Background Albumin has been widely used in clinical practise. While some of these indications are supported by the results of randomised studies, others are based only on clinical experience and have not been proved in prospective studies. Efforts should be made to define the indications for albumin use, so that patients gain the maximum benefit from its administration. Purpose To evaluate the cost saving obtained by the implementation of a guideline for albumin use in a 737-bed hospital. Materials and Methods Retrospective study that compared albumin use in two periods: July–September 2012 vs. July–September 2011. In June 2012 the guideline for albumin use was distributed to the medical staff. Physicians were requested to complete a form for each albumin order indicating the type and amount of albumin, the clinical service, and the indication for use. Albumin use data and costs were obtained from pharmacy service management system (SAP®) and were tabulated using the Excel® software. ResultsThe total amount of albumin ordered during the study period was 29.360 g (€63,246) vs. 53.195 g (€108,617) for the same period during 2011, which means a reduction of 45%. In terms of cost, the saving obtained amounted to €45,371 (58%). The albumin use by specialty had also changed; a major decrease in use of albumin was observed for Anaesthesiology 4,000 g (75%), General Surgery 3,080 g (65%), Nephrology 4,900 g (64%), Internal Medicine 3,860 g (56%), Haematology 1,410 g (53%) and Digestive 1,400 g (30%). On the other hand, Haemodialysis significantly increased its use of albumin to 2,805 g (65%), although within the approved indication of plasmapheresis. Conclusions An albumin use guideline with restrictions focused on albumin prescriptions had suficient efficacy to reduce consumption and save cost. In our hospital guideline the cost of implementation decreased a 58% (€181,484 per year). No conflict of interest.

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BackgroundAdalimumab and ustekinumab have demonstrated high effectiveness in the treatment of moderate-severe psoriasis in randomised controlled trials. There is, however, limited data available on the comparative effectiveness of ustekinumab and adalimumab in psoriasis patients unsuccessfully treated with a first biologic line with etanercept.PurposeTo evaluate the comparative effectiveness of adalimumab and ustekinumab in patients previously treated with etanercept using PASI 90 score.Material and methodsA single-centre, retrospective, observational, comparative study was carried out from 1 November 2011 to 31 November 2015. Participants were patients with moderate-severe psoriasis that, after unsuccessful etanercept therapy, were treated with adalimumab or ustekinumab. An unblinded revision of each patient’s clinical history was carried out to assess clinical data.The primary analysis compared the percentages of patients in each treatment group who achieved ≥90% improvement from baseline PASI score (PASI 90) at week 12. Secondary endpoints included percentages of patients with PASI 90 at week 96. Statistical analysis was performed with the SPSS 22.0 software.ResultsThirty-four psoriasis patients were included in the study: 15 (44.1%) patients received adalimumab and 19 (55.9%) received ustekinumab as a second-line therapy.The median age in adalimumab and ustekinumab group were 58 (SD 6.7) and 50 years (SD 17.3) (p=0.08).After 12 weeks of study treatment, 68.4% of ustekinumab-treated patients (13/19) achieved a PASI 90 response against 46.6% (7/15) in the adalimumab group (p=0.2). At week 96, more patients had a PASI 90 in the ustekinumab group compared with the adalimumab group, but the difference was not statistically significant (68.4% versus 46.6%; p=0,2).ConclusionPreviously studies have shown that adalimumab and ustekinumab are effective after anti-TNF inhibitors’ therapy.However, to our knowledge, the present study is the first to evaluate the comparative effectiveness measured as PASI 90 of ustekinumab and adalimumab in psoriasis patients that failed with etanercetp.Our results suggests that there is no significant difference in the efficacy of ustekinumab between ustekinumab and adalidumab in the percentage of patients achieving PASI90. Of course, these results need to be evaluated with randomised and prospective clinical trials.References and/or Acknowledgements1. J Dermatolog Treat2015;26(3):217–22.2. J Eur Acad Dermatol Venereol2011;25(9):1037–40.No conflict of interest

Background The recent marketing of new high-cost antifungal agents (echinocandins and azoles) requires the design of cost-effective treatment protocols. Purpose A new treatment guide for candidaemia and other invasive fungal infections for non-haematology adult patients was approved in June 2011. The main objective was to evaluate the cost reduction by introducing this protocol in a 737-bed University Hospital serving a population of more than 400,000 inhabitants. Materials and Methods Retrospective observational study between June and December 2011. We reviewed the medical records of patients whom were prescribed antifungal treatment during that time and we assessed the adjustment to the approved treatment guidelines. To quantify the avoided costs we extracted consumption data and costs of antifungals from the pharmacy service management system (SAP®) and compared them with the same period the previous year. Results During the study 43 non-haematology patients were treated with antifungal agents. In 38 patients (88.4%) the approved treatment guidelines were followed and in 5 patients (11.6%) they were breached.The most significant breaches occurred in internal medicine (22.2%) and in critical care (3.7%). Regarding avoided costs for the six months of the study, antifungal costs were reduced by 240,616 euros. We observed a 61.9% and 48% increase in use in fluconazole and anidulafungin, and a 42.8% and 41.7% decrease in caspofungin and liposomal amphotericin B use. These results are consistent with the recommendations contained in the guide (first line use of fluconazole in non-immunosuppressed patients and in azole resistance use anidulafungin). Micafungin use was restricted to the paediatric population with consumption equal to that in the previous period. Conclusions The treatment guideline compliance was excellent at our hospital, resulting in a significant decrease in antifungal expenses. Implementation of these guidelines in the management of high-cost drugs resulted in significant cost reductions and therefore in a more rational use of healthcare budgets. No conflict of interest.

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