Economic evaluation of oral ivermectin, alone or in combination with permethrin, versus permethrin, in the treatment of classic scabies in the Philippine Setting

Background and Objective@#Oral ivermectin is recommended as an alternative to topical permethrin in Japanese, European, and CDC-STI guidelines for treating classic scabies. The combination of oral ivermectin and topical permethrin is also used in some settings. Partial economic evaluations conducted in India and Egypt have conflicting results, and no cost-effectiveness analysis in the Philippines has compared ivermectin-based regimens to permethrin for scabies treatment. We aimed to determine the cost-effectiveness of oral ivermectin, alone or in combination with permethrin, compared to permethrin, in the treatment of Filipino adult patients with classic scabies.@*Methods@#We used a decision tree model to estimate the cost-effectiveness of two regimens, oral ivermectin alone or in combination with permethrin, compared with permethrin to treat adults and children aged five years and older with classic scabies in the outpatient setting from the household perspective in the Philippines. We estimated total costs and disability-adjusted life years (DALYs) over a one-month follow-up. Input parameters were obtained from secondary data, such as effect estimates for probabilities of clinical outcomes from a network meta-analysis, DALYs from the Global Burden of Disease 2019, and prevailing market cost in the Philippines (DPRI 2022 with recommended markup by DOH, and leading drugstores) as of August 2022. We computed for incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) to determine which of the interventions are cost-effective. Univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to assess the impact of parameter and structural uncertainty.@*Results@#Ivermectin-based regimens are suggested to be likely cost-saving compared to permethrin in the Philippine outpatient setting. Base case analysis showed that oral ivermectin had higher cost-savings (change in cost, -1,039.31; change in DALYS, 0.00027), while combination oral ivermectin/permethrin had higher DALYs averted (change in cost, PhP -1,019.78; change in DALYs, 0.00045), compared to permethrin. Combination oral ivermectin/permethrin (56%) was the most cost-effective, followed by oral ivermectin (44%) compared to permethrin (0%) through probabilistic sensitivity analysis. Estimates for ivermectin were sensitive to risk of cure for ivermectin vs permethrin using 1-way deterministic sensitivity analysis. Oral ivermectin was favored over combination oral ivermectin/permethrin at all thresholds based on the cost-effectiveness acceptability curve.@*Conclusion@#Both ivermectin-based regimens seem to be cost-saving compared to permethrin in the treatment of classic scabies in the Philippine outpatient setting. Clinicians may consider oral ivermectin, alone or in combination with permethrin as an alternative first-line or second-line treatment depending on patient preference, adverse event risk profile, availability, and economic capacity. This needs to be confirmed using primary data from Filipino patients to enhance the robustness of the findings and support evidence-based local decision-making in different settings. Less uncertainty in modelled parameters can give greater confidence in the results, which can be adopted for budget impact analysis and allow more rational resource allocation. Value of information analysis can be done to determine whether the expense of future RCTs or surveys in Filipinos to collect primary data is worth it. The cost of reducing uncertainty, if deemed worth the cost of further studies, may facilitate population-level decision-making and budget planning. Findings may further inform practice guideline development, coverage decisions, and national control program planning by providing the most cost-effective scabies intervention.

Effects of the distribution of product samples to patients and physicians by pharmaceutical companies

Background@#Distribution of product samples is a typical and traditional marketing and promotion strategy used by pharmaceutical companies. However, issues have been raised about their influence on physicians' prescribing behavior and patients' health outcomes. @*Objectives@#This study aimed to determine the effects of the distribution of product samples on physicians' prescribing behavior and adherence to patients' treatment regimens. It also sought to provide policy recommendations on product sample distribution and the administrative order on pharmaceutical promotion. @*Methodology@#The study involved a descriptive design. The study sites were Manila City, Cebu City, and Davao City. Data were collected using focus group discussions, key informant interviews, and surveys among patients and physicians. Content analysis was performed to analyze qualitative data, while descriptive statistics and measures of association were conducted to analyze quantitative data. @*Results@#A total of four FGDs were conducted with one FGD for each stakeholder group, and 846 patients and 286 physicians answered the study questionnaire. About half (48.0%) of the patients received product samples; 75.8% had low medication adherence. Product sample distribution was not significantly associated with patients' adherence (p=0.150). The majority of the physicians (69.2%) received product samples. There was no significant association between product sample distribution and physicians' prescribing behavior (p=0.111). It was found, however, that the distribution of product samples was significantly associated with the other physicians' prescribing behavior (p=0.009). The issues identified included the influence of medical representatives on physicians' prescribing behavior, incapacity of the poor and marginalized population to complete their treatment regimen due to lack of supply of product samples, and mentality of patients that product samples have better quality.@*Conclusion@#This study emphasized that the regulation of product sample distribution was justifiable since this might negatively influence professional behavior affecting rational prescribing and the use of medicines. Furthermore, the distribution of product samples did not directly translate to increased patients' medication adherence. Should the distribution of samples be continuously practiced, the provision of product samples should be strictly followed, and the distribution should be regulated and monitored to prevent the occurrence of violative practices.

Pharmacy students' perceptions of the formative objective structured clinical examinations (OSCE) and their learning outcomes

@#<p><strong>BACKGROUND</strong>: Objective structured clinical examinations (OSCEs) are used frequently in course subjects owing to their utility in determining the students' clinical competencies under a variety of simulated conditions. In the University of the Philippines (UP) College of Pharmacy, the use of a summative OSCE has already been used as a form of assessment in some of its courses. However, previous batches of students felt unprepared for their summative OSCE at the end of the semester. In particular, students reported unfamiliarity with the content and format of the said examination. To address this concern, formative OSCEs were conducted in a Pharmacy laboratory course.</p><p><strong>OBJECTIVE</strong>: This study aimed to evaluate the effect of the feedback component of formative OSCEs on the students' self-perceived learning and achievement of the course outcomes, facilitating knowledge, skills and attitudes development towards the course, and preparing them for the summative OSCE. It also sought to identify useful aspects of the formative OSCEs and how they can be improved further.</p><p><strong>METHODOLOGY</strong>: Four formative OSCEs were administered from January to May 2017 to all fourth-year pharmacy students taking Pharmacy 154 (Dispensing and Incompatibilities). The units covered were: (1) extemporaneous and sterile compounding; (2) over-the-counter (OTC) medicines and prescription drugs; (3) dangerous drugs and medical devices; and (4) therapeutic incompatibilities and medication safety. After each formative OSCE, feedbacks were provided to the students. Once all OSCEs were conducted, an online, self-administered questionnaire consisting of four parts was given to the students. Total population sampling was employed in the study. The responses (n = 44) were analyzed using frequency statistics. Thematic analysis was done for the aspects of the formative OSCEs that were most useful, and how they could be further improved.</p><p><strong>RESULTS AND CONCLUSION</strong>: The frequency analysis of responses from the questionnaire generally showed that the students had positive perceptions to the feedback component of the formative OSCEs. Still, there was no significant association found between passing the summative OSCE and the formative OSCEs owing to the differences in the content of each examination. Overall, formative OSCEs may be a good assessment tool to track the students' progress and give them constructive feedback in terms of the competencies expected in the course and to better prepare them for the summative OSCE. Increasing the time allotted for each station and orienting them better prior to formative OSCEs were the commonly suggested points for improvement.</p>