Total Drug Consumption Research Articles

MEDICATION IN THE COVID-19 PANDEMIC: Consumption of psychodrugs in two pharmacies in south fluminense

Social isolation and changes in routine during the COVID-19 pandemic had impacts on the mental health of the population and medicalization was used as a response to this problem. It is understandable that people face difficulties during periods of social deprivation, which can lead to symptoms such as fear, sadness and anxiety. However, it is important to emphasize that the approach to mental health should not be limited to medicalization alone. A study was carried out through document analysis in two pharmacies in the municipality of Barra Mansa, in Rio de Janeiro, in which the psychotropic drugs dispensed before, during and after the COVID-19 pandemic were quantified. The results obtained revealed that in pharmacy A from 2018 to 2019 there was a tendency towards an increase in the consumption of psychotropic drugs, with emphasis on antipsychotics, however the total consumption from 2019 to 2020 during the COVID-19 pandemic fell by 9.02%. In pharmacy B, in 2020, at the height of the COVID-19 pandemic in Brazil in 2021, there was a 26.35% reduction in the total consumption of psychotropic drugs. During the period of decline in cases of the disease in 2022, a 3.14% drop in the consumption of these medications was observed, but the consumption of anxiolytics increased by 149%. These results only show an increase in the consumption of antipsychotics in the pre-crisis period and an increase in the consumption of anxiolytics in the post-crisis period, highlighting medicalization, especially in the use of anxiolytics due to the dependence and tolerance that lead to prolonged use of these drugs.

Drug Consumption and Hydration Status: Analysis of the Associations in an Elder Population.

Hydration status plays a key role in healthy ageing, and it is potentially affected by several factors, including drug consumption. However, research on this issue to date is scarce, especially in highly vulnerable groups, such as the elderly. We aimed to study the relationship linking hydration status, analysed by means of a validated questionnaire, 24 h urine analysis, body composition assessment, and drug consumption in a sample of old adults. A total of 144 elders were included in the study. Cardiovascular drug consumption was significantly associated with a lower water intake in men (β = -0.282, p = 0.029). Moreover, urinary analysis revealed that total drug intake as well as the consumption of diuretics and cardiovascular drugs were associated with poorer hydration status, whereas genito-urinary drugs were associated with an opposite effect, and these results were confirmed in terms of body composition. Hence, total drug consumption (β = -0.205), diuretic (β = -0.408), cardiovascular (β = -0.297), and genito-urinary drugs (β = 0.298) were significantly associated (p < 0.05) with total body water. The obtained results confirmed the impact of chronic treatment with certain drugs on hydration status. Nutritional interventions may be of great interest in certain population groups in order to prevent complications due to altered hydration status.

A CTL-Inspired Killing System Using Ultralow-Dose Chemical-Drugs to Induce a Pyroptosis-Mediated Antitumor Immune Function.

A Cytotoxic T lymphocyte-inspired system capable of using ultralow-dose chemical drugs to manipulate cell death is needed to investigate the antitumor immunotherapy. Recent studies reveal pyroptosis promotes antitumor immune function. However, high-dose chemotherapy leads to cytokine release syndrome by pyroptosis. Therefore, pyroptosis-inducing ultralow-dose chemotherapy is potential in preclinical and clinical research, but its efficacy, safety, and the antitumor immune responses are not clear. Here, a near-infrared light controllable killing system (BIK system) is established by which ultralow-dose doxorubicin can be spatiotemporally transported to tumor cells and mediate efficient pyroptosis. This BIK system reduces total drug consumption to less than one-thirtieth the common dose in vitro. Moreover, this BIK system exhibited good tumor targeting and tumor penetration. This system is applied for pyroptosis-induced antitumor therapies, which shows less than ≈25µg kg-1 doxorubicin is sufficient for tumor regression with negligible injuries to major organs. The antitumor immune function are proven to correlate with the impressive efficacy of pyroptosis-inducing ultralow-dose chemotherapy. This study provides new insights into the design of nanoassisted systems for activating the antitumor immunity by microstimulation; the application of the BIK system suggests that ultralow-dose chemotherapy is sufficient for inducing a robust pyroptosis-mediated antitumor immunity.

Analgesic Effect of Intraoperative Intravenous S(+)-Ketamine During Total Knee Arthroplasty Surgery: Study Protocol for a Randomized Controlled Clinical Trial.

Total knee arthroplasty (TKA) is currently the main treatment for end-stage knee disease. The number of cases of TKA in China increased from 53,880 in 2011 to 374,833 in 2019, representing a 5.9-fold increase. Moderate to severe pain often occurs after TKA, which seriously affects postoperative rehabilitation, patient satisfaction, and overall outcome. Multimodal analgesia is considered the ideal solution. Adequate postoperative analgesia can not only reduce pain, opioid consumption, and, consequently, opioid-related adverse events, but can also reduce the length of hospital stay and costs and improve rehabilitation and patient satisfaction. Effective multimodal pain management in the early postoperative period is essential for anesthesiologists. Additional studies have demonstrated that a low-dose intravenous infusion of ketamine can be administered as an adjuvant drug to alleviate acute postoperative pain. Therefore, we aim to appraise the efficacy and safety of intraoperative intravenous injection of S(+)-ketamine to relieve acute pain after TKA in older patients. This is a protocol for a randomized, placebo-controlled trial. A total of 144 participants aged 65 years and older undergoing TKA will be randomly allocated into the S(+)-ketamine and placebo groups in a 1:1 ratio. S(+)-ketamine or the placebo will be intravenously administered at 0.3 mg/kg/h during the operation by anesthesiologists. Blinded evaluation by trained investigators will be completed at 2 hours, 24 hours, and 48 hours after surgery. The primary outcome measure will be the numeric rating scale score at rest and movement at 24 hours after surgery. The secondary outcomes will include the numeric rating scale scores at rest and movement at 2 hours and 48 hours after surgery, the number of patients who require additional analgesics during the first 48 hours after operation, the total consumption of opioids or nonsteroid anti-inflammatory drugs during the first 48 hours after operation, and adverse events at 2, 24, and 48 hours after operation. The protocol was registered at Clinical Trials.gov on February 26, 2022. It was performed in accordance with the approved guidelines and regulations of the participating institutions. Recruitment began in April 2022. Data collection is expected to conclude in September 2024. Study completion is expected in December 2024. A randomized, controlled, clinical study was designed to observe the analgesic effect of intraoperative intravenous administration of a lower dose of S(+)-ketamine (0.3 mg/kg/h) in older patients after TKA surgery. The protocol will appraise the efficacy and safety of intraoperative intravenous injection of S(+)-ketamine to relieve acute pain after TKA in older patients who may benefit from the administration of S(+)-ketamine. ClinicalTrials.gov NCT05289050; https://clinicaltrials.gov/ct2/show/NCT05289050. DERR1-10.2196/53063.

Pharmacoepidemiological Analysis of Antibacterial Agents Used in a Provisional Hospital in Aktobe, Kazakhstan, in the Context of COVID-19: A Comparison with the Pre-Pandemic Period.

In the context of the global spread of Coronavirus Disease 2019 (COVID-19), the issue of evaluating and optimizing the use of antibacterial drugs becomes especially relevant. The coronavirus pandemic has provided a unique opportunity to study the dynamics of the consumption of antibacterial agents and their impact on public health. The rational use of antibiotics is a key aspect of the fight against antimicrobial resistance, which makes this study particularly important. The aim of this study was to assess changes in the consumption of antibacterial drugs among patients hospitalized with COVID-19 during the peak of the 2020 pandemic and compare them with data from 2019 prior to the pandemic. This study collated data on antibacterial drug consumption in a regional hospital in Aktobe, which served a large population of patients during the pandemic. A pharmacoepidemiological study was conducted using the Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) methodology. The pharmacoepidemiological study using the international ATC/DDD methodology revealed a concerning pattern of irrational consumption of antibacterial drugs, including cephalosporins, azalides, second-generation fluoroquinolones, and systemic aminoglycosides in Aktobe. Among antibacterial drugs during the pandemic, the most significant increase in consumption was from the group of cephalosporins (19,043 DDD/100 bed-days). The share of their consumption was 35.4% of the total consumption of antibacterial drugs. Pharmacoepidemiological studies using the international methodology ATC/DDD showed an alarming picture of irrational consumption of antibacterial drugs of the group of cephalosporins, azalides, fluoroquinolones, and aminoglycosides in Aktobe, and, in this case, excessive use of the identified antibiotics raises concerns about the possibility of increasing the problem of resistance to microbes.

Consumption of psychotropic drugs in Croatia before and during the COVID-19 pandemic: a 10-year longitudinal study (2012-2021).

This longitudinal study aimed to examine the trends in antipsychotics, antidepressants, anxiolytics, and hypnotics/sedatives consumption in Croatia over a 10-year period (2012-2021). The study also assessed whether the COVID-19 pandemic had an impact on the yearly consumption of psychotropic drugs. Data were collected from Croatian Agency for Medicinal Products and Medical Devices (HALMED) and presented as defined daily doses per 1000 inhabitants per day (DDD/TID). The consumption before (2012-2019) and during the COVID-19 pandemic (2020-2021) was compared with interrupted time series analysis. There was an increase in total consumption of analyzed psychotropic drugs in Croatia between the years 2012 and 2021, from 115.47 DDD/TID in 2012 to 155.50 DDD/TID in 2021. An increasing trend was observed in the consumption of all 4 analyzed groups of medicines (antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants). Anxiolytics accounted for 59% (68.29/115.47 DDD/TID), and hypnotics and sedatives for 8.5% (9.76/115.47 DDD/TID) of total consumption in 2012. At the end of a 10-year period, hypnotics and sedatives represented 12% (19.05/155.50 DDD/TID) and anxiolytics 54% (83.53/155.50 DDD/TID) of psychotropic drugs consumption. The total consumption of psychotropic drugs was not significantly different before and during COVID-19 pandemic(estimate ± standard error = 5.029 ± 6.899, t = 0.729, P = 0.490). Croatia had a high, continuously increasing consumption of psychotropic drugs. National anxiolytics consumption was one of the highest globally, while consumption of antidepressants was rather low compared to other high-income countries. The COVID-19 pandemic did not seem to influence the yearly utilization of psychotropic drugs in Croatia.

Komparativna analiza potrošnje antihistaminika za sistemsku upotrebu u Republici Srbiji i nordijskim zemljama u periodu 2009-2019

Introduction: According to the ATC system of drug classification, group R06 includes H1 antihistamines for systemic use, which are divided into drug groups of the 1st and 2nd generation. Aim: Since there are no national guidelines in Serbia, for treating most allergic diseases, our aim was to compare pharmaceutical products and treatment strategies of systemic antihistamines use in Serbia with that in the Nordic countries that have been recognized as countries with good pharmacoeconomic practice. Material and methods: Data on drug consumption in the Republic of Serbia, the Kingdom of Norway, the Republic of Finland, and the Kingdom of Denmark were collected from the publications of national drug regulatory agencies for the period from 2009 to 2019. Results: Loratadine was the most commonly consumed antihistamine in Serbia in 2009, making 72.32% of the total consumption of drugs in the R06 group. During observed period the consumption of cetirizine increased 21.8 times, levocetirizine increased 36.6 times, desloratadine increased 2.6 times. The most commonly used antihistamines in Serbia in 2016 were: loratadine with 34.86%, followed by desloratadine with 18.70%, and ketotifen with 14.52% of the total consumption of drugs in the R06 group. In 2019, the most commonly used antihistamines were levocetirizine, loratadine, desloratadine and cetirizine. In Norway as well as in Finland and Denmark, during all eleven years (2009-2019) cetirizine was the most consumed antihistamine with mild increase trend in consumption of 1.5-5.74-20.5%. The second most consumed antihistamine in Norway and in Finland was desloratadine and in Denmark, fexofenadine. A decrease in consumption was recorded in case of loratadine in all three Scandinavian countries. First generation antihistamines promethazine and dexchlorpheniramine showed a continuous but minimal downward trend. Conclusion: Unlike Norway, Sweden and Denmark, in Serbia in the last 11 years, the consumption trends of antihistamines have not been consistent and seem to depend on various factors such as price.

A structure of the antihypertensive drugs consumption in the population of several regions of the Russian Federation

Aim to study the characteristics of the consumption of antihypertensive (AG) drugs in the population of several regions of the Russian Federation the Samara region, the Nizhny Novgorod region and the Republic of Tatarstan.&#x0D; Material and methods. The range of AG drugs sold in the retail pharmaceutical market of the Samara and Nizhny Novgorod regions and the Republic of Tatarstan was selected for the study. To manage the obtained data, we used several methods like structural, comparative, logical, predictive, retrospective, graphic, marketing analysis. The results were processed using the normalization method and methods of mathematical statistics.&#x0D; Results. The monopreparations kept the main share of sales in each region: 90.22% in the Samara region, 90.85% in the Nizhny Novgorod region, and 93.72% in the Republic of Tatarstan). In 2021, the leaders in consumption were ACE inhibitors (28.41%, 26.61% and 32.7%, respectively in each region) and -blockers (25.87%, 29.02% and 21.15%). In total, these two subgroups accounted for more than a half of all monopreparations sold, counted in packages. In the subgroup of fixed combinations, the angiotensin II receptor blockers + diuretic were the most popular, which account for 35.38%, 29.73% and 22.13% of drug sales in this subgroup in the Samara, Nizhny Novgorod regions and the Republic of Tatarstan, respectively. In the subgroup of combined antihypertensive drugs, the multicomponent fixed combinations were among the leaders (10.22%, 8.20%, 12.10%, respectively in each region), however, in the total consumption of antihypertensive drugs, they accounted for less than 1%.&#x0D; Conclusion. This study revealed the features of the consumption of drugs prescribed for arterial hypertension in the Samara and Nizhny Novgorod regions, as well as in the Republic of Tatarstan in 2021. We identified the groups of antihypertensive drugs of most demand and found the leaders within these groups. It was established that there was a relationship between the volume of sales of antihypertensive medicines in physical terms (in packages) in the Samara region for the period 20172021 and the population of this region.

THE MAIN TRENDS IN THE POPULATION CONSUMPTION OF MEDICINES PRESCRIBED FOR ARTERIAL HYPERTENSION IN THE RUSSIAN FEDERATION

Arterial hypertension is a widespread disease and a major risk factor for the development of lethal cardiovascular pathologies. To reduce this risk, timely detection of arterial hypertension, control of blood pressure levels and effective drug therapy for high blood pressure are necessary. Relevance. Study of population consumption of drugs used for hypertension in the retail sector of the pharmaceutical market in the Russian Federation for the period from 2017 to 2021. Methods. We used the methods of retrospective, predictive, structural, logical, comparative, graphic, marketing, pharmacoepi- demiological analyzes when conducting this study. The results were processed using the normalization method and methods of mathematical statistics. Results. The analysis of the structure and study of the characteristics of the population consumption of drugs used for arterial hy- pertension in the territory of the Russian Federation for the period 2017-2021 was carried out. The main share of sales falls on monopreparations: 92.04% - in physical terms, 74.55% - in monetary terms. In the rare pharmacy sales of antihypertensive drugs in the Russian Federation, the share of fixed combinations is 7.96% in physical terms and 25.64% in monetary terms. The most popular antihypertensive drugs in both in-kind and monetary terms over the estimated period are ACE inhibitors and β-blockers. In the subgroup of fixed combinations, “angiotensin II receptor blocker + diuretic” and “ACE inhibitor + diuretic” are in the lead. In the total consumption of antihypertensive drugs, the share of multicomponent fixed combinations accounts for only 0.44% in physical terms, but in monetary terms this figure is 2.51%. According to the results of the survey, doctors were more likely to be conservative in prescribing antihypertensive drug therapy, preferring single drugs, and medical specialists receive information about new drugs mainly at conferences, when meeting with medical representatives, and also from the Internet. Conclusion. Based on the results of the study, an educational program for medical and pharmaceutical specialists “Modern range of drugs prescribed for the prevention and treatment of hypertension” was developed.

Supply of medicines by humanitarian organizations in war conditions

Natural and war disasters lead to stagnation in economic, social and, yes, health development. During the war, the own production of medicines was significantly reduced or even completely stopped due to the destruction of factories, the impossibility of securing raw materials for the production of medicines, and due to the difficulty of importing, transporting and distributing medicines. Even during the war, chronic non-communicable diseases that require daily intake of several groups of drugs are common, the therapy is long-term, and it is necessary to provide a large amount of drugs for these patients. (Abrams J. Nitroglycerin and long-acting nitrates. N Engl J Med 1980; 302:1234). Under these conditions, humanitarian organizations are often the only ones who are able to secure and deliver medicines to certain war-affected areas, which was the case in Bosnia and Herzegovina. Frequent scientific and non-scientific discussions indicate that the medicines donated through humanitarian organizations are outdated and inadequate in relation to the needs of the population. In my research related to the humanitarian organization "Igasa", which included a clinic and a pharmacy and provided help through diagnostics and therapy mainly to chronic internal medicine patients, and for the period from January 2, 1994 to December 31, 1995. I found the following data: 12,839 patients with (CVD, GIO and diabetes mellitus) sought help in this clinic and pharmacy. Of these, 68.00% had CVD, 17.00% GIO and 15.00% diabetes mellitus. Of the total number of patients, 59.00% were women, and 41.00% were men. A significant difference was recorded in the number of patients with CVD according to GIO and diabetes mellitus (p = &lt; 0.001). The highest consumption of drugs was for the treatment of CVD patients (75.00%), while the number of drugs for the treatment of GIO and diabetes mellitus amounted to (25.00%) of the total drug consumption, this is shown by a significant difference (p = &lt; 0.001). The total monetary value of medicines issued in the period 1994 and 1995 in the humanitarian pharmacy "Igasa" is 369,816.28 KM. There was a significant difference in the consumption of medicines as well as the difference in the monetary value of the dispensed medicines between the humanitarian pharmacy "Igasa" and the civilian pharmacy "Bascarsija".

Triangulating Amsterdam’s illicit stimulant use trends by wastewater analysis and recreational drug use monitoring

Drug consumption estimates are of relevance because of public health effects as well as associated criminal activities. Wastewater analysis of drug residues enables the estimation of drug consumption and drug markets. Short-term and long-term trends of cocaine, MDMA (ecstasy), amphetamine (speed) and methamphetamine (crystal meth), were studied for the city of Amsterdam. MDMA (+41%) and cocaine (+26%) showed significantly higher weekend vs. week consumption, while no differences were observed for the other drugs. The consumption of MDMA, cocaine, amphetamine and methamphetamine significantly increased between 2011 and 2019. Weekly trends emerging from wastewater analyses were supported by qualitative and quantitative data from a recreational drug use monitoring scheme. However, information collected in panel interviews within nightlife networks and surveys among visitors of pubs, clubs and festivals only partially reflected the long term increase in consumption as registered from wastewater analysis. Furthermore, methamphetamine use was not well presented in survey data, panel studies and test service samples, but could be monitored trough wastewater analysis. This illustrates that wastewater analysis can function as an early warning if use and user groups are small or difficult to reach trough other forms of research. All in all, this study illustrates that wastewater-based epidemiology is complementary to research among user groups, and vice versa. These different types of information enable to connect observed trends in total drug consumption to behaviour of users and the social context in which the use takes place as well as validate qualitative signals about (increased) consumption of psychoactive substances. Such a multi angular approach to map the illicit drug situation on local or regional scale can provide valuable information for public health.

Antidepressant use in Turkey by provinces: panel data analysis

Abstract Objectives The objective of this analysis is to show differences in antidepressant use by year and by provinces of Turkey and to understand possible factors that cause these differences. Methods The drug data were obtained from the IMS Health Turkey Medical Index, and the per capita usage was calculated by proportioning with the population. Provinces with combined data were excluded from the study. Sixty provinces with complete data obtained from the IMS Health and Turkish Statistical Institute (TUIK) were included in the analysis. Physician visits per capita annual data were extracted from the Ministry of Health statistics. Population and per capita gross domestic product data of provinces were obtained from TUIK. A panel data regression model was established in the study. Key findings The model explained 99.25% of the variation in antidepressant consumption unit per person, which is a dependent variable. In our study, it was observed that there was no statistically significant effect of age and income in antidepressant usage. However, per capita physician consultation and the total population have a significant effect on per capita antidepressant use. Therefore, when the other variables are kept constant and the total population increases by 1%, the coefficient of antidepressant use per capita increases by 0.62%. Conclusions According to our analysis, in the majority of the provinces, antidepressant use exceeded the expected level. If the population density of Turkey increases, the ratio of antidepressant usage in the total consumption of drugs may grow. It is necessary to investigate whether there is overuse and to determine underlying causes and preventive measures.

A ten-year study of anti-diabetic drugs utilization in Iran.

According to the world health organization (WHO), by the year 2030 diabetes will become the world's seventh leading cause of death. This study aimed to design and conduct a descriptive pharmacoepidemiological investigation of anti-diabetic drugs utilization during a ten-year period using the anatomical therapeutic classification/defined daily dose (ATC / DDD) system in Iran. Based on pharmaceutical wholesalers' sale reports, sale data, including value and volume, were retrieved from the Iranian Annual Pharma Statistics for 2009-2018. The ATC/DDD system was used to standardize the raw sales data. Anti-diabetic drug utilization was reported as DDD per 1000 person in the population per day. Expenditure was calculated as USD per DDD. Results were then analyzed descriptively. During the ten-year study period, total anti-diabetic drug consumption increased by 235.53%. Insulin utilization grew by 148.65%, whereas non-insulin agents' use showed a 132.68% increase. Anti-diabetic drugs' expenditure increased by almost 9-fold, but changes were accompanied with many fluctuations. Although the absolute expenditure of almost all classes of anti-diabetic drugs were increasing, this growth was greater in biguanides, which only includes metformin in Iran. Approximately one-third of anti-diabetic drugs expenditures were related to fast-acting insulins. Imported drugs share in cost was significant, but not in consumption. The overall share of insulin consumption was less than 19%, but their share of total value reached 60% of the anti-diabetic market. The growing trend in both insulin and non-insulin anti-diabetic drugs utilization is a substantial issue for health authorities' policy making for sustainable access to medicine.

Comparison of ketofol versus propofol for procedural sedation and analgesia in cervical cancer brachytherapy: A prospective, randomized double blind study

Most common drug used for outpatient procedural sedation and analgesia is propofol, with limitations like systemic hypotension. Combining propofol with ketamine preserves sedation efficacy, minimizing their respective adverse effects. So, we aimed to compare ketofol (ketamine+propofol) versus propofol regarding their total drug consumption, recovery profile, effect on haemodynamic and respiratory parameters in brachytherapy patients. A prospective, randomized, controlled double blind study was carried out in 100 female patients between 20-60 years, 30-70kg, ASA I-III undergoing brachytherapy as outpatient procedure on elective basis, after ethical clearance from institutional committee. These were randomly divided into 2 groups (50 each). Group P-Injpropofol (10mg/ml) 2mg/kg for induction and 20mg as supplementation. Group K-Injketofol (10mg/ml) (ketamine 50mg+propofol 100mg, 1:2) 2mg/kg for induction and 20 mg as supplementation.The supplementation dose required was significantly higher in propofol group (800mg) as compared to ketofol group (20mg) (p=0.00). Also, the fall in SBP and DBP was significantly less in ketofol group than propofol group (p&amp;#60;0.01). The mean awakening time (time from end of procedure to MRSS =3) andmean recovery time (time from end of procedure to achievement of Aldrete score 10) was more in ketofol group than propofol group (p&amp;#60;0.003), the difference was less than 1-2 min, so it was clinically not significant. Ketamine-propofol combination in 1:2 ratio in a single syringe as ketofolis better alternative to propofol in providing sedation and analgesia with better haemodynamic stability, for outpatient brachytherapy procedure in cancer cervix patients.

The Health Costs of Cost-Sharing

We use the design of Medicare’s prescription drug benefit program to demonstrate three facts about the health consequences of cost-sharing. First, we show that an as-if-random increase of 33.6% in out-of-pocket price (11.0 percentage points (p.p.) change in coinsurance, or $10.40 per drug) causes a 22.6% drop in total drug consumption ($61.20), and a 32.7% increase in monthly mortality (0.048 p.p.). Second, we trace this mortality effect to cutbacks in life-saving medicines like statins and antihypertensives, for which clinical trials show large mortality benefits. We find no indication that these reductions in demand affect only ‘low-value’ drugs; on the contrary, those at the highest risk of heart attack and stroke, who would benefit the most from statins and antihypertensives, cut back more on these drugs than lower risk patients. Similar patterns exist for other drug–disease pairs, and irrespective of socioeconomic circumstance. Finally, we document that when faced with complex, high-dimensional choice problems, patients respond in simple, perverse ways. Specifically, price increases cause 18.0% more patients (2.8 p.p.) to fill no drugs, regardless of how many drugs they had been on previously, or their health risks. This decision mechanically results in larger absolute reductions in utilization for those on many drugs. We conclude that cost-sharing schemes should be evaluated based on their overall impact on welfare, which can be very different from the price elasticity of demand.

Field evaluation of diffusive gradients in thin-film passive samplers for wastewater-based epidemiology

There is a need for a simple water sampling technique to enable routine monitoring of community drug consumption through wastewater-based epidemiology (WBE). This study investigates the potential use of diffusive gradients in thin films to sample organic compounds (o-DGT) for WBE. Three types of resin gels (HLB, XAD 18, and XDA-1) within o-DGT samplers each were deployed in triplicate at the inlets of two sewage treatment plants of Southern Asian cities. The target compounds included 15 illicit drugs and 18 antibiotics. A comprehensive evaluation was undertaken regarding each resin's ability to accumulate the target compounds and accuracy by comparing active samples. The organic compounds accumulated on each resin gel were characterised at the molecular level using Fourier transform ion-cyclotron-resonance mass spectrometry (FT-ICR MS). The results showed that the HLB resin performed better than the XAD 18 and XDA-1 resins. Based on calculations using the HLB-DGT data, methamphetamine and heroin were the two most popular illicit drugs consumed among the studied populations, and were followed by ketamine and codeine, which agreed well with the authoritative reports and reference data. The total drug consumption in Hanoi was one order of magnitude higher than that in Guangzhou, thus implying a probably more serious drug situation in the former. Overall, the findings of this study demonstrate that o-DGT passive samplers are a promising tool for WBE studies, particularly at WWTPs or in urban streams where an automatic sampler for taking composite water samples is absent.

How Risky Is That Risk Sharing Agreement? Mean-Variance Tradeoffs and Unintended Consequences of Six Common Risk Sharing Agreements.

Background. Pharmaceutical risk sharing agreements (RSAs) are commonly used to manage uncertainties in costs and/or clinical benefits when new drugs are added to a formulary. However, existing mathematical models of RSAs ignore the impact of RSAs on clinical and financial risk. Methods. We develop a model in which the number of patients, total drug consumption per patient, and incremental health benefits per patient are uncertain at the time of the introduction of a new drug. We use the model to evaluate the impact of six common RSAs on total drug costs and total net monetary benefit (NMB). Results. We show that, relative to not having an RSA in place, each RSA reduces expected total drug costs and increases expected total NMB. Each RSA also improves two measures of risk by reducing the probability that total drug costs exceed any threshold and reducing the probability of obtaining negative NMB. However, the effects on variance in both NMB and total drug costs are mixed. In some cases, relative to not having an RSA in place, implementing an RSA can increase variability in total drug costs or total NMB. We also show that, for some RSAs, when their parameters are adjusted so that they have the same impact on expected total drug cost, they can be rank-ordered in terms of their impact on variance in drug costs. Conclusions. Although all RSAs reduce expected total drug costs and increase expected total NMB, some RSAs may actually have the undesirable effect of increasing risk. Payers and formulary managers should be aware of these mean-variance tradeoffs and the potentially unintended results of RSAs when designing and negotiating RSAs.

Laparoskopik Kolesistektomi Geçiren Hastalarda Ultrasonografi Eşliğinde Uygulanan Transversus Abdominis Plan Bloğun Perioperatif Analjezi ve Hasta Konforuna Katkısı

Objective: Inadequate pain management after laparoscopic cholecystectomy is an important problem that can lead to complications and negatively affect the patient’s recovery. Transversus abdominis plane block can contribute to postoperative analgesia in abdominal surgeries. The aim of this study is to investigate the effects of preoperative unilateral or bilateral transversus abdominis plane block on perioperative analgesia in patients underwent laparoscopic cholecystectomy and its contribution to patient comfort. Methods: A total of 75 patients were randomized into 3 groups as Group-1 (n=25) without unblocking, Group-2 (n=25) with unilateral block and Group-3 (n=25) with bilateral block. Block was applied to Group 2 and Group 3 under general anesthesia before surgery. Demographic characteristics of patients, intraoperative opioid consumption, postoperative 30 min, 2, 4, 8, 12 and 24 hours VAS rest-VAS cough scores, analgesic consumption in patient controlled analgesia, postoperative additional analgesic requirement, side effects, mobilization times and patient satisfaction were recorded. Results: The dose of remifentanil consumed intraoperatively was significantly lower in Group-3. VAS values were significantly different among the groups until the 12th hour postoperatively. The VAS rest and VAS cough values were lower in the Group 3. There was a significant difference among the groups in the patient-controlled analgesia devices when the bolus dose demand/given amounts and the total amount of drugs requested/consumed were compared. Total drug consumption was determined in the highest Group-1 and the lowest in Group-3. The satisfaction scores of the patients in group-3 were higher than the other groups. Conclusion: Our study showed that transversus abdominis plane block application in laparoscopic cholecystectomy surgeries contributed to decreased perioperative analgesic consumption and lower VAS scores up to 12 hours. Transversus abdominis plane block, which was performed with laparoscopic cholecystectomy in the preoperative period, has been shown to be an effective analgesic method.

PIH13 Consumption of Drugs for the Treatment of Benign Prostate Hyperplasia in Ukraine Compared to the Baltic Countries

Analyze the volume and structure of consumption of drugs for the treatment of Benign prostatic hyperplasia (BPH) in Ukraine for 2016-2018 and compare their consumption with data in Latvia and Estonia. Estimation of drug consumption was performed according to the ATC / DDD method. During the study, the international index DDD / 1000 inhabitants / day (DID) was calculated. The number of packages of drugs sold during the year in Ukraine was taken from the information system "Pharmexplorer” of the company "Morion” (November 2016-2018). DDD for drugs was obtained from the WHO website (http://www.whocc.no/atc_ddd_index/). The level of drug consumption in Latvia and Estonia was estimated using statistics from these countries. The highest consumption in all countries studied was found for tamsulosin. Its consumption levels in Ukraine amounted to 1.93-2.71 DID, in Estonia - 6.25-7.22 DID, and in Latvia - 4.08-5.14 DID. The second leader in consumption in the two comparison countries, apart from Ukraine, was the combination of tamsulosin and dutasteride. The level of consumption of this combination in Estonia (2.71-3.34 DID), on average, exceeded the level in Ukraine 49 times, and in Latvia - 12 times. The third leader in consumption in Ukraine and Estonia were herbal preparations of Sabalis serrulatae, which were absent in the Latvian. The third leader in consumption In Latvia was finasteride (0.97-1.00 DID). In terms of the total consumption of study drugs, the clear leader was Estonia, in second place - Latvia and Ukraine took the last place. The alpha-1-blocker tamsulosin was the leader in the level of consumption among drugs for the treatment of BPH in Ukraine, Estonia, and Latvia during 2016-2018. In terms of consumption of the studied drugs, the first place was taken by Estonia, the second - Latvia, and Ukraine - the last place.

Фармакоекономічні аспекти використання варфарину та нових оральних антикоагулянтів для профілактики тромбоемболічних ускладнень у пацієнтів із фібриляцією передсердь

Мета роботи – оцінити вартість профілактики тромбоемболічних ускладнень (церебральна або системна емболія) у пацієнтів із фібриляцією передсердь при застосуванні варфарину порівняно з новими оральними антикоагулянтами в умовах сучасної української системи охорони здоров’я.Матеріали і методи. Використано фармакоекономічні методи мінімізації витрат та загальної вартості лікування захворювання. Споживання лікарських засобів (ЛЗ) визначали за методологією АТС/DDD на підставі даних системи дослідження ринку ЛЗ Pharmexplorer, економічну доступність ЛЗ оцінювали відповідно до значення показника Ca.s.Результати та обговорення. Проведено аналіз порівняльної ефективності та безпечності нових пероральних антикоагулянтів (НОАК) і варфарину за даними останніх систематичних оглядів і метааналізів. За результатами аналізу фармацевтичного ринку встановлено, що на цей час в активному роздрібному продажі в Україні є 15 препаратів НОАК (2 препарати апіксабану, 6 препаратів дабігатрану та 7 препаратів ривароксабану) і 11 препаратів варфарину від 4 виробників. Визначено, які саме ЛЗ, що містять тотожну речовину, є найдешевшими в перерахуванні щодо вартості однієї встановленої добової дози (defined daily dose, DDD). Виявлено, що за показником Ca.s. 80 % препаратів варфарину належать до середньодоступних, а всі НОАК – до малодоступних. Рівень загального споживання антикоагулянтних ЛЗ в Україні в 2019 р. становив 1,7 DDDs, що з урахуванням поширеності фібриляції передсердь в українській популяції (0,4–1 %) дозволяє припустити існування значної кількості хворих з фібриляцією передсердь, які не отримують належної антикоагулянтної терапії. Встановлено, що рівень споживання ЛЗ групи антикоагулянтів не залежить від вартості препарату.Висновки. Загальні витрати на один рік профілактичної антикоагулянтної терапії варфарином для одного пацієнта з фібриляцією передсердь з урахуванням витрат на контроль ефективності та безпечності лікування за результатами розрахунків становлять 3339,5 грн. Рік фармакотерапії ривароксабаном коштує 19 357,5 грн, дабігатраном – 18 809,6 грн, апіксабаном – 17 744,6 грн, що дозволяє вважати варфарин економічно доцільнішим препаратом для лікування пацієнтів із фібриляцією передсердь порівняно з НОАК в чинних умовах функціонування системи охорони здоров’я України (з перспективи платника-пацієнта).