PHP8 ADVERSE DRUG REACTIONS IN GERMANY: COST ANALYSIS OF INTERNAL MEDICINE HOSPITALIZATIONS

La irrupción de las nuevas tecnologías en la vida cotidiana ha supuesto una enorme revolución a la hora de determinar tanto las relaciones entre los sujetos como de comprender e interpretar la realidad. Por ello, la alfabetización mediática se plantea hoy como una disciplina indispensable en los sistemas educativos de todo el mundo. Este artículo recoge los resultados obtenidos en un experimento con estudiantes de educación secundaria. El objetivo es observar hasta qué punto la alfabetización mediática puede resultar de utilidad a la hora de potenciar las competencias interpretativas de los estudiantes. La muestra está formada por alumnos de 14-15 años, pertenecientes al curso Décimo de tres centros escolares de Guayaquil. La variable independiente es conformada por cinco spots. Los resultados subrayan que, al margen del contexto socioeconómico, los alumnos instruidos mediáticamente muestran una capacidad interpretativa y decodificadora superior a aquellos otros que no lo fueron.  &nbsp

Health care use and costs of adverse drug events emerging from outpatient treatment in Germany: A modelling approach

<p>Abstract</p> <p>Background</p> <p>This study's aim was to develop a first quantification of the frequency and costs of adverse drug events (ADEs) originating in ambulatory medical practice in Germany.</p> <p>Methods</p> <p>The frequencies and costs of ADEs were quantified for a base case, building on an existing cost-of-illness model for ADEs. The model originates from the U.S. health care system, its structure of treatment probabilities linked to ADEs was transferred to Germany. Sensitivity analyses based on values determined from a literature review were used to test the postulated results.</p> <p>Results</p> <p>For Germany, the base case postulated that about 2 million adults ingesting medications have will have an ADE in 2007. Health care costs related to ADEs in this base case totalled 816 million Euros, mean costs per case were 381 Euros. About 58% of costs resulted from hospitalisations, 11% from emergency department visits and 21% from long-term care. Base case estimates of frequency and costs of ADEs were lower than all estimates of the sensitivity analyses.</p> <p>Discussion</p> <p>The postulated frequency and costs of ADEs illustrate the possible size of the health problems and economic burden related to ADEs in Germany. The validity of the U.S. treatment structure used remains to be determined for Germany. The sensitivity analysis used assumptions from different studies and thus further quantified the information gap in Germany regarding ADEs.</p> <p>Conclusions</p> <p>This study found costs of ADEs in the ambulatory setting in Germany to be significant. Due to data scarcity, results are only a rough indication.</p

Dose-Specific Adverse Drug Reaction Identification in Electronic Patient Records: Temporal Data Mining in an Inpatient Psychiatric Population

BACKGROUND: Data collected for medical, filing and administrative purposes in electronic patient records (EPRs) represent a rich source of individualised clinical data, which has great potential for improved detection of patients experiencing adverse drug reactions (ADRs), across all approved drugs and across all indication areas. OBJECTIVES: The aim of this study was to take advantage of techniques for temporal data mining of EPRs in order to detect ADRs in a patient- and dose-specific manner. METHODS: We used a psychiatric hospital’s EPR system to investigate undesired drug effects. Within one workflow the method identified patient-specific adverse events (AEs) and links these to specific drugs and dosages in a temporal manner, based on integration of text mining results and structured data. The structured data contained precise information on drug identity, dosage and strength. RESULTS: When applying the method to the 3,394 patients in the cohort, we identified AEs linked with a drug in 2,402 patients (70.8 %). Of the 43,528 patient-specific drug substances prescribed, 14,736 (33.9 %) were linked with AEs. From these links we identified multiple ADRs (p < 0.05) and found them to occur at similar frequencies, as stated by the manufacturer and in the literature. We showed that drugs displaying similar ADR profiles share targets, and we compared submitted spontaneous AE reports with our findings. For nine of the ten most prescribed antipsychotics in the patient population, larger doses were prescribed to sedated patients than non-sedated patients; five patients exhibited a significant difference (p < 0.05). Finally, we present two cases (p < 0.05) identified by the workflow. The method identified the potentially fatal AE QT prolongation caused by methadone, and a non-described likely ADR between levomepromazine and nightmares found among the hundreds of identified novel links between drugs and AEs (p < 0.05). CONCLUSIONS: The developed method can be used to extract dose-dependent ADR information from already collected EPR data. Large-scale AE extraction from EPRs may complement or even replace current drug safety monitoring methods in the future, reducing or eliminating manual reporting and enabling much faster ADR detection. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40264-014-0145-z) contains supplementary material, which is available to authorised users

Adherence to Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation: A Cross-National Comparison in Six European Countries (2008-2015)

Aims: To describe and compare the adherence to different direct oral anticoagulants (DOACs) in eight European databases representing six countries. Methods: Longitudinal drug utilization study of new users (≥18 years) of DOACs (dabigatran, rivaroxaban, apixaban) with a diagnosis of non-valvular atrial fibrillation (2008-2015). Adherence was examined by estimating persistence, switching, and discontinuation rates at 12 months. Primary non-adherence was estimated in BIFAP and SIDIAP databases. Results: The highest persistence rate was seen for apixaban in the CPRD database (81%) and the lowest for dabigatran in the Mondriaan database (22%). The switching rate for all DOACs ranged from 2.4 to 13.1% (Mondriaan and EGB databases, respectively). Dabigatran had the highest switching rate from 5.0 to 20.0% (Mondriaan and EGB databases, respectively). The discontinuation rate for all DOACs ranged from 16.0 to 63.9% (CPRD and Bavarian CD databases, respectively). Dabigatran had the highest rate of discontinuers, except in the Bavarian CD and AOK NORDWEST databases, ranging from 23.2 to 64.6% (CPRD and Mondriaan databases, respectively). Combined primary non-adherence for examined DOACs was 11.1% in BIFAP and 14.0% in SIDIAP. There were differences in population coverage and in the type of drug data source among the databases. Conclusion: Despite the differences in the characteristics of the databases and in demographic and baseline characteristics of the included population that could explain some of the observed discrepancies, we can observe a similar pattern throughout the databases. Apixaban was the DOAC with the highest persistence. Dabigatran had the highest proportion of discontinuers and switchers at 12 months in most databases (EMA/2015/27/PH)

Discrete-Choice-Experimente zur Messung der Zahlungsbereitschaft f&uuml;r Gesundheitsleistungen - ein&nbsp;anwendungsbezogener Literaturreview

Aim: Discrete choice experiments (DCE) are a method to assess willingness-to-pay (WTP) within the framework of cost-benefit analysis. Compared to traditional tools, DCE offer a broad application spectrum for the measurement of preferences. The objective of this paper was to evaluate the application of DCE in the measurement of willingness-to-pay for medical interventions. Method: A literature review was conducted in healthcare and economic databases (PubMed, EconLit), as well as manual search and citation-tracking in bibliographies for papers and books published in the period 01 / 1998 - 05 / 2010. Results: Compared to conventional methods, utility measurement using DCE provides two advantages. First, the experiment is less cognitive demanding for respondents. Second, willingness-to-pay and DCE are based on a valid theoretical basis. From the literature, validity, reliability, acceptance by respondents, practicability, and efficiency were evaluated as criteria for assessing DCE. These criteria proved to be of high methodological validity and reliability. Particularly, the results concerning internal consistency and theoretical validity are very encouraging. DCE provide an informative basis for identifying medical service features which create a higher benefit for patients, eliminating services for which no willingness-to-pay exists, and the conception of medical services offered to specific patient groups. Optimized results may be achieved if the respondents are familiar with the framing of the decision situation. Particularly in healthcare systems where respondents exhibit inadequate price sensitivity, this may be a difficulty. Conclusion: DCE are a versatile tool for WTP measurement in health economics, which enables researchers both to evaluate process attributes and to observe individual trade-offs between service attributes. By mimicking everyday decision-making situations the method is especially suitable for the evaluation of intervention-specific effects. However, numerous criteria require empirical examination. Focusing on WTP measurement, aside from experimental design aspects, particularly psychological aspects and cognitive problems of decision heuristics should be taken into consideration