DRUG USE INDICATORS IN PATIENTS WITH TYPE 2 DIABETES IN A TERIARY HEALTHCARE FACILITY IN NIGERIA

Objective: The study analyzed the utilization pattern of antidiabetic drugs at the outpatient clinic of a teaching hospital in Nigeria to document information for enhancing the rational use of drugs in type 2 diabetes. Methods: A retrospective analysis of prescription records of patients with type2 diabetes, seen between the months of May and October, 2013 was carried out; adapting the World Health Organization's (WHO) recommended drug use indicators. Data was analyzed for drug use indicators, concurrent illnesses and co-prescribed medications. Results: A total of 286 prescriptions of T2DM were collected and analyzed. Mean age of patients was 61(±11.8) years. The number of drugs per prescription averaged 4(±1.6), with majority of prescriptions, 70% containing between 3 and 5 drugs each. Metformin (55.8%) was the most commonly prescribed antidiabetic drug followed by glibenclamide (35.1%). Antibiotics were prescribed in 11% of encounters. The percentage of drugs prescribed by generic name was 58%. Hypertension was identified in 42.2% of the diabetic patients as the most co-existing condition. Conclusion: The study suggests a significant compliance to T2DM treatment guidelines but with scope for improved rational use of drug to reduce the risk of drug therapy problems and enhance patients' quality of life. It provides a baseline data for further studies on institutional drug use in diabetes

African countries are working together to enhance medicine use

Growing burden of infectious and NCDs across Africa, e.g. 70% of world’s HIV patients live in sub-Sahara Africa and 30 to 45% of adults have hypertension. This requires groups to collaborate. This is happening, e.g. SAHTAS, PharfA and MURIA. MURIA is researching antibiotic use, adherence to medicines and strengthening DTCs. This should continue to optimise medicine use and scarce resources. The socioeconomic burden of diseases is increasing in Africa. For instance in 2011, 70% of the world’s HIV population resided in sub-Sahara Africa. There are also growing rates of AMR, which necessitates newer more expensive antibiotics adding to costs. There is also a growing burden of NCDs, 3 out of 4 patients with hypertension currently live in LMICs, with prevalence rates up to 30% to 45% among adults in Africa. Alongside this, up to 70% of total healthcare expenditure is spent on medicines in LMICs; much of this out-of-pocket. Consequently, an urgent need to strengthen collaborative research to improve medicine use. Summary of groups working together in Africa including the Medicines Utilisation Research in Africa (MURIA) group. African Strategies for Health identifies and advocates best practices, as well as works with others to develop sustainable solutions. Pharmacology for Africa (PharfA) organises and promotes pharmacology on the African continent, including research in clinical pharmacology, alongside the IUPHAR sub-division. ISPOR Africa co-ordinates activities from the different African country chapters. SAHTAS is a scientific and professional society for all those who produce, use, or encounter HTA in Southern Africa, and WHO International and Regional groups are improving antibiotic drug utilisation capabilities in Africa. The MURIA group was established in 2015 [1]. Ongoing collaborative research includes (i) initiatives to optimise antibiotic use; (ii) methods to enhance adherence to anti-infective prescribing guidance, (iii) approaches to improve adherence to HIV and NCDs; (iv) researching current anti-hypertensive and anti-diabetes medicines utilisation patterns and knowledge; (v) approaches to enhance DTC activities, and (vi) strengthening medicine utilisation capabilities [2,3]. These activities have already strengthened research ties across Africa. A number of groups are already working across Africa to enhance appropriate medicine use, and should continue. Ongoing MURIA activities include antibiotic point-prevalence studies, ongoing research into infectious diseases, NCDs and DTCs including adherence as well as the third workshop and symposium in Namibia in 2017

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Evaluating the Treatment Costs for Uncomplicated Malaria at a Public Healthcare Facility in Nigeria and the Implications

Background: Accurate information on the facility costs of treatment is essential to enhance decision making and funding for malaria control. Objective: To estimate the costs of providing treatment for uncomplicated malaria through a public health facility in Nigeria. Methods: Hospital costs were estimated from a provider perspective, applying a standard costing procedure. Capital and recurrent expenditures were estimated using an ingredient approach combined with step-down methodology. Costs attributable to malaria treatment were calculated based on the proportion of malaria cases to total outpatient visits. The costs were calculated in local currency, and converted to the US Dollars at the 2013 exchange rate. Results: Total annual costs of N28.723 million (US$182,953.65), was spent by the facility for the treatment of uncomplicated malaria, at the rate of US$31.49 per case, representing approximately 25% of the hospital total expenditure in the study year. Personnel accounted for over 82.5% of total expenditure, followed by antimalarial medicines at 6.6%. Over 45% of outpatients visits were for uncomplicated malaria. Changes in personnel costs, drug prices and malaria prevalence significantly impacted on the study results, indicating the need for improved efficiency in the use of hospital resources. Conclusion: Malaria treatment currently consumes a considerable amount of resources in the facility, driven mainly by personnel cost and a high proportion of malaria cases. There is scope for enhanced efficiency to prevent waste and reduce costs to the provider and ultimately the consumer

Cost-effectiveness analysis of three leprosy case detection methods in Northern Nigeria.

BACKGROUND: Despite several leprosy control measures in Nigeria, child proportion and disability grade 2 cases remain high while new cases have not significantly reduced, suggesting continuous spread of the disease. Hence, there is the need to review detection methods to enhance identification of early cases for effective control and prevention of permanent disability. This study evaluated the cost-effectiveness of three leprosy case detection methods in Northern Nigeria to identify the most cost-effective approach for detection of leprosy. METHODS: A cross-sectional study was carried out to evaluate the additional benefits of using several case detection methods in addition to routine practice in two north-eastern states of Nigeria. Primary and secondary data were collected from routine practice records and the Nigerian Tuberculosis and Leprosy Control Programme of 2009. The methods evaluated were Rapid Village Survey (RVS), Household Contact Examination (HCE) and Traditional Healers incentive method (TH). Effectiveness was measured as number of new leprosy cases detected and cost-effectiveness was expressed as cost per case detected. Costs were measured from both providers' and patients' perspectives. Additional costs and effects of each method were estimated by comparing each method against routine practise and expressed as incremental cost-effectiveness ratio (ICER). All costs were converted to the U.S. dollar at the 2010 exchange rate. Univariate sensitivity analysis was used to evaluate uncertainties around the ICER. RESULTS: The ICER for HCE was $142 per additional case detected at all contact levels and it was the most cost-effective method. At ICER of$194 per additional case detected, THs method detected more cases at a lower cost than the RVS, which was not cost-effective at $313 per additional case detected. Sensitivity analysis showed that varying the proportion of shared costs and subsistent wage for valuing unpaid time did not significantly change the results. CONCLUSION: Complementing routine practice with household contact examination is the most cost-effective approach to identify new leprosy cases and we recommend that, depending on acceptability and feasibility, this intervention is introduced for improved case detection in Northern Nigeria

Programme unit costs (US$).

<p>Programme unit costs (US$).</p