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Aims: To study the current prescription pattern and to analyze the cost of the treatment Prescribed to RA patients referred to rheumatology OPD in KEM hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine and Department of Pharmacology, Seth GSMC & KEM Hospital, between July 2011 and December 2011. Methodology: The study protocol was approved by the institutional ethics committee. Patients attending Rheumatology OPD for existing RA disease were recruited as per inclusion criteria. Written informed consent was sought. It was a cross-sectional study. Total 100 consecutive rheumatoid arthritis patients (fulfilling the American College of Rheumatology Criteria 1987) were recruited from 1st July to 1st September 2011. Results: Majority of patients (67%) in the study population were on combination of two DMARDs. Most frequently prescribed two DMARDs combination was methotrexate and hydroxychloroquine (64%). Average total cost per prescription was found to be 763.39 (US$ 14), while average hospital and out of pocket expense were 281.12 (US$ 5) and 482.88 (US$ 9) respectively. Conclusion: The drug use pattern in RA was found to be DMARDs based and majority of the cost was borne by the patient. The total cost increased was due to administration of drugs to treat the adverse drug reaction. Prospective studies in a larger number of patients are needed to assess the utility of prescription audit and cost analysis of drugs used in RA.
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Introduction: Epidemiology of skin diseases has been studied and evaluated occasionally. In view of high incidence of skin diseases and economic burden that it poses, there is a need to evaluate the present epidemiology and prescribing pattern of skin disorders. Objective: To assess common skin conditions, drug utilization patterns and cost analysis in Dermatology Out patients Department (OPD) of Tertiary Care hospital. Methodology: After taking Ethics committee’s permission, prescriptions of 600 patients attending Dermatology OPD were audited. The prescriptions were analyzed for common skin conditions drug utilization and cost analysis. Results: The common skin conditions found were Pyoderma and Scabies while common classes of drugs prescribed were antiallergics, antifungals and steroids. Drugs prescribed by Generic name were 16.6% and Brand names were 83.4%. It was revealed that 30% of total drugs dispensed from hospital pharmacy and 70% from outside pharmacy. Average hospital and outside pharmacy costs were INR19.40 and INR116.20, respectively. The outside pharmacy cost of prescription (Spearman’s Rho = -0.130, p < 0.01) as well as cost paid by the patients (Spearman’s Rho = 0.408, p < 0.001) had a negative correlation with the socioeconomic score as the drugs were prescribed irrespective of the socioeconomic class. Conclusion: The dermatological prescription analysis gives a message to the prescribing physician to achieve rational and cost effective medical care. The drugs which are made available in the hospital pharmacy should be based on clinical evidence generated from meta-analysis of drug studies, pharmacoepidemiology and pharmacoeconomic studies. There is dire need for physicians training with regards to rational use of drugs and pharmacoeconomics. Hospital should make essential drugs available with continuous monitoring to improve the prescribing pattern. The limitation of this study is that the actual direct costs and indirect costs were not studied. It opens the scope for further study in this area.
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Rapid advances in the treatment of breast cancer, especially in the form of hormone therapy have truly increased the hope of longer and better disease-free survival for these patients. Exemestane, a third generation aromatase inhibitor has been extensively evaluated in metastatic as well as adjuvant therapy of breast cancer. It has also been evaluated for its safety profile, especially on bone and lipids. Exemestane provides hope to the patients with breast cancer both in early and metastatic disease. This review analyzes all the aspects of exemestane therapy.