Background Antifungal treatment is an important part of global expenditure. A significant increase in the use of these drugs does entail a higher cost. It is hoped that the use of these drugs will continue to increase each year. It is important to know the drug use distribution through the different units and the monetary cost in order to put forward pharmacist interventions. Purpose To describe the evolution of expenditure on, and consumption of, caspofungin, voriconazole, amphotericin B and fluconazole and significant fungaemia from 2009 to 2011. Materials and Methods Observational, retrospective study, carried out in a General Hospital. The consumption for every single patient of caspofungin, voriconazole, liposomal amphotericin B and fluconazole, from 2009 to 2011, were obtained from the Pharmacy Department Software databases (Langtools). Average prices were used to calculate the financial impact. In the microbiology department, blood cultures were done for every patient treated with these drugs for fungal isolates. Results Pharmaceutical spending on these four drugs versus general expenditure was 1.53%, 1.04% and 1.00% for the years 2009, 2010 and 2011 respectively. The evolution of consumption in units (including all presentations) and expenditure is shown in the following table (table 1). The total consumption of the main services in the study period is shown in the following table (table 2). The number of yeasts isolated from blood cultures was 20, 19 and 21 for the years 2009, 2010 and 2011 respectively, representing 2.48% of all positive blood cultures. Abstract DGI-036 Table 1 Units 2009 Spending 2009 (€) Units 2010 Spending 2010 (€) Units 2011 Spending 2011(€) Caspofungin 50 mg vial 426 198,935.95 218 94,934.03 148 64.714,53 Voriconazole 200 mg vial 541 41,914.25 468 37,146.39 731 44.453,75 Liposomal Amphotericin B 50 mg vial 1456 142,091.04 1353 132,042.78 1792 174.885,93 Fluconazole 400 mg vial 2759 4,566.79 2701 4,799.73 2623 4.711,38 Total 5182 387,508.03 4740 268,922.93 5294 288,765.59 Total pharmaceutical expenditure 25,310,713 25,824,331 28,771,067 Abstract DGI-036 Table 2 Units 2009 Spending 2009 (€) Units 2010 Spending 2010 (€) Units 2011 Spending 2011(€) Caspofungin 50 mg vial 426 198,935.95 218 94,934.03 148 64.714,53 Voriconazole 200 mg vial 541 41,914.25 468 37,146.39 731 44.453,.75 Liposomal Amphotericin B 50 mg vial 1456 142,091.04 1353 132,042.78 1792 174.885.93 Fluconazole 400 mg vial 2759 4,566.79 2701 4,799.73 2623 4.711,38 Total 5182 387,508.03 4740 268,922.93 5294 288,765.59 Total pharmaceutical expenditure 25,310,713 25,824,331 28,771,067 Conclusions Antifungal spending is disproportionately high considering the low number of fungal isolates, and entails a high use of empirical and prophylactic treatment. Haematology is, by far, the main department responsible for the use of antifungal treatment. Consumption of voriconazole and liposomal amphotericin B are increasing, meanwhile caspofungin is decreasing in recent years. No confl...
Background Most antineoplastic drugs approved in Spain have been qualified as ‘Hospital Treatment-Diagnosis’ by the Spanish Medicines Agency, so community pharmacists can dispense them. Nevertheless, in Andalusia, from December 2010 as the result of Government Resolution SC 403/10 hospital pharmacists must dispense every single oral chemotherapy treatment. Pharmacist surveillance, patient counselling and cost reduction have been investigated, but consumption trends have not been measured. Purpose To describe the evolution of consumption of oral chemotherapy drugs dispensed by a pharmacy department after Resolution SC 403/10 was approved. Materials and methods Observational, descriptive study, carried out in a General Hospital. The consumption of oral chemotherapy drugs was analysed from six months before SC 403/10 until two years after. Information obtained was stratified in six-month periods. Drug consumption was analysed using Defined Daily Doses (DDD/1000 inhabitants/year). Dispensing data were obtained from the pharmacist informatics devices (APD ATHOS). Costs were analysed using average drug acquisition prices. Results 25 drugs were dispensed during the period of time studied. 4 periods of six months were analysed: 04/2011–09/2011, 10/2011–03/2012, 04/2012–09/2012, and 10/2012–03/2013. Cost of oral chemotherapy was: 982,640 €, 1,729,191 €, 1,566,044 €, 1,512,347 €. DDD/1000 inhab/year: 0.16; 0.19; 0.20; 0.21. Cost increase was: 75.98%, -9.44%, -3.43%. In the last period of time 5 drugs were responsible for more than: 70% of total used: capecitabine, imatinib, mercaptopurine, vinorelbine, and chlorambucil. They represented only 38% of the total cost. 67% of total cost: imatinib, lenalidomide, capecitabine, sunitinib, and pazopanib. They accounted for only 57% of the total consumption. New drug consumption figures for 10/2012–03/2013 in DDD/1000 inhab/year: Greatest increases: capecitabine 0.008, vinorelbine 0.005, abiraterone 0.0026, gefitinib 0.0025, mercaptopurine 0.0021 Greatest decreases: erlotinib 0.004, sunitinib 0.0037, sorafenib 0.0028, imatinib 0.0025, lenalidomide 0.0023. Conclusions The consumption of oral chemotherapy drugs increased constantly, but expenditure declined. More commonly used drugs cost less. No conflict of interest.
Background and importance Chemotherapy induced nausea and vomiting (CINV) remains an important adverse effect as it affects the quality of life of patients, implies chemotherapy dose reductions and compromises adherence. Aim and objectives To evaluate the effectiveness of antiemetic therapy in the control of CINV, comparing groups of patients with adequate and inadequate patterns, according to clinical practice guidelines. Material and methods This was a longitudinal retrospective study for population characterisation and non-intervention. Patients receiving intravenous chemotherapeutic treatment from April to July 2018 were included. Independent variables: demographics (age and sex), and adequacy of the guidelines. Dependent variables: chemotherapy induced nausea (CIN), quantified by adding the scores obtained through a self-administered questionnaire based on the CTCAE scale, for the three phases (anticipated+acute +delayed); and chemotherapy induced vomiting (CIV), similarly quantified. Data are expressed as mean (SD) for continuous variables and absolute and relative frequency for categorical variables. Multivariable logistic regression models were used to study the association of adequacy and effectiveness. Statistical analyses were performed with the R software (V.3.4.3). A p value <0.05 was considered statistically significant. Results A total of 797 chemotherapy cycles were administered to 148 patients during the study period. Of these, 133 patients aged 62.26 (11.13) years, 70 (52.63%) women, were included. They were divided into three groups, according to the adequacy of the guidelines: sufficient (75), excessive (38) and insufficient (20). The excess deviations (OR=0.311 (0.038, 1.535), p=0.197) or insufficient adequacy (OR=0.388 (0.057, 1.878), p=0.278) were not predictors of nausea. In contrast, insufficient adequacy was a predictor of vomiting (OR=17.907 (2.078, 290.042), p=0.015), while the excess deviation was not (OR=1.799 (0.064, 37.415), p=0.688). Conclusion and relevance For all CINV anticipated, acute and delayed phases considered together, an insufficient antiemetic pattern was associated with worse control of vomiting, but not nausea. In future studies, separate assessment of the influence of the adequacy of the antiemetic pattern on each of the CINV phases deserves further investigation. REFERENCES AND/OR ACKNOWLEDGEMENTS No conflict of interest.
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