Home About us Contact
|
Home About us Contact | ||
|
|
||
Medication Costs (medication + cost)
Selected AbstractsReduction in Medication Costs for Patients with Chronic Nonmalignant Pain Completing a Pain Rehabilitation Program: A Prospective Analysis of Admission, Discharge, and 6-Month Follow-Up Medication CostsPAIN MEDICINE, Issue 5 2009Julie L. Cunningham PharmD ABSTRACT Objective., Chronic nonmalignant pain (CNMP) is both a prevalent and a costly health problem in our society. Pain rehabilitation programs have been shown to provide cost-effective treatment. A treatment goal for some rehabilitation programs is reduction in the use of pain-related medication. Medication costs savings from pain rehabilitation programs have not been analyzed in previous studies. Design., This prospective cohort study of 186 patients with CNMP addresses the costs of medications at admission to a 3-week outpatient pain rehabilitation program, at discharge, and at 6-month follow-up. Medication use was determined through a detailed pharmacist interview with patients at admission and discharge. Patients were sent questionnaires 6 months after program completion, which obtained current medication information. Results., Statistically significant medication cost savings were seen for program completers at discharge and at 6-month follow-up (P < 0.05). The mean (standard deviation) daily prescription medication cost reduction from admission to discharge was $9.31 ($12.70) using the average wholesale price of medications. From the original study cohort, 121 patients completed the 6-month follow-up survey. The mean daily prescription medication cost savings from admission to 6-month follow-up was $6.68 ($14.40). Conclusion., Patients benefited from significant medication cost savings at the completion of the 3-week outpatient pain rehabilitation program and maintained significant savings after 6 months. This study adds to the current literature on the economic value of comprehensive pain rehabilitation programs. [source] Cost of Alzheimer's disease in a developing country settingINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2005M. Zencir Abstract Purpose To evaluate the economic impact of AD in Denizli, Turkey. Design and Methods This observational study was conducted with 42 AD patients and their primary caregivers. During the initial interview, demographic data and medical histories were collected with questionnaires. For an observational period of 15 days, data on time spent for patient care were collected using standard forms. Calculations on direct cost (e.g. per day medication, outpatient physician visits during the last 3 months), indirect cost (e.g. time spent for care by caregiver for daily living (ADL) and instrumental activity of daily living (IADL)) were made by summing up and taking averages of the appropriate items. ANOVA, and linear regressions were the methods for comparisons. Results The primary caregivers of the patients mainly were their children and/or spouses. The maximum mean time spent (h/week) was 21.0 (17.5) for severely damaged cognition. The average annual cost per case was between $1,766 [95% Confidence Intervals (CI); 1.300,2.231] and $4,930 (95% CI; 3.3714,6.147). The amount of caregiver cost was the most significant item in the overall cost and it showed an increase with the declining cognitive function of patients. Daily medication cost reflected the same pattern. In contrast, cost of outpatient physician was the lowest among the patients with the worst cognition. Conclusions These results suggest that recently AD has become a significant cost for developing countries. This pilot study gives an idea of the cost of AD in developing countries where determining the actual cost can be difficult. Copyright © 2005 John Wiley & Sons, Ltd. [source] Oxymetazoline is Equivalent to Ciprofloxacin in Preventing Postoperative Otorrhea or Tympanostomy Tube ObstructionTHE LARYNGOSCOPE, Issue 2 2005Veena V. Kumar MD Abstract Objective: To compare the effectiveness of ciprofloxacin and oxymetazoline solutions instilled after tympanostomy tube placement in the prevention of postoperative otorrhea and tube occlusion. Study Design: Prospective cross-sectional series. Methods: We reviewed all bilateral myringotomy and tube placement operations performed by two full-time attending pediatric otolaryngologists during a 9 month period. Data from 488 patients who underwent surgery for otitis media were collected. Demographic and clinical variables including age, sex, number of tube insertions in the past, previous adenoidectomy, type of effusion present at surgery, and type of drop prescribed postoperatively were recorded. All patients were evaluated in the office 2 to 4 weeks postoperatively. Multivariate logistic regression analysis was used to estimate the relationship of these variables with the occurrence of otorrhea and tube patency. Odds ratios were calculated. Results: No significant differences in postoperative otorrhea or tube patency were found between ciprofloxacin (Ciloxan) and oxymetazoline solutions (Afrin, Visine LR). Conclusion: Oxymetazoline and ciprofloxacin solutions are equivalent in the prevention of postoperative otorrhea and tube occlusion after tympanostomy tube placement. The implications for medication cost and potential adverse reactions are discussed. [source] Utilization of antiepileptic drugs during pregnancy: Comparative patterns in 38 countries based on data from the EURAP registryEPILEPSIA, Issue 10 2009The EURAP Study Group Summary We assessed the utilization of antiepileptic drugs (AEDs), 1999,2005, in 4,798 prospective epilepsy pregnancies from 38 countries participating in EURAP, an international AED and pregnancy registry. Prominent differences in utilization patterns were observed across the various countries. Exposure to second-generation AEDs ranged from 3.5% in India and 7.3% in Italy to 75% in Denmark. Even wider variation was recorded in exposure to individual AEDs. The utilization of second-generation AEDs increased over time (for lamotrigine, from 9.9% of all pregnancies before 2001 to 29.6% after 2003). The differences in use of individual AEDs across countries probably reflect lack of evidence concerning the optimal treatment of epilepsy in women of childbearing age, as well as variation in country-specific traditions, medication costs, and drug promotion. Our observations underscore the need for comparative studies to investigate the factors influencing the prescription of AEDs during pregnancy, as well as their influence on pregnancy outcome. [source] Clinician attitudes towards prescribing and implications for interventions in a multi-specialty group practiceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2008Robert J. Fortuna MD Abstract Background, Prescribing decisions are subject to a myriad of external forces, including patient requests for advertised medications. Although numerous factors influence prescribing, resources to support unbiased evidence-based prescribing are not widely available. Methods, To guide future interventions, we surveyed clinicians about influences on prescribing, awareness of pharmaceutical costs and attitudes towards computerized decision support. A 21-item survey was sent to 604 prescribing clinicians in a large multi-specialty group practice that employs a robust electronic medical record. Results, Surveys were returned from 405 clinicians (67%). Most respondents (87%) felt that direct-to-consumer (DTC) advertising prompts patients to request inappropriate medications, and more than one in five clinicians (22%) reported difficulty declining patients' requests for advertised medications. Providers with more clinical sessions per week reported greater difficulty. Although 93% of clinicians felt they have access to the information needed to guide prescribing, only about half (54%) reported they are aware of how much patients pay for prescription medications. Clinicians' awareness of medication costs varied considerably by specialty, with behavioural health clinicians being the most aware. The majority of providers (79%) stated that computerized prescribing alerts are a clinically useful source of information. Conclusions, Although the majority of clinicians reported that DTC advertising leads many patients to request medications that are inappropriate for their condition, a sizable proportion of clinicians reported difficulty declining these requests, and many are unaware of medication costs. Interventions to support prescribing decisions should provide the busiest clinicians with up-to-date, specialty-specific evidence and cost information. [source] Heart failure from diastolic dysfunction related to hypertension: Guidelines for managementJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 5 2005APRN-BCArticle first published online: 6 OCT 200, DeAnn Thomas-Kvidera MSN Purpose To provide advanced practice nurses with a greater understanding of the pathophysiology, diagnostics, and management of diastolic dysfunction resulting from hypertension. Data sources Electronic database searches were performed using Medline and CINAHL. Data were obtained from medical textbooks and research and review articles. Conclusions As the number of older adults with heart failure (HF) continues to increase, so will the need for effective care and guidance. In addition to further testing of appropriate pharmacologic regimens, adherence factors such as medication costs and patients' functional abilities must be considered. Implications for practice HF resulting from diastolic dysfunction has emerged as a separate entity over the past 10,15 years. One of the most common causes of diastolic dysfunction is uncontrolled hypertension. Populations at greatest risk include elders, particularly women, and African Americans. [source] The costs of heparin-induced thrombocytopenia: a patient-based cost of illness analysisJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2009T. WILKE Summary.,Background and objectives:,Due to the complexity of heparin-induced thrombocytopenia (HIT), currently available cost analyses are rough estimates. The objectives of this study were quantification of costs involved in HIT and identification of main cost drivers based on a patient-oriented approach. Methods:,Patients diagnosed with HIT (1995,2004, University-hospital Greifswald, Germany) based on a positive functional assay (HIPA test) were retrieved from the laboratory records and scored (4T-score) by two medical experts using the patient file. For cost of illness analysis, predefined HIT-relevant cost parameters (medication costs, prolonged in-hospital stay, diagnostic and therapeutic interventions, laboratory tests, blood transfusions) were retrieved from the patient files. The data were analysed by linear regression estimates with the log of costs and a gamma regression model. Mean length of stay data of non-HIT patients were obtained from the German Federal Statistical Office, adjusted for patient characteristics, comorbidities and year of treatment. Hospital costs were provided by the controlling department. Results and conclusions:,One hundred and thirty HIT cases with a 4T-score ,4 and a positive HIPA test were analyzed. Mean additional costs of a HIT case were 9008 ,. The main cost drivers were prolonged in-hospital stay (70.3%) and costs of alternative anticoagulants (19.7%). HIT was more costly in surgical patients compared with medical patients and in patients with thrombosis. Early start of alternative anticoagulation did not increase HIT costs despite the high medication costs indicating prevention of costly complications. An HIT cost calculator is provided, allowing online calculation of HIT costs based on local cost structures and different currencies. [source] Asthma and allergy medication use and costs among pediatric primary care patients on asthma controller therapyPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 8 2006Vasilisa Sazonov-Kocevar As observational studies in children initiating GINA-Step 3 therapies are scarce, we evaluated outcomes and costs in a primary care cohort. Two-yr retrospective cohort study included French children (age: 6,14) continuously followed in BKL-Thalès database who received ,2 consecutive prescriptions for GINA-Step 3 therapy (=addition of montelukast or other controllers (,other'), such as increasing inhaled-corticosteroid dose (hICS), adding long-acting , agonist (LABA), or ICS + LABA). After matching on gender and propensity score, medication use [rescue (short-acting , agonists), acute (antibiotics (AB), oral corticosteroids (OCS)), allergy (antihistamines, nasal steroids) and other respiratory] was estimated via mean number of prescriptions and mean cost (per child/per month), and cost trends. During 12-month follow-up, children adding montelukast (n = 71) vs. ,other' (n = 213) had similar asthma rescue/acute and allergy medication use. Subgroup with asthma and allergic rhinitis (A + AR) adding montelukast used less OCS and AB (p = 0.014). Two-yr cost trends suggest stable asthma/allergy medication use in montelukast group (,0.83) compared with increase in ,other' (,5.39), which was driven by nasal steroid use [,0.32 (,other') vs. ,,0.04 (montelukast), p = 0.0013]. In subgroup with A + AR decline in asthma/allergy medication use in montelukast group (,,0.47) vs. increase in ,other' (,11.05), p = 0.015, was driven by differences in AB and OCS (p = 0.04) and nasal steroid use (p = 0.001). Concomitant asthma/allergy medication use was similar in children adding montelukast or ,other' controllers (hICS, LABA, ICS + LABA), while children with allergic rhinitis on montelukast used less AB. Concomitant medication costs after addition of montelukast remained stable, while ,other' group experienced increase, especially in children with concomitant allergic rhinitis. [source] Impact of regular attendance by infectious disease specialists on the management of hospitalised adults with community-acquired febrile syndromesCLINICAL MICROBIOLOGY AND INFECTION, Issue 10 2004A. Borer Abstract The impact of attendance by infectious disease specialists (IDS) on hospitalised adults with community-acquired infection was assessed by studying 402 consecutive febrile adults who were admitted randomly to either of two internal medicine wards over a 4-month period and given intravenous antibiotics. In ward 1, patients were attended by IDS, whereas those in ward 2 were attended by physicians from other specialties. In total, 160 patients were treated in ward 1 and 242 in ward 2 (median age 66 years; 49% male). The case-mix was comparable. Only 39% of ward 2 patients underwent minimal fever diagnostic tests compared to 82% in ward 1 (p < 0.001). Ward 1 and 2 patients received 188 and 315 antibiotic courses, respectively, of which 32% and 20% required approval from IDS (p 0.003). Patients in ward 1 were more likely to receive ceftriaxone (7.5% vs. 2%; p 0.002), erythromycin (7% vs. 1.5%; p 0.002) and cefuroxime (48% vs. 26%; p < 0.0001), but were less likely to receive amoxycillin,clavulanate (8% vs. 28%; p < 0.0001). The mean durations of therapy were 3.6 and 3.2 days (not significant), and therapy was deemed to be completely appropriate in 55.5% and 43% of cases, respectively (p 0.012). The crude mortality rates were 6.3% and 7.9%, respectively (not significant), while the medication costs were US$ 27.4 and US$ 26.4/patient/antibiotic day, respectively. Regular attendance by IDS resulted in significantly higher rates of accurate diagnosis and appropriate therapy. IDS prescribed more restricted (and expensive) agents, but preferred less expensive agents among unrestricted drugs, thereby offsetting the overall medication costs. [source] | ||||||||||