Dutasteride plus Tamsulosin therapy versus Tamsulosin Monotherapy in the treatment of lower urinary tract symptoms: A Cost-utility analysis

Introduction: Lower Urinary Tract symptoms (LUTS)? impacts the quality of life of about 23.8% of the male population in Iran, diagnosed with Benign Prostatic Hyperplasia, annually . The current pharmacological treatment protocol for LUTS are α-blockers and 5-alpha reductase inhibitors (such as Dutasteride). This study was designed to estimate the cost-utility of dutasteride plus tamsulosin therapy for LUTS from the perspective of the Iran Health System. Methods and Results: A Markov model was developed to estimate healthcare costs and patient outcomes, measured by quality-adjusted life years (QALYs), for patients with moderate to severe LUTS. The model, compared four mutually exclusive health states in two alternative treatment options: tamsulosin (0.4 mg/day) and dutasteride plus tamsulosin (0.5mg+0.4 mg/day). time horizon was 35 years, with the duration of one year per cycle. The discount rates for utilities and costs were 3% and 5% respectively. A meta-analysis was conducted to estimate advese drug reactions (ADRs) and After Surgery Events (ASEs) probabilities. Total Cost consists of the direct costs of medications, as well as inpatient and outpatient services (general practice and urology specialist examinations, hospitalizations, laboratory services, diagnostic procedures, TURP surgical procedures, treatment of AUR, and treatment in emergency care services). One-way sensitivity testing and Probabilistic Sensitivity Analyses (PSA) were performed for virtual cohort of 1,000 patients with LUTS. Utility weights for each health states were obtained from a meta-analysis of published studies with EQ5D method. These weights are calculated 0.86, 0.79, 0.72 and 0 in mild, moderate, severe and death states, respectively. The probability of ASEs (CI 95%) were calculated as: TUR syndrome (0-0.0109), Blood transfusion (0.0296-0.0676), Urinary incontinence (0.0198-0.1894), urethral stricture (0.0392-0.0769) and UTI (0.0169-0.0787). After 35 years, the incremental cost-effectiveness ratio for combination therapy was $5159, well within the threshold range typically applied in Iran. PSA showed that the probability of being cost-effective in combination therapy is 89% to 94%, also the model showed the most sensitivity to dutasteride unit price and surgery incidence with monotherapy. Conclusions: Combination therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in Iran

Preparation and Evaluation of Nicotine Slow Release Mucoadhesive Film for NRT**

Abstract Introduction: Nicotine replacement therapy (NRT) with gradual decreasing the amount of nicotine is one of the smoking cessation methods. Nicotine dosage forms on the market are including gum and skin patches. Mucoadhesive formulations are the novel drug delivery systems that can be used for NRT. Mucoadhesive nicotine film (MNF) when placed in the upper gum, will adhere to mucosa and release the nicotine in a controlled manner. MNF will meet the immediate and long-term need of the individual to the nicotine, and could decrease his/her dependency on smoking. Methods and Results: The mucoadhesive films were prepared using different conventional bioadhesive polymers such as HPMC, PVP, Na Alginate, Ethyl cellulose and Eudragit RL100; and Glycerin as the plasticizer for formulations of nicotine hydrogen tartrate, which is more stable form of nicotine. The pharmaceutics characteristics of film include rate of drug release and in vitro adhesion, disintegration time and swallow amount were evaluated. The formulations make with PVP have improved adhesion properties and formulation with HPMC (6 cP) or Na.Alginate released nicotine in the average less than an hour. Drug release from formulations contains HPMC (15000cP) took long about 120 minutes, but in formulations contains Eudragit was within 4.5 to over 6 hours. Conclusions: The best formulation with suitable adhesion and rate of release contains Eudragit RL100 and Glycerin that release nicotine for 5 hour. NRT: Nicotine replacement therapy (NRT) gives you nicotine – in the form of gum, patches, sprays, inhalers, or lozenges – but not the other harmful chemicals in tobacco. NRT can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological (emotional) aspects of quittin

Corporate social responsibility and customer loyalty during the Covid-19 pandemic: evidence from pharmacy practice

Purpose: In recent years, corporate social responsibility (CSR) has taken on a more prominent role in both large and small businesses because of its significant impact on various aspects of business performance. To date, a growing body of literature has demonstrated the mechanisms whereby CSR practices affect organizational outcomes; however, there has been little research examining how CSR practices contribute to customer loyalty within the pharmacy context. As such, this study aims to explore how CSR practices influence the loyalty of pharmacy customers, particularly in relation to the mediatory effects of customer-company identification (CCI) and customer trust. Design/methodology/approach: A survey questionnaire was developed and administered to collect the required data from the pharmacy context. The resultant data were subjected to exploratory factor analysis to identify the scale dimensions, followed by multiple regression analysis to test the hypotheses. Findings: Analysis of the results (n = 528) revealed that perceived CSR indirectly impacts loyalty through the mediatory effects of trust and CCI. All hypothesized effects were also confirmed via empirical testing. Originality/value: The findings of this research suggest that not only are CSR activities responsive to societal concerns, but they can also promote customer identification with pharmacies and strengthen customer trust, which can, in turn, lead to long-term customer loyalty