Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Search for new therapeutic alternatives for leishmaniasis is considered essential by the World Health Organization, due to the high toxicity of the drugs currently used, its high cost and the risk of resistance. In Brazil, it is used three drugs to treat leishmaniasis: meglumine antimoniate and two formulations of amphotericin B (deoxycholate and liposomal). This study is a piggy-back evaluation linked to a multicentric clinical trial with the objective to perform a decision analysis between the treatment regimens for visceral leishmaniasis, for both adults and children. For this end, it was performed analysis of the data obtained in the state of Sergipe from 62 patients randomized to treatment with meglumine antimoniate (group A), considered the first line treatment in Brazil, amphotericin B deoxycholate (group B), liposomal amphotericin B (group C) and the combined regimen of meglumine antimoniate with liposomal amphotericin B (group D), in order to conduct a decision analysis from among these therapeutic regimens for both adults and children. To this end, two scenarios were considered: scenario 1 is the currently prevailing in Brazil, where patients are always treated as possible on an outpatient basis with meglumine antimoniate, although with a smaller monitoring on its potentially lethal side effects and a possible lower adherence to treatment. In the scenario 2, patients are hospitalized during the treatment period, with a better monitoring of clinical and laboratory parameters of the patient, although with a higher risk of nosocomial infections and increasing treatment costs. In terms of security, there is an emphasis on amphotericin B deoxycholate as the one that presents a greater amount of serious and potentially lethal adverse reactions, with an average of 2 severe reactions per patient. From the viewpoint of cost-efficacy, for scenario 1 the meglumine antimoniate remains the treatment of choice for both adults and children. However, in scenario 2, the combination of drugs (group D) presented itself as the most costeffective for both adults and children. From this study it became clear, from a safety point of view for the patient, the need to evaluate both therapeutic regimens, particularly amphotericin B deoxycholate, such as the treatment scenarios for visceral leishmaniasis. / A busca por novas alternativas terapêuticas para as leishmanioses é considerada essencial pela Organização Mundial da Saúde, em virtude da elevada toxicidade dos medicamentos atualmente utilizados, seu alto custo e o risco de resistência. No Brasil, utilizam-se três drogas para o tratamento da leishmaniose: o antimoniato de meglumina e as formulações de anfotericina B (desoxicolato e lipossomal). Este estudo é uma análise econômica atrelada a um ensaio clínico multicêntrico, com o objetivo de se realizar uma análise de decisão entre os esquemas terapêuticos para a leishmaniose visceral, tanto para adultos como para crianças. Para tal, foram utilizados os dados obtidos do estado de Sergipe, onde foram acompanhados 62 pacientes, randomizados para tratamento com antimoniato de meglumina (grupo A), considerado o esquema de primeira escolha no Brasil, anfotericina B desoxicolato (grupo B), anfotericina B lipossomal (grupo C) e o esquema terapêutico combinado de antimoniato de meglumina com anfotericina B lipossomal (grupo D). Na análise de decisão, foram considerados dois cenários: o cenário 1, atualmente existente no Brasil, no qual os pacientes são tratados sempre que possível ambulatorialmente com o antimoniato de meglumina, porém com um menor acompanhamento de suas reações adversas potencialmente letais e uma possível menor adesão ao tratamento. Já no cenário 2, os pacientes são internados durante todo o período do tratamento, com um melhor monitoramento dos parâmetros clínicos e laboratoriais do paciente, porém com um risco maior de infecções hospitalares e aumento de custos do tratamento. No quesito segurança, há um destaque para a anfotericina B desoxicolato como sendo a que apresenta uma maior quantidade de reações adversas graves e potencialmente letais, com uma média de 2 reações graves/paciente. Já no ponto de vista de custo-eficácia, para o cenário 1 o antimoniato de meglumina continua sendo o tratamento de primeira escolha, tanto para adultos como para crianças. Porém, no cenário 2, a combinação de medicamentos (grupo D) se apresentou como o mais custo-eficaz tanto para adultos como para crianças. Deste estudo evidenciou-se, do ponto de vista de segurança ao paciente, a necessidade de reavaliação tanto dos esquemas terapêuticos, particularmente a anfotericina B desoxicolato, como dos cenários de tratamento para a leishmaniose visceral.

Submitted by Neusa Fagundes (neusa.fagundes@unioeste.br) on 2018-03-09T19:11:49Z No. of bitstreams: 2 Érica_Taguti2014.pdf: 1522601 bytes, checksum: 0c0c5940962174392fdd910bcc90e985 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-03-09T19:11:50Z (GMT). No. of bitstreams: 2 Érica_Taguti2014.pdf: 1522601 bytes, checksum: 0c0c5940962174392fdd910bcc90e985 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2014-12-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The aims of this research were update systematic reviews available about partial and complete economic studies of linezolid and estimate differential cost between intravenous and oral administration with hypothetical linezolid switch therapy (intravenous to oral or nasogastric tube). A systematic review was conducted using the terms "clinical outcomes", "analysis cost", "economic outcomes" and "pharmacoeconomic studies" and "linezolid" in the databases Cochrane, IPA, Medline and Scopus, associated with manual search. It was also conducted a cost-minimization analysis among hospitalized patients who used oral and/or intravenous linezolid forms between August, 2009 and August, 2013 in a public hospital in southern Brazil. The research was presented in three different papers. For systematic review were found 1352 articles, of which 24 fulfilled inclusion criteria for the systematic review of partial economic studies and 43 for systematic review of complete economic evaluations. In general, linezolid showed better clinical and economic outcomes compared to antimicrobials such as vancomycin, daptomycin, teicoplanin, particularly in cases of pneumonia patients, infections of skin and soft tissues, infections of methicillin-resistant Staphylococcus aureus, for systematic review of partil and complete economic evaluations, due to the possibility switch therapy. In study of cost-minimization were evaluated records of 152 patients, 103 (67.8%) were treated with linezolid exclusively intravenous route and in 33 (31.7%) opportunities could have been the exchange to oral form administration of antimicrobial. The total cost per patient (mean) after changing from intravenous to oral administration was significantly lower than the real cost paid per patient (mean) (p<0.001). The cost savings associated with switching to oral linezolid administration would be US$14,328.32 over four years. / Os objetivos dessa pesquisa foram atualizar as revisões sistemáticas existentes de estudos econômicos parciais e completos da linezolida e descrever a economia de recursos com a hipotética troca da via de administração do medicamento (endovenosa para oral ou sonda nasoenteral) entre pacientes tratados em um hospital público. Foi conduzida uma revisão sistemática de estudos com os termos “clinical outcomes”, “cost analysis”, “economic outcomes” e “pharmacoeconomic studies” e “linezolid”, nas bases de dados Cochrane, IPA, Medline e Scopus, associado a busca manual. Também foi conduzida uma análise de custo-minimização entre pacientes hospitalizados que utilizaram as formas oral e/ou endovenosa de linezolida entre agosto de 2009 e agosto de 2013 em um hospital público paranaense. As pesquisa foram apresentadas em três diferentes artigos. Para a revisão sistemática foram encontrados 1352 artigos, sendo que 24 preencheram os critérios de inclusão para a revisão sistemática de estudos econômicos parciais e 43 para a revisão sistemática de avaliações econômicas completas. No geral, a linezolida mostrou melhores resultados clínicos e econômicos frente a antimicrobianos como vancomicina, daptomicina, teicoplanina, especialmente nos casos de pacientes com pneumonia, infeções de pele e tecidos moles e infeções por Staphylococcus aureus resistente a meticilina, para estudos econômicos parciais e completos, sendo um dos motivos relacionados à troca da via de administração endovenosa para oral. No estudo de custo-minimização, foram avaliados os prontuários de 152 pacientes, sendo 103 (67,8%) deles foram tratados com linezolida exclusivamente pela via endovenosa e em 33 (31,7%) oportunidades poderia ter ocorrido a troca para a forma oral de administração do antimicrobiano. O custo médio por paciente após a troca hipotética seria significativamente menor do que o valor real gasto (p<0,01) e a economia seria de R$ 32.680,03 em quatro anos.

Thesis (M.Pharm. (Pharmacy Practice))---North-West University, Potchefstroom Campus, 2008.

HIV/AIDS is already the leading cause of death worldwide (Unicef et al., 2004:10) with more than 5 million people out of a total of 46 million South Africans that were HIV positive in 2004, giving a total population prevalence rate of 11 per cent (Dorrington et al., 2004:1). Many people infected do not have access to even the basic drugs needed to treat HIV-related infections and other conditions (Wikipedia, 2004:3). The relative high price of many of the antiretroviral (ARV) drugs and diagnostics on the other hand are one of the main barriers to their availability in developing countries (Unicef et al., 2004:77). ARV drugs registered in South Africa include the Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) and Protease Inhibitors (PIs) (MCC, 2004:1). The objective of this study was to review, analyse and interpret the prescribing patterns of antiviral drugs, with special reference to antiretroviral drugs, in the private health care sector in South Africa by using a medicine claims database. A quantitative, retrospective drug utilisation review was performed. The data ranging from 1 January 2001 to 31 December 2001, 1 January 2002 to 31 December 2002, and 1 January 2004 to 31 December 2004 were used, dividing each year into three four-month periods, namely January to April, May to August, and September to December. It was found that 0.38 per cent (n=1 475 380) for 2001, 0.72 per cent (n=2 076 236) for 2002, and 1.68 per cent (n=2 595 254) for 2004 of all studied prescriptions for the research periods 2001, 2002, and 2004 respectively, contained ARV drugs. ARV drugs constituted 0.33 per cent (n=2 951 326) for 2001, 0.87 per cent (n=4 042 145) for 2002, and 1.92 per cent (n=5 305 882) for 2004 of the total number of medicine items prescribed for the study years 2001, 2002 and 2004 respectively. The total cost of ARV drugs amounted to R4 990 784.29, thus constituting 1.31 per cent of the total cost (R379 708 489) of all medicine items on the database for 2001, increased to R18 235 075.75, thus constituting 3.03 per cent of the total cost (R601 350 325) of all medicine items on the database for 2002, and increased to R34 714 483.64, thus constituting 5.25 per cent of the total cost (R661 223 146) of all medicine items on the database for 2004. It was found that 35.31 per cent (n=5 599) for 2001, 52.68 per cent (n=15 004) for 2002, and 74.27 per cent (n=43 482) for 2004 of all studied antiviral prescriptions for the research periods 2001, 2002, and 2004 respectively, contained ARV drugs. ARV drugs constituted 46.25 per cent (n=21 183) for 2001, 70.20 per cent (n=50 246) for 2002, and 85.87 per cent (n=118 718) for 2004 of the total number of antiviral medicine items prescribed for the study years 2001, 2002 and 2004 respectively. The total cost of ARV medicine items, represented 67.33 per cent (n=R4 990 784.29) during 2001, 84.72 per cent (n=R18 235 075.75) during 2002, and 91.20 per cent (n=R34 714 483.64) during 2004 of the total cost of all antiviral medicine items claimed through the database (n=R7412577.73 for 2001, n=R21523365.56 for 2002, and n=R38 064 347.38 for 2004). The average cost per ARV medicine items for 2004 increased from R317.93i190.80 for the period January to April to R369.2W219.50 for the period May to August, and decreased to R324.79±212.48 for the period September to December and resulted in a cost saving of R41 044.35 for the period May to August versus September to December for the ARV medicine items. The implementation of the pricing regulations could thus be a possible reason for this cost saving, due to fact that the single exit price only came into effect from May 2004. The weighted average number of ARV medicine items per prescription was 1.75*0.31 for 2001, increased to 2.35±0.03 to 2002 and remained stable on 2.35±0.02 for 2004. It was found that majority of prescriptions contained more combination ARV medicine items than single ARV medicine items, ranging from 6 834 (69.76 per cent; n=9 796) prescriptions containing combination ARV medicine items in 2001 and 32 941 (93.39 per cent; n=35 271) prescriptions containing combination ARV medicine items in 2002 to 98 805 (96.93 per cent; n=101 938) prescriptions containing combination ARV medicine items in 2004. Lastly, it was perceived that didanosine was the active ingredient with the largest prevalence for all three four-month periods of 2001 and also for the periods January to April and May to August of 2002, whilst efavirenz represented the active ingredient with the largest prevalence for the period September to December of 2002, and also for all three four-month periods of 2004. Didanosine represented the active ingredient with the highest total cost for the period January to April of 2001, whilst the combination of lamivudine/zidovudine represented the active ingredient with the highest total cost for the periods May to August and September to December of 2001, and also for all three-four month periods of 2002 and 2004. Nelfinavir has the highest average cost for period January to April of 2001, ritonavir for period May to August of 2001, and saquinavir mesylate for period September to December of 2001. Nelfinavir has the highest average cost for all three-four month periods of 2002, while didanosine has the highest average cost for all three four-month periods of 2004. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2006

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / Este estudo faz parte de um amplo projeto de avaliaÃÃo da AssistÃncia FarmacÃutica (AF) no municÃpio de Fortaleza-Ce, desenvolvido no Curso de Mestrado em CiÃncias FarmacÃuticas da UFC, com o apoio da SMS, FUNCAP e CNPq. Diante da evidÃncia de que os gastos mundiais e brasileiros em medicamentos permanecem aumentando, gera-se uma demanda de estudos em anÃlise de gastos, que se caracteriza como um estudo FarmacoeconÃmico. O presente trabalho partiu da necessidade de se desenvolver uma anÃlise do perfil dos medicamentos distribuÃdos e dos gastos pÃblicos correspondentes, na AtenÃÃo BÃsica de SaÃde (ABS) no municÃpio de Fortaleza-CearÃ, visando contribuir para a racionalizaÃÃo dos gastos e do uso dos medicamentos. Caracteriza-se como um estudo ecolÃgico com enfoque descritivo e exploratÃrio, de carÃter quantitativo, fazendo um corte temporal no ano de 2006. Teve como objetivo geral descrever e analisar o comportamento dos gastos pÃblicos e da distribuiÃÃo dos medicamentos para a ABS, relacionados ao municÃpio de Fortaleza (CE) e Ãs suas regiÃes administrativas. Para isso, caracterizou-se o financiamento da AssistÃncia FarmacÃutica na ABS, dimensionou-se o consumo de medicamentos em DDD/1.000 habitantes/dia, segundo ClassificaÃÃo ATC (2Â, 3 e 5 nÃveis), correlacionando com gastos. Eis os principais resultados e conclusÃes alcanÃadas: cumpriu-se totalmente o repasse dos recursos per capita pactuados pela CIB referentes aos medicamentos da AssistÃncia FarmacÃutica na ABS, pelas esferas gestoras; os gastos com os medicamentos da Lista Padronizada da ABS foram de R$ 10.069.267,11; a proporÃÃo entre as despesas empenhadas para saÃde e a despesas com medicamentos foi de 1,53%; o Grupo terapÃutico que representou o maior gasto foi o Antibacterianos para uso sistÃmico; o Subgrupo terapÃutico que representou o maior gasto foi o Antibacterianos beta-lactÃmicos/penicilinas; o Captopril 25mg foi o medicamento que envolveu o maior gasto em todas as Regionais. Conclui-se, que alguns medicamentos possuem consumo e gastos maiores que a mÃdia e que à necessÃrio que medidas sejam feitas para racionalizar a utilizaÃÃo desses medicamentos e para tornar a AssistÃncia FarmacÃutica mais eficiente. / This study belongs to a great evaluating research of Pharmaceutical Assistance in the city of Fortaleza â CearÃ, developed by Federal University of CearÃ, Secretary of Public Health of Fortaleza, FUNCAP and CNPq. From the evidence that the worldÂs expenses and BrazilÂs expenses in medicines remain increasing; there is a demand of studies on expenses evaluating, it means, studies on pharmacoeconomics. The present study was originated from the necessity to develop analysis of the characteristics of the medicines distributed and their corresponding public expenses, in Basic Health Care in the city of Fortaleza, state of Cearà â Brazil, aiming for contribute to the rationing of expenses and uses of medicines. It is an ecological study, with descriptive and exploratory approach, quantitative, in the year of 2006. Its principal objective is to describe and analyse the development of the public expenses and the distribution of the medicines for the Basic Health Care, related to Fortaleza and its six administrative regions. With this finality, it was described the funding of Pharmaceutical Assistance in Basic Health Care, it was measured the consumption of medicines in âdefined diary drug (ddd)â/ 1000 inhabitants/day and classified the medicines by the âAnatomical Therapeutic Chemical Classification System (ATC) (2Â, 3 and 5 levels)â, connecting with expenses, making a comparison among the six administrative regions of Fortaleza. These are the principal results and conclusions obtained: all the per capita resources planned by CIB were transferred, those related to the medicines of PA in BHC; the expenses with medicines from the BHC Standardized List were R$ 10.069.267,11; the proportion between the expenses for Health and for medicines was 1,53%; the Therapeutical Group with the biggest expenses was the Antibactericids for sistemic use; the Therapeutical Subgroup that represented the greatest expense was the Beta-lactamic Antibactericids/Penicilinas; Captopril 25mg was the more expensive medicine in all the six administrative regions. Concluding, some medicine have consumption and expenses greater than the media indicated by other studies; initiatives are necessary to rationalize the use of those medicine and for Pharmaceutical Assistance in Fortaleza become more efficient.

Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2006.

Thesis (M.Pharm. (Pharmacy Practice))---North-West University, Potchefstroom Campus, 2008.

Thesis (M.Pharm. (Pharmacy Practice))---North-West University, Potchefstroom Campus, 2008.

For patients afflicted with symptoms of anxiety and insomnia, benzodiazepines are generally a safe and effective short-term pharmacological treatment option. Although considered safer than other sedative-hypnotic medications, substantial concern exists regarding the addictive nature and abuse potential of benzodiazepines along with potentially inappropriate prescribing and utilization in clinically vulnerable populations. These medication misadventures can have a significant impact on public health. Examples of medication misadventures as they pertain to benzodiazepines include the prescribing and use in clinically vulnerable populations for whom they are contraindicated or their efficacy has not been evaluated, the development of tolerance or addiction, abuse of the medication, and the manifestation of negative health outcomes including cognitive impairment, withdrawal symptoms upon discontinuation, or the reoccurrence of a preexisting substance use disorder. In order to better understand medication misadventures associated with benzodiazepines retrospective analyses using populations extracted from large health claims databases are employed. To understand how benzodiazepine use may lead to adverse events causing patient harm, the risk of exacerbations in benzodiazepine users diagnosed with chronic obstructive pulmonary disease was estimated. The inherent risk of benzodiazepine addiction and abuse was estimated in an HIV-infected population, a population with a high prevalence of substance use disorders. This risk was estimated by first determining whether HIV-infected individuals are more likely to have any benzodiazepine use compared to their uninfected counterparts, and secondly, by examining the association between HIV-infection and potentially problematic benzodiazepine use. Finally, in an effort to mitigate unexpected and undesirable consequences to public health associated with the prescription drug abuse epidemic in the US, states have implemented prescription drug monitoring programs (PDMPs) to track the prescribing and dispensing of controlled substance medications. The effect of these programs on benzodiazepine dispensing is evaluated on a state and national level. Findings will provide healthcare professionals a better understanding regarding the risk of medication misadventures involving benzodiazepines when evaluating their appropriateness in patients with anxiety, depression, and insomnia. Additionally, policymakers will understand the implications of PDMPs on the dispensing of benzodiazepines as they become a more widely used tool to combat prescription drug abuse and diversion.

HIV/AIDS is already the leading cause of death worldwide (Unicef et al., 2004:10) with more than 5 million people out of a total of 46 million South Africans that were HIV positive in 2004, giving a total population prevalence rate of 11 per cent (Dorrington et al., 2004:1). Many people infected do not have access to even the basic drugs needed to treat HIV-related infections and other conditions (Wikipedia, 2004:3). The relative high price of many of the antiretroviral (ARV) drugs and diagnostics on the other hand are one of the main barriers to their availability in developing countries (Unicef et al., 2004:77). ARV drugs registered in South Africa include the Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) and Protease Inhibitors (PIs) (MCC, 2004:1). The objective of this study was to review, analyse and interpret the prescribing patterns of antiviral drugs, with special reference to antiretroviral drugs, in the private health care sector in South Africa by using a medicine claims database. A quantitative, retrospective drug utilisation review was performed. The data ranging from 1 January 2001 to 31 December 2001, 1 January 2002 to 31 December 2002, and 1 January 2004 to 31 December 2004 were used, dividing each year into three four-month periods, namely January to April, May to August, and September to December. It was found that 0.38 per cent (n=1 475 380) for 2001, 0.72 per cent (n=2 076 236) for 2002, and 1.68 per cent (n=2 595 254) for 2004 of all studied prescriptions for the research periods 2001, 2002, and 2004 respectively, contained ARV drugs. ARV drugs constituted 0.33 per cent (n=2 951 326) for 2001, 0.87 per cent (n=4 042 145) for 2002, and 1.92 per cent (n=5 305 882) for 2004 of the total number of medicine items prescribed for the study years 2001, 2002 and 2004 respectively. The total cost of ARV drugs amounted to R4 990 784.29, thus constituting 1.31 per cent of the total cost (R379 708 489) of all medicine items on the database for 2001, increased to R18 235 075.75, thus constituting 3.03 per cent of the total cost (R601 350 325) of all medicine items on the database for 2002, and increased to R34 714 483.64, thus constituting 5.25 per cent of the total cost (R661 223 146) of all medicine items on the database for 2004. It was found that 35.31 per cent (n=5 599) for 2001, 52.68 per cent (n=15 004) for 2002, and 74.27 per cent (n=43 482) for 2004 of all studied antiviral prescriptions for the research periods 2001, 2002, and 2004 respectively, contained ARV drugs. ARV drugs constituted 46.25 per cent (n=21 183) for 2001, 70.20 per cent (n=50 246) for 2002, and 85.87 per cent (n=118 718) for 2004 of the total number of antiviral medicine items prescribed for the study years 2001, 2002 and 2004 respectively. The total cost of ARV medicine items, represented 67.33 per cent (n=R4 990 784.29) during 2001, 84.72 per cent (n=R18 235 075.75) during 2002, and 91.20 per cent (n=R34 714 483.64) during 2004 of the total cost of all antiviral medicine items claimed through the database (n=R7412577.73 for 2001, n=R21523365.56 for 2002, and n=R38 064 347.38 for 2004). The average cost per ARV medicine items for 2004 increased from R317.93i190.80 for the period January to April to R369.2W219.50 for the period May to August, and decreased to R324.79±212.48 for the period September to December and resulted in a cost saving of R41 044.35 for the period May to August versus September to December for the ARV medicine items. The implementation of the pricing regulations could thus be a possible reason for this cost saving, due to fact that the single exit price only came into effect from May 2004. The weighted average number of ARV medicine items per prescription was 1.75*0.31 for 2001, increased to 2.35±0.03 to 2002 and remained stable on 2.35±0.02 for 2004. It was found that majority of prescriptions contained more combination ARV medicine items than single ARV medicine items, ranging from 6 834 (69.76 per cent; n=9 796) prescriptions containing combination ARV medicine items in 2001 and 32 941 (93.39 per cent; n=35 271) prescriptions containing combination ARV medicine items in 2002 to 98 805 (96.93 per cent; n=101 938) prescriptions containing combination ARV medicine items in 2004. Lastly, it was perceived that didanosine was the active ingredient with the largest prevalence for all three four-month periods of 2001 and also for the periods January to April and May to August of 2002, whilst efavirenz represented the active ingredient with the largest prevalence for the period September to December of 2002, and also for all three four-month periods of 2004. Didanosine represented the active ingredient with the highest total cost for the period January to April of 2001, whilst the combination of lamivudine/zidovudine represented the active ingredient with the highest total cost for the periods May to August and September to December of 2001, and also for all three-four month periods of 2002 and 2004. Nelfinavir has the highest average cost for period January to April of 2001, ritonavir for period May to August of 2001, and saquinavir mesylate for period September to December of 2001. Nelfinavir has the highest average cost for all three-four month periods of 2002, while didanosine has the highest average cost for all three four-month periods of 2004. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2006