BackgroundHospital Pharmacy Departments are providing pharmaceutical care since January 2017 for institutionalised patients in nursing homes (NH) in our region in order to optimise the available resources. The purpose of the pharmacist interventions (PI) is to improve the medication appropriateness in these patients, to adapt our Hospital Medicines Formulary (HMF) and to promote the rational use of drugs.PurposeTo describe PI regarding treatment prescribed for patients in a NH and to analyse its impact according to physicians’ acceptance.Material and methodsProspective, descriptive study conducted in a 140-bed NH from January to September 2017. Prescriptions were reviewed with the NH’s physician, and introduced in our e-prescribing program (e-PP). Patient and treatment data (sex, age, therapeutic groups, doses) were retrieved from e-PP management tool (inpatients’ clinical module). The following PI were described and registered: separate drug combinations (SdC), inclusion of new dose presentation in our HMF (iDP), dosage regimen modification (DRM), inclusion of new pharmaceutical form (iPF), change in the pharmaceutical form (cPF), pharmacological substitution according to HMS (PS), pharmacological substitution including a new drug in our HMF (iPS) and withdrawal of drugs not included in the HMF considered of low therapeutic value (LTV).ResultsWe reviewed the prescriptions of 125 patients (71% males), mean age 72 years (61–95). We introduced 695 medical prescriptions in our e-PP, average number of medications per patient: 5.5 (0–16).A total of 262 PI were registered: 150 accepted, 112 rejected. Regarding most accepted PI we observed: 38% (55) iPS, 16.6% (25) iDP, 10.6% (16) PS, 10.6% (16) cPF, 10% (15) LTV and 9.3% (14) SdC. Only six PI were accepted for DRM, and one for iPF.Regarding pharmacological substitution, the most affected therapeutic groups were antihypertensives (28%), antidepressants (10.6%) and cholesterol-lowering agents (9.3%).ConclusionInstitutionalised patients in a NH are elderly and they present high prevalence of polypharmacy. The assessment of the acceptance of PI in this centre (57%) showed that the pharmacist will be a key element in offering integrated care for patients in a NH. The wide variety of antihypertensive drugs on the market leads to increasing efforts to adapt these prescriptions to our HMF.No conflict of interest

OBJECTIVES: Biologic disease-modifying anti-rheumatic drugs (bDMARDs) are a major contributor to the substantial costs associated with psoriatic arthritis (PsA), a chronic inflammatory rheumatic disease associated with psoriasis. Currently there are no cost-effectiveness analyses (CEAs) comparing the interleukin-17A antagonists ixekizumab and secukinumab in Spain. A CEA was conducted from the perspective of the Spanish National Health System to compare the cost-effectiveness of ixekizumab versus secukinumab in bDMARD-naïve patients with PsA and concomitant moderate-to-severe psoriasis. METHODS: A Markov model with a lifetime horizon and monthly cycles was developed based on the widely accepted York model. The model included four health states: induction period (12 weeks), continuous treatment, best supportive care (BSC) and death. The response criterion was a combination of Psoriatic Arthritis Response Criteria and 90% improvement in Psoriasis Area Severity Index (PASI90). At the end of the bDMARD induction period, responders transitioned to continuous treatment with the induction bDMARD. Non-responders and patients who discontinued continuous treatment transitioned to BSC. Clinical efficacy data were derived from network meta-analyses. Health utilities were generated by applying a regression analysis to PASI and Health Assessment Questionnaire scores collected in the SPIRIT studies with ixekizumab in PsA for bDMARD-naïve patients with moderate-to-severe psoriasis. Only direct medical costs were included (year of costing 2017). RESULTS: Ixekizumab was associated with incremental reductions in costs of V5,333 and comparable gains in quality-adjusted life-years (QALYs) with a difference of 0.01 in favour of ixekizumab. Deterministic and probabilistic sensitivity analyses globally confirmed the base case results. CONCLUSIONS: Yielding comparable QALY gains at lower cost, ixekizumab is cost-effective versus secukinumab in biologic-naïve PsA patients with concomitant moderate-to-severe psoriasis in Spain.

OBJECTIVES: Vaccination is an effective medical intervention to reduce death and morbidity caused by infectious diseases. The aim of the study was to analyse the dispensing patterns of vaccines in South Africa from a medical insurance scheme perspective. METHODS: A retrospective drug utilisation study was conducted on a South African medical insurance administrator database for 2017. The database contained 3 898 535 records for medicine, medical devices and procedures. All products in ATC subgroup J07 (vaccines) were extracted and analysed. RESULTS: A total of 7 254 vaccines at a cost of R1 982 238.86 were dispensed in 2017 to 4 596 patients. The average age of patients was 32.57 (SD¼21.67) years, with 65.62% male patients. Bacterial vaccines (J07B) accounted for 47.13% of the total number of vaccines dispensed (28.24% of cost), viral vaccines for 36.89% (44.02% of cost), and combined bacterial and viral vaccines for 15.98% (27.73% of cost). The Influenza vaccine (J07BB01) accounted for most of the vaccines dispensed (26.70%), followed by tetanus toxoid (J07AM01, 23.85%) and the diphtheria-pertussis-poliomyelitistetanus-hepatitis B vaccine (J07CA12, 15.00%). Three-quarters of the influenza vaccine prescriptions were dispensed during March and April 2017. The trade name vaccine that was the most commonly dispensed was TetavaxR (tetanus toxoid) single dose syringe 0.5 ml. Sixty percent of these vaccines were dispensed to patients between 30 and 49 years (mostly to male patients). The average cost claimed per vaccine was R273.26, with pneumococcus, purified polysaccharide antigen (J07AL01) on average the most expensive (R794.49). Most vaccines were dispensed by private hospitals (27.29%) and registered nurses (34.86%), with only 11.18% dispensed by pharmacies. CONCLUSIONS: The influenza vaccine was the most commonly dispensed, followed by tetanus toxoid. This is possibly due to medical scheme members being mostly the economically active sector of the population where workplace vaccination campaigns are often offered.

thymoglobulin (2.5%). This difference was significant (p=0.0875). Conclusion and relevance In our cohort of patients there was a high prevalence of NI by MDR pathogens, with K pneumoniae the most frequent. Ceftazidime was the most commonly used antibiotic as an empirical treatment, and urinary infections the most prevalent within our population. There seems to be a correlation between developing an infection by MDR pathogens and the induction immunosuppressant treatments that included basiliximab, although prospective studies with a larger sample size are needed to confirm these preliminary results. REFERENCES AND/OR ACKNOWLEDGEMENTS No conflict of interest.

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