Inflammatory Bowel Diseases (Crohn's Disease and Ulcerative Colitis): Cost of Treatment in Serbia and the Implications

BACKGROUND: Although the costs of treating inflammatory bowel disease (IBD) in developed countries are well established, they remain largely unknown in countries with recent histories of socio-economic transition including Serbia. OBJECTIVE: To estimate the costs of treatment including the resources used by patients with IBD in Serbia from a societal perspective. This includes both Crohn's disease and ulcerative colitis. METHODS: This cost-of-illness study was conducted to identify direct, indirect and out-of-pocket costs of treating patients with IBD in Serbia. Patients with IBD (n = 112) completed a semi-structured questionnaire with data concerning their utilisation of heath-care resources and illness-related expenditures. All costs were calculated in Republic of Serbia dinars (RSD) at a 1-year level (2014) and subsequently converted to Euros. Median values and ranges were reported to avoid potential distortions associated with mean costs. RESULTS: Median total direct costs and total indirect costs per patient per year in patients with Crohn's disease were 192,614.32RSD (€1602.97) and 28,014.00RSD (€233.13) and 142,267.15RSD (€1183.97) and 21,436.00RSD (€178.39), respectively, in patients with ulcerative colitis. In both groups, the greatest component of direct costs was hospitalisation. CONCLUSIONS: Costs of IBD in Serbia are lower than in more developed countries for two reasons. These include the fact that expensive biological therapy is currently under-utilised in Serbia and prices of health services are largely controlled by the State at a low level. The under-utilisation of biologicals may change with the advent of biosimilars at increasingly lower prices

Medicines availability among hypertensive patients in primary healthcare facilities in a rural province in South Africa

Background: Control of blood pressure (BP) remains a challenge among patients in the public health system in South Africa. The objective was to assess availability of all prescribed antihypertensive medicines among patients with raised BP on the day they attended rural primary healthcare facilities (PHCs) and determine the association between medicines availability, the number of prescribed antihypertensive medicines and BP control. Methods: Secondary data from an operational study from rural PHCs in South Africa including patients’ demographics and BP, as well as data on medicine availability. Data analysis included descriptive and inferential statistics. Results: 55 black African patients were assessed, with 89.1% being female. Some data were not available for all 55 patients. The mean age was 61.3 years, and 54.6% did not have formal education. Two thirds (67.2%) of patients received all their antihypertensive medications whilst 25.5% received some of their medicines during the three months study period with no record in 7.3% of the patients. There was no significant relationship between receiving all antihypertensive medicines and BP control. The majority of patients on one antihypertensive had better BP control; however, this did not reach significance (p=0.069). Concerns with the lack of BP recording on all occasions in some patients (20%). Conclusion: One third of patients went home without all their antihypertensive medicines from the PHC facilities. Other concerns included the lack of routine BP monitoring and the number of prescribed medicines. Studies are ongoing to explore key issues with medicines availability and concerns with adherence and BP control

Quality prescribing in general practice

To implement continuous improvement of prescribing in general practice with a model closely linking the work of general practitioner and a clinical pharmacist aiming to improve the safety and efficiency of treatment with medicine. Emphasise is on polypharmacy (multiple medications) which is increasing across countries and although appropriate especially in patients with multiple comorbidities it can cause serious problems to patients and is a major challenge for the health care systems. Problems include adverse drug reactions and harmful drug interactions with reduced quality of life, increased overall morbidity, mortality and increased costs to health care systems

Quality and efficiency of statin prescribing across countries with a special focus on South Africa : findings and future implications

Statins are recommended first-line treatment for hyperlipidemia, with published studies suggesting limited differences between them. However, there are reports of under-dosing. South Africa has introduced measures to enhance generic utilization. Part one documents prescribed doses of statins in 2011. Part two determines the extent of generics versus originator and single-sourced statins in 2011 and their costs. Results: Underdosing of simvastatin in 2011 with average prescribed dose of 23.7 mg; however, not for atorvastatin (20.91 mg) or rosuvastatin (15.02 mg). High utilization of generics versus originators at 93–99% for atorvastatin and simvastatin, with limited utilization of single-sourced statins (22% of total statins – defined daily dose basis), mirroring Netherlands, Sweden and UK. Generics priced 33–51% below originator prices. Discussion: Opportunity to increase simvastatin dosing through education, prescribing targets and incentives. Opportunity to lower generic prices with generic simvastatin 96–98% below single-sourced prices in some European countries

Determinants of the Effectiveness of Antimicrobial Prophylaxis among Neurotrauma Patients at a Referral Hospital in Kenya: Findings and Implications

Background: Surgical site infections can occur adding to morbidity, mortality and costs, and can be particularly problematic in low and middle income countries. This includes infections in neurosurgical patients following surgery despite antimicrobial prophylaxis. The study aimed at measuring the incidence of surgical site infections (SSIs) and identifying factors that influence the effectiveness of antimicrobial prophylaxis in a leading hospital in Kenya. Methods: Prospective cohort study from April to July 2015 in the Neurosurgical ward of a leading referral hospital in Kenya. Adult head injury patients were recruited by universal sampling. Data was collected on prophylactic antibiotics and the occurrence of SSIs. Risk factors for infection were identified by logistic regression. Results: Eighty four patients were recruited, with 69 patients eventually analysed. Incidence of SSIs was 37.7% (n=26). The most common antibiotic used for prophylaxis was ceftriaxone. Patients on prophylaxis were less likely to be infected than those who did not receive prophylaxis; however, this was not statistically significant (RR 0.87, 95% CI 0.40-1.893). The presence of epidural haematoma was a risk factor for the development of SSIs (Crude RR 2.456, 95% CI 1.474-4.090). Overall, antimicrobial prophylaxis was effective only in patients who underwent evacuation of hematoma by craniotomy (risk reduction, 62.5% (CI, 29.0% -96.0%). Conclusion: Evacuation of haematomas through craniotomy increased the effectiveness of prophylaxis, and should be considered in the future. The rationale will be explored further to see if antibiotic prophylaxis can reduce SSIs in other patients with neuro trauma

Ongoing initiatives in China to enhance prescribing efficiency : impact and proposals for improvement

Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate this growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These measures are principally concentrated in hospitals as they account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives enhances irrational prescribing. Review the influence of recent measures on subsequent utilization and expenditure of high-volume classes in China to provide future guidance. Principally a narrative review of published studies of the proton pump inhibitors (PPIs), statins, renin–angiotensin inhibitor drugs and traditional Chinese medicines (TCMs) between 2004 and 2013 in the largest teaching hospital group in Chongqing District. Appeciable increase in drug utilisation including TCMs. Generics typically only 30% to 34% of total utilisation for the molecule for CV medicines, with decreasing trends in recent years. Greater utilisation of generic PPIs; however, this includes generic injectable preparations with considerably higher prices. Prices decreased over time, with appreciable reductions for some generics. Overall, considerable opportunities to save resources without compromising care. Restricting the formulary to just one statin, angiotensin receptor blocker or PPI based on the cheapest one would have saved 50-84% of total accumulated expenditures. Encouraging to see high utilisation of generic PPIs and low prices for some oral generics. However, real progress will only be made by addressing current perverse financial incentives. Potential reforms could include limiting the number of available medicines in a class to enhance the quality and efficiency of prescribing