Health technology assessment-informed pricing negotiation in China: higher negotiated price for more effective targeted anticancer medicines?

Background In China, health technology assessment (HTA) has recently been adopted in pricing negotiation for medicine listing in the National Reimbursement Drug List. At present, how HTA is applied to inform the decision-making process remains underreported. In order to explore how the adoption of HTA was translated into listing and price negotiation results in light of the confidential nature of the negotiating process, this study aimed to compare the negotiated price and the clinical benefit of selected targeted anticancer medicines (TAMs) involved in the 2019 negotiation. Main text Among 16 TAMs successfully negotiated, only four TAMs representing four indication groups had appropriate reference medicines for comparison and were, therefore, included in the analysis. The price and clinical benefit of the four TAMs were compared against one or two reference medicines with the same initial indications. The sales prices for nine TAMs before and after the negotiation were extracted from the centralized medication procurement system. Clinical benefits were evaluated based on evidence from published articles and clinical guidelines. The results suggested that, despite the application of HTA, both rational and irrational decisions had been made about the reimbursement of TAMs in the 2019 negotiation, warranting further investigation. Conclusion While the development and adoption of HTA has seen significant progress in China, actions are needed to ensure that the adoption of HTA is effectively applied in decisions on the reimbursement of medicines.

The Pattern of Medicine Use in Ethiopia Using the WHO Core Drug Use Indicators

Introduction. Rational medicine use is an appropriate prescribing, dispensing, and patient use of medicines for the diagnosis, prevention, and treatment of diseases. It is affected by several factors. Irrational use of medicine is a widespread problem at all levels of care. This review is aimed at assessing the medicine use pattern in health facilities of Ethiopia using the medicine use pattern developed by WHO/INRUD. Methods. Relevant literature was searched from Google Scholar, PubMed, Hinari, Web of Science, and Scopus using inclusion and exclusion criteria. A systematic review was used to summarize the medicine use pattern in health facilities of Ethiopia, and that WHO core drug use indicators were employed. Result. From 188 searched studies, 30 literatures were reviewed. The average number of drugs per encounter was 2.11. The percentage of encounters with antibiotics and injection was 57.16% and 22.39%, respectively. The percentage of drugs prescribed by generic name and from an essential drug list was 91.56% and 90.19%, respectively. On average, patients spent 5.14 minutes for consultation and 106.52 seconds for dispensing. From prescribed drugs, 67.79% were dispensed, while only 32.25% were labeled adequately. The availability of key essential medicines was 64.87%. The index of rational drug use value was 7.26. Moreover, the index of rational drug prescribing, index of rational patient-care drug use, and index of rational facility-specific drug use were 3.74, 2.51, and 1.01, respectively. Conclusion. Ethiopian health facilities were faced with antibiotic overprescribing, short consultation, and dispensing times, poor labeling of medicines, poor availability of key drugs, and nonadherence to the essential drug list. Routine, multidisciplinary awareness creation, and regulation should be implemented to promote rational medicine use at a national level.

Prescription Audit of Out-Patient Attendees in Gynecology Department in India

Background: Prescription auditing is a comprehensive clinical audit process that improves the quality of care by systematically reviewing treatment against defined criteria and making changes as a consequence. A prescription is a written order from a doctor to the person who will supply the drug. Every country has its own set of prescription information requirements and rules and regulations defining which pharmaceuticals require a prescription and who is eligible to write it. Objective: The study aims to determine the quality of out-patient department (OPD) prescription forms in Indian tertiary care, highlighting the elements that should be written in a prescription to improve the institution's overall quality of care. Methodology: This will be a cyclical activity that will assess prescriber's practice of generating prescription orders, refining it to solve problems detected, and comparing the outcomes to audit criteria that have been agreed upon. This will be a cross sectional study conducted in AVBRH hospital setting and data will be collected from OBGY OPD and will be analyzed using SPSS Version 25. Expected Results: According to the findings of the various prescription audits, the percentage of drugs administered by generic name is lower than required. The average number of antibiotic prescriptions is higher than the prescribed amount. NLEM's suggested drug list should be expanded. Conclusion: Prescribers must be aware of the need to write prescriptions in legible handwriting with capital letters for pharmaceuticals with generic names, as well as receive continuous training and be encouraged to do so. The most important condition for a prescription is that it be clear, understandable, and specific.

Evaluating antimicrobial prescribing in a Tertiary Healthcare Institution in Nigeria

Background Regular evaluation of antimicrobials prescriptions is important for optimal use. Objective This study determined the prescription patterns, class and costs of antimicrobials in the adult out-patient pharmacy of a Teaching Hospital in Nigeria. Methods A 1-year retrospective study from 1st January to 31st December 2018. The data, which included identification code, age, sex, antibiotics prescribed, number of antibiotics per prescription, number of medicines per prescription, dosage form, generic prescribing, drug on the essential drug list, and cost, were used in the analysis. The Chi-square test and Analysis of Variance were used to compare our data with the WHO–developed antimicrobial prescription Guidelines for Anatomical Therapeutic Chemical and Defined Daily Dose assignment of 2019. Results From 450 patient records, significantly more females (70%) were prescribed with antimicrobials (P = 0.0038). The prescription pattern showed that antimicrobials selection by class was significantly different (P < 0.0001) (top three being Amino-penicillin > Nitroimidazoles > Fluoroquinolone). In addition, age differed significantly (P < 0.0001) with 46–50 as the highest class. Dosage forms profile showed that the percentage of encounter with injections prescribed (1.8%) was less than WHO recommendation (13.4–24.1%). Most of the prescriptions (84.22%) were from the Essential Drug List. The average cost of prescriptions with two antimicrobials was the highest ($14.0807), then three ($10.7949), and one ($6.39858). The average number of drugs per prescription that had one (4.28), two (4.46), and three (5.55) antimicrobials, respectively, were more than double the average (2) recommended by WHO. Conclusion The study showed that most of the patterns are within limit, however, highlights the need for frequent evaluation.

INITIALLY BUILDING AND APPLYING A LIST OF DRUG INTERACTIONS AT VINH LONG GENERAL HOSPITAL, IN 2020

Background: Drug interactions are the main causes of adverse drug events. In order to promptly detect, and handle drug interactions, medical staff often have to look up information in different databases. However, in practice this is still difficult. Stemming from practical needs, we conducted the study "Initially building and applying a list of drug interactions at Vinh Long General Hospital, in 2020". Methods: The study built a list of drug interactions appearing in the list of outpatient drugs at Vinh Long General Hospital. Then, the above list was used to examine the drug interaction on 260 outpatient prescriptions at the hospital. Results: The main findings show that 23 pairs of interactions appearing in the outpatient drug list applied at Vinh Long General Hospital; The rate of prescriptions with interactions is still quite high (44.2%). Among prescriptions with interactions: the rate of prescriptions with 1 interaction was 58.2%; 13% of prescriptions have 3 types of interactions and 4.5% of prescriptions have more than 3 types of interactions. The proportion of prescriptions with interactions at level 1 – "need to be monitored" accounted for 72.2%. The rate of prescriptions with serious interactions requiring replacement of other drugs was 11.3% and contraindications was 2.6%.

Xylometazoline and oxymetazoline - unusual effects of everyday drugs (literature review)

The aim of the study is to systematize the knowledge about xylometazoline and oxymetazoline - commonly used nasal sprays with sympathicomimetic effect, mainly directly on α-adrenergic receptors [1]. A review of recent reports on possible side effects and new therapeutic options will be presented. Results: Over several years, reports have been published regarding descriptions of unusual cases of side effects, such as angina attack [4], a case of respiratory failure in a newborn [5], ischemic stroke [6], or anaphylactic reaction during routine surgery. In experiments using rats, on the other hand, it has been shown that these substances can also cause increased inflammation of the lower respiratory tract [7], as well as numerous ophthalmic problems [8]. Recent reports also suggest new uses for xylometazoline and oxymetazoline. In combination with lidocaine, an intranasal solution of xylometazoline has shown efficacy in the anesthesia of maxillary teeth in patients with minor carious lesions [9], and a beneficial therapeutic combination of oxymetazoline and dye laser (PDL) has also been reported for the treatment of rosacea, among others [10]. Conclusions: Although imidazoline derivatives were admitted to the drug list decades ago, still their pharmacological potential has not been fully exploited. Finding applications of these drugs in dermatology and dentistry may not only improve the efficacy and comfort of treatment, but also significantly reduce the costs of the whole therapy. The aforementioned reports on the side effects of xylometazoline and oxymetazoline should not be forgotten. It is possible that the presented examples will increase awareness to use these drugs with more respect, according to the recommendations on the leaflet.

Assessment of veterinary drugs dispensing practices in veterinary clinics in Gondar town, North West Ethiopia: a cross sectional study

<p class="abstract"><strong>Background:</strong> Dispensing practice plays a major role in the provision of rational drug therapy. This study aimed to assess the veterinary drug dispensing practice by pharmacists and other veterinarian assistance in veterinary clinic Gondar town.</p><p class="abstract"><strong>Methods:</strong> A cross-sectional prospective descriptive study was carried out in the OPD of three public veterinary clinics in Gondar town for three months. The health facility indicators were examined by ensuring the good dispensing practices in three veterinary clinic and availability of essential drug list.</p><p class="abstract"><strong>Results:</strong> The average consultation time was 13 min and 50 sec. The average dispensing time was 5 min and 3 sec calculated from 100 prescriptions. The percentage of drugs dispensed was 97.50% and percentage of drugs adequately labeled was high from the dispensed drugs (74.4%). The average patients with drug dosage knowledge were very low (25%). The result of the study revealed that the two veterinary clinic health facilities do not have any essential drug list. Out of three, one of them has a key drug from the WHO list 1 (30%) drug was available.</p><p class="abstract"><strong>Conclusions:</strong> The overall good dispensing practices at three veterinary clinics is low. Training, supportive supervision through continuous medical education, regular up-to-date medicine information and standard treatment guideline, and therapeutic audit are required for improvement of medicine use by prescriber and dispensers.</p>

Effects of Immune System-Related Medications on COVID-19 Outcome in a Cohort of Iranian Patients: Preliminary Report of a Data Mining Study

Background. Regulation of the immune system is critical for fighting against viral infections. Both suppression and hyperactivity of the immune system result in failure of treatment. The present study was designed to show the effects of immune system-related medications on mortality and length of stay (LOS) in a cohort of Iranian patients with coronavirus disease 2019 (COVID-19). Methods. A data mining study was performed on 6417 cases of COVID-19 covered by 17 educational hospitals of Iran University of Medical Sciences, Tehran. Association of a researcher-designed drug list with death and LOS was studied. For death outcome, logistic regression was used reporting odds ratio (OR) with 95% confidence interval (CI). For LOS, right censored Poisson regression was used reporting incidence rate ratio (IRR) with 95% CI. Results. Among the corticosteroids, prednisolone was a risk factor on death ( OR = 1.41 , 95 % CI = 1.03 − 1.94 ). This association was increased after adjustment of age interactions ( OR = 3.45 , 95 % CI = 1.01 − 11.81 ) and was removed after adjustment of ICU admission interactions ( OR = 2.64 , 95 % CI = 0.70 − 9.92 ). Hydroxychloroquine showed a protecting effect on death ( OR = 0.735 , 95 % CI = 0.627 − 0.862 ); however, this association was removed after adjustment of age interactions ( OR = 0.76 , 95 % CI = 0.41 − 1.40 ). Among the antivirals, oseltamivir showed a protecting effect on death ( OR = 0.628 , 95 % CI = 0.451 − 0.873 ); however, this association was removed after adjustment of age interactions ( OR = 0.45 , 95 % CI = 0.11 − 1.82 ). For reduction of LOS, the only significant association was for hydroxychloroquine ( IRR = 0.85 , 95 % CI = 0.79 − 0.92 ). Conclusion. The results of such data mining studies can be used in clinics until completing the evidence. Hydroxychloroquine may reduce mortality in some specific groups; however, its association may be confounded by some latent variables and unknown interactions. Administration of corticosteroids should be based on the conditions of each case.

Drug use pattern using WHO core drug use indicators in public health centers of Dessie, North-East Ethiopia

Background Rational drug use requires that patients receive and take medication appropriately. Though the process of diagnosis and pharmaceutical care is complex, World Health Organization (WHO)/international network for rational use of drugs (INRUD) core drug use indicators investigate drug use to minimize the hazardous effect of the drug and enhance the wise use of scares resources. This study assessed drug use patterns in health centers of Dessie town using WHO/INRUD indicators. Methods A cross-sectional study was conducted in public health centers of Dessie town. Data were retrospectively collected from 1500 prescriptions dispensed from January 1, 2018, to December 31, 2018 using WHO data collection tool to assess prescribing indicators. For patient care and health facility indicators, 600 patients and 3 health centers were prospectively reviewed. Systematic random sampling was used to select samples. Data were analyzed using the Statistical Package for the Social Sciences version 20. Results The average number of drugs per encounter was 2.1. The percentage of encounters with antibiotics and injection was 44% and 13.9%, respectively. The percentage of drugs prescribed by generic name and from an essential drug list was 98% and 100%, respectively. On average, patients spent 4.7 min for consultation and 105 s for dispensing. From 1305 prescribed drugs, 92% were dispensed, while only 4% were labeled adequately. More than half (54.8%) of patients had adequate knowledge of their medication. None of the health centers had an essential drug list. The availability of key essential medicines was 64.10%. Conclusion This study demonstrated irrational drug use practices in all healthcare facilities. Polypharmacy, antibiotics over-prescribing, short consultation and dispensing times, inadequate labeling of medicines, inadequate level of patients' knowledge about prescribed medicines, and unavailability of key drugs in stock were found to be the major problems. Continuous refreshment trainings on rational use of drugs and WHO recommendations should be given for prescribers and pharmacists. Further, we recommend studies involving large number of facilities to estimate overall prescribing practices.

Monoclonal antibodies for cancerous conditions in essential medicine list: An experience from a tertiary hospital in Bengaluru, India

Globally, cancer is emerging as a major public health problem. Monoclonal antibodies are extensively used for cancerous conditions at tertiary hospitals. Many of these are not easily available for patients seeking treatment from public sector. It is difficult for poor patients to afford these drugs on individual basis.The aim of our study is to calculate the prescribed daily dose of monoclonal antibody in cancerous conditions, to know the number of monoclonal antibody present in the essential drug list and to know the average total number of drugs prescribed in generic names. The average dose of the monoclonal antibody used is calculated and the common conditions for which it is used is tabulated and the drug usage is noted for both genders. The number monoclonal antibody present in the list of essential medicine of India and WHO is compared. The average total number of drugs prescribed in generic names is calculated.Average prescribed dose calculated was 382 mg for Trastuzumab, 455mg for rituximab. Only a few monoclonal antibodies were found in who essential drug. Only Trastuzumab and rituximab monoclonal antibody were found in the essential drug list of India. While, Trastuzumab is the most commonly (61%) prescribed drug in the generic form. The study concludes that Trastuzumab is the commonly used monoclonal antibody followed by Rituximab and Bevacizumab. Only Trastuzumab and rituximab were found in Indian essential drug list. Measures for Inclusion of other monoclonal anti bodies can be made by the policy decisions.