Therapeutic equivalence program: continued economic benefits in the context of rising costs and increased demand.

Objective The aim of this study was to describe the effect of a therapeutic equivalence program (TEP) in achieving financial sustainability from 2010-11 to 2014-15. Methods A TEP was introduced at Monash Health in 2006-07. Therapeutic medicine classes for inclusion were selected by stakeholder consensus and a preferred medicine for each class was chosen based upon therapeutic equivalence and cost considerations. New patients were commenced on a preferred medicine, but patients already prescribed another medicine from the same therapeutic class were not automatically switched to the preferred medicine. Data was obtained retrospectively from the pharmacy dispensing system, including the purchasing and issuing of all medicines from the preferred medicine classes. The prescribing patterns for preferred and comparator medicines were used as a measure of acceptance of the TEP, along with the savings produced by the program. Results Over the 5-year evaluation period, 18 therapeutic classes were targeted, including seven new classes. Six therapeutic classes from the 11 included in the TEP before 2010-11 were removed throughout the evaluation period when the comparative economic benefits were no longer present. The use of all preferred medicines increased following implementation and a total of AU$7.38million was saved from 2010-11 to 2014-15 and AU$10.54million across 2006-07 to 2014-15. Conclusions This paper provides an update on the progress of the TEP at Monash Health and outlines additional learnings gained. The market dynamics for pharmaceuticals means ongoing maintenance and review of the therapeutic medicine classes targeted is important to enable continued economic benefits. What is known about the topic? There is continued and increasing focus on efficient, cost-effective and financially sustainable medication management. There is limited information available on strategies that can be implemented at a health service level. What does this paper add? The TEP has resulted in sustained savings. The market dynamics for pharmaceuticals means ongoing maintenance and review of the therapeutic classes targeted is important to enable continued economic benefits. What are the implications for practitioners? TEP is a process of genuine disinvestment. Identification and resolution of critical factors in the success of the program may assist implementation at other health services.

A therapeutic equivalence program: evidence-based promotion of more efficient use of medicines.

OBJECTIVE: The development of an effective therapeutic equivalence program (TEP) through the collaborative support of medical staff, using the principles of disinvestment. DESIGN AND SETTING: A TEP was introduced at Southern Health, a metropolitan health service in Melbourne, in the 2006-07 financial year. Therapeutic classes were selected for the TEP by stakeholder consensus, and a preferred medication for each class was selected on the basis of cost considerations and therapeutic equivalence. New patients were commenced on preferred medicines, but patients receiving another medicine from a therapeutic class included in the program were not automatically switched to the preferred medicine. For the first 4 years of the program, prescribing patterns were monitored, and savings achieved (due to lower prices for and increased use of preferred medicines) were calculated on a monthly basis. MAIN OUTCOME MEASURES: Prescribing trends for preferred medicines, as a measure of acceptance of the TEP, and savings produced by the program. RESULTS: Over the 4-year study period, 11 therapeutic classes were targeted. The use of all preferred medicines increased once they become part of the TEP and a total of $3.16 million was saved. The annual savings increased each year, and the rate of increase was six times that of the increase in patient separations. CONCLUSIONS: The TEP at Southern Health resulted in significant savings. It showed that, by using a collaborative and evidence-based approach, the principles of disinvestment can be applied to use of medicines.

Is homatropine 5% effective in reducing pain associated with corneal abrasion when compared with placebo? A randomized controlled trial.

OBJECTIVE: To compare the change in visual analogue scale (VAS) pain ratings over 24 h following mechanical corneal abrasion between patients receiving sixth hourly drops of either 5% homatropine or placebo. METHODS: A triple blind randomized controlled trial was conducted on a convenience sample of eligible consenting adults who were randomized to receive either sixth hourly 5% homatropine (active) or 0.5% hypromellose (placebo) eye drops. VAS pain ratings were performed at 0, 6, 12, 18 and 24 h whereas the study drug was instilled at 0, 6, 12 and 18 h. The primary outcome was attainment of a clinically significant reduction in pain on the VAS (>20 mm decrease) from enrolment to each time point. RESULTS: There were no significant differences in baseline variables or VAS pain ratings at any time point between those in the homatropine (n= 20) and placebo (n= 20) groups. The percentages of patients reporting a >20 mm VAS decrease at 12 h were 50% (95% CI -27.2-72.8) and 60% (95% CI -36.1-80.9) for the homatropine and placebo groups, respectively. CONCLUSION: We found no significant difference in pain score reductions between the two groups but some level of therapeutic benefit is not excluded.