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Background The burden of macro- and microvascular complications in patients with Type 2 diabetes mellitus (T2DM) is substantial in Middle East countries. The current study assessed the healthcare resource utilization (HCRU) and costs related to cardiovascular and renal complications among patients with T2DM. Methodology This non-interventional, longitudinal, retrospective, cohort study collected secondary data from three insurance claims databases across Kingdom of Saudi Arabia (KSA) of patients diagnosed with T2DM. The study included adult patients aged ≥18 years diagnosed with first cardiovascular disease (CVD) during index time period and at least one T2DM claim anytime during the study time period. The primary analyses were conducted per database, stratified by three cohorts; patients with at least one claim every six months during the 1-year pre-index and 1-year post-index period (cohort 1), patients with at least one claim every six months during the 1-year pre-index, and two years post-index period (cohort 2) and patients with at least one claim every six months during the 1-year pre-index and 3-year post-index period (cohort 3). For each Payer database, demographics, CVD subgroups, HCRU, and costs were analysed. Descriptive statistics were used to analyse the data. Results The study sample comprised of 72–78% male and 22–28% female T2DM patients with CVD and renal complications. Patients in the age group of 35–65 years or above contributed to the significant disease burden. Nearly 68 to 80% of T2DM patients developed one CVD event, and 19 to 31% of patients developed multiple CVD events during the follow-up period. For most patients with comorbid CVD and renal disease, the average HCRU cost for post‑index periods was higher compared to 1-year pre-index period across the different visit types and activities. Conclusion The study findings elucidates the need for early initiation of therapies that would reduce the long-term cardiovascular and renal outcomes and the associated costs in patients with T2DM.

Background Medications often constitute a significant percentage of health care budgets; therefore ensuring rational medication use is essential. In December 2017, the Saudi Ministry of Health (MOH) introduced a national clinical review process for nonformulary medications (NFMs) requests across 284 MOH institutions to standardize review and approval process under the governance of Pharmacy and Therapeutics Committee (PTC). Objectives This study aims to describe the effectiveness of implementing a national clinical review process for NFMs on the approval rate, decision turnaround time, and potential cost savings within MOH institutions. Methods This was a retrospective, observational cohort study undertaken over 36 months. All NFM requests were received through an electronic system, linking all the ministry's regions and departments with a single coding system. Quantitative descriptive statistics: frequency, percentage, median, and interquartile range were used to present the results of this study. A P value ≤.05 was considered statistically significant. Results The approval rate among a total of 2388 NFM requests was 1733 (74%). The median submission turnaround time for NFM requests in 2018 to 2020 were 12.5 (interquartile range [IQR]: 5‐24), 7 (IQR: 3‐15), and 7 (IQR: 4‐14) working days, respectively (P ≤ .001). The median decision turnaround time for NFM requests in 2018 to 2020 were 7 (IQR: 4‐10), 5 (IQR: 3‐9), and 5 (IQR: 4‐8) working days, respectively (P = .019). Of the 615 disapproved requests, 514 (83.6%) were disapproved for a single reason. Moreover, disapproval of requests equated to a potential cost savings which exceeded 14.8 million United States dollars. Conclusions This initial study showed that implementing a structured, systematic review process for NFM requests resulted in potential cost savings and acceptable turnaround times for nonurgent requests. However, further studies are needed to examine the actual cost savings and clinical impact on patient outcomes.

Background High rates of non-prescription dispensing of antimicrobials have led to a significant increase in the antimicrobial overuse and misuse in Saudi Arabia (SA). The objective of this study was to evaluate the antimicrobial utilization following the enforcement of a new prescription-only antimicrobial dispensing policy in the community pharmacy setting in SA. Methods Data were extracted from the IQVIA database between May 2017 and May 2019. The antimicrobial utilization rates, based on sales, defined daily dose in grams (DDD), DDD/1000 inhabitants/day (DID), and antimicrobial-claims for the pre-policy (May 2017 to April 2018) and post-policy (June 2018 to May 2019) periods were assessed. Results Overall antimicrobial utilization declined slightly (~9–10%) in the post-policy versus pre-policy period (sales, 31,334 versus 34,492 thousand units; DDD, 183,134 versus 202,936), with higher claims (~16%) after policy implementation. There was a sudden drop in the utilization rate immediately after policy enforcement; however, the values increased subsequently, closely matching the pre-policy values. Utilization patterns were similar in both periods; penicillin was the most used antimicrobial (sales: 11,648–14,700–thousand units; DDD: 71,038–91,227; DID: 2.88–3.78). For both periods, the highest dip in utilization was observed in July (sales: 1,027–1,559 thousand units; DDD: 6,194–9,399), while the highest spike was in March/October (sales: 3,346–3,884 thousand units; DDD: 22,329–19,453). Conclusion Non-prescription antimicrobial utilization reduced minimally following policy implementation in the community pharmacies across SA. Effective implementation of prescription-only regulations is necessary.