CAN COST OF PHARMACOLOGICAL THROMBOLYTIC THERAPY BE A MEDICATION MANAGEMENT STRATEGY FOR ACUTE CORONARY SYNDROME?

ABSTRACTObjectives: In Indian health-care system with delayed access to a minimum number of catheter laboratories and rarity of insurance benefits, prehospitaland in-hospital thrombolytic has become the choice for patients with acute coronary syndrome (ACS), where many patients bear the economicburden of pharmacological thrombolytic. The present study was carried out to evaluate the pattern of prescribing of pharmacological thrombolyticagents in hospitalized ACS patients and associated cost burden.Methods: A prospective observational cohort study of prescription was conducted for in-patient admitted to intensive care unit for thrombolytic andantithrombotic drug utilization pattern. The direct cost analysis was performed from patient's perspective where a direct cost was calculated usingpharmacy bills. All other cost was assumed to be same.Results: Data of 288 patients were collected from which 108 (37.5%) patients were ST-elevation myocardial infarction (STEMI) and 180 (62.5%)patients were non-STEMI. The mean number of drugs prescribed was 11±2 which constitutes a mean of 3.1±0.7 reperfusion drugs. 59% of patientswere prescribed with enoxaparin (0.6 ml/seconds route) for the mean duration of 4 days. The average prescription cost for ACS admission was aroundRs.7159.5±5137.2 (Rs.1101-Rs.22202). The average cost of pharmacological thrombolytic therapy was Rs.4557±3468.3 (Rs. 23-Rs.12542). The meancost of pharmacological thrombolytic therapy was found to be 63% of the total direct cost of drugs borne by the patient. The cost of therapy waspositively correlated with duration of stay (p=0.000) and insignificantly correlated with a number of drugs.Conclusion: Antiplatelets were the most preferred followed by anticoagulants. The mean number of drugs per encounter was high but was rationalas per standard guidelines. The mean cost for pharmacological reperfusion therapy was found to be more than half of mean prescription cost for themanagement of ACS.Keywords: Acute coronary syndrome, Thrombolytic therapy, Cost, Medication management

Evaluation of cephalosporins utilization and compliance with reference to the hospital antibiotic policy of an Indian tertiary care hospital

Background: Emergence of bacterial resistance in hospital settings due to the liberal use of antibiotics which led to an altered impact on its therapeutic efficacy and outcome, thereby increasing the treatment costs in patients. In this regard the study aims to evaluate the cephalosporins utilization and compliance to the hospital antibiotic policy in general medicine ward.Methods: A prospective observational study was carried out over an eleven-month period in patients prescribed with cephalosporins. Clinical data of inpatients were collected and evaluated by using World Health Organization (WHO) core prescribing indicators and defined daily dose per 100 bed-days. The comparison between the cephalosporins prescribed in the chart records to the recommendations mentioned in the institutional antibiotic policy v.2.0, help to determine the deviations in their usage pattern.Results: A total of 370 patients were enrolled in the study, of which 54.6% were females. Cephalosporins were empirically prescribed in 240 (64.9%) cases. The average number of total antibiotics and cephalosporins per encounter was 1.6 and 1 respectively. Among the total antibiotics, 63.7% were cephalosporins. Third generation cephalosporins (98.4%) were commonly prescribed, with ceftriaxone (93%) in parenteral form for respiratory tract infections (31.9%). Total parenteral antibiotics prescribed were found to be 68.8% of which 88.6% were cephalosporins. Utilization pattern of cephalosporins amounted to be 4.95 DDD/100 bed-days. Overall compliance was achieved in 191 (51.6%) prescriptions.Conclusions: The rate of prescribing of cephalosporins was marginally high. There was a low rate of compliance towards policy which reflects the urgent need for repetitive intervention to comply antibiotic policy

Study of clinical efficacy, safety and tolerability of low cost branded generic antiepileptic drugs in children and adolescents

Background: Generic substitution is preferred to reduce healthcare costs and improve patient adherence. The review of literature showed that physicians all around the world were not comfortable in prescribing generic medications due to the lack of evidence on their safety and efficacy.Methods: A prospective study was conducted over a period of one year in Pune. The patients were categorized on their age and were assessed for the clinical effectiveness data (no. of breakthrough seizures and seizure free days) and safety data (no. of ADR episodes). The mean number of patients controlled and the frequency of adverse events at the 3rd and 6th month were calculated.Results: Authors assessed 150 newly diagnosed pediatric epileptic patients who received anti-epileptic drug monotherapy for at least 6 months, out of which 46 (30.66%) received Oxcarbazepine and 104 (69.33%) received Sodium Valproate. At the end of 3 months of therapy 140 (93.33%) patients were seizure free and 145 (96.66%) patients were seizure free at the end of  6 months. Adverse effects were observed in 14 (30.43) patients on oxcarbazepine and 26 (25%) patients on sodium valproate. The most common adverse effect was weight gain in 34 (22.66%) patients with both the AEDs.Conclusions: Seizure control was achieved in majority of the patients. In addition to the seizure control, the frequency of adverse effects was few and tolerable by the patients when prescribed with low cost branded generics

Assessment of Risk and Prophylaxis for Venous Thromboembolism and Adherence to the American College of Chest Physicians Recommendations during Early Days of Hospital Stay at a Tertiary Care Teaching Hospital in a Developing Country

Aim: The aim is to assess risk and evaluate the usage of pharmacological thromboprophylaxis adhering to the American College of Chest Physicians (ACCP) recommendations for prevention of venous thromboembolism (VTE) during early days of hospital stay in critically ill and surgery patients at a tertiary care teaching hospital. Patients and Methods: A prospective study was conducted over 1 year where all patients admitted in Intensive Care Unit (ICU), and surgery wards were enrolled in the study after an informed written consent. A structured pro forma was designed, and effective risk stratification for VTE was done. Patients were followed until discharge to record any pharmacological thromboprophylaxis according to the ACCP prevention of thrombosis recommendations. Results: A total of 210 patients included in this study as per the Caprini VTE Risk Assessment tool. Of 210, 150 (60%) patients were critically ill and 60 (40%) were surgical patients with an average age of 65.3 ± 11 and 55.4 ± 12 years, respectively. Of 150 critically ill patients, 21.3% of patients were classified having moderate VTE risk, 33.3% of patients having higher and 45.3% of patients having highest VTE risks. Of 60 postsurgical patients, 13.3% of patients were categorized having moderate VTE risk, 36.6% of patients having higher and 50% of patients having highest VTE risks. Pharmacological thromboprophylaxis was administered to 35.2% of patients, of which, 46.6% and 6.6% were ICU patients and postsurgical patients, respectively. This shows underutilization of pharmacological thromboprophylaxis. Adherence to guideline recommendations (choice of drug, dose, and duration) was observed in all postsurgical patients and 33% of critically ill patients. Conclusions: Pharmacological thromboprophylaxis to higher and highest VTE risk patients was too low, particularly in both the units and very low in surgery ward. Efforts required improving patient safety practice, particularly in higher and highest risk categories