Knowledge, attitude and perception of pharmacists and healthcare professionals about principles and methodology evaluation of pharmacoeconomic in the United Arab Emirates

Objectives The current work seeks to explore the knowledge, perceptions and attitudes towards the concept of pharmacoeconomics fundamental propositions and evaluation methodologies, among pharmacists and other healthcare providers in the UAE as the health expenditure is increasing. Methods A descriptive cross-sectional study was conducted amongst the licensed physicians in all specialties, all pharmacists and other healthcare professionals with a minimum of three months of experience those registered with the Ministry of Health and Prevention (MOHAP) and those working in the private sector in the UAE. Participants are sent an email containing a validated web-based electronic link to access the questionnaire. The questionnaire composed of three sections is used to assess the healthcare professionals' knowledge, attitude and perceptions regarding the concept, principles and methodology evaluation of pharmacoeconomics. Regression analysis was used to identify the factors affecting healthcare providers' knowledge and attitude regarding the criteria used in methodology evaluation of pharmacoeconomics. Key findings A total of 866 respondents participated. The average age of respondents was 42.1 +/- 8.8 SD. The average knowledge score on the principle of pharmacoeconomic was 40.4% with a 95% confidence interval (CI) of [38.9%, 41.8%]. Of the total participants, 663 (76.6%) had poor knowledge on the principle of Pharmacoeconomic, 172 (19.9%) had moderate knowledge and only 31 (3.6%) had good knowledge. The average attitude score about criteria used in pharmacoeconomic methodology evaluation was 82.3% with a 95% CI of [81.9%, 83.7%]. Conclusions There is a need to raise their awareness on pharmacoeconomics fundamentals and evaluation methodologies by including pharmacoeconomics course in curriculum and continuous workshops and training.

Economic aspects of COVID-19 treatment in a hospital setting

In April 2020 in order to prevent the spread of the new coronavirus infection COVID-19 on the territory of the Russian Federation, strict quarantine measures were introduced. In the shortest possible time, a large number of general hospitals were repurposed into COVID hospitals, recommendations were issued on the management of patients with a new coronavirus infection based on the existing global experience. The limited resources of the healthcare system in a pandemic require research into the pharmacoeconomic aspects of COVID-19. In the course of the study, a continuous retrospective analysis of the case histories of 6255 patients admitted to the Central Clinical Hospital RZD-Medicine was carried out. During the study period, 22% of patients received biological therapy. The average mortality rate of patients on biological therapy is 11.6%. An individual selection of the therapeutic dose of low molecular weight heparins was carried out, which showed high clinical efficacy. The developed methods were assessed from the perspective of pharmacoeconomics. The increase in the degree of damage to the lung tissue in patients with COVID-19, as well as the presence of concomitant diseases, entails an increase in the cost of treatment. Biotherapy can reduce the cost of treating patients with CT-4 by 16% by reducing the length of stay in the intensive care unit, the need for mechanical ventilation and reducing mortality.Copyright © 2021 Infectious Diseases: News, Opinions, Training. All rights reserved.

[Translated article] Efficacy and marginal cost of treatment with tocilizumab in COVID-19 patients.

OBJECTIVE: To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated. METHODS: Observational, single-center, retrospective study of a cohort of adult patients infected with SARS-COV2 treated with tocilizumab. The 1 year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated. RESULTS: 508 patients (66 ±â€¯13 years; 32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08; 95% CI 1.07-1.10; p < 0.001) and ICU admission at initiation of treatment (HR = 2.01; 95% CI 1.30-3.09; p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of €966 and a marginal cost/survivor of €1136. CONCLUSION: The efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy.

Acknowledgement to Referees

Olusola Adejumo, Nigeria Ziyad Almalki, Saudi Arabia Arthur Attema, the Netherlands Robert Bednarczyk, USA Alyssa Bilinski, USA Jacoline Bouvy, UK Ash Bullement, UK Julie Campbell, Australia Giorgio Colombo, Italy Douglas Coyle, Canada Ralph Crott, Belgium Maxwell Dalaba, Ghana Avram Denburg, Canada Bruno Detournay, France Roland Diel, Germany Isabelle Durand-Zaleski, France Simon Eckermann, Australia Lina Maria Ellegård, Sweden Trevor Ellison, USA Naghmeh Foroutan, Canada Samuel Frempong, UK Simon Frey, Germany Emily Gao, USA Livio Garattini, Italy Tim Govers, the Netherlands Ravi Goyal, USA Michael Grabner, USA Brett Hauber, USA Emily Holmes, UK Gareth Hopkin, Canada Don Husereau, Canada Maarten IJzerman, Australia Abdulmuminu Isah, Nigeria Michael Iskedjian, Canada Christian Jacob, Germany Marcel Jonker, the Netherlands Namita Joshi, USA Billingsley Kaambwa, Australia Hrishi Kale, USA Maria Kamusheva, Bulgaria Amy Kang, USA Ali Karahan, Turkey Ashleigh Kernohan, UK Florian Kirsch, Germany Akiko Kowada, Japan Kristine Kreis, Germany Gayathri Kumar, UK Admassu Lamu, Norway Dawn Lee, UK Shunping Li, China Tasneem Lokhandwala, USA Paula Lorgelly, UK Olena Mandrik, UK Louis Matza, USA Michela Meregaglia, Italy Paul Mitchell, UK Najmeh Moradi, Islamic Republic of Iran Sara Olofsson, Sweden Ibidunni Oloniniyi, Nigeria Jaime Ordoñez, Colombia Brian O'Rourke, Canada George Papadopoulos, Australia Yingwei Peng, Canada Julia Quitmann, Germany Santiago Rodriguez, Brazil Tom Roper, UK Eric Ross, USA Surasak Saokaew, Thailand Abdur Razzaque Sarker, Bangladesh Luwen Shi, China Gemma Shields, UK Affan Shoukat, Canada Ram Shrestha, USA Rajiv Singla, India Hyun Jin Song, USA Zhuo Su, USA Andrew Sutton, Canada Owen Tan, Australia Nandu Thalange, United Arab Emirates Kednapa Thavorn, Canada Frederick Thielen, the Netherlands Chloe Thomas, UK David Turner, UK Antoinette van Asselt, the Netherlands Anna Vassall, UK Jennifer Vaughn, USA Miroslav Verbič, Slovenia Matthijs Versteegh, the Netherlands Jeffrey Voigt, USA Fan Yang, UK We are also very grateful to the members of the journal's Honorary Editorial Board, who have acted as peer reviewers and authors, and have provided guidance on journal content, policy and processes: [...]all content in PharmacoEconomics - Open is already open access and we have published a number of articles relevant to the COVID-19 pandemic (see Issues 2–4). In 2021, PharmacoEconomics - Open will continue to provide you with quality health economics and outcomes research.

Efficacy and marginal cost of treatment with tocilizumab in COVID-19 patients. / Resultados en la práctica asistencial y coste marginal del tratamiento con tocilizumab en pacientes COVID-19.

OBJECTIVE: To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated. METHODS: Observational, single-center, retrospective study of a cohort of adult patients infected with SARS-CoV-2 treated with tocilizumab. The one-year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated. RESULTS: 508 patients (66 ± 13 years; 32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08; 95% CI 1.07-1.10; p < 0.001) and ICU admission at initiation of treatment (HR = 2.01; 95% CI 1.30-3.09; p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of € 966 and a marginal cost/survivor of € 1,136. CONCLUSION: The efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy.

Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report.

Heparin-induced thrombocytopenia is a life-threatening immune-mediated complication of unfractionated heparin therapy. Fondaparinux is a therapeutic alternative, but it has limited evidence for its use in patients on extracorporeal membrane oxygenation (ECMO). We present a series of three adult patients with COVID-19 on ECMO who were diagnosed with heparin-induced thrombocytopenia after 7-12 days of unfractionated heparin treatment and were switched to fondaparinux. Fondaparinux was initiated with an intravenous loading dose of 5 mg, followed by a dose of 2.5 mg subcutaneously every 8-12 h. Dosage was adjusted according to daily measured anti-Xa concentration with a target range of 0.4-0.7 mg/L. The total duration of treatment with fondaparinux and ECMO ranged from 13 to 26 days. One major bleeding episode unrelated to fondaparinux therapy was observed, and the transfusions requirement was also low in all patients. The ECMO circuit was changed once in each patient. This series provides a deep insight into the use of fondaparinux over an extended period of time in patients on ECMO. Based on the presented data, fondaparinux can be considered a reasonable and affordable anticoagulant in patients without a high risk of bleeding.

Editorial

The 5th European Conference on Oncology Pharmacy took place as a face-to-face exchange between colleagues in Hamburg 2022.

Pharmacoeconomical Aspects of Self-Medication, a Community Pharmacy Survey in Northern Kerala

Objectives: The main objectives of the study are to identify the socio-economic characteristics of lay persons who engage in self-medication activities, to determine the economic aspects of self-medication, to conduct cost minimization analysis, and to determine the consequences of self-medication. Method(s): A cross-sectional survey was conducted in community pharmacies throughout Northern Kerala for a period of 6 months from April 2021 to September 2021. A total of 300 participants were selected through consecutive sampling. Result(s): 117 people were from upper middle class families based on Kuppuswamy's scale. A majority of participants considered self-medication for economic benefits which confirmed that self-medication is closely related to the financial background of the respondents. The costs saved were measured by calculating the costs associated with hospital visits by them or family in the past 6 months for similar manifestations. During the study, the cost of branded drugs prescribed was determined as 70-1498.78% more than the generic versions. Hence, patients are spending much more on their treatment unaware about other alternative options. 117 participants experienced an adverse drug reaction after taking the medication, and 134 participants responded that their symptoms were not improving and 99 entrants had to visit the hospital who had an economic burden due to delay in detection of the disease. Conclusion(s): Thus, the study concluded that there is a strong relationship between pharmacoeconomics and self-medication behavior. Copyright © 2022 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Pharmacoeconomic studies in Cuba in the last 20 years

Introduction: Cuba is a country with development in the biotechnology and medicines field, where pharmacoeconomic studies provide significant evidence for decision-making;mainly at present when the country is immersed in the "Task of Ordering" and at the same time is affected by the pandemic of the new coronavirus. Objective: Characterize pharmacoeconomic studies in Cuba in the last 20 years. Methods: A bibliometric research was carried out for which the Cuban scientific production on pharmacoeconomics was recovered in the Scopus database for the period 2001-2020. Bibliometric indicators were used to obtain the number of documents, years of publication, sources, collaboration, type and patterns of institutional and country collaboration, as well as co-occurrence of keywords. Results: 648 documents were retrieved. The most productive year was 2010. The documents were published in 273 journals, 17 (6.2%) Cuban ones and 256 (93.8%) foreign. There were 449 documents (69.3%) in institutional collaboration and 199 (30.7%) without collaboration. The most productive institutions were the Center for Genetic Engineering and Biotechnology with 82 (12.7%) and the Center of Molecular Immunology, with 77 (11.9%). The collaboration network between countries showed three defined areas: Latin America, North America-Europe-India and Spain. The most published topics were effectiveness and safety of drugs, vaccines, and those related to cancer. Conclusions: The publications were characterized by being collaborative, with a slight predominance of national over international ones. Comprehensive economic assessments need to be expanded.

EVALUATING THE EFFICIENCY OF SPENDING ON ANTIMICROBIAL THERAPY IN THE PULMONOLOGY DEPARTMENT OF A MULTIDISCIPLINARY HOSPITAL IN A PANDEMIC SETTING

Introduction: Antimicrobial resistance is recognized as one of the top 10 threats to public health.Due to recent circumstanceswith the 2019 Covid pandemic worldwide, the urgency of monitoring antibiotic consumption and rational use of medications has increased. According to WHO recommendations, countries should aim to increase the proportion of Access group antibiotics consumption to 60% and higher in AWaRe classification system (Access,Watch and Reserve). The ABC/VEN analysis (80%, 15%, 5% of spending) is the simplest and most relevant method for evaluating the effectiveness of antibiotic therapy expenditures. Objectives: Evaluating the cost-effectiveness of antibiotic therapy in the Department of Pulmonology. Methods: ABC/VEN analysis was performed with data on antibiotic costs in the pulmonology department (30 beds) of a multidisciplinary regional hospital (844 beds in total) with 1 full-time clinical pharmacologist for no clinical pharmacy or pharmacology service. To analyze antibiotic consumption patterns according to the AWaRe 2021 classification, we used data on the number of antibiotics procured. Results: The results of the antibiotics spending analysis from 2019-2021 showed that all antibiotics from the most costly group A (80% of total spending) are in the Watch group (J01DH Carbapenems - Ertapenem, Doripenem, Meropenem;J01MA Fluoroquinolones - Levofloxacin;J01DD Third-generation-cephalosporins - Ceftazidime, Ceftriaxone and J01DE Fourth-generation-cephalosporins: Cefepime). Meanwhile, there has been an increase in the share of spending on the most consumed group of antibiotics, J01DH Carbapenems, from 42.9% in 2019 to 62.8% by 2021. On the contrary, there is downward trend in spending on the third-generation-cephalosporins which was 35.6% in 2019 and only 6.7% by 2021. Assessment of antibiotic prescription patterns in the pulmonology department based on classification AWaRe 2021 and WHO Model List of Essential Medicines (EML) 2021 (22nd edition) revealed a negative trend in the use of the most costly group (A) of antibiotics with a low level of evidence of efficiency or safety in pulmonology: Doripenem, Ertapenem, Levofloxacin, Cefepime. However, there is a positive result in the work of the clinical pharmacology service - the drugs mentioned above were moved into group B (medium-cost) by 2021, except for Cefepim, which was not purchased at all. Conclusion: Despite the positive trend in antibiotic consumption patterns (transfer of antibiotics with efficiency proof from gr A to gr B), current antibiotic therapy in the pulmonology department needs comprehensive optimization of approach to rational antibiotic use, strengthening pharmaceutical care by implementing a clinical pharmacy service that will conduct regular systematic evaluation and contribute to the pharmacoeconomic expediency of antibiotic therapy. Suchmeasures lead to an improvement of the quality of medical care for the population and reduce the cost of this nosology, which proves that there is a need for a comprehensive detailed analysis.

Barriers and Facilitators of Pharmacoeconomic Studies: A Review of Evidence from the Middle Eastern Countries.

The world is facing a continuous increase in medical costs. Due to the surge in disease prevalence, medical science is becoming more sensitive to the economic impact of medications and drug therapies. This brings about the importance of pharmacoeconomics, which is concerned with the effective use of health resources to optimize the efficiency and costs of medications of treatment for the best outcomes. This review was conducted to find out the potential barriers and facilitators to implementing pharmacoeconomic studies in the Middle Eastern region having both high- and low-income countries. The varying economies in the region depict diverse healthcare systems where implementation of pharmacoeconomics faces a large number of challenges and is also aided by numerous facilitators that contribute to the growth of its implementation. In this context, we have reviewed the status of pharmacoeconomics in Middle Eastern countries in research databases (Google Scholar, MEDLINE, Science Direct and Scopus) using keywords ("pharmacoeconomics", "barriers", "facilitators", "Middle East"). The study reported that Yemen, Syria, Palestine, Iran, Iraq, Jordan and Lebanon are the lowest-income countries in the Middle East and the implementation of pharmacoeconomics is the poorest in these states. The UAE, Saudi Arabia and Israel are high-income rich states where economic aspects were comparatively better but still a large number of barriers hinder the way to its effective implementation. These include the absence of national governing bodies, the lack of data on the effectiveness of medications, the absence of sufficient pharmacoeconomic experts and the lack of awareness of the importance of pharmacoeconomics. The main facilitators were the availability of pharmacoeconomic guidelines, the encouragement of pharmacoeconomic experts and the promotion of group discussions and collaborations between researchers and policymakers. Cost-benefit analysis is still evolving in Middle Eastern countries, and there is a great need for improvement so that states can effectively benefit from cost analysis tools and utilize their health resources. In this regard, governments should develop national governing bodies to evaluate, implement pharmacoeconomics at the local and state levels and bring about innovation in the field through further research and development incorporating all sectors of pharmacy and pharmaceutics. The data presented in this research can further be extended in future studies to cover the various domains of pharmacoeconomics including cost-minimization analysis, cost-effectiveness analysis and cost-benefit analysis and their applications within the healthcare sectors of Middle Eastern countries.

Cost utility analysis of Remdesivir and Dexamethasone treatment for hospitalised COVID-19 patients - a hypothetical study.

BACKGROUND: Sars-Cov-2 is a novel corona virus associated with significant morbidity and mortality. Remdesivir and Dexamethasone are two treatments that have shown to be effective against the Sars-Cov-2 associated disease. However, a cost-effectiveness analysis of the two treatments is still lacking. OBJECTIVE: The cost-utility of Remdesivir, Dexamethasone and a simultaneous use of the two drugs with respect to standard of care for treatment Covid-19 hospitalized patients is evaluated, together with the effect of Remdesivir compared to the base model but based on alernative assumptions. METHODS: A decision tree for an hypothetical cohort of Covid-19 hospitalized patients, from an health care perspective and a one year horizon is specified. Efficacy data are retrieved from a literature review of clinical trials, whilst costs and utility are obtained from other published studies. RESULTS: Remdesivir, if health care costs are related to the days of hospitalization, is a cost saving strategy. Dexamethasone is cost effective with an ICER of 5208/QALY, and the concurrent use of Remdesivir and Dexamethasone is the most favorable strategy for higher level of willingness to pay thresholds. Moreover, if Remdesivir has a positive effect on mortality the utility is three times higher respect to base case. Whereas, if health care costs are not related to the length of patient hospitalization Remdesivir has an ICER respect to standard of care of 384412.8/QALY gained, which is not cost effective. We also find that Dexaamethasone is cost effective respect to standard care if we compute the cost for live saved with an ICER of 313.79 for life saved. The uncertainty of the model parameters is also tested through both a one-way deterministic sensitivity analysis and a probabilistic sensitivity analysis. CONCLUSION: We find that the use of Remdesivir and/or Dexamethasone is effective from an economic standpoint.

A Cost-Benefit Analysis of COVID-19 Vaccination in Catalonia.

(1) Background: In epidemiological terms, it has been possible to calculate the savings in health resources and the reduction in the health effects of COVID vaccines. Conducting an economic evaluation, some studies have estimated its cost-effectiveness; the vaccination shows highly favorable results, cost-saving in some cases. (2) Methods: Cost-benefit analysis of the vaccination campaign in the North Metropolitan Health Region (Catalonia). An epidemiological model based on observational data and before and after comparison is used. The information on the doses used and the assigned resources (conventional hospital beds, ICU, number of tests) was extracted from administrative data from the largest primary care provider in the region (Catalan Institute of Health). A distinction was made between the social perspective and the health system. (3) Results: the costs of vaccination are estimated at 137 million euros (€48.05/dose administered). This figure is significantly lower than the positive impacts of the vaccination campaign, which are estimated at 470 million euros (€164/dose administered). Of these, 18% corresponds to the reduction in ICU discharges, 16% to the reduction in conventional hospital discharges, 5% to the reduction in PCR tests and 1% to the reduction in RAT tests. The monetization of deaths and cases that avoid sequelae account for 53% and 5% of total savings, respectively. The benefit/cost ratio is estimated at 3.4 from a social perspective and 1.4 from a health system perspective. The social benefits of vaccination are estimated at €116.67 per vaccine dose (€19.93 from the perspective of the health system). (4) Conclusions: The mass vaccination campaign against COVID is cost-saving. From a social perspective, most of these savings come from the monetization of the reduction in mortality and cases with sequelae, although the intervention is equally widely cost-effective from the health system perspective thanks to the reduction in the use of resources. It is concluded that, from an economic perspective, the vaccination campaign has high social returns.