Cost-effectiveness analysis of dapagliflozin in addition to standard therapy in heart failure with reduced ejection fraction: A Qatari healthcare perspective

Background: Dapagliflozin has been shown to reduce the risk of heart failure hospitalization and cardiovascular mortality in patients with heart failure with reduced ejection fraction (HFrEF). 1,2 This work aims to determine the cost-effectiveness of dapagliflozin added to standard therapy versus standard therapy alone in patients with HFrEF, regardless of the presence or absence of type 2 diabetes mellitus (T2DM). Methods: A lifetime Markov model was constructed to compare the health outcomes and costs of dapagliflozin added to standard therapy versus standard therapy alone from a Qatari public healthcare perspective (Figure 1). 2 The cohort is comprised of HFrEF patients with left ventricular ejection fraction (LVEF) ? 40%, and New York Heart Association (NYHA) class II-IV with an average age of 65 years, based on Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure (DAPA-HF) trial (Table 1). 1,2 The model consisted of three health states: 'stable', 'hospitalization for heart failure', and 'dead'. Clinical inputs were derived from the results of DAPA-HF trial and costs, and utilities were estimated from published sources as well as publicly available sources in Qatar. 3 The main outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained (QALY). All outcomes and costs were discounted at a rate of 3% annually. Sensitivity analyses were conducted to confirm the robustness of the results. The study was based on published data; therefore ethics approval was not required. Results: Dapagliflozin added to standard care prevented 112 heart failure hospitalization and resulted in an additional cost of QAR 33,890 (USD 9,309). This equated to an ICER of QAR 101,763 (USD 27,951) per QALY gained, below the US willingness-to-pay threshold of USD 150,000 per QALY gained. Sensitivity analyses showed the findings to be robust. Conclusion: Dapagliflozin in addition to standard care appears to be a cost-effective strategy for patients with HFrEF, regardless of the presence or absence of T2DM.qscienc

Economic impact of clinical pharmacist interventions in a general tertiary hospital in Qatar

Background With an increasingly strained health system budgets, healthcare services need to continually demonstrate evidence of economic benefits. This study sought to evaluate the economic impact of interventions initiated by clinical pharmacists in an adult general tertiary hospital. Methods A retrospective review of clinical pharmacist interventions was carried out throughout followup durations in March 2018, July/August 2018, and January 2019 in Hamad General Hospital (HGH) at Hamad Medical Corporation (HMC) in Qatar. The study included clinical pharmacy interventions data of patients admitted to the internal medicine, critical care, and emergency wards. Included interventions were documented by clinical pharmacists or clinical pharmacy specialists, and approved by physicians. Interventions by non-clinical pharmacists or with missing data were excluded. Adopting the perspective of HMC, we calculated the total economic benefit, which is the sum of the cost savings and the cost avoidance associated with the interventions. Cost savings was defined as the reduced cost of therapy associated with therapy changes minus the cost of intervention and cost avoidance was the cost avoided by eliminating the occurrence of adverse drug events (ADEs). Sensitivity analyses were performed to assess the robustness of results against uncertainties. Results A total of 852 interventions, based on 340 patients, were included. The analysis projected an annual total benefit of QAR 2,267,036 (USD 621,106) based on a negative cost-savings of QAR-175,139 (USD-47,983) and a positive cost avoidance of QAR741,898 (USD203,260) over the 3-month follow-up period. The uncertainty analysis demonstrated the robustness of outcomes, including a 100% probability of positive economic benefit. Conclusions The clinical pharmacist intervention was associated witScopu

Management of chronic myeloid leukaemia: current treatment options, challenges, and future strategies.

Small molecule therapy is a critical component of targeted anticancer treatment, with tyrosine kinase inhibitors (TKIs) being the first compounds to treat the clonal Chronic Myelogenous Leukaemia (CML) translocation t (9;22) (q34; q11) effectively since 2001. TKIs, such as imatinib, have improved the 10-year survival rate of CML patients to 80%. They bind the kinase and inhibit downstream signaling pathways. However, therapy failure may be seen in 20-25% of CML patients due to intolerance or inadequacy related to dependent or independent mechanisms. This review aimed to summarize current treatment options involving TKIs, resistance mechanisms and the prospective approaches to overcome TKI resistance. We highlight -dependent mechanisms of TKI resistance by reviewing clinically-documented mutations and their consequences for TKI binding. In addition, we summarize independent pathways, including the relevance of drug efflux, dysregulation of microRNA, and the involvement of alternative signaling pathways. We also discuss future approaches, such as gene-editing techniques in the context of CML, as potential therapeutic strategies

Incidence, risk factors, and feto-maternal outcomes of inappropriate birth weight for gestational age among singleton live births in Qatar : a population-based study

Background Abnormal fetal growth can be associated with factors during pregnancy and at postpartum. Objective In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes associated with small-for-gestational age (SGA) and large-for-gestational age (LGA) infants. Methods We performed a population-based retrospective study on 14,641 singleton live births registered in the PEARL-Peristat Study between April 2017 and March 2018 in Qatar. We estimated the incidence and examined the risk factors and outcomes using univariate and multivariate analysis. Results SGA and LGA incidence rates were 6.0% and 15.6%, respectively. In-hospital mortality among SGA and LGA infants was 2.5% and 0.3%, respectively, while for NICU admission or death in labor room and operation theatre was 28.9% and 14.9% respectively. Preterm babies were more likely to be born SGA (aRR, 2.31; 95% CI, 1.45–3.57) but male infants (aRR, 0.57; 95% CI, 0.4–0.81), those born to parous (aRR 0.66; 95% CI, 0.45–0.93), or overweight (aRR, 0.64; 95% CI, 0.42–0.97) mothers were less likely to be born SGA. On the other hand, males (aRR, 1.82; 95% CI, 1.49–2.19), infants born to parous mothers (aRR 2.16; 95% CI, 1.63–2.82), or to mothers with gestational diabetes mellitus (aRR 1.36; 95% CI, 1.11–1.66), or pre-gestational diabetes mellitus (aRR 2.58; 95% CI, 1.8–3.47) were significantly more likely to be LGA. SGA infants were at high risk of in-hospital mortality (aRR, 226.56; 95% CI, 3.47–318.22), neonatal intensive care unit admission or death in labor room or operation theatre (aRR, 2.14 (1.36–3.22). Conclusion Monitoring should be coordinated to alleviate the risks of inappropriate fetal growth and the associated adverse consequences.The PEARL-Peristat study was funded by Qatar National Research Fund (Grant no NPRP 6-238-3-059) and was sponsored by the Medical Research Centre, Hamad Medical Corporation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.The study was approved by the Hamad Medical Corporation Institutional Review Board, with a waiver of consent. It was funded by Qatar National Research Fund (Grant no NPRP 6-238-3-059) and was sponsored by the Medical Research Centre, Hamad Medical Corporation. The authors want to thank their respective institutions for their continued support. The publication of this article is funded by the Qatar National Library, Doha, Qatar

Prevalence, predictors, and outcomes of major congenital anomalies : a population-based register study

Congenital anomalies (CAs) are a leading cause of morbidity and mortality in early life. We aimed to assess the incidence, risk factors, and outcomes of major CAs in the State of Qatar. A population-based retrospective data analysis of registry data retrieved from the Perinatal Neonatal Outcomes Research Study in the Arabian Gulf (PEARL-Peristat Study) between April 2017 and March 2018. The sample included 25,204 newborn records, which were audited between April 2017 and March 2018, of which 25,073 live births were identified and included in the study. Maternal risk factors and neonatal outcomes were assessed for association with specific CAs, including chromosomal/genetic, central nervous system (CNS), cardiovascular system (CVS), facial, renal, multiple congenital anomalies (MCAs) using univariate and multivariate analyses. The incidence of any CA among live births was 1.3% (n = 332). The most common CAs were CVS (n = 117; 35%), MCAs (n = 69, 21%), chromosomal/genetic (51; 15%), renal (n = 39; 12%), CNS (n = 20; 6%), facial (14, 4%), and other (GIT, Resp, Urogenital, Skeletal) (n = 22, 7%) anomalies. Multivariable regression analysis showed that multiple pregnancies, parity ≥ 1, maternal BMI, and demographic factors (mother’s age and ethnicity, and infant’s gender) were associated with various specific CAs. In-hospital mortality rate due to CAs was estimated to be 15.4%. CAs were significantly associated with high rates of caesarean deliveries (aOR 1.51; 95% CI 1.04–2.19), Apgar < 7 at 1 min (aOR 5.44; 95% CI 3.10–9.55), Apgar < 7 at 5 min (aOR 17.26; 95% CI 6.31–47.18), in-hospital mortality (aOR 76.16; 37.96–152.8), admission to neonatal intensive care unit (NICU) or perinatal death of neonate in labor room (LR)/operation theatre (OT) (aOR 34.03; 95% CI 20.51–56.46), prematurity (aOR 4.17; 95% CI 2.75–6.32), and low birth weight (aOR 5.88; 95% CI 3.92–8.82) before and after adjustment for the significant risk factors. This is the first study to assess the incidence, maternal risk factors, and neonatal outcomes associated with CAs in the state of Qatar. Therefore, a specialized congenital anomaly data registry is needed to identify risk factors and outcomes. In addition, counselling of mothers and their families may help to identify specific needs for pregnant women and their babies.Open Access funding provided by the Qatar National Library. The PEARL-Peristat study was funded by Qatar National Research Fund (Grant no NPRP 6-238-3-059) and was sponsored by the Medical Research Centre, Hamad Medical Corporation.Scopu

Evidence of community pharmacists' response preparedness during COVID-19 public health crisis: A cross-sectional study

Introduction: Community pharmacists are often the first point of contact for the public, especially during pandemics. As outlined by the International Pharmaceutical Federation, community pharmacists have an important public health role during this Coronavirus Disease 2019 (COVID-19) public health emergency. We therefore investigated the current practices, response preparedness and professional development needs of community pharmacists in Qatar. Methodology: A descriptive cross-sectional online 38-item questionnaire-based survey constructed on evidence-based public health roles of pharmacists was conducted between 28 May and 18 June 2020. Questions related to current practices required responses on a 5-point Likert-type scale ranging from "always"to "never". The questionnaire was evaluated for validity and the reliability analysis showed a Cronbach's alpha coefficient of 0.921. Results: The response (n = 311) rate for the survey was 34.2%. More than 75% of pharmacists "always"encouraged and practiced hygiene and social distancing measures. On the other hand, the proportion of pharmacists "always"involved in patient assessment, education or providing information related to COVID-19 and application of evidence-based protocol ranged from 32 to 73%. The vast majority (87-96%) of pharmacists indicated that they needed professional development related to COVID-19. Overall, 77% of pharmacists either "strongly agreed"or "agreed"that they have all the necessary COVID-19 related emergency response preparedness and training. Country from which pharmacists obtained their first degree, and the type of pharmacy where they practice influenced their overall perception toward emergency response preparedness. Conclusions: Community pharmacists in Qatar are willing to receive additional training related to COVID-19 public health crisis despite being prepared to engage with patients. 2021 ElGeed et al.Scopu

Clinical pharmacy service innovation in an obstetrics and gynecology setting: A case study from Qatar

Clinical pharmacy services have evolved rapidly and been developed largely to cover a wide range of patient care settings and therapeutic areas. However, clinical pharmacists' services in obstetrics and gynecology (OB/GYNE) setting are not commonly available in many developing countries. In addition, literature describing clinical pharmacists' role in OB/GYNE settings is limited. This chapter provides a general overview of pharmacists' role in OB/GYNE and outlines a case study of pharmacy services provided in an OB/GYNE setting in Qatar. The case study provides a description of the activities and responsibilities of the clinical pharmacist and highlights the challenges and opportunities in this setting. The current work retrospectively describes a 2-year period of clinical pharmacy service activities at the OB/GYNE Department at Women's Hospital (now Women's Wellness and Research Center) in Qatar. A narrative of the provided services is described through available resources, hospital website and electronic system, and pharmacy key informants. The estimated clinical pharmacist to bed ratio is 1 to 35-40 beds. Patient care-related activities such as medication review, patient education, and multidisciplinary rounds represent the main role of clinical pharmacists. Other nonclinical roles in which clinical pharmacists are actively involved include educational and research activities. Clinical pharmacists are challenged by the high turnover nature of the patient population, variable levels of case complexity, having patients in health transition states, and limited medication safety infrastructure. The clinical pharmacy services are limited to the inpatient setting, while documentation of activities done by clinical pharmacists needs to be enhanced. Providing clinical pharmacy services in the OB/GYNE field is a fruitful initiative in our setting. Having such a special patient population warrants the expansion of clinical pharmacy services in this clinical setting. 2021 Elsevier Inc. All rights reserved.Scopu

The Use of the Gene Expression Omnibus (GEO) Database to Study Gene Expression and Methylation Patterns in Cases of Preterm Birth and Associated Diseases

Objective Analysis of gene expression and methylation patterns in preterm births (PTB) and associated diseases from microarray data using the Gene Expression Omnibus (GEO) database. We hypothesise that reported upregulation/downregulation of expression patterns is associated with cases of PTB. Design This is a retrospective study done to observe any reported significant changes in gene expression or methylation patterns between PTB, associated diseases, and full-term births (FTB). Methods Eight comparative studies on PTB were analysed where cases of FTB were used as controls (GSE178609, GSE48125, GSE197795, GSE190215, GSE150167, GSE166956, GSE188949, GSE225881). Upon accessing the GEO database, cases (PTB) and controls (FTB) were highlighted, and analysis of the data performed. The data was then filtered for statistically significant changes with an adjusted p-value of Results Of the 8 datasets, 3 displayed significant changes in expression patterns after application of the filtering criteria. Firstly, the study analysing profiles of umbilical cord exosomes in PTB vs FTB with bronchopulmonary dysplasia (BPD) (GSE190215) showed downregulation in expression of genes in PTB linked to lung function including ciliary function (CFAP61), respiratory insufficiency (CLCN6), and thoracic dysplasia (MORN1). Analysis of the amniotic fluid cell-free transcriptome in spontaneous PTB (GSE166956) showed upregulation of various genes associated with inflammatory processes including IL1A, JAML, SRGN, NFKB, and NAMPT. Finally, the dataset comparing methylation profiles in PTB cases with and without BPD (GSE188949) displayed hypomethylation in cases with no BPD in genes ACP5, linked to lung fibrosis, and STK11IP, associated with lung carcinoma. Hypermethylation of CSTA, identified in lung cancer, was also reported. Conclusion The utilization of GEO to analyse gene expression and methylation patterns in cases of PTB and associated diseases has linked various significant genes in potentially impacting such cases. Despite this work being preliminary, it displays a promising avenue of research and through further analysis of multiple datasets can allow for further understanding of the genetic aetiology of PTB. Future work could be done through further understanding of the relevant genes’ function and their pathways and strengthening the validity of the expression patterns in promoting PTB by determining any overlap between the different datasets submitted.</p