Healthcare resources and costs associated with nonvalvular atrial fibrillation in Spain: apixaban versus acenocoumarol.

Aim: Healthcare resources usage and costs associated to nonvalvular atrial fibrillation (NVAF) were analyzed in Spain. Methods: This is an observational and retrospective study on patients with NVAF who started their treatment with apixaban or acenocoumarol between 1 January 2015 and 31 December 2017. Results: 2160 patients treated with apixaban were paired (1:1) with patients treated with acenocoumarol (propensity score matching). Apixaban reduced the incidence of strokes and systemic embolisms, minor and major bleedings and deaths, versus acenocoumarol. Apixaban led to reductions of 80, 55 and 43% in costs related to nursing visits, hospitalizations, and emergency visits, respectively, leading to annual cost savings of €274/patient, from the perspective of society. Conclusion: Our results suggested that apixaban is a cost-effective alternative for patients with NVAF.

[Prudent use of antibiotics and suggestions for improvement from community and hospital pharmacy]. / Uso prudente de antibióticos y propuestas de mejora desde la farmacia comunitaria y hospitalaria.

Appropriate use of antibiotics requires an interdisciplinary approach in which hospital and community pharmacies play a key role. The activities carried out in hospital pharmacy can be divided into 3 stages: a) before prescription: through the selection of antimicrobial agents, the creation of guides on prophylaxis and empirical treatments, and incorporation of the decisions into computer programmes that provide detailed electronic prescriptions; b) during prescription: prescription assessment, dose adjustment, patient information and infection data, preparation of doses to be used, pharmacokinetic adjustments and monitoring of treatment duration, and c) after treatment: clinical audits and measurements of the use of antibiotics. In community pharmacy, activities include promoting patient compliance, pharmacotherapeutic follow-up of patients to prevent and detect drug-related problems and avoidance of over-the-counter drug dispensation. Suggestions for improvement include mainly training in monitoring the use of antimicrobials, integration in interdisciplinary teams and avoiding the sale of over-the-counter antibiotics.