scholarly journals ePrescribing: Reducing Costs through In-Class Therapeutic Interchange

2016 ◽  
Vol 07 (04) ◽  
pp. 1168-1181 ◽  
Author(s):  
Shane Stenner ◽  
Rohini Chakravarthy ◽  
Kevin Johnson ◽  
William Miller ◽  
Julie Olson ◽  
...  
Keyword(s):  
Health Plan ◽  
Proton Pump ◽  
Serotonin Receptor ◽  
Cost Savings ◽  
Employee Health ◽  
Prescription Data ◽  
Therapeutic Interchange ◽  
Reducing Costs ◽  
Serotonin Receptor Agonists ◽  
Outpatient Prescriptions

SummaryIntroduction Spending on pharmaceuticals in the US reached $373.9 billion in 2014. Therapeutic interchange offers potential medication cost savings by replacing a prescribed drug for an equally efficacious therapeutic alternative.Methods Hard-stop therapeutic interchange recommendation alerts were developed for four medication classes (HMG-CoA reductase inhibitors, serotonin receptor agonists, intranasal steroid sprays, and proton-pump inhibitors) in an electronic prescription-writing tool for outpatient prescriptions. Using prescription data from January 2012 to June 2015, the Compliance Ratio (CR) was calculated by dividing the number of prescriptions with recommended therapeutic interchange medications by the number of prescriptions with non-recommended medications to measure effectiveness. To explore potential cost savings, prescription data and medication costs were analyzed for the 45,000 Vanderbilt Employee Health Plan members.Results for all medication classes, significant improvements were demonstrated – the CR improved (proton-pump inhibitors 2.8 to 5.32, nasal steroids 2.44 to 8.16, statins 2.06 to 5.51, and serotonin receptor agonists 0.8 to 1.52). Quarterly savings through the four therapeutic interchange interventions combined exceeded $200,000 with an estimated annual savings for the health plan of $800,000, or more than $17 per member.Conclusion A therapeutic interchange clinical decision support tool at the point of prescribing resulted in increased compliance with recommendations for outpatient prescriptions while producing substantial cost savings to the Vanderbilt Employee Health Plan – $17.77 per member per year.Therapeutic interchange rules require rational targeting, appropriate governance, and vigilant content updates.Citation: Stenner SP, Chakravarthy R, Johnson KB, Miller WL, Olson J, Wickizer M, Johnson NN, Ohmer R, Uskavitch DR, Bernard GR, Neal EB, Lehmann CU. eprescribing: reducing costs through in-class therapeutic interchange.

Sodium Nitroprusside as a Hyperinflation Drug and Therapeutic Alternatives

2018 ◽  
Vol 31 (4) ◽  
pp. 374-381 ◽  
Author(s):  
Alex Cobb ◽  
Luciana Thornton
Keyword(s):  
Sodium Nitroprusside ◽  
Hypertensive Crisis ◽  
Antihypertensive Agents ◽  
Cost Savings ◽  
Similar Efficacy ◽  
Evidence Base ◽  
Adverse Outcomes ◽  
Channel Blockers ◽  
Acute Hypertension ◽  
Therapeutic Interchange

Sodium nitroprusside (SNP) is a generically available and rapid-acting intravenous (IV) vasodilator that has been used clinically for decades. Prior to 2013, the cost of SNP was relatively low, and SNP was an affordable option for the treatment of acute hypertension. However, from 2013 to 2017, average wholesale prices for SNP rose to as high as US$900 per vial, earning the drug its status as a “hyperinflation drug.” Hyperinflation drugs pose a significant challenge for pharmacy departments. A multidisciplinary effort involving stakeholders from many backgrounds, including pharmacists, physicians, and nurses, is key to developing an effective cost containment strategy. A therapeutic interchange, wherein a drug with similar efficacy is substituted for another, is often an appropriate strategy to address rising drug costs. Fortunately, alternative drugs with a solid evidence base exist for the management of acute hypertension. The dihydropyridine calcium channel blockers, clevidipine and nicardipine, are IV titratable antihypertensive agents with favorable pharmacokinetic and safety profiles. Various studies indicate that clevidipine and nicardipine are effective alternatives to SNP for indications including hypertensive crisis and postoperative hypertension. Some hospitals have reported significant cost savings without adverse outcomes by substituting clevidipine or nicardipine for SNP. This article is intended to serve as a review of the evidence for clevidipine and nicardipine as potential substitutes for SNP and to provide strategies to successfully implement this therapeutic interchange.

Estimated cost savings associated with the use of valsartan in heart failure in a large US health plan

2007 ◽  
Vol 10 (3) ◽  
pp. 229-238
Author(s):  
Dean G Smith ◽  
Feride Frech-Tamas ◽  
William Randle ◽  
Ronald Preblick
Keyword(s):  
Heart Failure ◽  
Health Plan ◽  
Cost Savings

scholarly journals 5HT1A Serotonin Receptor Agonists Inhibit Plasmodium falciparum by Blocking a Membrane Channel

2003 ◽  
Vol 47 (12) ◽  
pp. 3806-3809 ◽  
Author(s):  
Christopher P. Locher ◽  
Peter C. Ruben ◽  
Jiri Gut ◽  
Philip J. Rosenthal
Keyword(s):  
Serotonin Receptor ◽  
Surface Membrane ◽  
Resistant Isolate ◽  
Neurological Involvement ◽  
Membrane Channel ◽  
Transport Pathway ◽  
Human Lung Fibroblast ◽  
Receptor Agonists ◽  
Serotonin Receptor Agonists

ABSTRACT Toidentify new leads for the treatment of Plasmodium falciparum malaria, we screened a panel of serotonin (5-hydroxytryptamine [5HT]) receptor agonists and antagonists and determined their effects on parasite growth. The 5HT1A receptor agonists 8-hydroxy-N-(di-n-propyl)-aminotetralin (8-OH-DPAT), 2,5-dimethoxy-4-iodoamphetamine, and 2,5-dimethoxy-4-bromophenylethylamine inhibited the growth of P. falciparum in vitro (50% inhibitory concentrations, 0.4, 0.7, and 1.5 μM, respectively). In further characterizing the antiparasitic effects of 8-OH-DPAT, we found that this serotonin receptor agonist did not affect the growth of Leishmania infantum, Trypanosoma cruzi, Trypanosoma brucei brucei, or Trichostrongylus colubriformis in vitro and did not demonstrate cytotoxicity against the human lung fibroblast cell line MRC-5. 8-OH-DPAT had similar levels of growth inhibition against several different P. falciparum isolates having distinct chemotherapeutic resistance phenotypes, and its antimalarial effect was additive when it was used in combination with chloroquine against a chloroquine-resistant isolate. In a patch clamp assay, 8-OH-DPAT blocked a P. falciparum surface membrane channel, suggesting that serotonin receptor agonists are a novel class of antimalarials that target a nutrient transport pathway. Since there may be neurological involvement with the use of 8-OH-DPAT and other serotonin receptor agonists in the treatment of falciparum malaria, new lead compounds derived from 8-OH-DPAT will need to be modified to prevent potential neurological side effects. Nevertheless, these results suggest that 8-OH-DPAT is a new lead compound with which to derive novel antimalarial agents and is a useful tool with which to characterize P. falciparum membrane channels.

Oral Serotonin Receptor Agonists

2005 ◽  
Vol 23 (3) ◽  
pp. 259-274 ◽  
Author(s):  
Jennifer H Lofland ◽  
David B Nash
Keyword(s):  
Serotonin Receptor ◽  
Receptor Agonists ◽  
Serotonin Receptor Agonists

scholarly journals Employee Health Management as Part of Corporate Culture and Productivity Tool

2020 ◽  
pp. 115-125
Author(s):  
A. I. Sosnilo ◽  
D. A. Snetkova
Keyword(s):  
Corporate Culture ◽  
Health Management ◽  
Cost Savings ◽  
Employee Health ◽  
Healthcare Management ◽  
Employee Productivity ◽  
Start Ups ◽  
Domestic Companies ◽  
Healthcare Management System ◽  
Legal Entities

The article analyzes modern methods of personnel health management and provides examples of the implementation of the most interesting methods in foreign and Russian companies. The rationale is presented that the launching of healthcare management system can contribute to the improvement of competitiveness and growth of employee productivity, strengthening of corporate spirit, as well as creates a positive image and reputation of the company. The authors analyze the dynamics of the VHI market as one of the most demanded practices on care for the health of employees in Russia. The calculations are made on the dynamics of concluding VHI contracts with individuals and legal entities. The authors determine the dynamics of the average premium on VHI with legal entities for the last three years and the rates of increase of the volume of contracts from 2015 to 2019. Also the rolling factor of insurance payments is calculated. The forecast of the volume of VHI contracts with individuals for 2020–2022 is made. Also examples of the application of international medical voluntary insurance policies (MMS) in the performance of offi duties in dangerous working conditions, which can lead to the emergence of professional or serious diseases, are provided. The data on medical start-ups, which are able to positively aff the care of companies about the health of employees, are summarized. The authors provide data on practices on employee health care in domestic companies Lukoil, Rostelecom, Sberbank, Seventh Continent, etc., as well as data on cost savings of companies in the implementation of the system of employee health management. Some recommendations on the application of methods of managing the health of employees in domestic companies are presented.

A Pharmacy-Managed Intravenous to Enteral Proton-Pump Inhibitor Conversion Program

2003 ◽  
Vol 38 (8) ◽  
pp. 753-757
Author(s):  
Thomas F. Turco
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Medical Staff ◽  
Eligible Patient ◽  
Relative Effectiveness ◽  
Tertiary Care ◽  
Cost Savings ◽  
Gi Bleeding ◽  
Evaluation Period ◽  
Protocol Conversion

This article describes a pharmacy-managed, intravenous (IV) to enteral proton-pump inhibitor (PPI) program at a 377-bed tertiary care, teaching community hospital. IV pantoprazole was not restricted by indication, service, or patient location. Pharmacy converted any eligible patient prescribed an IV PPI to either pantoprazole tablets or lansoprazole capsules, packets, or enteral suspension according to protocol. Over a four-month evaluation period, 113 patients (mean age of 66 years) were prescribed IV PPIs for primarily suspected or documented GI bleeding. Gastroenterology specialists initiated 85% of IV PPI therapy. The most common dosage of IV PPI was 40 mg, once or twice daily with a median duration of 3 to 4 days. Continuous infusion IV PPI therapy was used for only two patients, both with GI bleeding. IV pantoprazole was converted to an enteral PPI in 73 of 113 patients in dosages of pantoprazole 40 mg or lansoprazole 30 or 60 mg administered once (32%) or twice (68%) daily. Pharmacists initiated 34% of the conversions. The total PPI expenditure was $6200 during the evaluation period. Daily acquisition cost savings, based on nominal pricing, ranged from approximately $5 to $25. Initial evaluation of the conversion program resulted in protocol revision and education of the medical staff, in an effort to minimize days of IV PPI use and encourage transition to enteral therapy. The protocol conversion dosage of lansoprazole 60 mg twice daily was changed to 30 mg twice daily and enteral pantoprazole tablets were deleted from the protocol (all IV PPI is converted to lansoprazole, 30 mg twice daily). Although IV pantoprazole remained on the hospital formulary, the medical staff were educated about the relative effectiveness of IV and enteral PPI therapy and the use of histamine-2 receptor antagonists for various indications. Prescribers of IV pantoprazole are now required to document the rationale for use. The Pharmacy and Therapeutics Committee will continue to explore the role IV PPI therapy, based on efficacy, safety, and cost.

scholarly journals Effects of 5-HT1A serotonin receptor agonists on parkinsonism

1999 ◽  
Vol 79 ◽  
pp. 43
Author(s):  
Masahiro Nomoto ◽  
Takao Shimizu ◽  
Shunsuke Tsujimura ◽  
Takeo Fukuda
Keyword(s):  
Serotonin Receptor ◽  
Receptor Agonists ◽  
Serotonin Receptor Agonists
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