 21% were diagnosed of OAD during current hospitalization. Prior OAD medications included ICS-LABA(27%), SABA-SAMA(27%), ICS-LABA-LAMA(4%). None were on LABA-LAMA therapy. 35% didn’t receive any prior therapy. Adherence to OAD treatment was 52%. 49% had ≥ 1 exacerbation in the last 1 yr, with 28% requiring hospitalization. Commonest presentation of AEOAD included dyspnea(90%), cough(69%), fever(47%) with SpO2 (93.3 ± 5.6), RR (28.8 ± 8) & eosinophil count (412.9 ± 706.9). All patients were treated with triple nebulization of Budesonide/Formoterol/Glycopyrronium (500/20/25 mcg) by Jet nebulizer for median duration of 5 days (1-17 days). Most (94%) were prescribed concomitant antibiotics for median duration of 4 days (1-11 days). 45% needed respiratory support in form of NIV (40%), MV (28%) or ECMO (1%). Median duration of hospitalization was 6 days (1-11 days). On discharge, therapies like ICS-LABA(46%), ICS (39%), SAMA-SABA (24%), LAMA (10%) were prescribed. Majority (55%) were prescribed home Nebulization treatment. CONCLUSIONS: Though traditionally SABA/SAMA combination is preferred for AEOAD, we observed growing use of Glycopyrronium/formomterol/Budesonide triple nebulization. Testing this strategy in controlled clinical trials will further validate the role of glycopyrronium based nebulization in AECOPD patients. CLINICAL IMPLICATIONS: Owing to its faster onset of action & cardiovascular safety, Glycopyrronium based Triple nebulization can be a potential alternative clinical strategy for management of hospitalized AEOAD patients. DISCLOSURES: Employee relationship with Glenmark Pharmaceuticals Ltd Please note: since last42 months Added 04/27/2021 by HANMANT VENKATRAO BARKATE, source=Web Response, value=Salary Employee relationship with Glenmark Pharmaceuticals Ltd Please note: since last 42 months Added 04/28/2021 by HANMANT VENKATRAO BARKATE, source=Web Response, value=Salary No relevant relationships by SAGAR PANCHAL, source=Web Response No relevant relationships by NIRANJANA PANIGRAHI, source=Web Response Employee relationship with Glenmark Pharmaceuticals Ltd Please note: 8 years Added 04/27/2021 by Saiprasad Patil, source=Web Response, value=Salary

Chronic use of the unfixed combination of ACE-inhibitors and beta-blockers in Italy from 2013 to 2019 through the healthcare administrative data.

The association between an ACE-inhibitor and a beta-blocker is recommended in case of complicated arterial hypertension and heart failure with reduced ejection fraction. This retrospective drug-utilization study has described its chronic use from the Italian National Healthcare Service perspective. From the ReS (Ricerca e Salute) database, collecting Italian healthcare administrative data, patients receiving an ACE-inhibitor or a beta-blocker from 2013 to 2019 were selected. The prevalence of use (patients treated/1000 inhabitants) and of continuous treatment (patients treated for ≥80% period from the supply to the end of the same year - by means of dosage units - per 1000 inhabitants) of each single active substance were assessed. Among patients continuously treated, those supplied with an ACE-inhibitor and a beta-blocker (unfixed and fixed combinations) were analyzed in terms of prevalence of continuous treatment. Subjects treated with the unfixed combination ramipril-bisoprolol in 2019 were characterized by gender and age. The prevalence of ACE-inhibitors' use increased from 49.7/1000 inhab. in 2013 to 50.2 in 2019: ramipril was the most supplied each year (28.9 to 31.6/1000 inhab.). The prevalence of continuous treatment increased from 27.4 to 28.3/1000 inhab.: ramipril the most continuously dispensed (16 to 18/1000 inhab.). The prevalence of beta-blockers' use increased from 61.0 to 90.4/1000 inhab.: bisoprolol the most supplied and with the highest increase (27.1 to 52.2/1000 inhab.). The prevalence of continuous treatment increased from 33.1 to 55.8/1000 inhab.: bisoprolol the most continuously dispensed (18 to 37/1000 inhab.). Among patients with continuous supplies, from 49,843 a 51,496 were treated with associations between an ACE-inhibitor and a beta-blocker on an ongoing basis. Half of them were continuously treated with the unfixed combination ramipril-bisoprolol (4.3 to 4.8/1000 inhab.). In 2019, subjects with continuous supplies of ramipril-bisoprolol were mainly males (63.4%) and elderly (mean age 71±12), and the prevalence of use increased with age. These findings, together with recommendations from the main international guidelines encourage to make available also ramipril and bisoprolol as fixed dose combination, in order to simplify the therapy administration and improve the adherence, especially among elderly and patients with multimorbidity.

A Retrospective Drug Utilization Study on Psychiatric Illness in a Tertiary Care Teaching Hospital

Psychiatric disorders are now widely recognized as a major contributor to the global burden of disease. It has been described that there is an increased risk of adverse effects when more than one psychotropic drug is prescribed. Knowledge of the pattern of utilization of drugs in the general population can be achieved through the conduct of drug utilization studies. The present study has therefore been conducted to observe the pattern of drug use in psychiatry patients in a tertiary care hospital.
 Aim and Objective:
 To assess the epidemiology of various psychiatric illnesses among the study population
 To assess the Prescribing Pattern of drugs in Psychiatric Illness.
 To assess the drug-drug interactions in the prescription using MICROMEDEX.
 Methodology: A retrospective descriptive observational study was performed in a tertiary care hospital. A total of 100 prescriptions were collected from MRD. 
 Results: The study reported that 66% of patients were males and 34% were females. The average number of drugs and psychotropic drugs per prescription is six and four respectively. Around 61.98% of drugs in the prescription are psychotropic drugs, among that 40.17% of benzodiazepines are majorly used, followed by 34.27% of antipsychotics. Almost 95 prescriptions had a minimum of one drug-drug interaction. 
 The average number of psychotropics per prescription was higher than in studies. The average number of drugs per prescription was 5.84, which lead to polypharmacy.
 Conclusion: Using WHO indicators prescription analysis was done and it showed some deviation from the standard value which can be improved. Polypharmacy was noted in this study. Most of the drug is prescribed in the brand name which should be avoided.

Drug-utilisation profiles and COVID-19

Coronavirus disease 2019 (COVID-19) has substantially challenged healthcare systems worldwide. By investigating population characteristics and prescribing profiles, it is possible to generate hypotheses about the associations between specific drug-utilisation profiles and susceptibility to COVID-19 infection. A retrospective drug-utilisation study was carried out using routinely collected information from a healthcare database in Campania (Southern Italy). We aimed to discover the prevalence of drug utilisation (monotherapy and polytherapy) in COVID-19 versus non-COVID-19 patients in Campania (~ 6 million inhabitants). The study cohort comprised 1532 individuals who tested positive for COVID-19. Drugs were grouped according to the Anatomical Therapeutic Chemical (ATC) classification system. We noted higher prevalence rates of the use of drugs in the ATC categories C01, B01 and M04, which was probably linked to related comorbidities (i.e., cardiovascular and metabolic). Nevertheless, the prevalence of the use of drugs acting on the renin-angiotensin system, such as antihypertensive drugs, was not higher in COVID-19 patients than in non-COVID-19 patients after adjustments for age and sex. These results highlight the need for further case–control studies to define the effects of medications and comorbidities on susceptibility to and associated mortality from COVID-19.

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital

BackgroundPreoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences.MethodsA retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25.ResultsThe study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations.ConclusionsSurgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

Use of anti-reflux medications in infants under 1 year of age: a retrospective drug utilization study using national prescription reimbursement data

Non-specific symptoms such as irritability, vomiting, and back arching during the infant period are often attributed to gastroesophageal reflux. While numerous studies have shown no significant benefit to the use of acid suppressant medications in this population, these medications are frequently prescribed in response to these symptoms. Our goals were to understand how often children were being prescribed this medication. To do this, data was extracted from a national database for reimbursement of prescribed medications through the General Medical Services scheme (GMS). Infants aged less than 1 year and eligible for reimbursement under GMS were included for analysis. A total of 450 infants per 10,000 eligible population received an anti-reflux preparation from the following drug classes (H2 antagonists, proton pump inhibitors, or alginate preparations) in 2018. This is compared with that in 2009 where only 137 per 10,000 eligible infants received these medications. This increase was predominantly attributable to an increase in ranitidine prescriptions.Conclusion: Despite a change in clinical guidelines, anti-reflux preparations are increasingly being prescribed to infants aged less than 1 year. The reasons behind the increase in prescriptions containing these medications cannot be ascertained from this data. This may suggest a proportion of these prescriptions may be unwarranted in this population. What is Known: • The prescription of PPIs in infants has increased in a number of countries. • Use of anti-reflux medications has a very poor evidence base in infancy. What is New: • This data focuses only on an infant age group in a "well" cohort. • Ranitidine may contribute to increased acid-suppressant use in infancy.

OUTCOMES OF PEOPLE LIVING WITH HIV IN TWO PUBLIC-SECTOR PSYCHIATRIC FACILITIES IN THE EASTERN CAPE USING EFAVIRENZ-CONTAINING REGIMENS.

Background:People with mental disorders are more vulnerable to human immunodeficiency virus (HIV) infection. A part of first-line treatment for HIV, efavirenz, is routinely avoided in patients with mental illness due to the risk of potential aggravation of the mental illness. This study aimed to determine the outcomes of people living with HIV/AIDS who were mental healthcare users admitted to two public-sector psychiatric facilities and who were prescribed an efavirenz-containing regimen.Materials and Methods:A retrospective drug utilization study was conducted at two public-sector psychiatric hospitals in the Eastern Cape of South Africa. Patients aged 18 years or older living with HIV were included in the study. Follow-up reviews were conducted at four, 12 and 24 weeks. The patients were seen by doctors at the hospital and notes on progress and medication were recorded in medical records. The files were then reviewed.Results:A total of 37 patients were enrolled. However, just 26 were reviewed at 24 weeks. A total of 43.2% (n=16) were female patients and the average age of the patients was 39.38±8.76 years. At the baseline, 32.4% (n=12) patients were diagnosed with schizophrenia. A total of 81.08% (n=30) of patients experienced an improvement in psychiatric symptoms after 24 weeks. Of these, 43.3% (n=13) were on an efavirenz-containing regimen.Conclusion:Majority of the patients demonstrated an improvement in their psychiatric conditions to the extent that they were discharged into the community. This finding suggests that patients with psychiatric disorders on efavirenz can experience stabilisation of their psychiatric symptoms.

A retrospective study on prescribing pattern and cost analysis of proton-pump inhibitors used among adults of Saudi Arabia

Abstract Objective To evaluate the use of proton-pump inhibitors (PPIs) for treatment of different gastric disease in Saudi population and their related administration cost. Materials and methods It was a cross-sectional retrospective drug utilization study. The utilization rates and cost analysis of each PPIs class of drugs were compared. Study data were obtained from pharmacy database. Data between 1 January 2019 and 31 December 2019 were investigated, including incidence, prevalence and duration of use of proton-pump inhibitors among adults of Saudi Arabia. Key findings We observed 26 798 (4.27%) prescription of PPIs were dispensed in the in-patient and out-patient pharmacy department of Al-Mana Group of Hospital (AGH) Al khobar. Among all the PPIs user, more than the half ((53.01%, n = 14 208), 95% CI (52.42–53.62)) were male. 30–40 years age patients (24.57%, 95% CI (24.06–25.09) (n = 6585)) were highest number of PPI users. Nearly, equal number of PPI users belongs between 51–60 years ((20.88%, n = 5596), 95% CI (20.40–21.37)) and >60 years ((20.36%, n = 5456), 95% CI (19.8–20.85)). Among all the dispensed PPIs drugs, Pantoprazole is dispensed to the highest number of patients (79.09% (95% CI, 78.61–79.58) (n = 21 197)) while their average duration of therapy was 18.86 days. Among all PPIs, pantoprazole average unit wise cost was highest SR 8.83 (USD 2.35) in comparison to other PPIs. Conclusion In our study, among all the PPIs Pantoprazole was prescribed to the highest number of patients also it was costliest; hence, their safe and effective use must be warranted. Current study will also help in to develop nation database regarding utilization of proton-pump inhibitors.

PIN35 UTILIZATION, SPENDING AND PRICE TRENDS FOR ANTIVIRAL (FLU AGENTS) IN THE US MEDICAID PROGRAMS: EMPIRICAL DATA ANALYSIS FROM 1999-2018.

To examine trends in the utilization, pharmacy reimbursement, and prices of flu antiviral medications in the US Medicaid-covered population A retrospective drug utilization study was conducted using the national summary files for outpatient drug utilization and expenditure for flu anti-viral medications from the Centers for Medicare & Medicaid Services from January 2000 through June 2017, to examine the annual trends of the number of prescriptions, reimbursement expenditures, and the prices of flu antiviral medications. The study drugs included Oseltamivir phosphate (Tamiflu) and zanamivir (Relenza). The total number of prescriptions for flu anti-viral medications increased rapidly from 49,512 in 2000 to 1,134,353 in 2017. During the same period, the total pharmacy reimbursement for flu anti-viral medications in Medicaid increased from approximately $2.4 million in 2000 to approximately $244million in 2017. Tamiflu had a dominant market share with an average of 97.5% throughout the study period when compared to Relenza. The price per Tamiflu prescription drug increased over time, ranging from approximately $53 in 2000 to $213 in 2017, while Relenza increased from $42 to $63 in the same period. Medicaid expenditures and the number of prescriptions for flu anti-viral medications abruptly increased over the study period between 2000 and 2017. Increases in flu anti-viral drug expenditures from 2000 to 2017 were primarily due to the rising utilization of flu antiviral medications.

PND125 PREGABALIN PRESCRIBING IN PRIVATE HEALTHCARE SETTINGS IN SOUTH AFRICA WITH SPECIFIC FOCUS ON DOSAGES

Pregabalin is registered in South Africa for post-herpetic neuralgia and painful diabetic polyneuropathy in adults. The primary aim of the study was to analyse the prescribing patterns and cost of pregabalin with the focus on dosages. A retrospective drug utilisation study was conducted on a South African medical insurance administrator database for 2018. All products in ATC group N03AX16 were analysed. A total of 726 patients (54.41% males) were prescribed 1888 pregabalin products. The average age of patients was 50.38 (SD=13.59) years. Two trade name products were prescribed (the originator and one generic), and both were available in capsules in strengths of 25 mg, 75 mg and 150 mg. The originator accounted for 72.83% of prescription volume. The 75 mg capsules of the originator product was prescribed the most (44.92% of prescriptions), followed by the 25 mg capsule of the originator. The average Prescribed Daily Dose (PDD) was 73.44 mg. Most prescriptions were dispensed by pharmacies (57.10%), followed by hospitals (32.10%). Smaller quantities were prescribed in hospitals. If only pharmacy prescriptions were considered, the average PDD of pregabalin in the 464 patients was 89.36 (SD= 67.38) mg. The most popular specific PDD was 75 mg, followed by 150 mg. Pregabalin is used for different indications, also often off-label. Similarly, a wide variation of dosages were prescribed. In pharmacies, a PDD of 75 mg was the most popular dose. The importance of accurate diagnosis codes in electronic databases to enable dosage linking cannot be overemphasised.

PSY26 - OPIOID PRESCRIBING IN A SOUTH AFRICAN MEDICAL INSURANCE SCHEME SETTING

Opioid analgesics are reported to be overprescribed in various parts of the world. Since data for South Africa in its entirety is not available, studies on available electronic dispensing databases can add a valuable insight into opioid prescribing patterns in the country. The primary aim of the study was to determine which opioids are prescribed in a medical insurance scheme setting in South Africa. A retrospective drug utilisation study was conducted on a South African medical insurance administrator database for 2017. The database contained 3 898 535 records for medicine, medical devices and procedures. All products in ATC subgroup N02A (opioids) were extracted and analysed. A total of 102 255 opioids were dispensed to 33 249 patients (72.47% male patients). The average age of patients was 40.80 (SD=12.26) years. Patients received on average 3.08 (SD=5.57) opioid prescriptions over the year. Most opioids were dispensed by private hospitals (46.45%), followed by general medical practices (43.38%) and pharmacies (9.74%). Dihydrocodeine and paracetamol (N02AJ06, 45.09%) were dispensed the most, followed by tramadol (N02AX02, 28.99%), and tramadol and paracetamol combined (N02AJ13, 9.67%). These three agents together accounted for 83.75% of all opioid analgesics dispensed. Pethidine (N02AB02) accounted for 4.74% and morphine (not in combination) (N02AA01) for 4.48%. A total amount of R2 560 040.07 was claimed by patients, of which R2 004 941.77 was reimbursed. Generic substitution is compulsory in South Africa. The average amount claimed per opioid was only R25.04 (SD=R56.72). Tramadol was, for example, dispensed as its originator, in addition to seven branded generics. Opioid prescribing seemed to be in line with the South African guidelines, and overuse could not be detected. A follow-up study focusing specifically on codeine is recommended, since South Africa is often portrayed in the media as one of the codeine hotspots in the world.

PMU16 - DISPENSING PATTERNS OF VACCINES IN A PRIVATE HEALTHCARE SETTING IN SOUTH AFRICA

Vaccination is an effective medical intervention to reduce death and morbidity caused by infectious diseases. The aim of the study was to analyse the dispensing patterns of vaccines in South Africa from a medical insurance scheme perspective. A retrospective drug utilisation study was conducted on a South African medical insurance administrator database for 2017. The database contained 3 898 535 records for medicine, medical devices and procedures. All products in ATC subgroup J07 (vaccines) were extracted and analysed. A total of 7 254 vaccines at a cost of R1 982 238.86 were dispensed in 2017 to 4 596 patients. The average age of patients was 32.57 (SD=21.67) years, with 65.62% male patients. Bacterial vaccines (J07B) accounted for 47.13% of the total number of vaccines dispensed (28.24% of cost), viral vaccines for 36.89% (44.02% of cost), and combined bacterial and viral vaccines for 15.98% (27.73% of cost). The Influenza vaccine (J07BB01) accounted for most of the vaccines dispensed (26.70%), followed by tetanus toxoid (J07AM01, 23.85%) and the diphtheria-pertussis-poliomyelitis-tetanus-hepatitis B vaccine (J07CA12, 15.00%). Three-quarters of the influenza vaccine prescriptions were dispensed during March and April 2017. The trade name vaccine that was the most commonly dispensed was TetavaxR (tetanus toxoid) single dose syringe 0.5 ml. Sixty percent of these vaccines were dispensed to patients between 30 and 49 years (mostly to male patients). The average cost claimed per vaccine was R273.26, with pneumococcus, purified polysaccharide antigen (J07AL01) on average the most expensive (R794.49). Most vaccines were dispensed by private hospitals (27.29%) and registered nurses (34.86%), with only 11.18% dispensed by pharmacies. The influenza vaccine was the most commonly dispensed, followed by tetanus toxoid. This is possibly due to medical scheme members being mostly the economically active sector of the population where workplace vaccination campaigns are often offered.

Drug utilization study of two generic antibiotics in a tertiary hospital in Bogotá

Introduction: The Colombian national pharmaceutical policy establishes as a strategy the generation of greater pharmaco-epidemiological research at the national level, especially in the case of antibiotic drugs. Objective: To provide local pharmaco-epidemiological evidence regarding the effectiveness, conditions of use and safety of generic meropenem and cefepime in a tertiary hospital in Bogotá. Materials and methods: We conducted a descriptive, longitudinal and retrospective drug utilization study. The data were collected from the medical histories of all the patients who had cefepime or meropenem prescribed. Results: We included 82 patients treated with cefepime and 91 treated with meropenem in the study. Most of the patients were in services different from the intensive care unit (taking cefepime: 59.8%, and meropenem: 52.7%). Only 21.9% of the patients treated with cefepime and 49% of those treated with meropenem were seen by an infectious disease specialist. The antibiogram was performed for 47% and 60% of the patients treated with cefepime and meropenem, respectively. The most frequent indication for cefepime were respiratory infections and for meropenem, genitourinary ones. Therapeutic success rates were 61.7% for cefepime and 63.0% for meropenem. Conclusions: This study contributes evidence regarding the therapeutic performance of two generic antibiotics used in tertiary hospitals. There were no reports of therapeutic failure during the study period. In the cases of non-response, pharmacokinetic alterations, unfavorable clinical conditions, and inappropriate choice of antimicrobial treatment were identified as frequent factors.

Use of Prescription Medications That Potentially Interfere With Blood Pressure Control in New-Onset Hypertension and Treatment-Resistant Hypertension.

Withdrawing medications that interfere with blood pressure (BP) is recommended in patients with uncontrolled BP, yet real-world use of such agents is not well characterized among individuals with hypertension. We aimed to evaluate the use of BP-interfering prescription medications among US patients with hypertension. This retrospective drug utilization study used medical and prescription claims (January 2008 to December 2014) in the MarketScan commercial claims database. We included adults, aged 18-65 years, with a hypertension diagnosis (International Classification of Diseases, Ninth Revision, code 401) and ≥1 antihypertensive medication fill. Two hypertension cohorts were examined-new antihypertensive drug users (incident hypertension) and patients requiring titration to a fourth antihypertensive (incident treatment-resistant hypertension [TRH]). Patient-level exposure to BP-interfering medications was assessed 6 months before and after the index date, defined as the first prescription fill of an antihypertensive drug or the first occurrence of overlapping use of ≥4 antihypertensive drugs. We identified 521,028 patients with incident hypertension and 131,764 patients with incident TRH. The most prevalent BP-interfering prescription medications were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophens, and hormones. Overall, 18.3% of the incident hypertension cohort and 17.6% of the incident TRH cohort initiated a BP-interfering medication following antihypertensive titration. Among patients previously taking a BP-interfering medication, 57.6% with incident hypertension and 64.9% with incident TRH refilled that medication after antihypertensive intensification. The use of prescription BP-interfering medications, especially NSAIDs, is prevalent among patients requiring intensification of their antihypertensive regimen. Greater efforts to limit the use of these medications, where feasible, may be required among patients with uncontrolled hypertension.

Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study

BackgroundFluoroquinolones (FQ) are increasingly prescribed for children, despite being labeled for only a limited number of labeled pediatric indications. In this multicenter retrospective drug utilization study, we analyzed indications for systemic FQ prescriptions in hospitalized children and the appropriateness of the prescribed dose.MethodsUsing data obtained from electronic medical files, the study included all children who received a systemic FQ prescription in two Belgian university children’s hospitals between 2010 and 2013. Two authors reviewed prescribed daily doses. Univariate and multivariate logistic regression models were used to analyze risk factors for inadequately dosing.Results262 FQ prescriptions for individual patients were included for analysis. 16.8% of these prescriptions were for labeled indications, and 35.1% were guided by bacteriological findings. Prescribed daily dose was considered to be inappropriate in 79 prescriptions (30.2%). Other FQ than ciprofloxacin accounted for 9 prescriptions (3.4%), of which 8 were correctly dosed. Underdosing represented 45 (56.9%) dosing errors. Infants and preschool children were at particular risk for dosing errors, with associated adjusted OR of 0.263 (0.097–0.701) and 0.254 (0.106–0.588) respectively.ConclusionsFQ were often prescribed off-label and not guided by bacteriological findings in our study population. Dosing errors were common, particularly in infants and preschool children. FQ prescriptions for children should be improved by specific pediatric antimicrobial stewardship teams. Furthermore, pharmacokinetic studies should optimise dosing recommendations for children.

Thrombotic risk minimization for Diane-35 and generics.

This study aimed to evaluate the effect of risk minimization measures on cyproterone acetate/ethinylestradiol (CPA/EE) use in the Netherlands. Potential indications of use and concomitant pharmacy dispensing of other hormonal contraceptives (HC) were assessed among new users in 2011, 2012, and 2014. In this retrospective drug utilization study, new CPA/EE users were identified by pharmacy dispensings in the PHARMO Database Network in 2011, 2012, and 2014. Recent dispensing of drugs to treat acne and concomitant dispensing of other HC were also assessed. General practitioner records were linked to identify diagnoses of acne, other hyperandrogenic conditions, menstrual problems, or consultations for contraceptive management in the preceding year. The number of new CPA/EE users identified per year was 7876 in 2011 and 7562 in 2012 (3.7 new users per 1000 women in both years) and 1401 in 2014 (0.7 per 1000 women). The proportions of users with acne diagnosis or treatment were 55% in 2011, 52% in 2012, and 47% in 2014. Concomitant use of other HC was observed for 3% of new CPA/EE users in 2011, and 2% in 2012 and 2014 (median duration 78days). Another 25% were potential concomitant users (median duration 60days). This descriptive analysis showed similar proportions of CPA/EE users examined with acne or other hyperandrogenic conditions, or with recent acne treatment, or concomitant dispensing of other HC in the Netherlands before and after the referral procedure. The key observation was a strong overall reduction of CPA/EE use in the Netherlands.