scholarly journals A Study to Evaluate Pharmacoeconomics of Antihypertensive Drugs in a Tertiary Care Teaching Hospital

2020 ◽  
Vol 10 (4-s) ◽  
pp. 176-180
Author(s):  
Nimmy N John ◽  
Athira Krishnan ◽  
JV Midhun ◽  
Riya Juan
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Financial Burden ◽  
Tertiary Care ◽  
Cost Effective ◽  
Effective Therapy ◽  
P Value ◽  
Major Public Health Problem ◽  
Care Hospital

Background: Hypertension is a major public health problem associated with large health burden as well as high economic burden at individual and population levels. A prospective observational study carried out in in-patients admitted to general medicine department of tertiary care hospital to evaluate the most cost effective therapy among the monotherapy of Amlodipine and combination therapy of telmisartan + hydrochlorthiazide. Methods: A total of 120 Hypertensive patients case records prescribed with monotherapy of Amlodipine and combination therapy of Telma H were reviewed and evaluated using descriptive statistics and ‘p’ value and assessed for their financial burden based on the cost per tablet for an year, Cost effectiveness ratio for the patients with controlled Blood Pressure by using a particular drug. Results: Out of 120 patients females were more (59.2%) and most of them were under the age group of 41-60 years. Majority of the patients had a known history of hypertension (65%). Most of the patients were prescribed with Telma H 40/12.5mg (40%) followed with Amlong 5mg (35.8%). There was a significant positive correlation (i.e., p value= 0.05) between persistence patterns of patients with drug therapy. Probability of patients with controlled Blood Pressure taking Amlong 10 mg were 82.35% followed by patients with Amlong 5mg. Conclusion: This study clearly showed that monotherapy of amlodipine is the most cost effective therapy than combination therapy of Telma H in order to reduce financial burden to the patient as well as to decrease the complications. Keywords: Hypertension, Pharmacoeconomics, Cost effectiveness, Blood Pressure.

A comparative study of monotherapy versus combination therapy in patients with stage-1 hypertension in terms of efficacy and cost effectiveness and to assess the medication adherence

2018 ◽  
Vol 9 (1) ◽  
pp. 147 ◽  
Author(s):  
Ritu A Mathew ◽  
Samuel Johnson ◽  
Shalumol Jose ◽  
Shampa Chakraborty ◽  
Kenneth N ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Combination Therapy ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Financial Burden ◽  
Cost Effective ◽  
Dual Therapy ◽  
Individual Therapy ◽  
Stage 1

Hypertension has multiple pathogenesis and majority of patients require two or more antihypertensive drugs to provide optimum control of blood pressure. The aim is to compare the effectiveness of mono therapy versus combination therapy in patients with stage-1 hypertension, to assess the medication adherence and to compare the cost incurred per day for the different therapies. Patient’s demographical details and history was recorded in a data entry form. Outcome of the treatment was measured in terms of reduction in systolic and diastolic blood pressure. Patient’s medication adherence was assessed using modified Medication Adherence Scale. Economic outcomes were measured in terms of cost of individual therapy. The data was entered into the excel sheet and statistically analysed using ANOVA. Results showed that dual therapy is the most effective in reducing the mean systolic (28.75 mm Hg) and diastolic (8.875) blood pressure with the combination of Amlodipine + Telmisartan being the most effective. Here, 66 patients (33%) were found to be adherent and 134 patients (67%) were found to be non- adherent. It was found that AMLOKIND 2.5, LOSAKIND and ATEN 50 were the most cost effective brands of drug from the classes of calcium channel blockers, angiotensin receptor blockers and beta blockers respectively. Comparison of effectiveness of various antihypertensive therapies showed that dual therapy shows maximum reduction in mean systolic BP and thus it can be prescribed more often in Stage I hypertensive patients. The poor adherence scores indicate that a multidisciplinary approach with a greater involvement of the patient is required to increase the compliance of the patient. Also cost effective drugs need to be prescribed more in order to decrease the financial burden on the patients. Keywords: Blood pressure; Monotherapy; Dual therapy; Triple therapy; Medication adherence

scholarly journals Profile of tuberculous pneumothorax and comparison with pulmonary tuberculosis without pneumothorax

2019 ◽  
Vol 7 (3) ◽  
pp. 658
Author(s):  
Gayatri D. Yellapu ◽  
Surya K. Vipparthi ◽  
Rohini K. Vangara
Keyword(s):  
Pulmonary Tuberculosis ◽  
Hospital Stay ◽  
Past History ◽  
Financial Burden ◽  
Tertiary Care ◽  
Control Group ◽  
P Value ◽  
Care Hospital ◽  
Common Cause ◽  
The Mean

Background: Tuberculosis is the most common cause of secondary spontaneous pneumothorax (SSP) in India. The prevalence of SSP in patients with pulmonary tuberculosis (PTB) is between 1- 3%. There were only few studies in the literature that specifically analyze tuberculous PNTX. In a study from this hospital, author found PTB was the most common cause of SSP. Now, author aimed at studying the clinical profile of tuberculosis associated PNTX cases and compared with pulmonary tuberculosis cases without PNTX.Methods: This was a single centre prospective observational case control study done at a tertiary care hospital. Fifty patients of tuberculous pneumothorax as cases, and 100 patients of pulmonary tuberculosis without pneumothorax were taken as control. The demographic data, clinical presentation, and radiologic presentation, outcomes after treatment were recorded in both the groups. The data was analyzed using statistical software (SPSS) using appropriate statistical tools.Results: The mean age of patients in the PNTX group was 38.18±14.132, where as in the control group it was 45.29±14.89 (p-value of 0.0052). Past history of tuberculosis was present in 27 (54%) cases of PNTX group and in 41 (41%) cases in the control group (p-value of 0.091). The mean duration of length of hospital stay in PNTX group was 16.5±11.865 days and in non-pneumothorax group was 6.2±2.54 days (p-value was 0.0001).Conclusions: Tuberculous pneumothorax was more common between 30-40 yrs age group. Gender and smoking have no association with PNTX. Tuberculous pneumothorax was more common in previously treated cases of TB. Patients with tuberculous PNTX have prolonged hospital stay and complications resulting in increased morbidity, financial burden and mortality.

Comparison of Dexamethasone with Ondansetron for Prevention of Post-Operative Nausea and Vomiting

2021 ◽  
Vol 15 (11) ◽  
pp. 3464-3466
Author(s):  
Nazeer Ahmed ◽  
Muhammad Arif Baloch ◽  
Muhammad Sharif ◽  
Zafar ullah ◽  
Yasir Reda Toble
Keyword(s):  
Laparoscopic Surgery ◽  
Tertiary Care ◽  
Cost Effective ◽  
Nausea And Vomiting ◽  
P Value ◽  
Care Hospital ◽  
Group I ◽  
Anesthesia Group ◽  
Cost Effective Alternative ◽  
Post Operative Nausea

Objective: To examine the effectiveness of dexamethasone and ondansetron in reducing the incidence of post-operative nausea and vomiting (PONV) in patients following laparoscopic surgery. Patients and Methods: A total number of 100 patients who were planned for laparoscopic surgery under general anesthesia having age 20-60 years were included in this study from a tertiary care hospital from Dec-2019 to June-2021. Patients were divided in to two group using Draw randomization technique. Group I; in these patients IV dexamethasone 8 mg was given at the time of induction of anesthesia. Group II; in these patients Ondansetron (4 mg IV) was given at induction of anesthesia. After completing the surgery and shifting the patient to the recovery room frequency of PONV within 6 hours after surgery was noted. Results: Mean age of the patients was 43.31±10.41 years. There were 54 (54.00%) male patients and 46 (46.00%) female patients. There were 75 (75.00%) patients with ASA I and 25 (25.00%) patients with ASA II. PONV occurred in 11 (22.00%) patients in dexamethasone group and in 21 (42.00%) patients in ondansetron group (p-value 0.03). Conclusion: After laparoscopic surgery, dexamethasone decreased the prevalence of nausea and vomiting. A single dosage of dexamethasone was proven to be a safe and cost-effective alternative to a single dose of ondansetron. Keywords: Dexamethasone, Ondansetron, post-operative Nausea and vomiting.

scholarly journals Pharmacoeconomic comparison of losartan and amlodipine in patients of hypertension in a tertiary care teaching hospital

2017 ◽  
Vol 6 (3) ◽  
pp. 552
Author(s):  
Iram Shaifali ◽  
H. K. Singh
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Pharmacoeconomic Analysis ◽  
Tertiary Care ◽  
Cost Effective ◽  
Mean Blood Pressure ◽  
Open Label ◽  
Compliance Cost ◽  
Hypertensive Patients ◽  
The Cost

Background: To conduct a pharmacoeconomic comparison (cost-effectiveness analysis) and to evaluate the overall safety and efficacy of Losartan and Amlodipine in reducing the Mean blood pressure per mm Hg in hypertensive patients.Methods: This was a prospective, randomized, open label, observational analysis of cost-effectiveness; into compare the cost of Losartan 50mg and Amlodipine 5mg in hypertensive patients using either of the two drugs. A total of 80 newly diagnosed drug naïve hypertensive patients were considered for the comparison, of which 40 patients were prescribed Losartan and the other 40 were prescribed Amlodipine as per the recommended dosage. Based on the data, statistical analysis was carried out using SPSS Software Version 21.Results: The two drugs were found to be equi-effective in reducing the blood pressure to the target goal, at their respective equivalent doses Moreover, the cost of reducing 1 mm of Hg mean blood pressure with Losartan was 103.42 INR, whereas that of Amlodipine was 57.11 INR. Hence the cost incurred in treating elevated BP was markedly lower with the Amlodipine group as compared to the Losartan group.Conclusions: This pharmacoeconomic analysis shows that Amlodipine is more cost-effective as compared to Losartan when the cost per mm Hg reduction in mean blood pressure is considered. Hence in India, where the cost of drug is a significant deterrant to patient compliance, cost-effective therapy of chronic disease like hypertension is of prime importance.

scholarly journals Strengthening opportunistic screening for hypertension: report from a tertiary care institution in a district of West Bengal, India

2019 ◽  
Vol 6 (9) ◽  
pp. 3878
Author(s):  
Ritu Ghosh ◽  
Sanghamitra Maulik ◽  
Saikat De ◽  
Tanmoy Tikader ◽  
Sankar Nath Jha ◽  
...  
Keyword(s):  
Blood Pressure ◽  
West Bengal ◽  
Lifestyle Modification ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Opportunistic Screening ◽  
Cross Sectional ◽  
Socio Demographic Factors

Background: Hypertension is a major public health problem in India and considered as a silent killer disease. The national program for prevention and control of cancer, diabetes, CVD and stroke (NPCDCS) recommended opportunistic screening for hypertension at all levels health facility. The present study was conducted with the objectives to estimate the magnitude of hypertension among the General OPD attendees aged 18 years and above in tertiary care hospital in a district of West Bengal and to find out the factors influencing hypertension among them.Methods: The study was a hospital based observational, descriptive study with cross sectional design and conducted among 244 study participants in 2018. Study variables included socio demographic factors and both modifiable and non-modifiable risk factors for hypertension.Results: In this study 40.2% subjects had normal blood pressure, 18.4% were known hypertensive and 101 (41.3%) people were newly diagnosed as having high blood pressure. Among known hypertensive, 75% had poor control of hypertension. Age, religion, family history of hypertension, body mass index (BMI) and central obesity had significant association with hypertension.Conclusions: The study recommended strengthening of opportunistic screening of all patients for hypertension at all levels of health care, especially through the village health nutrition day platform and providing treatment free of cost. Awareness generation and counselling for lifestyle modification should also be strengthened.

scholarly journals APPROPRIATE EMPIRICAL MANAGEMENT OF MICROBIAL INFECTIONS IN A TERTIARY CARE HOSPITAL: A COST- EFFECTIVENESS APPROACH.

2018 ◽  
Vol 11 (2) ◽  
pp. 124 ◽  
Author(s):  
Onchari Divinah N ◽  
Josin Mary Simon ◽  
Sneha Tomy ◽  
Arun Prasath R ◽  
Sivakumar V
Keyword(s):  
Cost Effectiveness ◽  
Tract Infection ◽  
Tertiary Care ◽  
Cost Effective ◽  
Klebsiella Pneumonia ◽  
Care Hospital ◽  
Microbial Infection ◽  
Sensitivity Pattern ◽  
Microbial Infections ◽  
Effective Drugs

 Objective: Antibiotics are mostly prescribed empirically to decrease health-care costs. This has led to the misuse of antibiotics thereby making them inefficient in the treatment of infections. The aim of this study was to determine the appropriate, cost-effective drug for the empirical therapy in microbial infections.Methods: A prospective observational study was conducted for a period of 6 months. Cost-effectiveness ratio (CER) of these antibiotics prescribed was calculated to determine the cost-effective drugs for the common microorganisms and common infections.Results: In a population of 205 patients, 54.6% were treated based on antibiotic sensitivity pattern whereas 45.3% were treated empirically. In known microbial infections, the prevailing microorganism was extended-spectrum beta-lactamase (ESBL) producing Escherichia-coli (14.3%), Staphylococcus aureus (10.6%), Pseudomonas aeruginosa (9.8%), Klebsiella pneumonia (9.8%), and K. pneumoniae ESBL (6.81%). Based on the CER, the most cost-effective drugs for these organisms were found to be ciprofloxacin, clindamycin, ofloxacin, levofloxacin, and amikacin, respectively. In unknown microbial infection (empirical treatment), Diabetic Foot Infection (DFT) (25.8%), respiratory tract infection (RTI) (23.6%), and urinary tract infection (UTI) (16.1%) were the most common infections. The most cost-effective drugs for these infections were clindamycin, levofloxacin, and azithromycin, respectively. The predominant microorganism in DFT was found to be S. aureus (71%), in UTI was found to be E. coli ESBL (52%), and in RTI were found to be P. aeruginosa (42.4%) and K. pneumonia (32.3%).Conclusion: Appropriate empirical antibiotic treatment is associated with a lower medical cost and a better success rate in patients with microbial infections.

scholarly journals Relation between Glycemic Control among the Patients with Type 2 DM and Level of Blood Pressure

2021 ◽  
Vol 22 (1) ◽  
pp. 12-17
Author(s):  
Md Al Amin ◽  
Tahira Zannat ◽  
Md Nazim Uddin ◽  
Md Moniruzzaman ◽  
Md Habibullah ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Type 2 Dm ◽  
The Mean

Introduction: Inadequate glycemic control among patients with type 2 diabetes constitutes a major public health problem and risk factor for the development of diabetes related complications. Hypertension is a common co-morbid condition of diabetes. Hypertension as a factor for poor glycemic control in diabetes patients has not been properly evaluated in Bangladesh. The aim of the study was to assess status of glycemic control among patients with Type 2 DM depending on the level of blood pressure in a tertiary care hospital. Method: This cross sectional study was carried out among 200 adult patients of either gender with type 2 diabetes mellitus, in the Department of Medicine and endocrinology, Dhaka Medical College Hospital from January to June 2015. Results: The mean age of the respondents were 56.85(±10.84) years, ranging from 35 to 77 years. Among 200 patients, 129 (64.5%) were hypertensive and 71 (35.5%) were normotensive with a mean duration of hypertension was 10.03 (±3.39) years. The mean HbA1c for all diabetic, hypertensive and normotensive patients were 7.41% (±1.35), 7.63% (±1.30) and 7.02% (±1.37) respectively. The mean HbA1c was significantly higher in hypertensive than normotensive group (p=0.002). The mean HbA1c was also significantly higher in patients with duration of hypertension (p=0.03) for more than 10 years and in patients who used beta blocker (p=0.005) and diuretics (p=0.02) as hypertensive medication. Among the patients with normal BMI and on dietary modification, those who were hypertensive had significantly higher (p=0.00008) mean HbA1c (7.12(±0.99)) than those were normotensive (5.01(±0.01)). Conclusion: The glycemic control in type 2 DM is found to be poor among the hypertensive patients. There is a complex association of multiple factors like age, gender, duration of hypertension and medications strongly influence the glycemic control of type 2 diabetics with hypertension. J MEDICINE JAN 2021; 22 (1) : 12-17

scholarly journals Predictive Accuracy of Procalcitonin in Diagnosing Bacteraemia in Adult Patients in a Tertiary Hospital in Madurai, India

2021 ◽  
Vol 8 (21) ◽  
pp. 1711-1716
Author(s):  
Virgin Joena
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Predictive Accuracy ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
P Value ◽  
Care Hospital ◽  
Presumptive Diagnosis ◽  
Two Samples ◽  
Significant Difference

BACKGROUND Bacteraemia is the presence of bacteria in the bloodstream that are alive and capable of reproducing. The incidence of bloodstream infections (BSI) either of the community-acquired origin or of hospital-acquired origin has dramatically increased. Identifying patients with high risk of bacteraemia in emergency department (ED) using predictive models is needed. The present study was conducted to evaluate the efficacy of procalcitonin as well as other biomarkers as diagnostic, predictive markers of bacteraemia in an adult patient population in India. METHODS A descriptive observational study was conducted at the ED of a tertiary care hospital in India. Fifteen years or older patients who were ready to give at least two samples of blood for blood culture were recruited. Data on demographic variables, predisposing conditions, clinical presentations, laboratory tests, and presumptive diagnosis was analysed using SPSS and P value of 0.05 was considered statistically significant. A logistic model was built using an iterative procedure which was later simplified into a coefficient-based scoring system. RESULTS Out of 78 patients, (66.67 %) from the emergency department and (33.33 %) from out-patient department (OPD) were enrolled. Among the study population, 40 (51.28 %) were with bacteraemia, and the remaining 38 (48.72 %) had no bacteraemia. There was no statistically significant difference in levels of procalcitonin, pulse rate, respiratory rate, systolic blood pressure, diastolic blood pressure, SPO2, total count, MCV, RDW, MPV, albumin, urea, creatinine between bacteraemia and no bacteraemia. (P value > 0.05). The mean procalcitonin was 33.02 ± 43.46. CONCLUSIONS Although, increased PCT levels can be useful as predictors of bacteremias in the emergency department, interpretation should be made carefully when deciding the prescription of antibiotics. KEYWORDS Procalcitonin, Bacteraemia, PCT levels

scholarly journals COMPARISON OF EFFICACY AND ADVERSE DRUG REACTIONS OF MONOTHERAPY VERSUS COMBINATION THERAPY OF ANTIHYPERTENSIVES AMONG DIABETIC HYPERTENSIVE PATIENTS IN A TERTIARY CARE HOSPITAL

2017 ◽  
Vol 10 (2) ◽  
pp. 385
Author(s):  
Laxminarayana Kurady Bairy
Keyword(s):  
Blood Pressure ◽  
Adverse Effect ◽  
Combination Therapy ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Drug Group ◽  
Combination Group ◽  
Care Hospital ◽  
Drug Reactions ◽  
Pedal Edema

Objective: To compare the efficacy and adverse drug reactions of monotherapy and combination therapy of antihypertensive drugs in diabetic hypertensive patients.Methods: A prospective observational study of 18 months duration was conducted in the Department of Medicine of a tertiary care hospital in South India. A total of 200 patients were included in the study. Using a standard proforma, the details of patients such as demographic data and antihypertensive medications were collected and analyzed for efficacy and safety.Results: Of 200 patients studied, 50% received monotherapy whereas the remaining 50% received combination therapy. There was male preponderance (54%) in the study population, with the mean age being 60.07±11.32 years. In monotherapy group, most commonly prescribed drug was amlodipine (38%), whereas in combination group, angiotensin receptor blocker (ARB) or calcium channel blocker (CCB) + beta blocker (18%) was commonly prescribed among 2-drug group and ARB+ thiazide+ CCB (25.6%) among 3-drug group. Monotherapy and combination therapy were analyzed to be equally efficacious in reducing systolic blood pressure and diastolic blood pressure. Based on the adverse effect profile, monotherapy comparatively produced more adverse effects than combination group. Amlodipine-induced pedal edema (56.7%) was the most common adverse effect observed, and it was predominantly managed by changing it to be a better tolerable CCB, namely cilnidipine.Conclusion: The combination therapy may be a better treatment option in selected patient population.Keywords: Systolic blood pressure, Diastolic blood pressure, Amlodipine, Cilnidipine, Pedal edema.

scholarly journals Incremental cost-effectiveness and tolerability of Diclofenac + Proton pump inhibitor compared to tramadol in the treatment of knee osteoarthritis

2018 ◽  
Vol 7 (2) ◽  
pp. 252
Author(s):  
Mehwish Majeed ◽  
Shaheena Rasool ◽  
Afkat Ahmad
Keyword(s):  
Cost Effectiveness ◽  
Knee Osteoarthritis ◽  
Incremental Cost ◽  
Proton Pump ◽  
Tertiary Care ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Care Hospital ◽  
Open Label ◽  
Hospital Patients

Background: In a climate of economic uncertainty, cost effectiveness analysis is a potentially important tool for making choices about health care interventions. Patients with knee osteoarthritis are treated mostly with Diclofenac (NSAID) + Proton Pump Inhibitors (PPI) and Tramadol (Opioids) in everyday practice.Aim: Present study was aimed to assess clinical effectiveness, adverse events and cost-effectiveness between Diclofenac + PPI and Tramadol.Methods: Authors conducted prospective randomised control open label study on 40 patients at Orthopedic OPD of tertiary care hospital. Patients were given either Tramadol controlled releases tablets (200mg CR OD) or Diclofenac sustained release tablets (100mg SR OD) + PPI (Omeprazole 20mg OD) for two weeks. Clinical effectiveness was assessed by KOOS osteoarthritis index score consisting of five parameters and visual analogue scale. Suspected ADRs were recorded and incremental cost effective ratio for both drugs was calculated.Results: After application of KOOS questionnaire Authors found net quality gain in symptoms was 24.45 in diclofenac +PPI group which was much higher against 14.15 found in tramadol group. Again ADR profile of tramadol was 29 with nausea and somnolence topping the list which was far more than only 10 in DIC +PPI group. Lastly cost-effective analysis was done where again DIC+PPI showed average cost effective ratio 5.73 verses tramadol 11.8 with an incremental cost-effectiveness ratio (ICER) of -2.72.Conclusions: Diclofenac +PPI is as effective as tramadol in the treatment of pain due to knee osteoarthritis with the potential for feAuthorsr side effects. Diclofenac + PPI was also found to be cost-effective when compared with tramado.

Sign in / Sign up

Export Citation Format

Share Document