Comparative Costs of Antibacterial Usage in Sexually Transmitted Infections in a Nigerian Teaching Hospital

Purpose: To evaluate the cost of antibacterial usage to patients in a tertiary health facility in Nigeria.Methods: Drug utilization evaluation was carried out retrospectively among patients with sexually transmitted infections (STIs) over a one-year period between 2005 and 2006 in Lagos University Teaching Hospital (LUTH), Nigeria. Case notes numbering 230 and containing 317 prescriptions were sampled consecutively with the aid of diagnostic coding cards. Relevant data including case demographics, diagnosis, prescribed drugs, and dosages were extracted and the associated costs analysed.Results: A majority of the patients (82.3 %) were youths aged 21 - 40 years. Higher prevalence was observed among male patients (70.2 %). The proportion of drugs prescribed in generic and branded names were 82.1 and 17.9 %, respectively. Total number of antibacterial doses was 7284 at a total cost of NGN239,420.00 (US$1,841.69). Average antibacterial cost per patient was NGN1,040.96 (US$8.00). Quinolones were the most widely prescribed class of antibacterial agents (31.1 % of cases) at a cost of NGN81,646.00 (US$628.05) representing 34.1$1.00 per day). Furthermore, a greater proportion of the antibacterial cost was due to a few agents, the use of which should be evidence-based and closely monitored.Keywords: Antibacterial therapy, Cost, Antibacterial utilization, Infectious diseasesTropical Journal of Pharmaceutical Research December 2010; 9 (6): 549-55

Prehospital video triage of potential stroke patients in North Central London and East Kent: rapid mixed-methods service evaluation

Background In response to COVID-19, alongside other service changes, North Central London and East Kent implemented prehospital video triage: this involved stroke and ambulance clinicians communicating over FaceTime (Apple Inc., Cupertino, CA, USA) to assess suspected stroke patients while still on scene. Objective To evaluate the implementation, experience and impact of prehospital video triage in North Central London and East Kent. Design A rapid mixed-methods service evaluation (July 2020 to September 2021) using the following methods. (1) Evidence reviews: scoping review (15 reviews included) and rapid systematic review (47 papers included) on prehospital video triage for stroke, covering usability (audio-visual and signal quality); acceptability (whether or not clinicians want to use it); impact (on outcomes, safety, experience and cost-effectiveness); and factors influencing implementation. (2) Clinician views of prehospital video triage in North Central London and East Kent, covering usability, acceptability, patient safety and implementation: qualitative analysis of interviews with ambulance and stroke clinicians (n = 27), observations (n = 12) and documents (n = 23); a survey of ambulance clinicians (n = 233). (3) Impact on safety and quality: analysis of local ambulance conveyance times (n = 1400; April to September 2020). Analysis of national stroke audit data on ambulance conveyance and stroke unit delivery of clinical interventions in North Central London, East Kent and the rest of England (n = 137,650; July 2018 to December 2020). Results (1) Evidence: limited but growing, and sparse in UK settings. Prehospital video triage can be usable and acceptable, requiring clear network connection and audio-visual signal, clinician training and communication. Key knowledge gaps included impact on patient conveyance, patient outcomes and cost-effectiveness. (2) Clinician views. Usability – relied on stable Wi-Fi and audio-visual signals, and back-up processes for when signals failed. Clinicians described training as important for confidence in using prehospital video triage services, noting potential for ‘refresher’ courses and joint training events. Ambulance clinicians preferred more active training, as used in North Central London. Acceptability – most clinicians felt that prehospital video triage improved on previous processes and wanted it to continue or expand. Ambulance clinicians reported increased confidence in decisions. Stroke clinicians found doing assessments alongside their standard duties a source of pressure. Safety – clinical leaders monitored and managed potential patient safety issues; clinicians felt strongly that services were safe. Implementation – several factors enabled prehospital video triage at a system level (e.g. COVID-19) and more locally (e.g. facilitative governance, receptive clinicians). Clinical leaders reached across and beyond their organisations to engage clinicians, senior managers and the wider system. (3) Impact on safety and quality: we found no evidence of increased times from symptom onset to arrival at services or of stroke clinical interventions reducing in studied areas. We found several significant improvements relative to the rest of England (possibly resulting from other service changes). Limitations We could not interview patients and carers. Ambulance data had no historic or regional comparators. Stroke audit data were not at patient level. Several safety issues were not collected routinely. Our survey used a convenience sample. Conclusions Prehospital video triage was perceived as usable, acceptable and safe in both areas. Future research Qualitative research with patients, carers and other stakeholders and quantitative analysis of patient-level data on care delivery, outcomes and cost-effectiveness, using national controls. Focus on sustainability and roll-out of services. Study registration This study is registered as PROSPERO CRD42021254209. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 26. See the NIHR Journals Library website for further project information

Comparative Costs of Antibacterial Usage in Sexually Transmitted Infections in a Nigerian Teaching Hospital

Purpose: To evaluate the cost of antibacterial usage to patients in a tertiary health facility in Nigeria.Methods: Drug utilization evaluation was carried out retrospectively among patients with sexually transmitted infections (STIs) over a one-year period between 2005 and 2006 in Lagos University Teaching Hospital (LUTH), Nigeria. Case notes numbering 230 and containing 317 prescriptions were sampled consecutively with the aid of diagnostic coding cards. Relevant data including case demographics, diagnosis, prescribed drugs, and dosages were extracted and the associated costs analysed.Results: A majority of the patients (82.3 %) were youths aged 21 - 40 years. Higher prevalence was observed among male patients (70.2 %). The proportion of drugs prescribed in generic and branded names were 82.1 and 17.9 %, respectively. Total number of antibacterial doses was 7284 at a total cost of NGN239,420.00 (US$1,841.69). Average antibacterial cost per patient was NGN1,040.96 (US$8.00). Quinolones were the most widely prescribed class of antibacterial agents (31.1 % of cases) at a cost of NGN81,646.00 (US$628.05) representing 34.1$1.00 per day). Furthermore, a greater proportion of the antibacterial cost was due to a few agents, the use of which should be evidence-based and closely monitored.Keywords: Antibacterial therapy, Cost, Antibacterial utilization, Infectious diseasesTropical Journal of Pharmaceutical Research December 2010; 9 (6): 549-55

An assessment of generic drug use in management of chronic diseases in Lagos State, Nigeria

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Cost implication of irrational prescribing of chloroquine in Lagos State general hospitals

Background: A major share of the hospital budget is spent on drugs. Irrational use of these drugs is a waste of financial and human resources that could have been deployed for another use within the hospital setting especially in cases where such drugs are provided free to patients. Also there is increased morbidity and progression of severity with irrational use. The objective of this study was to determine the irrational use of chloroquine and the subsequent cost implications in Lagos State general hospitals.Methodology: A retrospective study period of one year (January to December, 2000) was selected. A total of 18,781 prescription forms of “Free Eko Malaria” were sampled for children and adults from all the Lagos State general hospitals. Drug costs in each prescription form were identified. Cost effectiveness analysis of chloroquine tablet and intramuscular injection was undertaken.Results: The average cost of medicine per prescription was N 132.071 ($1.03) which should have been N 94.22 ($0.73) if prescribed rationally. The total cost of prescriptions for malaria under study was N 2,480,425.00 ($19,348.09). About 68$13,100.19)} of the total cost was lost to irrational prescribing. This is a waste of scarce resources. When the prescriptions were differentiated into the different dosage forms prescribed, the prescriptions containing intramuscular injections only had over 90% of the cost lost to irrational prescribing. Cost effectiveness analysis showed that chloroquine tablet was 17 times more cost effective than chloroquine injection (intramuscular) from a health care system perspective while it was 14 times more cost effective from a patient perspective.Conclusion: There is waste of scarce resources with irrational dispensing of drugs and these resources could have been deployed to other uses or areas within the hospitals. The tablet chloroquine was more cost effective than injection chloroquine (intramuscular). Increasing the cost of tablets, decreasing effectiveness of tablets, decreasing the cost of injections and increasing the effectiveness of injections did not change the cost effectiveness conclusion