Adherence to oral anticancer chemotherapies and estimation of the economic burden associated with unused medicines.

Background The list of oral and expensive chemotherapy agents has lengthened over the last few years and has created unique medication adherence concerns. In a real-life setting, patients often do not take their medications as prescribed. This pattern is associated with poor outcomes and increased health care costs. Objectives To estimate the adherence to oral anticancer chemotherapies and to determine the economic burden of unused medicines due to patients' death. Setting Alsace (France). Method This retrospective study was carried out by using ERASME, an Insurance Healthcare database. Main outcome measures Adherence was calculated using medication possession ratio and economic impact using prescription refill data. Results 10,734 patients were treated with oral anticancer medicines (cytotoxic agents, hormonal and targeted therapies). Averaged adherence of 0.86 was observed although it varied significantly between subclasses (cytotoxic agents: 0.69 ± 0.14, hormonal therapy: 0.91 ± 0.17 and targeted therapy: 0.79 ± 0.17). 1631 patients died during the study period. The expenses related to unused chemotherapies amounted to €152,175. Conclusions Our data showed that overall adherence to oral anticancer medicines was above the acceptable limit of adherence of 80% with a marked graduation in values between cytotoxic agents, hormonal and targeted therapies. These statistical significant differences in medication possession ratio could be related to the intrinsic toxicity of the three subclasses of molecules, their tolerance and adverse effects. To limit the cost associated with unused medicines, interventions such as dispensing expensive oral anticancer chemotherapies per unit over shorter periods and not only on monthly intervals could be implement.

Knowledge, behaviors and practices of community and hospital pharmacists towards biosimilar medicines: Results of a French web-based survey.

This study's aims were: 1) to extract a comprehensive overview of the knowledge, experience and opinions of both community pharmacists and hospital pharmacists regarding biosimilar medicines in France; and 2) to identify the perceived problems and solutions to promoting their prescription. A 2015 web-based survey was conducted by the Observatoire des Médicaments, des Dispositifs Médicaux et de l'Innovation Thérapeutique of Alsace. A total of 802 pharmacists responded to the survey. Many (536, 66.8%, [95% confidence interval (CI) 63.6-70.1]) indicated that they were not familiar with biosimilars. Half of community pharmacists (95% CI 42.7-57.3) stated that they were not at all informed about biosimilar drugs, compared with 15.7% (95% CI 12.9-18.6) of hospital pharmacists. Almost all respondents (781, 97.4%, [95% CI 96.3-98.5]) had at least one pending question on biosimilars. Most of the questions were related to the manufacturing process, safety, substitution rules and the international non-proprietary name prescription. At the time of the study, 467 pharmacists (58.2%, [95% CI 54.8-61.6]) had already validated a prescription for a biosimilar drug, mainly for filgrastim. These latter were more comfortable in explaining the benefit of biosimilar medicines to the patient. Pharmacists were rather favorable to biosimilar drugs, and about 9 of 10 quoted healthcare cost savings as incentives to their prescription. However, many did not agree with allowing biosimilar substitution. "Patients' wishes to be treated with the originator" and "indication extrapolation" were the two main constraints identified. The survey highlighted the need to provide French pharmacists with accurate and comprehensive information regarding biosimilar medicines.

Rheumatologists' Perceptions of Biosimilar Medicines Prescription: Findings from a French Web-Based Survey.

BACKGROUND: Healthcare cost savings are closely linked to prescribers' confidence in and acceptance of the prescription of biosimilar drugs. OBJECTIVES: The aim of this study was to assess the knowledge, experience and opinions of hospital-based and office-based French rheumatologists with regard to biosimilar medicines and to identify the barriers to and possible options to promote their prescription. METHODS: A web-based, self-administered survey was conducted among French rheumatologists from June 8 to August 2, 2015. RESULTS: A total of 116 rheumatologists responded to the survey. Many reported having little knowledge and a lack of available information about biosimilar drugs, especially office-based rheumatologists. 98.3% of the respondents had at least one question about biosimilars, and seven in ten raised issues regarding substitution, iatrogenic effects or cost savings that might be achievable. Only eight rheumatologists had already prescribed a biosimilar drug. The most common barriers reported were indication extrapolation and a lack of data about tolerability. Nine out of ten physicians thought that starting a treatment with a biosimilar drug in biologic treatment-naïve patients was possible. The rheumatologists' opinions were rather favorable towards the implementation of biosimilars, but a majority expressed a negative opinion about substitution by the pharmacist. CONCLUSIONS: Our survey gave a better appreciation of the concerns associated with biosimilar prescriptions. Targeted communication initiatives, deeper experience and availability of new clinical data may help to address the outstanding questions and should overcome the misunderstandings surrounding biosimilar drugs among rheumatologists.

Drug-dispensing problems community pharmacists face when patients are discharged from hospitals: a study about 537 prescriptions in Alsace.

OBJECTIVES: To identify both type and frequency of the challenges community pharmacists face when dispensing drugs from hospital discharge prescriptions, to describe the measures undertaken to resolve the issues at stake and to list their consequences. DESIGN: We carried out an observational study in the community pharmacies of the French region of Alsace and asked the community pharmacy staff to review 537 hospital discharge prescriptions in 2013 using anonymous data collection forms. SETTING AND PARTICIPANTS: Nineteen community pharmacies. MAIN OUTCOME MEASURES: Number of patients informed about their medication (at hospital and/or community pharmacy), type and frequency of issues encountered during drug dispensing, type and frequency of measures undertaken to resolve the issues, type and frequency of the consequences regarding drug dispensing. RESULTS: Community pharmacists faced 165 challenges from 145 hospital discharge prescriptions (i.e. 27.5% out of 528 analysed prescriptions), mostly correlated to the quality of the prescriptions (n = 100, 60.6%) or to logistical matters (n = 54, 32.7%). A mere 36.8% of the patients received information pertaining to their medication while being hospitalized. Of note, 40.5% of the prescriptions were delivered to pharmacies within 2 days following the patients' discharge. In order to resolve the different issues preventing drugs from being dispensed (n = 33/145 prescriptions), pharmacists sought information, mainly from patients, colleagues and hospital prescribers. The pharmacists were able to dispense all the drugs prescribed in 138 out of 145 cases (95.2%). CONCLUSIONS: This study highlighted the challenges encountered by community pharmacists and their significant contribution to the continuity of care upon patients being discharged from hospitals.

Analysis and Breakdown of Overall 1-Year Costs Relative to Inpatient and Outpatient Care Among Rheumatoid Arthritis Patients Treated with Biotherapies Using Health Insurance Claims Database in Alsace.

BACKGROUND: The economic burden linked to rheumatoid arthritis (RA) has greatly increased since the inclusion of biotherapies in the therapeutic arsenal. OBJECTIVES: This study aimed first to look at the breakdown of the rheumatoid arthritis patients on biotherapy in Alsace, France, in 2012, then to evaluate the annual cost per treated patient for each management pathway: inpatient care with intravenous biotherapies and/or outpatient care through the use of subcutaneous drugs, and finally to conduct a cost comparison with a focus on infliximab, adalimumab and etanercept. METHODS: This observational study was conducted in Alsace using 2012 health claims data from the DCIR (Données de Consommation Inter Régime) and PMSI (Programme de Médicalisation des Systèmes d'Information) databases, taking into account direct medical and non-medical costs in a real-life setting and from a National Health Insurance perspective. RESULTS: There were 5702 RA patients, i.e. 0.31 % of the Alsace population in 2012, including 1075 subjects (18.85 %) receiving biotherapy treatment. The most frequently prescribed biotherapies were etanercept and adalimumab. The estimated overall cost of care of these 5702 patients was €30.3 million, with about 50 % for the care of the 18.85 % patients on biotherapy. Average costs for inpatient, outpatient and mixed care ranged from €14,197 to €16,873 per patient per year. Annual average cost for management of a single RA patient with infliximab was significantly higher than with adalimumab and etanercept: €16,480 versus €14,116 and €14,338, respectively. CONCLUSION: These findings confirm the trends of initial modelling approaches and quantify the cost difference between various biotherapy management pathways.

Anticoagulant-related hospital admissions: serious adverse reactions identified through hospital databases.

PURPOSE: A growing number of patients today receive anticoagulants. These drugs can cause serious adverse reactions leading to patients' hospitalization. The present study aimed to assess the number of hospital admissions as a result of anticoagulant adverse reactions in Alsace, a French region of 1.8 million inhabitants, and to estimate the economic burden associated with their management. METHODS: A retrospective analysis was performed using data extracted from the regional and anonymous hospital Programme de Médicalisation des Systèmes d'Information (PMSI) database to assess the number of hospital admissions and the associated costs. Stays from public and private hospitals were extracted from the database using two International Classification of Diseases, 10th revision, codes referring to anticoagulant drugs: 'T45.5-Poisoning by anticoagulants' and 'Y44.2-Anticoagulants' adverse effect in therapeutic use'. Costs were calculated from official French tariffs. RESULTS: Within a 2-year period from 1 Januray 2010 to 31 December 2011, 462 anticoagulant-related hospital admissions, predominantly in elderly patients, were identified in Alsace. These stays, as a result of anticoagulant adverse reactions, represented a cost of 2 050 127.86 euros (including hospitalization and expensive drugs). CONCLUSION: Regional PMSI database constitutes an effective tool to explore anticoagulant-related hospital admissions. Based on our study, one can state that the cost of anticoagulation therapies lies not only in the price of the drugs but also in the cost of adverse reaction management. Policy makers should be aware of this reality and should focus on better medication supervision in order to improve patient safety and reduce expenses.

Medication in nursing homes in Alsace: a preferential list of drugs obtained by consensus.

ABSTRACT: In order to improve patient care, OMEDIT (Observatory of drugs, medical devices and therapeutic innovation) Alsace, conducted a study to develop a Preferential list of Drugs adapted to the Elderly (PDE list) in nursing homes. The study conducted from December 2011 to June 2012 was organized in 4 phases: 1) creation of a preliminary list of drugs from those currently used in nursing homes in Alsace, 2) application of a two-round Delphi process to evaluate the preliminary list involving mobilization of experts from different backgrounds (geriatricians, general practitioners, pharmacists …), 3) identification of molecules considered in literature as potentially inappropriate, 4) generation of a final PDE list, including information concerning proper use of drugs for prescription and administration. 53 experts participated in the study. In the first round, 338 drugs were on the preliminary list, 246 were considered as appropriate by experts and 28 as inappropriate. 64 drugs without consensus were submitted to a second round. 32 of them were considered as inappropriate and 32 others remained on the list with no consensus. These last 32 were evaluated by OMEDIT and 3 were considered as appropriate drugs for the elderly. Totally, 252 drugs constitute the final PDE list from our study. The PDE list constitutes a new guide for optimization of both prescription and administration of drugs in nursing homes and could help reduce misuses and poly-medication, which are constant preoccupations to avoid adverse drug reactions in elderly. KEY POINTS: ● The study was carried out with the aim to create a Preferential list of Drugs adapted to the Elderly (PDE list) in nursing homes using a modified Delphi method. ● The PDE list constitutes a new guideline to harmonize practices in nursing homes and to help physicians and nurses to achieve best possible care management.