role of pharmacoeconomics in formulary decision making in different hospitals in Riyadh, Saudi Arabia

To assess the trend of using pharmacoeconomic information by Pharmacy and Therapeutics [P and T] committees when making formulary decisions. A cross-sectional study conducted in 2007, using structured survey questionnaires which were distributed to members of the P and T committees in 11 different hospitals in Riyadh, Saudi Arabia. A total of 100 survey questionnaires were sent to head of pharmacy departments of 11 different hospitals in Riyadh, Saudi Arabia. Out of these, 48 questionnaires were completed and returned. Of the total respondents participated in the study, 64.58% were medical doctors and 16.66% were pharmacists and 75% of the respondents said they have applied pharmacoeconomic evaluations in their decision making process. More than 80% of the respondents perceived that they had a fair knowledge of pharmacoeconomics. Approximately 80% of respondents expressed some degree of agreement that pharmacoeconomics should be applied as a decision making tool. The majority of decision-makers [95%] expressed the interest in attending workshops on pharmacoeconomics. The study showed that pharmacoeconomics can play an important role in the P and T committee formulary decisions. However, more education to health care professionals and to hospital administrators should be conducted to facilitate the use of such a tool. Also, hospitals should recruit health care professionals with pharmacoeconomic expertise to manage limited health resources in the best way available

burden of ischemic heart disease at a major cardiac center in central Saudi Arabia

To estimate the direct medical costs associated with ischemic heart disease [IHD] at Prince Sultan Cardiac Center [PSCC] in Riyadh, Saudi Arabia. This is a prevalence-based prospective observational cost of illness study conducted in PSCC, Riyadh, Kingdom of Saudi Arabia between April and June 2009. All patients diagnosed or suspected of having IHD at admission were included. They were followed up until discharge, or performing coronary artery bypass graft [CABG], or changing diagnosis. Clinical data were extracted from the patients' computerized database, and combined with the unit cost of services to calculate costs. A total of 205 patients were recruited and diagnosed with stable angina [SA, 47.8%], unstable angina [USA, 24.4%], ST-segment elevation myocardial infarction [STEMI, 19.5%], and non-ST-segment elevation myocardial infarction [NSTEMI, 8.3%]. Most of the patients were Saudi males, aged between 40-75 years. Eighty-seven percent of patients had 2 or more co-morbidities, and 32% of the patients were obese. The average cost was 40,164 Saudi Riyals [SAR]/patient [US$10,710]. Medication contributed the lowest in the costs [3.2%]. A cost associated with SA was SAR33,991, USA was SAR35,107, NSTEMI was SAR46,585, and STEMI was SAR58,877 per patient. The lowest mean hospital length of stay was 6.5 days with SA. The average length of stay increased with the number of co-morbidities from 5.67 days [no co-morbidity] to 11.25 days [6 co-morbidities]. The IHD is of high economic burden in the country. Among IHD types studied, the resource consumption associated to STEMI was the highest in terms of costs, and hospital length of stay

Pattern of intravenous proton pump inhibitors use in ICU and Non-ICU setting: a prospective observational study

The use of intravenous acid-suppressive therapy for stress ulcer prophylaxis in critically ill patients with specific risk factors has been recommended for over a decade. However, there is a lack of supporting data regarding the extension of such therapy to non-critically ill patients [non-ICU]. The aim of this study was to compare appropriate indications with current practicing patterns in adult non-ICU and ICU patients, contributing factors and financial impact of inappropriate use. A prospective cross-sectional study was carried out at a tertiary teaching Hospital in Riyadh, Saudi Arabia. For a period of 4 consecutive months, all hospitalized patients on IV PPI, aged 18 and above, were identified. A concise listing of indications considered appropriate for the use of IV PPI was pre-defined based on material from available literature and guidelines. A total of 255 patients received IV PPI. Inappropriate use of IV PPI was significantly higher in non-ICU [71.7%] than in ICU [19.8%] patients [P=0.01]. The most common cause for inappropriate use in non-ICU patients was stress ulcer prophylaxis [SUP]. In ICU patients, appropriate indicators for IV PPI were SUP [47.9%], PUD [11.5%], and the UGIB [20.8%]. There was a high association between appropriate uses of IV PPI with respect to endoscopic procedure and also between appropriate uses of IV PPI to subsequent discharge with oral PPI in non-ICU patients. The total estimated direct cost [drug acquisition cost] for inappropriate use of IV PPI during the study period was 11,000 US dollars. Inappropriate IV PPI utilization was predominant in non-ICU patients, mostly for stress ulcer prophylaxis that leads to a waste of resources. Applying appropriate policies, procedures and evidence-based guidelines, educated physicians and surgeons can clearly limit inappropriate IV PPI use