RESUMO
Objetivo: El objetivo principal fue evaluar y comparar tres programasde entrega de medicamentos requeridos por los pacientes atendidosen las consultas externas de farmacia hospitalaria: mediante centros desalud, empresa de mensajería externa y oficinas de farmacia. El objetivosecundario fue analizar el coste económico desde la perspectiva delsistema público de salud.Método: Se utilizó el análisis modal de fallos y efectos para el objetivoprincipal. El análisis económico se realizó mediante un estudio de minimización de costes.Resultados: Los resultados en índice de probabilidad de riesgo fueron184 puntos para la entrega mediante centros de salud, 170 mediantemensajería y 126 mediante oficina de farmacia. El estudio económicomostró que actualmente el programa con menor coste económico fue ladispensación mediante oficina de farmacia respecto a mensajería y centros de salud (7.986,52 versus 18.434,52 y 11.417,08 ).Conclusiones: La entrega mediante oficina de farmacia tiene el menoríndice de probabilidad de riesgo debido en gran parte al papel delfarmacéutico en la custodia y conservación del medicamento. (AU)
Objective: The main purpose of this study was to analyze and comparethree different medication delivery methods used by the outpatient careunit of a hospital pharmacy, namely health center collection, communitypharmacy collection and home delivery. The secondary purpose was tocompare the economic cost of those methods for the Spanish health service.Method: A failure mode and effects analysis was carried out to attain theprimary objective. For the secondary objective, an in-depth analysis wasperformed of the economic costs associated with each program using acost-minimization analysis.Results: The failure mode and effects analysis resulted in scores of184, 170 and 126 points for the health center collection, home deliveryand community pharmacy collection programs, respectively. The economic evaluation, for its part, rendered estimated costs of 18,434.52,11,417.08 and 7,986.52 for home delivery, health center collectionand community pharmacy collection services, respectively.Conclusions: The results of the study indicated that collection at the community pharmacy was the program associated to the lowest risk, most likely dueto the crucial role of the pharmacist regarding the custody and preservation of medicines. (AU)
Assuntos
Humanos , Análise Custo-Benefício , Assistência Farmacêutica/economia , Hospitais , EspanhaRESUMO
OBJECTIVE: The main purpose of this study was to analyze and compare three different medication delivery methods used by the outpatient care unit of a hospital pharmacy, namely health center collection, community pharmacy collection and home delivery. The secondary purpose was to compare the economic cost of those methods for the Spanish health service. METHOD: A failure mode and effects analysis was carried out to attain the primary objective. For the secondary objective, an in-depth analysis was performed of the economic costs associated with each program using a cost-minimization analysis. RESULTS: The failure mode and effects analysis resulted in scores of 184, 170 and 126 points for the health center collection, home delivery and community pharmacy collection programs, respectively. The economic evaluation, for its part, rendered estimated costs of 18,434.52, 11,417.08 and 7,986.52 for home delivery, health center collection and community pharmacy collection services, respectively. CONCLUSIONS: The results of the study indicated that collection at the community pharmacy was the program associated to the lowest risk, most likely due to the crucial role of the pharmacist regarding the custody and preservation of medicines. As regards cost, dispensation at the community pharmacy was also associated with the lowest cost. Nevertheless, this finding was biased by the fact that, given the generous collaboration of pharmaceutical distributors during the COVID-19 pandemic, the cost of transport and delivery to the pharmacy during the study period was zero. Further economic analyses are required to evaluate the costs of community pharmacy delivery and determine their impact on the public health system in cases where transport costs are different from zero.
Objetivo: El objetivo principal fue evaluar y comparar tres programas de entrega de medicamentos requeridos por los pacientes atendidos en las consultas externas de farmacia hospitalaria: mediante centros de salud, empresa de mensajería externa y oficinas de farmacia. El objetivo secundario fue analizar el coste económico desde la perspectiva del sistema público de salud.Método: Se utilizó el análisis modal de fallos y efectos para el objetivo principal. El análisis económico se realizó mediante un estudio de minimización de costes.Resultados: Los resultados en índice de probabilidad de riesgo fueron 184 puntos para la entrega mediante centros de salud, 170 mediante mensajería y 126 mediante oficina de farmacia. El estudio económico mostró que actualmente el programa con menor coste económico fue la dispensación mediante oficina de farmacia respecto a mensajería y centros de salud (7.986,52 versus 18.434,52 y 11.417,08 ).Conclusiones: La entrega mediante oficina de farmacia tiene el menor índice de probabilidad de riesgo debido en gran parte al papel del farmacéutico en la custodia y conservación del medicamento. Respecto al estudio económico, también la dispensación mediante oficina de farmacia obtuvo el menor coste pero con una importante limitación: fue asignado un coste cero relativo a la empresa distribuidora y a la entrega del medicamento en las oficinas de farmacia por la colaboración altruista durante la pandemia. Si el coste fuese distinto de cero, serán necesarios nuevos estudios para evaluar el impacto económico el sistema público de salud.
Assuntos
Custos e Análise de Custo , Análise do Modo e do Efeito de Falhas na Assistência à Saúde , Assistência Farmacêutica/economia , Serviço de Farmácia Hospitalar/economia , Análise Custo-Benefício , Humanos , EspanhaRESUMO
The extravasation of chemotherapeutic agents is a challenge for oncologic care teams. The management of nonliposomal (conventional) anthracyclines is well established in clinical practice guidelines, including general measures and specific antidotes, such as dexrazoxane. However, there is little scientific evidence on the management of liposomal and pegylated liposomal anthracyclines. The aim of this paper was to review the scientific literature on the extravasation of liposomal and pegylated liposomal anthracyclines and determine the clinical impact of this type of extravasation, focusing on dexrazoxane. The literature was searched using two databases: PubMed and Embase. Three searches were conducted, using liposomal anthracycline extravasation, pegylated liposomal anthracycline extravasation, and liposomal doxorubicin extravasation as keywords, respectively. Seven articles fulfilled the study eligibility criteria and included seventeen cases in humans. Extravasation occurred with three drugs: liposomal doxorubicin in nine (53%) patients, liposomal daunorubicin in four (23.5%) patients, and pegylated liposomal doxorubicin in four (23.5%) patients. General measures for extravasations were applied in all patients, but only three patients received dexrazoxane. All cases were completely resolved at 2-3 months, except for one patient, in whom dexrazoxane was not used. In animals, dexrazoxane decreased both the frequency of wounds produced by pegylated liposomal doxorubicin and their extent. The pharmacokinetic profiles of liposomal and pegylated liposomal anthracyclines differ from those of conventional anthracyclines, modifying their effectiveness and safety. General measures may be inadequate to heal areas affected by extravasation, which may require the administration of dexrazoxane. However, each case should be evaluated individually for the administration of dexrazoxane in off-label use until scientific evidence is available on its effectiveness and safety as an antidote for these formulations of anthracyclines.
