Implementation of a New Cost-effective HPLC/UV-System for Therapeutic Drug Monitoring of Antidementia Drugs in Medical Routine Analysis Shown by the Example of Galantamine (Reminyl®)

2008 ◽  
Vol 41 (05) ◽  
Author(s):  
R Koeber ◽  
HH Kluenemann ◽  
D Melchner ◽  
E Haen
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Cost Effective ◽  
Routine Analysis ◽  
Therapeutic Drug ◽  
Antidementia Drugs

scholarly journals Therapeutic Drug Monitoring: Fundamentals, And Optimization

2021 ◽  
Author(s):  
Ahmed Ali ◽  
Mahran Abdel-Rahman
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Cost Effective ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Relevant Research ◽  
Request Form ◽  
Narrow Therapeutic Range ◽  
Analytical Tools

Therapeutic drug monitoring (TDM) is a teamwork clinical pharmacokinetic services aimed to optimize pharmacotherapy of certain drugs such as those with a narrow therapeutic range, complicated pharmacokinetics. It involves the determination of drug level in blood samples taken at the appropriate time. Interpretation of results requires integration of pharmacokinetics, the pharmacodynamics of the drug and the patient’s clinical profile. To be cost-effective the service should be optimized. This review was written by experts from different developing countries to highlight the fundamentals of the service and provide suggestions for its optimization. These cover the rationale of requesting drug level, design of request form, optimal sampling, and analytical tools. guidelines for appropriate interpretation of drug levels; completeness of the roles of the qualified medical team; continuing education and skills development; involve the patients in improving the service, conducting relevant research; use PK software and integration of TDM with pharmacogenomics

Cost-effective assays for use in monitoring carbamazepine, phenobarbital, and phenytoin in serum.

1989 ◽  
Vol 35 (8) ◽  
pp. 1782-1784 ◽  
Author(s):  
F M Moore ◽  
D Simpson
Keyword(s):  
Gas Chromatography ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Fluorescence Polarization ◽  
Cost Effective ◽  
Therapeutic Drug ◽  
Negative Bias ◽  
Good Precision ◽  
Repeat Analysis ◽  
Precision And Accuracy

Abstract Using Syva "EMIT" reagents and the Cobas Bio centrifugal analyzer, we have developed cost-effective assays for therapeutic drug monitoring of carbamazepine, phenobarbital, and phenytoin. With these optimized methods one can assay up to 2470 samples with a single 100-test EMIT kit with good precision and accuracy. Between-batch CVs, based on results of repeat analysis of routine patients' samples, were 4.6%, 7.0%, and 5.3%, respectively. Results correlated well with those by methods previously used [gas chromatography and fluorescence polarization (Abbott TDx)], but there was a negative bias (-10.9%) of our method for phenobarbital results in patients' samples, as compared with those obtained with the TDx.

Abstract 502: Cost-effectiveness Of Therapeutic Drug Monitoring In Patients With Resistant Hypertension

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Oliver Chung ◽  
Klaus BONAVENTURA ◽  
Christian Sohns ◽  
Wilhelm Haverkamp ◽  
Wilhelm Haverkamp ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Therapeutic Drug Monitoring ◽  
Incremental Cost ◽  
Drug Monitoring ◽  
Resistant Hypertension ◽  
Cost Effective ◽  
Antihypertensive Drug Therapy ◽  
Therapeutic Drug ◽  
Life Years ◽  
Wide Range

Background: Non-adherence to anti-hypertensive medications poses a significant problem in the treatment of patients with presumed resistant hypertension (RH). Our recent study has shown that therapeutic drug monitoring (TDM) is a useful tool not only for detecting medication non-adherence but also exploring the barrier to antihypertensive drug therapy, resulting effective BP control. However, the cost effectiveness of TDM in the management of resistant hypertension has not been investigated. Method: A Markov model was used to evaluate life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios in RH patients receiving either TDM optimized therapy or standard best medical therapy (BMT). The model ran from the age of 30 to 100 years or death, using a cycle length of 1 year. Efficacy of TDM was modeled by reducing risk of hypertension-related morbidity and mortality. Results: In the age group of 60-year olds, TDM gained 1.07 QALYs in men and 0.97 QALYs in women at additional costs of є3,854 and є3,922, respectively. Given a willingness-to-pay threshold of є35,000 per QALY gained, the probability of TDM being cost-effective compared to BMT was ≥95% in all age groups from 30 to 90 years. Incremental cost-effectiveness ratios were influenced mostly by the annual frequency of TDM testing, the rate of non-responders to TDM, and the magnitude of effect of TDM on systolic blood pressure (Figure). Conclusion: Therapeutic drug monitoring presents a potential cost-effective health care intervention in patients diagnosed with RH. Importantly, this finding is valid for a wide range of patients, independent of gender and age.

scholarly journals P449 Cost Effectiveness of a Proactive Therapeutic Drug Monitoring Strategy in Patients with Inflammatory Bowel Disease Receiving Infliximab

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S445-S446
Author(s):  
J Doherty ◽  
R Varley ◽  
M Healy ◽  
C Dunne ◽  
F Mac Carthy ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Cost Effectiveness ◽  
Therapeutic Drug Monitoring ◽  
Bowel Disease ◽  
Drug Monitoring ◽  
Cost Savings ◽  
Cost Effective ◽  
Therapeutic Drug ◽  
Dose Increase ◽  
Inflammatory Bowel

Abstract Background Proactive therapeutic drug monitoring (TDM) has not demonstrated improved therapy outcomes compared with clinically-based dosing strategies. While the use of proactive TDM incurs additional assay-related costs this strategy may be cost-effective due to TDM-driven therapy dose de-escalation and discontinuation. Methods We aimed to assess if proactive-TDM is cost-effective in clinical practice. A proactive TDM strategy was utilized in our unit with infliximab (IFX) and antibody-to-infliximab (ATI) levels assessed at trough in all inflammatory bowel disease(IBD) patients receiving IFX. Baseline demographics and IFX dosing schedules were documented. Patients were grouped based on disease activity status. Patients with IFX levels outside therapeutic range had dosing adjusted as appropriate. IFX dose adjustments were not protocolized and were at physicians discretion. IFX dosing regimens following proactive TDM were documented and net effect on IFX infusions number over the subsequent year extrapolated. Increase or decrease in drug-related costs on an annualized basis were estimated. Results 108 patients were included. Median age 36 years. 46% were female. 36% had ulcerative colitis, 60% Crohn’s disease. 35% were receiving concomitant immunomodulators. 56% were in remission at the time of TDM. 44%, 30% and 26% had IFX levels < 3 µg/mL, 3 – 7 µg/mL and > 7 µg/mL. IFX levels were significantly lower in patients with active disease compared with those in remission(p=0.008). Following proactive TDM assessment 37%, 11%, 36%, 13%, 2% and 1% of patients had no treatment change, therapy discontinuation, interval shortening, interval lengthening, dose increase and dose decrease respectively. Cost-effectiveness analysis focused on patients in remission (n=59). The use of proactive TDM-based IFX dosing resulted in a projected annualized reduction of 19.5 and 28.5 infusions due to IFX discontinuation and interval lengthening; the projected annualized increase in infusions was 39.1 and 4.3 due to IFX interval shortening and dose increase. This resulted in a net projected reduction of 4.7 IFX infusions per annum. Utilizing publicly available list prices for originator and biosimilar IFX and accounting for assay cost, projected cost savings resulting from proactive-TDM was 9105.0 and 6840.7 Euro per annum. Conclusion Proactive TDM in IBD patients in remission resulted in a modest reduction in the projected annualized number of infusions in our unit with consequent minor drug-related cost savings. Proactive-TDM encouraged cost-effective prescribing of IFX, however, the effect was minor. The frequency at which proactive TDM should be performed and whether subsequent rounds of proactive-TDM would continue to deliver similar cost savings is uncertain.

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