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.

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.

In a well-functioning medicine supply chain management system, procurement forms an integral part that needs to be closely monitored and integrated with other functions. Good procurement practices in the public health sector ensure that good quality efficacious medicines are distributed in the country in the right quantities and at reasonable costs. Pharmaceutical procurement is a major determinant of drug availability and total health costs. It is indicated that medicine expenditure represents the single largest expenditure after salaries and accounts for approximately 20 to 40% of the total healthcare budget, and up to 90% of household budgets in the Sub-Saharan region (MSH, 2012:1). Moreover, effective and efficient public sector procurement systems are essential for the achievement of millennium development goals and the promotion of sustainable development (WHO, 2011:2). The general aim of the study was to evaluate the current status of procurement and supply chain management systems in the public healthcare hospitals in Lesotho. The study set out to understand the policies, guidelines and practices governing medicine procurement in the public hospitals in Lesotho, and also to outline the impact of procurement activities on the overall operation and effectiveness of the healthcare services. A descriptive, cross-sectional study was conducted, focusing on all levels of medicine procurement and supply management systems in all public hospitals in Lesotho. The study period stretched over nine months, from January 2014 to September 2014. The study population was inclusive of 17 public healthcare hospitals in the country and the central medical store (CMS). The findings revealed that all hospitals studied (n=17) perform the functions of selection, procurement, quantification, ordering, inventory management, distribution as well as utilisation. Although an essential medicine list (EML) and standard treatment guidelines (STGs) are available for use, public hospitals do not adhere to the use of EML and STGs for medicine procurement (n=17). Therefore, procurement is not limited to medicines on the EML, it is based on the intensity of healthcare services provided, and public hospitals often request medicines that do not occur on the EML, but are necessary to address the different diseases and public health priorities in respective facilities. According to the Ministry of Health, all public facilities are mandated to procure medicines from the CMS. Public hospitals use their allocated funds for medicine to buy from the CMS, which will, in turn, procure medicines on behalf of the government and distribute to the hospitals as per request, since procurement is pooled at a central level (MOH, 2011:62). However, it was observed that only government facilities (n=11) procure medicines from the CMS only. Facilities that are owned by the Christian health association of Lesotho (CHAL) procure medicines from other places concurrently (n=6). Moreover, CHAL hospitals (n=6) indicated that they are not fully mandated to procure medicines only from the CMS; they can also procure from other agencies based on stock-outs at the CMS, price differences and urgency of obtaining the medicines required. Therefore, procurement practices at government and CHAL hospitals are not similar. The total expenditure on medicines for government hospitals was 7 088 754.50 Maloti and 121 338 713.05 Maloti in the years 2010/2011 and 2011/2012, respectively. The total expenditure for CHAL hospitals was 2 520 590 Maloti and 3 577 360 Maloti in 2010/2011 and 2011/2012, respectively. According to the findings, variance of budget and expenditure for government hospitals were 15 623 446.50 Maloti in 2010/2011 and 9 490 341.22 Maloti in 2011/2012. Variance of the budget and expenditure for CHAL Hospitals were 912 570 million Maloti in 2010/2011 and 922 640 million Maloti in 2011/2012. Most hospitals showed a variance of above 50% in 2010/2011. However, in 2011/2012, a shift pattern was observed indicating an improvement in the utilisation of funds allocated. This shift pattern may indicate a possible improvement in procurement practices, including the quantification and budgeting and commitment to procurement plans. Pharmaceutical management systems require sound policies and a legal framework that will provide a solid foundation for the systems. It is equally important that these policies and regulations are periodically updated to ensure that they address the current health situation in the country and are in line with international standards (MSH, 2012:4). However, some documents are very outdated, and therefore they do not reflect the current health situation in the country as well as procurement trends internationally, and these include national medicine policy, EML and STGs. In conclusion, the medicine procurement system in public hospitals should be strengthened and should incorporate continuous supportive supervision in order to facilitate and encourage adherence to good procurement practices, and therefore the constant availability of good quality, cost-effective essential medicines in the country. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015

In a well-functioning medicine supply chain management system, procurement forms an integral part that needs to be closely monitored and integrated with other functions. Good procurement practices in the public health sector ensure that good quality efficacious medicines are distributed in the country in the right quantities and at reasonable costs. Pharmaceutical procurement is a major determinant of drug availability and total health costs. It is indicated that medicine expenditure represents the single largest expenditure after salaries and accounts for approximately 20 to 40% of the total healthcare budget, and up to 90% of household budgets in the Sub-Saharan region (MSH, 2012:1). Moreover, effective and efficient public sector procurement systems are essential for the achievement of millennium development goals and the promotion of sustainable development (WHO, 2011:2). The general aim of the study was to evaluate the current status of procurement and supply chain management systems in the public healthcare hospitals in Lesotho. The study set out to understand the policies, guidelines and practices governing medicine procurement in the public hospitals in Lesotho, and also to outline the impact of procurement activities on the overall operation and effectiveness of the healthcare services. A descriptive, cross-sectional study was conducted, focusing on all levels of medicine procurement and supply management systems in all public hospitals in Lesotho. The study period stretched over nine months, from January 2014 to September 2014. The study population was inclusive of 17 public healthcare hospitals in the country and the central medical store (CMS). The findings revealed that all hospitals studied (n=17) perform the functions of selection, procurement, quantification, ordering, inventory management, distribution as well as utilisation. Although an essential medicine list (EML) and standard treatment guidelines (STGs) are available for use, public hospitals do not adhere to the use of EML and STGs for medicine procurement (n=17). Therefore, procurement is not limited to medicines on the EML, it is based on the intensity of healthcare services provided, and public hospitals often request medicines that do not occur on the EML, but are necessary to address the different diseases and public health priorities in respective facilities. According to the Ministry of Health, all public facilities are mandated to procure medicines from the CMS. Public hospitals use their allocated funds for medicine to buy from the CMS, which will, in turn, procure medicines on behalf of the government and distribute to the hospitals as per request, since procurement is pooled at a central level (MOH, 2011:62). However, it was observed that only government facilities (n=11) procure medicines from the CMS only. Facilities that are owned by the Christian health association of Lesotho (CHAL) procure medicines from other places concurrently (n=6). Moreover, CHAL hospitals (n=6) indicated that they are not fully mandated to procure medicines only from the CMS; they can also procure from other agencies based on stock-outs at the CMS, price differences and urgency of obtaining the medicines required. Therefore, procurement practices at government and CHAL hospitals are not similar. The total expenditure on medicines for government hospitals was 7 088 754.50 Maloti and 121 338 713.05 Maloti in the years 2010/2011 and 2011/2012, respectively. The total expenditure for CHAL hospitals was 2 520 590 Maloti and 3 577 360 Maloti in 2010/2011 and 2011/2012, respectively. According to the findings, variance of budget and expenditure for government hospitals were 15 623 446.50 Maloti in 2010/2011 and 9 490 341.22 Maloti in 2011/2012. Variance of the budget and expenditure for CHAL Hospitals were 912 570 million Maloti in 2010/2011 and 922 640 million Maloti in 2011/2012. Most hospitals showed a variance of above 50% in 2010/2011. However, in 2011/2012, a shift pattern was observed indicating an improvement in the utilisation of funds allocated. This shift pattern may indicate a possible improvement in procurement practices, including the quantification and budgeting and commitment to procurement plans. Pharmaceutical management systems require sound policies and a legal framework that will provide a solid foundation for the systems. It is equally important that these policies and regulations are periodically updated to ensure that they address the current health situation in the country and are in line with international standards (MSH, 2012:4). However, some documents are very outdated, and therefore they do not reflect the current health situation in the country as well as procurement trends internationally, and these include national medicine policy, EML and STGs. In conclusion, the medicine procurement system in public hospitals should be strengthened and should incorporate continuous supportive supervision in order to facilitate and encourage adherence to good procurement practices, and therefore the constant availability of good quality, cost-effective essential medicines in the country. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015

Due to the fact that the function of dispensing is not the exclusive practice of a single profession, there is much conflict surrounding the issue: it forms the crux of the pharmacy profession but it also forms part of doctors’ scope of practice. Separation of the acts of prescribing and dispensing would prevent the interest of the doctor, who has the potential to profit from selling medicines, being placed above the interest of the patient. It would, however, also affect the essential services that many dispensing doctors provide to pensioners, unemployed patients, those not covered by a medical scheme and those in rural areas. The implications of doctor dispensing are not clear as conflicting evidence suggests that dispensing doctors prescribe more medicine items, injections and antibiotics while preferring certain brand names on the one hand but on the other, evidence shows that dispensing doctors dispensed less expensive medicines compared to other health care providers. The main objective of this study was to analyse the prescribing patterns of dispensing doctors and other medicine providers in a section of the private health care sector of South Africa for 2005 to 2008 by using a medicine claims database. A retrospective drug utilisation review was conducted by extracting data from a medicine claims database for a four–year period, from 1 January 2005 to 31 December 2008. The results revealed that dispensing doctors had a lower cost per prescription compared to other health care providers (R112.66 ± R4.45 vs. R258.48 ± R23.93) and also had a lower cost per medicine item (R39.62 ± R2.18 vs. R112.43 ± R7.56) for the entire study period from 2005 to 2008. Dispensing doctors provided more items per prescription compared to other health care providers (2.85 ± 0.05 items vs. 2.30 ± 0.06 items) but other health care providers claimed more prescriptions per patient per year (7.50 ± 1.15 prescriptions vs. 3.29 ± 0.07 prescriptions). A higher percentage of generic medicine items were provided to patients visiting dispensing doctors. Dispensing doctors treated a majority of patients aged above 19 to 44 years of age while other health care providers treated a majority of patients above 59 years of age. Both dispensing doctors and other health care providers treated a majority of female patients and issued a majority of medicine items to treat acute conditions. The results also revealed that dispensing doctors generally provided relatively inexpensive medicine items, including generic and innovator items, for female and male patients of all ages while other health care providers showed the opposite trend and issued relatively expensive medicine items to these patients. However, when analysing the top twelve pharmacological groups claimed, dispensing doctors had relatively higher costs compared to other health care providers for nine of the pharmacological groups (central nervous system, analgesic, cardio–vascular, ear, nose and throat, dermatological, urinary system, antimicrobial, endocrine system and cytostatic). The pharmacological groups contributing to the highest number of medicine items and highest medicine cost contribution were the antimicrobial group for dispensing doctors and cardio–vascular group for other health care providers. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

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.

Due to the fact that the function of dispensing is not the exclusive practice of a single profession, there is much conflict surrounding the issue: it forms the crux of the pharmacy profession but it also forms part of doctors’ scope of practice. Separation of the acts of prescribing and dispensing would prevent the interest of the doctor, who has the potential to profit from selling medicines, being placed above the interest of the patient. It would, however, also affect the essential services that many dispensing doctors provide to pensioners, unemployed patients, those not covered by a medical scheme and those in rural areas. The implications of doctor dispensing are not clear as conflicting evidence suggests that dispensing doctors prescribe more medicine items, injections and antibiotics while preferring certain brand names on the one hand but on the other, evidence shows that dispensing doctors dispensed less expensive medicines compared to other health care providers. The main objective of this study was to analyse the prescribing patterns of dispensing doctors and other medicine providers in a section of the private health care sector of South Africa for 2005 to 2008 by using a medicine claims database. A retrospective drug utilisation review was conducted by extracting data from a medicine claims database for a four–year period, from 1 January 2005 to 31 December 2008. The results revealed that dispensing doctors had a lower cost per prescription compared to other health care providers (R112.66 ± R4.45 vs. R258.48 ± R23.93) and also had a lower cost per medicine item (R39.62 ± R2.18 vs. R112.43 ± R7.56) for the entire study period from 2005 to 2008. Dispensing doctors provided more items per prescription compared to other health care providers (2.85 ± 0.05 items vs. 2.30 ± 0.06 items) but other health care providers claimed more prescriptions per patient per year (7.50 ± 1.15 prescriptions vs. 3.29 ± 0.07 prescriptions). A higher percentage of generic medicine items were provided to patients visiting dispensing doctors. Dispensing doctors treated a majority of patients aged above 19 to 44 years of age while other health care providers treated a majority of patients above 59 years of age. Both dispensing doctors and other health care providers treated a majority of female patients and issued a majority of medicine items to treat acute conditions. The results also revealed that dispensing doctors generally provided relatively inexpensive medicine items, including generic and innovator items, for female and male patients of all ages while other health care providers showed the opposite trend and issued relatively expensive medicine items to these patients. However, when analysing the top twelve pharmacological groups claimed, dispensing doctors had relatively higher costs compared to other health care providers for nine of the pharmacological groups (central nervous system, analgesic, cardio–vascular, ear, nose and throat, dermatological, urinary system, antimicrobial, endocrine system and cytostatic). The pharmacological groups contributing to the highest number of medicine items and highest medicine cost contribution were the antimicrobial group for dispensing doctors and cardio–vascular group for other health care providers. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

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.

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.

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.