			Home About us Contact

Therapeutic Substitution (therapeutic + substitution)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Increased health costs from mandated Therapeutic Substitution of proton pump inhibitors in British Columbia

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2009
B. J. SKINNER
Summary Background, In 2003, British Columbia's PharmaCare programme implemented a drug reimbursement policy called Therapeutic Substitution, which required patients with acid-related diseases, primarily gastro-oesophageal reflux disease (GERD), to make a medically unnecessary switch from their prescribed proton pump inhibitor (PPI) to the cheapest available brand name PPI (Pariet, rabeprazole sodium), comprising a different (nongeneric) chemical. Aim, To evaluate the independent effects of PPI Therapeutic Substitution on individual healthcare utilization among those complying with the policy. Methods, We used the BC Ministry of Health Services' individual-level linked data, allowing isolation of healthcare utilization for the entire population of PPI consumers from 2002 to 2005. Results, After controlling for individual case variation in age, gender and a proxy for pre-existing health status, regression analysis revealed statistically significant greater overall use of PPIs, physician services and hospital services independently associated with patients who complied with Therapeutic Substitution. Over the 3-year period 2003,2005, this represented net healthcare expenditures totalling approximately C$43.51 million (C$9.11 million in total PPI drug expenditures, C$24.65 million for physician services and C$9.75 million for hospital services). Conclusion, Medically unnecessary drug switching caused by compliance with Therapeutic Substitution policy appears to be independently associated with higher overall healthcare utilization. [source]

The skin as a biofactory for systemic secretion of erythropoietin: potential of genetically modified keratinocytes and fibroblasts

EXPERIMENTAL DERMATOLOGY, Issue 6 2008
Frank Scheidemann
Abstract Background:, The skin is an interesting target tissue for gene therapy applications because of its ready accessibility. One possibility would be to utilize the genetically modified skin as a biofactory secreting a systemically needed product, such as erythropoietin (EPO). Methods:, Keratinocytes (KC) and fibroblasts (FB) were transduced with a retroviral vector encoding human EPO. Gene transfer efficiency was assessed by real-time PCR analysis and flow cytometry of transduced cells. In addition, EPO synthesis and secretion were analysed by quantifying the amount of RNA and secreted protein in both monolayer cultures and skin equivalents (SE). Results:, When cultured as a monolayer, EPO-KC synthesized significantly more EPO than EPO-FB, as shown by quantitatively measuring the amount of secreted protein and RNA. This correlated with an increased EPO-vector incorporation in KC compared with FB, demonstrated by determining both the percentage of transduced cells and the average transgene copy number per cell. In addition, in transduced cell cultures enriched to equally high percentages of EPO+ cells, KC showed a higher activity of EPO secretion than FB. Finally, when assembled in a SE, EPO-KC secreted significantly higher amounts of EPO than EPO-FB, although reduced secretory activity of EPO-KC monolayers grown in high calcium concentrations suggested that in stratified epidermis differentiated KC secrete less EPO than non-differentiated KC. Conclusion:, In summary, while both transduced KC and FB are able to synthesize and secrete human EPO, KC show higher potential in serving as possible target cells for therapeutic substitution with EPO, probably because of improved transduction rates and increased secretory activity. [source]

Potential Savings from an Evidence-Based Consumer-Oriented Public Education Campaign on Prescription Drugs

HEALTH SERVICES RESEARCH, Issue 5p1 2008
Julie M. Donohue
Objective. To estimate potential savings associated with the Consumer Reports Best Buy Drugs program, a national educational program that provides consumers with price and effectiveness information on prescription drugs. Data Sources. National data on 2006 prescription sales and retail prices paid for angiotensin-converting enzyme inhibitors (ACEIs), ,-blockers, calcium channel blockers, and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-coA) reductase inhibitors (statins). Study Design. We converted national data on aggregate unit sales of drugs in the four classes to defined daily doses (DDD) and estimated a range of potential savings from generic and therapeutic substitution. Principal Findings. We estimated that $2.76 billion, or 7.83 percent of sales, could be saved if use of the drugs recommended by the educational program was increased. The recommended drugs' prices were 15,65 percent lower per DDD than their therapeutic alternatives. The majority (57.4 percent) of potential savings would be achieved through therapeutic substitution. Conclusions. Substantial savings can be achieved through greater use of comparatively effective and lower cost drugs recommended by a national consumer education program. However, barriers to dissemination of consumer-oriented drug information must be addressed before savings can be realized. [source]

Pharmacopolitics, statin switching and therapeutic substitution: much ado about something

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2008
R. Minhas
No abstract is available for this article. [source]

The pharmacodynamic equivalence of levothyroxine and liothyronine: a randomized, double blind, cross-over study in thyroidectomized patients

CLINICAL ENDOCRINOLOGY, Issue 5 2010
Francesco S. Celi
Summary Context, The substitution of liothyronine (L-T3) for levothyroxine (L-T4) is commonly employed during thyroid hormone (TH) withdrawal in preparation for diagnostic and therapeutic interventions on thyroid cancer patients. Presently, only limited data are available on the L-T3 for L-T4 therapeutic substitution. Objective, To characterize the pharmcodynamic equivalence of L-T3 and L-T4. Design, Randomized, double-blind, cross-over intervention study. Setting, NIH clinical center. Patients, Ten thyroidectomized patients. Interventions, Study participants were treated with L-T3 or L-T4 with a target TSH , 0·5 , 1·5 mU/l for at least 30 days before undergoing inpatient testing. Following testing, subjects crossed-over according to the same scheme. Main outcome measures, Area under the serum concentration,time curve of TSH from 0 to 60 min (AUC0,60) and peak TSH serum concentration (Cmax) following thyrotropin-releasing hormone (TRH) stimulation test, total L-T4 and L-T3 dose (mcg/kg), and L-T4/L-T3 ratio. Results, No difference was observed for time 0 TSH values between L-T3 and L-T4 replacement phases (1·48 ± 0·77 vs. 1·21 ± 0·62 mU/l, P = 0·293) at average daily doses of 40·3 ± 11·3 mcg L-T3 and 115·2 ± 38·5 mcg L-T4, L-T3: L-T4 ratio 0·36 ± 0·06. TRH stimulation test resulted in similar L-T3 vs. L-T4 TSH responses with AUC0,60 of 326·1 (95% CI 232·6,457·1) and 247·1 (95% CI 153·8,397·1) mU* min/l (P = 0·285); and Cmax of 6·83 (95% CI 4·88,9·55) and 5·23 (95% CI 3·31,8·3) mU/l (P = 0·383). Conclusions, This is the first study addressing the equivalency between L-T3 and L-T4 therapy measured by baseline and TRH-stimulated TSH. The therapeutic substitution of L-T3 for L-T4 was achieved at approximately 1:3 ratio. [source]