Spelling suggestions: "subject:"farmakodynamik""
1 |
Retrospective analysis of the prescribing patterns of calcium channel blockers in a section of the private health care sector of South Africa / Ruan SmitSmit, Ruan January 2010 (has links)
Background: Calcium channel blockers are mainly divided into antihypertensive and antianginal
treatment agents. In 2000 it was estimated that 972 million adults worldwide were
living with hypertension and it is expected to affect 1.56 billion patients by 2025. The
incremental expenditure for the antihypertensive therapeutic group in the United States of
America was estimated at $US 55 billion per annum in 2006.
It was stated that around seven million people in the United States of America suffered from
angina, with around 400 000 new reports every year.
Objective: To determine the prescribing patterns of calcium channel blocker medicine items
during 2005 to 2008 in a section of the private health care sector of South Africa.
Methods: A retrospective quantitative drug utilisation review was done using a medicine
claims database ranging over four years from 1 January 2005 to 31 December 2008. The
total medicine claims database was divided into cardiovascular medicine items and then into
calcium channel blockers. These were analysed according to age as well as gender. Further
analysis included adherence of calcium channel blockers as well as an analysis of
prescribers of these items during the study period.
Results: The total number of patients on the medicine claims database consisted of
1 509 621 patients in 2005. This number decreased to 974 497 patients in 2008. The most
medicine items were dispensed in 2006 (n = 21 113 422) with an average cost of
R 92.82 (SD = 196.42) per medicine item.
It was noted that 16.05% (n = 242 264) of patients used at least one cardiovascular item in
2005. The percentage of cardiovascular medicine item users increased by 4.36% during the
study period to 20.41% (n = 198 847) in 2008. In 2008 the cardiovascular medicine items
dispensed were responsible for 19.18% (R 342 565 308.41) of the total cost of all medicine
items claimed.
In 2005 the results revealed that 1.63% (n = 318 258) of all medicine items dispensed were
calcium channel blocker medicine items. The percentage of calcium channel blockers
increased to 2.24% (n = 367 437) of the total number of medicine items in 2008. The cost
prevalence index was calculated for the calcium channel blockers and the value declined
from 1.5 in 2005 to 1.22 in 2008, which indicated that the items dispensed were relatively
expensive, but less than in 2005. An increase of 16.17% in the usage of generic medicine
items were noted from 2005 to 2008.
More female patients than male patients claimed medicine items during the study period. A
higher percentage of male patients used a cardiovascular medicine item as well as calcium
channel blockers during the study period compared to females and a larger percentage of
their medicine expenditure was used on cardiovascular medicine items as well as calcium
channel blockers compared to females.
The usage of cardiovascular medicine items as well as calcium channel blocker medicine
items increased with patient age. In 2008, 17.98% of patients older than 65 years of age
used a calcium channel blocker compared to 0.97% of patients aged > 25 <= 35 years. Only
60.34% of calcium channel blockers items were used with acceptable refill adherence rates
during the study. More than a third of the calcium channel blockers medicine items used had
unacceptable low adherence rates from 2005 to 2008.
In each of the study years the highest potential saving with generic substitution was seen
with amlodipine containing items. It was also observed that some generic substitutions could
be relatively more expensive than the innovator products and an increased cost instead of a
saving through generic substitution may have occurred.
Conclusion: This study highlighted the prescribing patterns and cost implications of calcium
channel blockers in the private health care sector of South Africa.
It is recommended that a more in–depth study of the adherence of calcium channel blockers
be done. This study should also include the cost strategies of generic substitution of calcium
channel blockers in South Africa. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.
|
2 |
Retrospective analysis of the prescribing patterns of calcium channel blockers in a section of the private health care sector of South Africa / Ruan SmitSmit, Ruan January 2010 (has links)
Background: Calcium channel blockers are mainly divided into antihypertensive and antianginal
treatment agents. In 2000 it was estimated that 972 million adults worldwide were
living with hypertension and it is expected to affect 1.56 billion patients by 2025. The
incremental expenditure for the antihypertensive therapeutic group in the United States of
America was estimated at $US 55 billion per annum in 2006.
It was stated that around seven million people in the United States of America suffered from
angina, with around 400 000 new reports every year.
Objective: To determine the prescribing patterns of calcium channel blocker medicine items
during 2005 to 2008 in a section of the private health care sector of South Africa.
Methods: A retrospective quantitative drug utilisation review was done using a medicine
claims database ranging over four years from 1 January 2005 to 31 December 2008. The
total medicine claims database was divided into cardiovascular medicine items and then into
calcium channel blockers. These were analysed according to age as well as gender. Further
analysis included adherence of calcium channel blockers as well as an analysis of
prescribers of these items during the study period.
Results: The total number of patients on the medicine claims database consisted of
1 509 621 patients in 2005. This number decreased to 974 497 patients in 2008. The most
medicine items were dispensed in 2006 (n = 21 113 422) with an average cost of
R 92.82 (SD = 196.42) per medicine item.
It was noted that 16.05% (n = 242 264) of patients used at least one cardiovascular item in
2005. The percentage of cardiovascular medicine item users increased by 4.36% during the
study period to 20.41% (n = 198 847) in 2008. In 2008 the cardiovascular medicine items
dispensed were responsible for 19.18% (R 342 565 308.41) of the total cost of all medicine
items claimed.
In 2005 the results revealed that 1.63% (n = 318 258) of all medicine items dispensed were
calcium channel blocker medicine items. The percentage of calcium channel blockers
increased to 2.24% (n = 367 437) of the total number of medicine items in 2008. The cost
prevalence index was calculated for the calcium channel blockers and the value declined
from 1.5 in 2005 to 1.22 in 2008, which indicated that the items dispensed were relatively
expensive, but less than in 2005. An increase of 16.17% in the usage of generic medicine
items were noted from 2005 to 2008.
More female patients than male patients claimed medicine items during the study period. A
higher percentage of male patients used a cardiovascular medicine item as well as calcium
channel blockers during the study period compared to females and a larger percentage of
their medicine expenditure was used on cardiovascular medicine items as well as calcium
channel blockers compared to females.
The usage of cardiovascular medicine items as well as calcium channel blocker medicine
items increased with patient age. In 2008, 17.98% of patients older than 65 years of age
used a calcium channel blocker compared to 0.97% of patients aged > 25 <= 35 years. Only
60.34% of calcium channel blockers items were used with acceptable refill adherence rates
during the study. More than a third of the calcium channel blockers medicine items used had
unacceptable low adherence rates from 2005 to 2008.
In each of the study years the highest potential saving with generic substitution was seen
with amlodipine containing items. It was also observed that some generic substitutions could
be relatively more expensive than the innovator products and an increased cost instead of a
saving through generic substitution may have occurred.
Conclusion: This study highlighted the prescribing patterns and cost implications of calcium
channel blockers in the private health care sector of South Africa.
It is recommended that a more in–depth study of the adherence of calcium channel blockers
be done. This study should also include the cost strategies of generic substitution of calcium
channel blockers in South Africa. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.
|
3 |
A longitudinal analysis of the prescribing patterns of anti–epileptic medicine by using a medicine claims database / T. van ZylVan Zyl, Tiaan January 2010 (has links)
The prevalence of epilepsy in society is general knowledge; however the impact on
social activity as well as other daily factors are not always fully recognised. Epilepsy
frequently poses a problem with regard to work–related activities (Heaney, 1999:44).
Moran et al. (2004:425) indicated that the major impacts of epilepsy on life were work
and school difficulties, driving prohibition, psychological and social life of which
restriction of work or schooling has the greatest impact on epileptic’s life. In all cases
the type, severity, and frequency of the seizures as well as the age would be relevant.
Davis et al. (2008:451) established that 39% of all epileptics were not adherent to their
therapy and in patients over 65 this was even higher at 43 %. Non–adherence with antiepileptic
medicine appears to be related to increased health care utilisation and costs
and may also lead to an increased probable accidents or injuries
The general objective was to investigate anti–epileptic medicine prescribing patterns
and treatment cost in a section of the private health care sector by using a medicine
claims database.
A retrospective drug utilisation study was done on the data claims from a pharmacy
benefit management company for the study period 1 January 2005 to 31 December
2008.
Firstly epilepsy was investigated in order to understand the disease and to determine
the prevalence and treatment thereof. It was found that epilepsy is still one of the most
common neurological conditions and according to the findings, 2 out of every hundred
patients were using anti–epileptic medicine in this section of the private health care
sector. To make this condition socially more acceptable and understandable, public
education for special target groups concerning the disorder must be conducted as well
as employment training programmes for people with epilepsy themselves. The utilisation patterns of anti–epileptic drugs were reviewed, analysed and interpreted.
It was determined that anti–epileptic medicine items are relatively expensive with
regards to other medicine items on the total database. With regard to gender, more
females are using anti–epileptic medicine than males on the database. The largest age
group of patients using anti–epileptic medicine, is between > 40 years and <= 64 years of
age. It was also clear that prevalence increase as age increase.
With regard to the different prescribers, the number of items prescribed by a general
practitioner was almost double that of the other prescribers. It was further established
that newer anti–epileptic medicines are more expensive than older anti–epileptic
medicine according to the cost per tablet in this section of the private health care
sector.
Carbamazepine and valproate were the two active ingredients that were most
frequently prescribed as a single item on a prescription. After a cost–minimisation
analysis was done, R134 685.66 could have been saved when generic substitution was
implemented.
The refill–adherence rate decreased as age increased. Only 30.46% of the trade
names was refilled according to acceptable refill–adherence rates. The refill–adherence
rate according to active ingredient showed that medicine items containing,
phenobarbitone/vit B or gabapentin had the lowest unacceptable refill–adherence rate.
The limitations for this study was stipulated and recommendations for further research
regarding anti–epileptic medicine were also made. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.
|
4 |
Prescribing patterns of medicines used in Parkinson's and other related diseases in the private health care sector of South Africa / S. van der MerweVan der Merwe, Suné January 2010 (has links)
Parkinson's disease is the most recurrent movement disorder and has a radical effect on the lives of people. This chronic neurological disorder is accompanied by a significant social and financial burden with a negative brunt on sufferers' quality of life. The main cause of Parkinson's disease is still unknown, however, the main goal of existing treatment for Parkinson's disease is to improve the patient's quality of life and ability to go about as normally and easily as possible. The general objective of this study was to investigate the prescribing patterns of medicine items used in Parkinson's disease and other movement disorders associated with Parkinson's disease, as well as the cost associated with the medication in a section of the private health care sector of South Africa.
A quantitative, retrospective drug utilisation review (DUR) study was performed according to data obtained from a medicine claims database, of a South African pharmacy benefit management company (PBM) for four consecutive years (i.e. 2005 to 2008).
Of all patients on the total database 0.26% (n = 3 993) were Parkinson's disease patients in 2005 (N = 1 509 621), 0.28% (n = 4 423) in 2006 (N = 1 558 090), 0.34% (n = 4 028) in 2007 (N = 1 178 596) and 0.42% (n = 4 072) in 2008 (N = 974 497). Female Parkinson's disease patients were between 56% and 60% of all Parkinson's disease patients from 2005 to 2008. According to age groups, Parkinson's disease patients had the highest representation in age group five (70 80 years) and age group six (> 80 years).
In total the number of Parkinson's disease prescriptions claimed through the PMB accounted for 0.3% from 2005 to 2007 and 0.4% in 2008 of all prescriptions claimed on the database. From 2005 (N = R1 819 865 251) to 2008 (N = R1 785 871 013) Parkinson's disease expenditures represented 0.6% (2005, n = R10 459 835; 2006, n = R11 320 616; 2007, n = 11 040 596; 2008, n = 10 697 155) of the total database's prescription expenditure. The female gender and patients of 70 years and older, presented with the highest number of prescriptions claimed and also with the highest costs within the specific age and gender groups.
In 2005 the medicine treatment expenditure for a year's Parkinson's disease treatment was approximately R2 619 R4 179, decreasing with 2% to R2 559 R4 237 in 2006, from thereon increasing with 7% to R2 740 R 4 337 in 2007, decreasing again with 4% to R 2 627 R4 424 in 2008.
Medicine item analyses indicated that dopaminergic medicine items were the most frequently used antiparkinson medicine items from 2005 to 2008. Carbidopa/levodopa containing medicine items were most frequently claimed throughout the study period. The average cost per tablet increased from 2005 to 2008, with the most expensive tablets during the four–year study period indicated as, Tasmar® 100 mg tab and Permax® 1 mg tab. The PDD of all antiparkinson medicine items appeared intact. There were only two medicine items that indicated a PDD, above the maximum daily dosage, namely Permax® 1 mg tablets and Tasmar® 100 mg tablets.
The frequencies of medicine items prescribed in combination decreased rather drastically with an increase of medicine items per prescription throughout the study period. CNS medicine items prescribed together with antiparkinson medicine items per prescription often occurred. The highest frequencies encountered in combination with antiparkinson medicine items were found to include the antidepressants, hypnotics, antipsychotics and anxiolytic medicine items.
A majority of antiparkinson medicine items (53.50%, n = 4 691) had low refill–adherence rates below 90% and were therefore unacceptable. These accounted for 41.62% (n = R16 398 512) of the total cost (N = R39 402 898) of all antiparkinson medicine items included in this study. Only 36.78% (n = 3 225) of antiparkinson medicine items had acceptable refill–adherence rates between 90% and 110%. Those with unacceptably high refill–adherence rates accounted for 9.72% (n = 852) of all antiparkinson medicine items and represented 6.5% (n = R2 574 597) of the total cost.
Conclusion: It can be concluded that even though antiparkinson medicine items are used by only a small percentage of the total patient population in a section of the private health care sector of South Africa, they are expensive and bear implications for the patient as well as medical schemes. Good prescribing patterns were adhered to, with the exception of the poor refill–adherence of antiparkinsons medication items. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.
|
5 |
Prescribing patterns of biologic immunomodulating medicine in the South African private health care sector / Ilanca RouxRoux, Ilanca January 2010 (has links)
Advances in molecular immunology and rapid technical evolution during the past two
decades have led to a new class of medicines called biologics. Recently, a large number of
biologics, or biologic immunomodulators, directed towards an array of immune–mediated
diseases, have entered the market. This has lead to a dramatic change in the
immunotherapy of autoimmune diseases, as biologics present new potential to improve or
substitute conventional immunosuppressive therapies. According to literature, biologics are
used by only a small number of a health plan’s members, (approximately one per cent), but a
single occurrence can be relatively expensive. Furthermore, there is an indication that the
frequency of use and cost of biologics are on the rise, and as more biologics enter the
market, health plans and employers face the challenge of controlling costs while ensuring
that biologics are affordable.
The general objective of this study was to determine the prevalence and cost of biologic
immunomodulating medicine in the treatment of certain autoimmune diseases during the
period 2005 to 2008 in a section of the private health care sector of South Africa, by
employing a medicine claims database as a source to obtain necessary information.
A quantitative, retrospective drug utilisation review (rDUR) was performed on computerised
medication records (medicine claims data) for four consecutive years (i.e. 2005 to 2008)
provided by a pharmacy benefit management company (PBM). The study population
consisted of all patients on the database who received at least one medicine item with
adalimumab, etanercept, infliximab, interferon beta–1a, interferon 1–b or rituximab as active
ingredient and who were diagnosed with either rheumatoid arthritis (RA), multiple sclerosis
(MS) or Crohn’s disease between 1 January 2005 and 31 December 2008.
Between 2005 and 2008, an average of 1,305,201 patients appeared on the total database,
and of these 0.055% (n = 713) received biologic immunomodulating medicine. More than two
thirds of biological users were female and most patients who received these medicine items
were between the ages of 39 and 64 years, followed by those patients aged between 25 and 39 years. Biologic immunomodulating medicine items (n = 11,914) and biologic prescriptions
(n = 9,537) represented 0.016% of the total number of medicine items (N = 76,129,173) and
0.030% of the total number of prescriptions (N = 31,985,153). The percentage contribution
of biologic immunomodulators to the total number of medicine items and prescriptions on the
total database increased each year, and in four years’ time the percentage of all the
medicine items on the total database that included biologic immunomodulators had tripled,
from 0.009% to 0.023%.
The total cost of biologic immunomodulating medicine accounted for 1.278% of the total cost
(N = R7, 483,759,176.23) of all medication claimed through the PBM between 2005 and
2008. The percentage contribution of biologic immunomodulators to the total medicine
expenditure also increased from one year to another for the four–year study period. The
average cost of a biologic immunomodulating medicine item increased with 71.10% from
2005 (R5602.71 ± 2166.61) to (R9586.25 ± 5956.56) in 2008. The CPI for biologic
immunomodulators, (CPI = 60.00 for 2005; CPI = 74.62.17 for 2006; CPI = 85.26 for 2007;
and CPI = 86.96 for 2008) indicated that biologic immunomodulating medicine items were
relatively expensive and the d–value between the average cost per biologic
immunomodulator and the average cost per non–biological medicine item (d–value = 2.54 in
2005, d–value = 3.32 in 2006, d–value = 2.23 in 2007 and d–value = 1.59 in 2008) furthermore
indicated that the impact of biological therapies was large and practically significant.
Rheumatoid arthritis patients represented 19.78% of the total number of patients (n = 713)
who claimed the biologic immunomodulators during the four–year period, MS patients (n =
172) represented 24.12% and Crohn’s patients (n = 11) represented 1.5%. Biological drugs
prescribed to RA patients represented 0.28% (n = R20, 708,818.82) of the total cost (N = R7,
483,759,176.23) of all medication claimed through the PBM during the four–year period, while
those prescribed to MS patients represented 0.41% (R30, 922,520.07) and those prescribed
to Crohn’s disease patients represented 0.015% (R1, 108,568.02).
Although biologic immunomodulating medicine items used in the treatment of RA, MS and
Crohn’s disease are relatively expensive, it seems that the number of other medication
prescribed to patients with these diseases decreased after treatment with biologics, which
may influence the medicine treatment cost of these patients.
It can be concluded that even though biologic immunomodulators are used by only a very
small percentage of the total patient population in a section of the private health care sector
of South Africa, they are relatively expensive and have a considerable impact not only the
medical aid scheme, but also on the patient. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.
|
6 |
A longitudinal analysis of the prescribing patterns of anti–epileptic medicine by using a medicine claims database / T. van ZylVan Zyl, Tiaan January 2010 (has links)
The prevalence of epilepsy in society is general knowledge; however the impact on
social activity as well as other daily factors are not always fully recognised. Epilepsy
frequently poses a problem with regard to work–related activities (Heaney, 1999:44).
Moran et al. (2004:425) indicated that the major impacts of epilepsy on life were work
and school difficulties, driving prohibition, psychological and social life of which
restriction of work or schooling has the greatest impact on epileptic’s life. In all cases
the type, severity, and frequency of the seizures as well as the age would be relevant.
Davis et al. (2008:451) established that 39% of all epileptics were not adherent to their
therapy and in patients over 65 this was even higher at 43 %. Non–adherence with antiepileptic
medicine appears to be related to increased health care utilisation and costs
and may also lead to an increased probable accidents or injuries
The general objective was to investigate anti–epileptic medicine prescribing patterns
and treatment cost in a section of the private health care sector by using a medicine
claims database.
A retrospective drug utilisation study was done on the data claims from a pharmacy
benefit management company for the study period 1 January 2005 to 31 December
2008.
Firstly epilepsy was investigated in order to understand the disease and to determine
the prevalence and treatment thereof. It was found that epilepsy is still one of the most
common neurological conditions and according to the findings, 2 out of every hundred
patients were using anti–epileptic medicine in this section of the private health care
sector. To make this condition socially more acceptable and understandable, public
education for special target groups concerning the disorder must be conducted as well
as employment training programmes for people with epilepsy themselves. The utilisation patterns of anti–epileptic drugs were reviewed, analysed and interpreted.
It was determined that anti–epileptic medicine items are relatively expensive with
regards to other medicine items on the total database. With regard to gender, more
females are using anti–epileptic medicine than males on the database. The largest age
group of patients using anti–epileptic medicine, is between > 40 years and <= 64 years of
age. It was also clear that prevalence increase as age increase.
With regard to the different prescribers, the number of items prescribed by a general
practitioner was almost double that of the other prescribers. It was further established
that newer anti–epileptic medicines are more expensive than older anti–epileptic
medicine according to the cost per tablet in this section of the private health care
sector.
Carbamazepine and valproate were the two active ingredients that were most
frequently prescribed as a single item on a prescription. After a cost–minimisation
analysis was done, R134 685.66 could have been saved when generic substitution was
implemented.
The refill–adherence rate decreased as age increased. Only 30.46% of the trade
names was refilled according to acceptable refill–adherence rates. The refill–adherence
rate according to active ingredient showed that medicine items containing,
phenobarbitone/vit B or gabapentin had the lowest unacceptable refill–adherence rate.
The limitations for this study was stipulated and recommendations for further research
regarding anti–epileptic medicine were also made. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.
|
7 |
Prescribing patterns of medicines used in Parkinson's and other related diseases in the private health care sector of South Africa / S. van der MerweVan der Merwe, Suné January 2010 (has links)
Parkinson's disease is the most recurrent movement disorder and has a radical effect on the lives of people. This chronic neurological disorder is accompanied by a significant social and financial burden with a negative brunt on sufferers' quality of life. The main cause of Parkinson's disease is still unknown, however, the main goal of existing treatment for Parkinson's disease is to improve the patient's quality of life and ability to go about as normally and easily as possible. The general objective of this study was to investigate the prescribing patterns of medicine items used in Parkinson's disease and other movement disorders associated with Parkinson's disease, as well as the cost associated with the medication in a section of the private health care sector of South Africa.
A quantitative, retrospective drug utilisation review (DUR) study was performed according to data obtained from a medicine claims database, of a South African pharmacy benefit management company (PBM) for four consecutive years (i.e. 2005 to 2008).
Of all patients on the total database 0.26% (n = 3 993) were Parkinson's disease patients in 2005 (N = 1 509 621), 0.28% (n = 4 423) in 2006 (N = 1 558 090), 0.34% (n = 4 028) in 2007 (N = 1 178 596) and 0.42% (n = 4 072) in 2008 (N = 974 497). Female Parkinson's disease patients were between 56% and 60% of all Parkinson's disease patients from 2005 to 2008. According to age groups, Parkinson's disease patients had the highest representation in age group five (70 80 years) and age group six (> 80 years).
In total the number of Parkinson's disease prescriptions claimed through the PMB accounted for 0.3% from 2005 to 2007 and 0.4% in 2008 of all prescriptions claimed on the database. From 2005 (N = R1 819 865 251) to 2008 (N = R1 785 871 013) Parkinson's disease expenditures represented 0.6% (2005, n = R10 459 835; 2006, n = R11 320 616; 2007, n = 11 040 596; 2008, n = 10 697 155) of the total database's prescription expenditure. The female gender and patients of 70 years and older, presented with the highest number of prescriptions claimed and also with the highest costs within the specific age and gender groups.
In 2005 the medicine treatment expenditure for a year's Parkinson's disease treatment was approximately R2 619 R4 179, decreasing with 2% to R2 559 R4 237 in 2006, from thereon increasing with 7% to R2 740 R 4 337 in 2007, decreasing again with 4% to R 2 627 R4 424 in 2008.
Medicine item analyses indicated that dopaminergic medicine items were the most frequently used antiparkinson medicine items from 2005 to 2008. Carbidopa/levodopa containing medicine items were most frequently claimed throughout the study period. The average cost per tablet increased from 2005 to 2008, with the most expensive tablets during the four–year study period indicated as, Tasmar® 100 mg tab and Permax® 1 mg tab. The PDD of all antiparkinson medicine items appeared intact. There were only two medicine items that indicated a PDD, above the maximum daily dosage, namely Permax® 1 mg tablets and Tasmar® 100 mg tablets.
The frequencies of medicine items prescribed in combination decreased rather drastically with an increase of medicine items per prescription throughout the study period. CNS medicine items prescribed together with antiparkinson medicine items per prescription often occurred. The highest frequencies encountered in combination with antiparkinson medicine items were found to include the antidepressants, hypnotics, antipsychotics and anxiolytic medicine items.
A majority of antiparkinson medicine items (53.50%, n = 4 691) had low refill–adherence rates below 90% and were therefore unacceptable. These accounted for 41.62% (n = R16 398 512) of the total cost (N = R39 402 898) of all antiparkinson medicine items included in this study. Only 36.78% (n = 3 225) of antiparkinson medicine items had acceptable refill–adherence rates between 90% and 110%. Those with unacceptably high refill–adherence rates accounted for 9.72% (n = 852) of all antiparkinson medicine items and represented 6.5% (n = R2 574 597) of the total cost.
Conclusion: It can be concluded that even though antiparkinson medicine items are used by only a small percentage of the total patient population in a section of the private health care sector of South Africa, they are expensive and bear implications for the patient as well as medical schemes. Good prescribing patterns were adhered to, with the exception of the poor refill–adherence of antiparkinsons medication items. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.
|
8 |
Prescribing patterns of biologic immunomodulating medicine in the South African private health care sector / Ilanca RouxRoux, Ilanca January 2010 (has links)
Advances in molecular immunology and rapid technical evolution during the past two
decades have led to a new class of medicines called biologics. Recently, a large number of
biologics, or biologic immunomodulators, directed towards an array of immune–mediated
diseases, have entered the market. This has lead to a dramatic change in the
immunotherapy of autoimmune diseases, as biologics present new potential to improve or
substitute conventional immunosuppressive therapies. According to literature, biologics are
used by only a small number of a health plan’s members, (approximately one per cent), but a
single occurrence can be relatively expensive. Furthermore, there is an indication that the
frequency of use and cost of biologics are on the rise, and as more biologics enter the
market, health plans and employers face the challenge of controlling costs while ensuring
that biologics are affordable.
The general objective of this study was to determine the prevalence and cost of biologic
immunomodulating medicine in the treatment of certain autoimmune diseases during the
period 2005 to 2008 in a section of the private health care sector of South Africa, by
employing a medicine claims database as a source to obtain necessary information.
A quantitative, retrospective drug utilisation review (rDUR) was performed on computerised
medication records (medicine claims data) for four consecutive years (i.e. 2005 to 2008)
provided by a pharmacy benefit management company (PBM). The study population
consisted of all patients on the database who received at least one medicine item with
adalimumab, etanercept, infliximab, interferon beta–1a, interferon 1–b or rituximab as active
ingredient and who were diagnosed with either rheumatoid arthritis (RA), multiple sclerosis
(MS) or Crohn’s disease between 1 January 2005 and 31 December 2008.
Between 2005 and 2008, an average of 1,305,201 patients appeared on the total database,
and of these 0.055% (n = 713) received biologic immunomodulating medicine. More than two
thirds of biological users were female and most patients who received these medicine items
were between the ages of 39 and 64 years, followed by those patients aged between 25 and 39 years. Biologic immunomodulating medicine items (n = 11,914) and biologic prescriptions
(n = 9,537) represented 0.016% of the total number of medicine items (N = 76,129,173) and
0.030% of the total number of prescriptions (N = 31,985,153). The percentage contribution
of biologic immunomodulators to the total number of medicine items and prescriptions on the
total database increased each year, and in four years’ time the percentage of all the
medicine items on the total database that included biologic immunomodulators had tripled,
from 0.009% to 0.023%.
The total cost of biologic immunomodulating medicine accounted for 1.278% of the total cost
(N = R7, 483,759,176.23) of all medication claimed through the PBM between 2005 and
2008. The percentage contribution of biologic immunomodulators to the total medicine
expenditure also increased from one year to another for the four–year study period. The
average cost of a biologic immunomodulating medicine item increased with 71.10% from
2005 (R5602.71 ± 2166.61) to (R9586.25 ± 5956.56) in 2008. The CPI for biologic
immunomodulators, (CPI = 60.00 for 2005; CPI = 74.62.17 for 2006; CPI = 85.26 for 2007;
and CPI = 86.96 for 2008) indicated that biologic immunomodulating medicine items were
relatively expensive and the d–value between the average cost per biologic
immunomodulator and the average cost per non–biological medicine item (d–value = 2.54 in
2005, d–value = 3.32 in 2006, d–value = 2.23 in 2007 and d–value = 1.59 in 2008) furthermore
indicated that the impact of biological therapies was large and practically significant.
Rheumatoid arthritis patients represented 19.78% of the total number of patients (n = 713)
who claimed the biologic immunomodulators during the four–year period, MS patients (n =
172) represented 24.12% and Crohn’s patients (n = 11) represented 1.5%. Biological drugs
prescribed to RA patients represented 0.28% (n = R20, 708,818.82) of the total cost (N = R7,
483,759,176.23) of all medication claimed through the PBM during the four–year period, while
those prescribed to MS patients represented 0.41% (R30, 922,520.07) and those prescribed
to Crohn’s disease patients represented 0.015% (R1, 108,568.02).
Although biologic immunomodulating medicine items used in the treatment of RA, MS and
Crohn’s disease are relatively expensive, it seems that the number of other medication
prescribed to patients with these diseases decreased after treatment with biologics, which
may influence the medicine treatment cost of these patients.
It can be concluded that even though biologic immunomodulators are used by only a very
small percentage of the total patient population in a section of the private health care sector
of South Africa, they are relatively expensive and have a considerable impact not only the
medical aid scheme, but also on the patient. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.
|
9 |
An analysis of the usage of antibiotics in the private health care sector : a managed health care approach / Renier CoetzeeCoetzee, Renier January 2004 (has links)
The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental
role in the effectiveness, efficiency and responsiveness of health care systems. However,
health care expenditure is a great cause for concern and many nations around the world
struggle to contain rising health care costs.
Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation
review (DUR) and disease management have emerged as control tools to ensure cost effective
selection and use of medicine. These managed care instruments are often used to determine
whether new strategies or interventions, such as the implementation of a managed medicine
reference price list, are appropriate and have "value".
The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the
private health care sector of South Africa.
The research design used in this study was retrospective, non-experimental and quantitative.
The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31
April 2003) from the central medicine claims database of Medschem&. Data was analysed
according to prevalence, cost and original (innovator) or generic medicine items. For the
purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and
"others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations,
quinolones, chloramphenicol and aminoglycosides.
The results of the empirical investigation showed the total number of medicine items claimed
during the study period amounted to 49098736 medicine items having a total expenditure of
R7150344897.00. There was a decrease in the prevalence of original (innovator) products
during the two-year period. The prevalence of generic products increased from 25.87% to
32.47%.
A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43
representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the
two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics
constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original
(innovator) products contributed 62.32% and generic products 37.68% to the total cost of all
antibiotics claimed.
It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed
(n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43)
for the two-year period. The average cost of beta-lactam items ranged between R112.88 *
69.95 and R122.18 + 81.42.
The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference
pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of
composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine
expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics
claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of
all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed
R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at
the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved.
Cost analysis indicated that it is possible to reduce health care costs by implementing strategies
with the aim to reduce medicine cost. Further research, however, is necessary and in this
regard recommendations for further research were formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.
|
10 |
An analysis of the usage of antibiotics in the private health care sector : a managed health care approach / Renier CoetzeeCoetzee, Renier January 2004 (has links)
The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental
role in the effectiveness, efficiency and responsiveness of health care systems. However,
health care expenditure is a great cause for concern and many nations around the world
struggle to contain rising health care costs.
Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation
review (DUR) and disease management have emerged as control tools to ensure cost effective
selection and use of medicine. These managed care instruments are often used to determine
whether new strategies or interventions, such as the implementation of a managed medicine
reference price list, are appropriate and have "value".
The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the
private health care sector of South Africa.
The research design used in this study was retrospective, non-experimental and quantitative.
The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31
April 2003) from the central medicine claims database of Medschem&. Data was analysed
according to prevalence, cost and original (innovator) or generic medicine items. For the
purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and
"others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations,
quinolones, chloramphenicol and aminoglycosides.
The results of the empirical investigation showed the total number of medicine items claimed
during the study period amounted to 49098736 medicine items having a total expenditure of
R7150344897.00. There was a decrease in the prevalence of original (innovator) products
during the two-year period. The prevalence of generic products increased from 25.87% to
32.47%.
A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43
representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the
two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics
constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original
(innovator) products contributed 62.32% and generic products 37.68% to the total cost of all
antibiotics claimed.
It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed
(n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43)
for the two-year period. The average cost of beta-lactam items ranged between R112.88 *
69.95 and R122.18 + 81.42.
The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference
pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of
composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine
expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics
claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of
all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed
R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at
the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved.
Cost analysis indicated that it is possible to reduce health care costs by implementing strategies
with the aim to reduce medicine cost. Further research, however, is necessary and in this
regard recommendations for further research were formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.
|
Page generated in 0.0224 seconds