Acquisition cost of dispensed drugs in individuals with multiple medications A register-based study in Sweden

Objectives: To analyse the acquisition cost of dispensed prescription drugs for individuals with multiple medications in a national population. Methods: We collected and analysed individual based data regarding the acquisition cost of dispensed prescription drugs for all individuals with five or more dispensed drugs (DP >= 5) in Sweden 2006 (2.2 million). Results: Individuals with DP >= 5 (24.5% of the population) accounted for 78.8% of the total acquisition cost, and individuals with DP >= 10(8.6% of the population) and DP >= 15(3.0% of the population) accounted for 46.3% and 23.2%, respectively. The average acquisition cost per defined daily doses (DDD) generally decreased with increasing age. The highest average cost per ODD was observed for individuals with DP >= 10. The acquisition cost for women with DP >= 5 represented 56.0% of the total acquisition cost. Men with DP >= 5 represented 44.0% of the total acquisition cost. Conclusions: In an entire national population, individuals with multiple medication accounted for four fifths of the total acquisition cost of dispensed drugs. Actions to reduce the number of prescription drugs for the group of patients with a number of different drugs may also result in a substantial reduction of the total acquisition cost. (C) 2011 Elsevier Ireland Ltd. All rights reserved

Dose-Response Mixed Models for Repeated Measures – a New Method for Assessment of Dose-Response

Purpose In this paper we investigated a new method for dose-response analysis of longitudinal data in terms of precision and accuracy using simulations. Methods The new method, called Dose-Response Mixed Models for Repeated Measures (DR-MMRM), combines conventional Mixed Models for Repeated Measures (MMRM) and dose-response modeling. Conventional MMRM can be applied for highly variable repeated measure data and is a way to estimate the drug effect at each visit and dose, however without any assumptions regarding the dose-response shape. Dose-response modeling, on the other hand, utilizes information across dose arms and describes the drug effect as a function of dose. Drug development in chronic kidney disease (CKD) is complicated by many factors, primarily by the slow progression of the disease and lack of predictive biomarkers. Recently, new approaches and biomarkers are being explored to improve efficiency in CKD drug development. Proteinuria, i.e. urinary albumin-to-creatinine ratio (UACR) is increasingly used in dose finding trials in patients with CKD. We use proteinuria to illustrate the benefits of DR-MMRM. Results The DR-MMRM had higher precision than conventional MMRM and less bias than a dose-response model on UACR change from baseline to end-of-study (DR-EOS). Conclusions DR-MMRM is a promising method for dose-response analysis