WHICH DRUGS ARE BULLYING US FINANCIALLY? PRESCRIPTION COST ANALYSIS IN EX-SERVICEMAN POLYCLINIC DISPENSARY IN INDIA

Aims: To carry out prescription cost analysis in Ex-Serviceman Contributory Health Scheme (ECHS) Polyclinic dispensary in India Study Design: Retrospective Prescription Cost Analysis Place And Duration Of Study: ECHS Polyclinic Dispensary from 01 December 2019 to 31 December 2019 on all working days Methodology: A total of 8295 prescriptions were received at ECHS dispensary in the month of December 2019 at an average of 346 prescriptions per day and a maximum of 445 per day and minimum of 242 per day. On each working day data were collected for previous day and segregated in pre-dened format as per National List of Essential Medicines (NLEM) 2015. The cost toward each group of drugs were calculated on prescribed quantity of medicines and added to calculate unit prescription cost at ECHS Dispensary. Results: It is observed that the highest number of prescriptions 4599 (55.44%) were from General OPD. The total cost of prescribed medicines worked out to be INR 25,55,103.81 for the month of December 2019. Most of the cost was ascribed to amount of INR 13,03,489.31 (51.02%) by section 21 (Hormones, other endocrine medicines and contraceptives). The estimated unit cost of prescription was INR 308.03. Conclusion: Implementing change in prescribing behaviors remains a major challenge for administrators and an inclusive approach with integrated with non-coercive educational approach should be utilized to change the behavior in prescriptions writing. Inculcating the culture of cost awareness amongst the health care providers pays good dividends in the long run. As far as cost containment in the healthcare facility is concerned, the rst step forward can be cost awareness toward what and how much clinician are prescribing.

Trends of Antibiotic Use and Expenditure After an Intensified Antimicrobial Stewardship Policy at a 2,200-Bed Teaching Hospital in China

Objective: This study aimed to evaluate the effects of intensified Chinese special rectification activity on clinical antibiotic use (CSRA) policy on a tertiary-care teaching hospital.Methods: A 48-month longitudinal dataset involving inpatients, outpatients, and emergency patients were collected. Study period included pre-intervention stage (adopting soft measures like systemic training) and post-intervention stage (applying antibiotic control system to intensify CSRA policy). Antibiotic use was evaluated by antibiotic use rate (AUR) or antibiotic use density (AUD). Economic indicator was evaluated by antibiotic cost in prescription or antibiotic expenditure in hospitalization. Data was analyzed by interrupted time series (ITS) analysis.Results: The medical quality indicators remained stable or improved during the study period. AUR of inpatients (AURI) declined 0.553% per month (P = 0.025) before the intervention and declined 0.354% per month (P = 0.471) after the intensified CSRA policy was implemented. AUD, expressed as defined daily doses per 100 patients per day (DDDs/100PD), decreased by 1.102 DDDs/100PD per month (P = 0.021) before and decreased by 0.597 DDDs/100PD per month (P = 0.323) thereafter. The ratio of antibiotic expenditure to medication expenditure (AE/ME) decreased by 0.510% per month (P = 0.000) before and fell by 0.096% (P = 0.000) per month thereafter. AE per patient decreased by 25.309 yuan per month (P = 0.002) before and decreased by 7.987 yuan per month (P = 0.053) thereafter. AUR of outpatient (AURO) decreased by 0.065% per month before (P = 0.550) and decreased by 0.066% per month (P = 0.994) thereafter. The ratio of antibiotic cost to prescription cost in outpatient (ACO/PCO) decreased by 0.182% per month (P = 0.506) before and decreased by 0.216% per month (P = 0.906) thereafter. AUR of emergency patient (AURE) decreased by 0.400% per month (P = 0.044) before and decreased by 0.092% per month (P = 0.164) thereafter. The ratio of antibiotic cost to prescription cost in emergency patient (ACE/PCE) decreased by 0.616% per month (P < 0.001) before and decreased by 0.151% per month (P < 0.001) thereafter.Conclusions: Implementation of CSRA policy was associated with declining antibiotic use and antibiotic expenditure in inpatients, outpatients, and emergency patients. However, it is also important to note that the declining trend of antibiotic consumption slowed due to the limited capacity for decline in the later stages of CSRA intervention.

Prevalence, Factors and Cost Comparison due to Potentially Inappropriate Medications (PIMs) of Elderly Outpatients in a State Hospital in Malaysia.

Introduction: Malaysia will be a full aging nation by 2030. The elderly (aged >65 years old) population often has multiple comorbidities, which increases the risk of polypharmacy and potentially inappropriate medications (PIMs). This study aims to investigate the prevalence, factors associated with PIMs among elderly outpatients, and its burden of direct pharmacotherapy cost to the Ministry of Health Malaysia. Materials and method: A cross-sectional study involving clinic prescriptions among the elderly with more than one-month prescribing duration received from a tertiary hospital specialist clinic pharmacy from March to April 2017. Patient identifiers were screened using the Pharmacy Information System (PhIS) by including prescriptions from other clinics while excluding multiple visits and duplicate prescriptions. Patients were categorised as PIM group and non-PIM groups using Beers Criteria 2015. Logistic regression analysis was conducted to examine the factors associated with PIMs. The median monthly prescription cost was compared between PIM and non-PIM groups by Mann-Whitney test. Results: Among 472 patients, 39.4% of patients had at least one PIM while 60.6% of patients did not receive any PIM. The number of medications prescribed was an independent risk factor contributing to PIMs (OR:2.04; 95% CI:1.40, 2.97). The median monthly prescription cost for the PIM group was MYR 29.50 (?USD 7.53) which was not statistically significant (p=0.735) compared with the non-PIM group which was MYR 28.50 (USD 7.28). Conclusion: PIM was frequently prescribed in our setting with the number of medications as the only factor. However, the prescribing of PIM did not add nor reduce the direct cost of pharmacotherapy.

Clinical Response and Cost-Savings Associated With Generic Fluticasone Propionate/Salmeterol Multidose, Dry-Powder Inhaler in Asthma Patients Managed in an Ambulatory Care Practice Setting

Background: Fluticasone propionate/salmeterol multidose, dry powder inhaler (MDPI) was the first and only authorized generic inhaled corticosteroid/long-acting beta agonist (ICS/LABA) combination inhaler at the time of this study. This offers the potential for significant prescription cost-savings for both patients and accountable care organizations. The objective of the study was to demonstrate patients’ clinical response to generic fluticasone propionate/salmeterol MDPI when switched from one of its brand name competitors. Methods: The study was approved by the Institutional Review Board at MCPHS University. This was a prospective chart review of a large, multi-center ambulatory care organization in the Greater Boston area. Patients 12 years of age or older who were switched from a brand-name ICS/LABA inhaler to the generic fluticasone/salmeterol MDPI were included in the study. The primary endpoint was worsened asthma control requiring a change in therapy, oral corticosteroid therapy, or hospitalization at or before 12 weeks after the inhaler was switched. Results: In total, 203 patients met inclusion criteria. Of those 203 patients, 35 had a change in therapy due to worsened asthma control (17.2% of patients, 95% CI 12.0% to 22.4%) within 12 weeks. Total projected yearly prescription cost-savings for patients who were switched and remained on the generic inhaler was $581,628. Conclusion: Eighty-three percent of patients maintained appropriate asthma control after switching from a brand ICS/LABA inhaler to the generic fluticasone/salmeterol MDPI for 12 weeks. Switching to the generic inhaler resulted in significant prescription cost-savings for the accountable care organization.

The Perceptions of Patient Copayment on the Reported Adherence to Prescription Medication

BACKGROUND: In South Africa, a large proportion of the population is dependent entirely on the publicly funded system for healthcare, while private funding covers only a small percentage of those who can afford to pay for health insurance or out-of-pocket payments. Non-compliance to medical treatment is a well-known problem and may lead to an increase in healthcare costs. OBJECTIVES: To investigate how the perception of prescription copayments influences medication use and the effect of this on safe and correct medicine usage METHODS: The study was conducted with a sample of patients from the Umbilo suburb of eThekwini, South Africa. Participants were members of a medical scheme and completed a questionnaire after informed consent. The questionnaire design included an eight-item scale to ascertain the degree of concern regarding prescription costs. Quantitative data were analysed using descriptive statistics; associations between household characteristics and outcomes were explored using odds ratios and chi square analysis. RESULTS: Overall 82% of the participants reported that prescription cost was a major factor that influenced medication collection. The association between demographic data and concern scale was assessed and revealed that participants had an increased concern with meeting prescription costs (OR 1.73, 95% CI 0.66-4.52). Most (93%) of the participants with a salary less than ZAR10 000 indicated a concern with prescription costs (chi square=21.7, df=2, p<0.05). CONCLUSION: The study indicated that prescription cost posed as a barrier to medication adherence as the copayment affected patients’ decisions to continue optimal treatment.