scholarly journals Cost Savings of Using Updated Thai Red Cross Intradermal Regimen in a High-Throughput Anti-Rabies Clinic in New Delhi, India

2019 ◽  
Vol 4 (1) ◽  
pp. 50 ◽  
Author(s):  
Bijit Kundu ◽  
Girish Meshram ◽  
Shrinath Bhargava ◽  
Omprakash Meena
Keyword(s):  
High Throughput ◽  
Financial Burden ◽  
Cost Savings ◽  
Red Cross ◽  
Post Exposure Prophylaxis ◽  
New Delhi ◽  
Before And After ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
Rabies Vaccination

Replacement of the Essen intramuscular (EIM) by the updated Thai Red Cross intradermal (UTRCID) regimen for rabies post-exposure prophylaxis (PEP), in high-throughput hospitals of India, has been advocated since 2006 thanks to its cost-effectiveness. However, several anti-rabies clinics in India and other parts of the world have not initiated this switchover of regimens because of the paucity of financial literature, generated in realistic settings, regarding the same. We calculated the procurement costs of various items required for providing rabies vaccinations via the EIM regimen and UTRCID regimen, on an annual basis, a year before and after the switchover. From a healthcare provider’s perspective, the cost of vaccination per patient was calculated to be 5.60 USD for the EIM regimen and 2.40 USD for the UTRCID regimen. The switchover to the UTRCID regimen from the EIM regimen reduced the financial burden of the rabies vaccination by almost 60%. Procurement of vaccine vials contributed to the majority of the cost (>94%) in both of the regimens. Procurement of syringes with fixed needles contributed negligibly (<6%) to the financial burden in both the regimens. A policy to progressively switch over to the UTRCID regimen from the EIM in all high-throughput anti-rabies centers of India would dramatically reduce the economic burden of running a successful anti-rabies program.

scholarly journals 992. Rethinking the 28-day HIV nPEP Dispensing Practice: A Pediatric ID Clinic Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S524-S525
Author(s):  
David Zhang ◽  
Julia Rosebush ◽  
Palak Bhagat ◽  
Allison Nelson ◽  
Veena Ramaiah ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Wholesale Price ◽  
Cost Savings ◽  
Patient Characteristics ◽  
Post Exposure Prophylaxis ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
The University ◽  
Lost To Follow Up

Abstract Background In July 2017, The University of Chicago Comer Children’s Hospital Emergency Department (ED) transitioned from a 5-day to a 28-day HIV nPEP (non-occupational post-exposure prophylaxis) dispensation model in an effort to increase adherence. Anecdotal reports of patients lost to follow-up after ED discharge called into question the utility and cost-effectiveness of this practice. We analyzed HIV nPEP follow-up rates in our clinic, explored reasons for nonadherence, and performed basic cost-savings analyses to inform potential changes to our dispensation model. Methods A retrospective review of both electronic health and pharmacy records was conducted for patients prescribed 28-days of HIV nPEP in the ED and scheduled for outpatient follow-up in Pediatric ID clinic from July 2017-June 2019. Clinic provider documentation of nPEP adherence and reasons for nonadherence were examined. Patients were given an initial dose of nPEP regimen in the ED and provided all subsequent doses to complete at home. Using average wholesale price (AWP), we calculated the total cost of each regimen and potential savings if a shorter duration of HIV nPEP supply was dispensed. Results 50 patients received a 28-day supply of HIV nPEP. Please refer to Table 1 regarding baseline patient characteristics. Of these, only 19 (38%) patients had documented outpatient follow-up after nPEP initiation. Median time to follow-up was 6 days (IQR: 3.0-9.0 days). Of the 19 patients with follow-up, 3 admitted to medication non-adherence. Although side effects were elicited in a total of 9 patients (18%), only 1 cited medication intolerance as the reason for discontinuing their nPEP. Given the relatively short time to follow-up, a potential savings of $1720-2211/patient could be achieved if a 10-14 day supply was dispensed. Conclusion Outpatient follow-up after 28-day HIV nPEP dispensation in our ED was &lt; 40%, calling into question the cost-effectiveness of this dispensation model. While our current practice alleviates nPEP interruption due to potential insurance issues and pick-up delays, follow-up and adherence are not assured. The significant cost-savings with a shorter supply at the outset may encourage more robust follow-up and adherence. Disclosures All Authors: No reported disclosures

scholarly journals Post exposure compliance of rabies vaccination among cases attending anti-rabies clinic at tertiary care centre, Rajasthan

2019 ◽  
Vol 6 (4) ◽  
pp. 1618
Author(s):  
Dilip Raj ◽  
Mahendra Kumar Verma ◽  
Dharmesh Kumar Sharma ◽  
Sudhakar Sharma ◽  
Munmun Yadav
Keyword(s):  
Compliance Rate ◽  
Tertiary Care ◽  
Red Cross ◽  
Post Exposure Prophylaxis ◽  
Tertiary Care Centre ◽  
Long Distance ◽  
Post Exposure ◽  
Number Of Patients ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination

Background: Rabies is one of the deadliest diseases of mankind, and has terrified since antiquity. It is 100 per cent fatal, however, 100% preventable. In India, rabies causes an estimated 20,565 deaths with 17.4 million exposures to animal bites, mainly dog bites, occurring every year. In India a person is bitten by an animal in every 2 seconds and someone dies from rabies every 30 second. Complete post-exposure prophylaxis is necessary among the animal bite cases for complete protection. Hence this study aims to determine the patient’s compliance for intradermal anti-rabies vaccination and also to determine the constraints for compliance.Methods: A retrospective record based study was conducted in the ARC of S.M.S.M.C, Jaipur where patients were provided intradermal rabies vaccination (updated Thai Red Cross regimen) for post-exposure prophylaxis. The records maintained at ARC-SMSMC under department of community medicine from March 2016- February 2017 were analysed. The total number of patients was 8873 from which 8590 subjects were recruited for the study after excluding category I cases, pre-exposure cases rat bite, human bite, re-exposure and pre-exposure cases. The major constraints were found out by interviewing the patient/guardian through the telephone.Results: The compliance rate for intradermal rabies vaccination (IDRV) is 81.87%. The major constraints were timings not convenient, personal or social workload, long distance from the hospital, forgotten the dates.Conclusions: The compliance rate for rabies vaccination is considerably low for this highly fatal disease. Considering these major constraint factors, the animal bite victims should be motivated effectively through health education at the time of initiation of vaccination course to attain the goal of rabies free India.

scholarly journals Economical way to decrease financial burden: anti rabies vaccines by intra dermal administration in developing countries

2020 ◽  
Vol 7 (4) ◽  
pp. 1419
Author(s):  
Prachi Kori ◽  
Manju Toppo ◽  
Seema Patel
Keyword(s):  
Developing Countries ◽  
Financial Burden ◽  
Care Facility ◽  
Health Care Facility ◽  
Cost Benefit ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Dermal Administration ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination

Background: To prevent deaths due to rabies only remedy available is post exposure prophylaxis. The major constraint is affordability to anti-rabies vaccine for intramuscular administration or intra dermal administration as PEP. So, intra dermal anti rabies vaccination (IDRV) as recommended by WHO in developing countries like India, reduces the quantity and cost of vaccination, although in most of the health facilities still intra muscular anti rabies vaccination is preferred. Objective of our study is to assess the cost benefit of intra dermal anti rabies vaccination and to find out the demographic profile of patients attending ARV clinic.Methods: It is a hospital record-based study done after ethical committee approval, carried out in a tertiary health care facility, Hamidia hospital, Bhopal (M.P.), India.Results: Our study includes 4818 entries of dog bite cases in whom vaccination cost is found to be approximately Rs. 3,90,420 with Intra dermal administration and it reduces vaccine cost by 60-70% compared with mostly preferred intramuscular vaccination. Among them 31.47% were below 14 years of age and majority 75% were male. Category III bite cases are most common 83.6% and commonest site of dog bite was over the lower limb 68.73%.Conclusions: Intra dermal regimen is more cost beneficial compared to intra muscular regimen, which is thus more helpful to reduce financial burden in developing countries like India.

scholarly journals Profile of patients admitted with rabies in Epidemic Disease Hospital of Mysore, India

2018 ◽  
Vol 5 (7) ◽  
pp. 2997
Author(s):  
Mudassir Azeez Khan ◽  
Prathyusha Joe ◽  
Pashupathy M. ◽  
Laxman M.
Keyword(s):  
Communicable Disease ◽  
Hospital Staff ◽  
Post Exposure Prophylaxis ◽  
Epidemic Disease ◽  
History Of ◽  
Disease Hospital ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
Immunisation Status ◽  
Rabies Vaccination

Background: Rabies is the only communicable disease of man that is 100 percentage fatal, yet it is easily preventable with timely and appropriate administration of vaccine and immunoglobulin. Rabies is still a neglected disease and the study was undertaken to determine the socio-demographic, clinical profile and the immunisation status of patients admitted with rabies in Epidemic Disease hospital, Mysore.Methods: The study was done retrospectively by observation of case records and registers for a period of ten years from 2008 to 2017.Results: Case records of 44 patients admitted with rabies were obtained. Most of them were males above the age of 40 years and reported history of dog bite (72.7%). Majority had symptoms 1-2 months after the animal bite. The classical symptoms of hydrophobia were present in 86.4% patients. All the 44 patients expired in the hospital. None of them had a complete post exposure prophylaxis of antirabies vaccination and immunoglobulin. The reasons for the same were obtained from case records and by interviewing the doctor in charge. The non-availability of vaccine and immunoglobulin, decreased knowledge and expertise in administration of immunoglobulin among hospital staff in the periphery were some of the reasons.Conclusions: The cost incurred, loss of wages and not understanding the importance of completion of anti-rabies vaccination by the animal bite victims can be addressed only by providing the immunoglobulin and vaccine at very low costs, adequate training of doctors and ensuring the availability of vaccine and drugs. 

scholarly journals Traveller exposures to animals: a GeoSentinel analysis

2020 ◽  
Vol 27 (7) ◽  
Author(s):  
Michael P Muehlenbein ◽  
Kristina M Angelo ◽  
Patricia Schlagenhauf ◽  
Lin Chen ◽  
Martin P Grobusch ◽  
...  
Keyword(s):  
Mammalian Species ◽  
Wild Animal ◽  
Post Exposure Prophylaxis ◽  
Behavioral Modification ◽  
Surveillance Network ◽  
Domestic Species ◽  
Wide Range ◽  
Animal Bites ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination

Abstract Background Human coexistence with other animals can result in both intentional and unintentional contact with a variety of mammalian and non-mammalian species. International travellers are at risk for such encounters; travellers risk injury, infection and possibly death from domestic and wild animal bites, scratches, licks and other exposures. The aim of the present analysis was to understand the diversity and distribution of animal-related exposures among international travellers. Methods Data from January 2007 through December 2018 from the GeoSentinel Surveillance Network were reviewed. Records were included if the exposure was non-migration travel with a diagnosis of an animal (dog, cat, monkey, snake or other) bite or other exposure (non-bite); records were excluded if the region of exposure was not ascertainable or if another, unrelated acute diagnosis was reported. Results A total of 6470 animal exposures (bite or non-bite) were included. The majority (71%) occurred in Asia. Travellers to 167 countries had at least one report of an animal bite or non-bite exposure. The majority (76%) involved dogs, monkeys and cats, although a wide range of wild and domestic species were involved. Almost two-thirds (62.6%) of 4395 travellers with information available did not report a pretravel consultation with a healthcare provider. Conclusions Minimizing bites and other animal exposures requires education (particularly during pretravel consultations) and behavioral modification. These should be supplemented by the use of pre-exposure rabies vaccination for travellers to high-risk countries (especially to those with limited access to rabies immunoglobulin), as well as encouragement of timely (in-country) post-exposure prophylaxis for rabies and Macacine alphaherpesvirus 1 (herpesvirus B) when warranted.

Paralytic rabies: An acute flaccid myelitis after inadequate post exposure prophylaxis

2019 ◽  
Vol 49 (4) ◽  
pp. 301-302
Author(s):  
Ashok Kumar Pannu ◽  
Raichur Vijay Kumar ◽  
Deeksha Vijaykumar ◽  
Lakshmi Priya ◽  
Harpreet Singh ◽  
...  
Keyword(s):  
Post Exposure Prophylaxis ◽  
Middle Aged ◽  
Post Exposure ◽  
Acute Flaccid Myelitis ◽  
Clinical Syndromes ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination

Rabies has two distinct clinical syndromes, encephalitic (or ‘furious’) and paralytic (or ‘dumb’). The paralytic form presents as acute flaccid myelitis and is more common in patients who received post-exposure anti-rabies vaccination without rabies immunoglobulins. We have recently had the opportunity to manage a middle-aged man presenting as ‘dumb’ paralytic rabies.

How will the cost of biosimilars affect patients’ willingness to receive them?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18338-e18338
Author(s):  
R Donald Harvey ◽  
Megan McGrath ◽  
John W. Cook ◽  
Margie D Dixon ◽  
Rebecca D. Pentz
Keyword(s):  
Financial Burden ◽  
Cost Savings ◽  
Drug Market ◽  
Oncology Patients ◽  
Convenience Sample ◽  
Anti Cancer ◽  
Negative Perceptions ◽  
Oncology Care ◽  
The Cost ◽  
Patients Experience

e18338 Background: The cost of oncology care is increasing. The NIH projects that the oncology drug market will reach $111.9 billion by 2020. Studies show that oncology patients experience considerable financial burden, regardless of insurance status and in general believe that oncology medications are too expensive. However, there is some evidence outside of oncology that suggests patients may not trust generics or cheaper medications. Therefore, there is a need to assess oncology patients’ views of a biosimilars and their potential to reduce costs. Methods: We surveyed a convenience sample of 79 oncology patients in clinics and the infusion center. The survey consisted of five questions on cost and patient participation in decision making. Results: Of 79 patients approached, 75 (95%) completed the survey. Fifty (66%) believed that expensive medications do not work better than less costly ones for the same disease; yet only 30 of those 50 (60%) and 44% overall (33/75) would prefer that their doctor prescribe them the cheaper version of their anti-cancer medication. Of the 20 respondents who believed that expensive drugs do not work better but still wanted the more expensive drugs for themselves, 8 believed cancer was too serious of an illness to take any chances with a cheaper medication, 5 wanted the most expensive that insurance would cover and 2 wanted the best possible medication. 90.67% respondents (68/75) wanted to know if their physician was prescribing a cheaper version of their drug. Conclusions: Our results show that, overall, oncology patients agree that cheaper medications work as well as more expensive ones, but there are definite concerns among some patients that drug price may be a proxy for quality, particularly in cancer. Overcoming these negative perceptions among patients will be important if optimal cost savings are going to be realized with expanded biosimilar use.

scholarly journals A single center retrospective analysis of a protocol for high-dose methotrexate and leucovorin rescue administration

2017 ◽  
Vol 25 (1) ◽  
pp. 76-84 ◽  
Author(s):  
Zak Cerminara ◽  
Alison Duffy ◽  
Jennifer Nishioka ◽  
James Trovato ◽  
Steven Gilmore
Keyword(s):  
Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Protocol Implementation ◽  
Dose Methotrexate ◽  
Before And After ◽  
The Cost

Background Methotrexate has a wide dosing range. High-dose methotrexate is a dose of 1000 mg/m2 or greater. In the 1970s, the incidence of mortality associated with High-dose methotrexate ranged from 4.6 to 6%. In 2012, the University of Maryland Medical Center implemented a standardized high-dose methotrexate protocol. The purpose of this study was to evaluate whether the institution followed recommendations based on the Bleyer nomogram for the administration of high-dose methotrexate more closely after the implementation of the protocol. Methods In this retrospective chart review, 37 patients received 119 cycles of high-dose methotrexate before the protocol implementation (1 January 2009 through 31 December 2010) and 45 patients received 106 cycles of high-dose methotrexate after protocol implementation (1 January 2013 through 31 December 2014). Patient characteristics, protocol data, and complications were analyzed. Results Protocol implementation significantly reduced the deviation of methotrexate level timing at 24, 48, and 72 h: median 7.47 vs. 1.46 h, 7.23 vs. 1.35 h, and 7.00 vs. 1.52 h before and after implementation, respectively (p < 0.0001 for each). The protocol significantly reduced deviation of the first dose of leucovorin administration: median 5.2 vs. 0.675 h before and after implementation, respectively (p<0.0001). After protocol implementation, there was an increase in the use of leucovorin prescriptions written appropriately for patients discharged before methotrexate levels reached a value of ≤0.05 µmol/L. Conclusions Implementation of a protocol for the administration of high-dose methotrexate improved the adherence to consensus recommendations. Further analysis is needed to assess clinical pharmacist involvement and the cost savings implications within this protocol.

scholarly journals Safety and immunogenicity of intradermal rabies vaccination for post exposure prophylaxis

2016 ◽  
pp. 692-696
Author(s):  
Ravish Hardanahalli ◽  
Rachana Annadani ◽  
Madhusudana Shampur ◽  
Veena Vijayashankar ◽  
Ashwath Doddabele ◽  
...  
Keyword(s):  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination
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