maryam rangchian

Drug use evaluation (DUE) helps to investigate and modify the pattern of drug administration with the aim of improving patient care and cost saving. Considering the important indications for intravenous immunoglobulin (IVIG) and its high cost, assessment of its prescription pattern could be helpful in increasing the efficiency of the health system.This study aimed to investigate the pattern of IVIG use in a tertiary teaching hospital.

This retrospective study included all inpatients who received IVIG in spring and summer 2020. The needed information was extracted from patients’ files. Data were analyzed using SPSS and compared with the standard guidelines.

A total of 72 patients received IVIG. The indications were “FDA-approved” and “CEDITacknowledged” in 33.3% and 61.1% of the cases, respectively, and 45.8% adhered to the “red” indications of the UK protocol. Moreover, all prescriptions were in accordance with the approved indications of the FDO (Iranian Food and Drug Organization) guideline. Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy, and COVID-19 were the three most common causes of IVIG administration. Additionally, 66.7% had received the recommended dose regimen and 51.3% experienced drug side effects requiring some measures.

The occurrence of adverse drug reactions in more than half of the studied patients and related costs substantiate the need for enhancing physicians’ refrain from the unnecessary prescription of the IVIG, nursing staff’s knowledge, and the inclusion of a clinical pharmacist in the healthcare team.

Drug utilization evaluation (DUE) was performed to assess using drugs with special conditions such as antibiotics. Vancomycin is one of the essential antibiotics that is effective on methicillin-resistant Staphylococcus aureus, but unreasonable use of vancomycin, in addition to cost, leads to outbreak microbial resistance, which is a concern for health care systems all around the world. The aim of this study was to evaluate vancomycin use in teaching hospitals in Hamedan, Iran.

This retrospective study was performed on patients who received vancomycin for at least 72 hours in intensive care units and infectious wards between April and September 2020 in the teaching hospitals of Hamedan. Data were obtained from patients’ medical records and entered into predesigned checklists.

From 661 patients, 441 were males and 247 were females. They received vancomycin for an average of 5.75 days. The most prevalent indication for vancomycin use was surgery. Only 40 patients had sensitive microbial culture to vancomycin, while 356 of them (53.9%) had no microbial culture at all. According to HICPAC guidelines, the overall appropriate use of vancomycin was 44.8%.

According to the results, the irrational use of vancomycin must be corrected to achieve maximum optimal use; thus, performing and adhering to microbial culture, deploying clinical pharmacists, and holding explanatory sessions for health care are recommended for this purpose.

This cross-sectional descriptive study aimed to evaluate older adults or their caregivers’ attitudes and preferences toward ease of use and compliance of various dosage forms and to improve medication consumption in the elderly population.

This research was conducted in 2021 using a validated questionnaire asking respondents about problems experienced through consuming various dosage forms, preferences regarding dosage forms and frequency, and demographics. The content validity index and content validity ratio were used in the validation evaluation.

The incorrect medication in the elderly is mainly the result of forgetfulness. In addition, poor compliance was partly related to difficulty dividing tablets, large-sized drugs, and undesirable taste. Most elders preferred swelling pills and oral routes of administration. They further preferred to take fewer drugs in less-divided doses, just after a meal, at noon, or at bedtime. The child resistance packaging is unsuitable for them, and the blister or container with screw caps is preferred, and they adhere more to a medication when they are younger and more educated without relevance to gender or with whom they live.

Our findings revealed that the formulation and administration of drugs according to elder preferences could improve their adherence to the medication.

Internal reference pricing (IRP) is one of the pharmaceutical pricing approaches, which is widely favored by health policymakers in different countries as a cost-containment tool for managing medicine expenditure. Evidence related to the implementation of this method confirms its usefulness in reducing pharmaceutical costs. Accordingly, the purpose of this study was to calculate potential changes in pharmaceutical expenditure using the IRP method for products belonging to three pharmaceutical categories in the pharmaceutical system of Iran.

This routine data study assessed the potential effect of IRP in three pharmaceutical categories including statins, non-steroidal anti-inflammatory drugs, and proton pump inhibitors (PPIs). Two scenarios for reference groups (levels 4 and 5 of the ATC code) and four scenarios for the reference price (i.e., the minimum, median, mean, and the mean of three minimum prices in the reference group) were considered in this regard, and the price and sales data source was the report published by the Iranian Food and Drug Administration. Then, cost changes were calculated with each hypothetical scenario. It was assumed that other intervening factors remain unchanged, including consumers and prescribers’ behavior.

Based on the results, the two largest potential saving effects belonged to the minimum price scenario and the mean of the scenario of the three minimum prices, respectively. However, the results showed that the consequence of using a price scenario other than the minimum price as the reference price is highly related to the details of the distribution of prices in the related reference group. In addition, appropriate decisions regarding outlier products (e.g., imported products) might have extremely important effects on the result, especially for the mean price scenario. The minimum price scenario concomitant with a premium for superior products can also be considered, but part of it is outside the scope of this study and requires independent research.

Thus if an appropriate scenario is selected for the reference price and group, the IRP method has the potential to reduce the costs of medicines. Therefore, pharmaceutical policymakers must pay enough attention to the details of planning this system and the needed procedure for updating the details of this system.

Prostate cancer (PCa) is the third most diagnosed cancer among men in Iran with approximately 4200 new cases in 2015. Considering the rapid growth of cancer diagnosis, this study aims to investigate the economic burden of PCa patients and their health-related quality of life (HRQoL) A retrospective survey was conducted on 500 registered patients to discover the pattern of care and distribution of patients in the main treatment categories. In the next step, a multi-center survey of the patients under treatment was conducted. The objective of this survey was to estimate direct medical costs (DMC), non-medical costs, and productivity losses for patients and family members. HRQoL was measured by the Functional Assessment of Cancer Therapy–Prostate questionnaire. Despite high age of patients (72±9.25 years), only 53.3% of them were retired or disabled. The largest proportion of patients (54.3%) received medicinal or surgical hormone therapy. Radical prostatectomy was the main treatment for 31.7% of patients, 10.2% received radiation therapy, and 3.8% underwent chemotherapy. DMC for incident population was approximately 12.5 million US dollars/year, and the highest average cost per capita belonged to chemotherapy patients. Unpredictably, productivity loss was nearly as much as direct cost. The mean score for HRQoL was 0.62±0.16 for all patients. Orchiectomy group had the lowest HRQoL score (0.55±0.16). Chemotherapy patients suffered the worst scores in the physical well-being subscale (0.47±0.24). Hormone therapy patients had the least scores in the prostate-specific subscale (0.50±0.18). The economic burden of PCa is estimated approximately 25.8 million US dollars per year for incident population. When we refer to the high proportion of patients diagnosed in advanced state of the disease and higher per capita cost for these patients, policy makers should promote screening strategies to control health care costs and to increase both life expectancy and HRQoL.