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.

2018. Age, sex and pharmacotherapy were collected for each patient. AR was calculated using an Anticholinergic Burden web tool Calculator which includes 10 different Anticholinergic scales described in a systematic review. The scales offer final AR scores classified in three groups: low, medium and high, according to the risk categorisation made by the authors of each scale. Higher scores are associated with increased AR. RESULTS: We analysed 111 patients; mean age:73.93±8.35 years, 79.28% males. Mean prescribed drugs: 7.39±3.94. There were 16 patients (14.41%) without risk; 35 (31.53%) with medium risk and 35 (31.53%) with high risk. Twenty-five patients (22.52%) did not receive any anticholinergic drug.According to AR score, 70 patients (58.3%) were taking at least one anticholinergic drug, 39 drugs were involved.We identified 39 drugs with anticholinergic potency being the most common: alprazolam (43.6%), mirtazapine (25.6%), lorazepam (23.1%), sertraline (20.5%). Regarding ATC code, drugs from "N05 psycholeptics" group were mainly involved (30.63%); followed by "N06. Psychoanaleptics" (10.81%)and "A10. Drugs used in diabetes"(9.9%). CONCLUSIONS: A high proportion of elderly patients are at risk of anticholinergics adverse events because of their prescribed treatment. In consequence, detection of AR can be an important strategy for optimising treatment in these patients, particularly in those suffering from dementia. Pharmaceutical care in elderly nursing home enables the optimisation of pharmacotherapy, improving patient safety. REFERENCES AND/OR ACKNOWL-EDGEMENTS All staff of Geriatric-Healthcare Centre.

structural change. Since 2016, only two pharmaceuticals (both in oncology) have undergone both European JA and national assessment in Germany. This is the first time that the methodology applied in the different assessments is compared based on concrete examples. METHODS: Differences between the JA and the corresponding German assessment report were analyzed for Midostaurin in the indication of FLT3-positive acute myeloid leukemia (JA published November 2017) and Alectinib in the indication of ALK-positive advanced non-small cell lung cancer (JA published January 2018). The comparison features five key items previously identified: body of evidence, comparators, endpoints, evidence synthesis, and subgroups. RESULTS: While in Germany only RCT data with a specific comparator was accepted in each case, non-RCTs and multiple comparators were included in the JA leading to a larger body of evidence (1 study vs. 3 studies in each example). Indirect comparisons were considered only in the JAs (e.g. Alectinib vs. Ceritinib). Furthermore, some endpoints not regarded as relevant in Germany, such as progression-and disease-free survival, were presented within the JAs. The methodology used to evaluate the certainty of results differed significantly. However, there were also similarities between JA and the German assessment: both approaches follow the principles of evidence-based medicine; central endpoints were overall survival, health-related quality of life, and safety; subgroups investigated were consistent. CONCLUSIONS: The examples reviewed confirm that the outcome of European JAs and their German equivalent can be expected to differ for methodological reasons. In general, JAs offer a broader spectrum of possibilities in terms of suitable evidence and analytical methods. Nevertheless, a high degree of consensus was observed in the final evaluations suggesting a strong potential for future harmonization of the different procedures.

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BackgroundMacitentan is a new endothelin receptor antagonist (ERA) which was compared with placebo in the SERAPHIN trial. The results showed no superior efficacy or safety compared (indirectly) with other ERAs but better hepatic tolerance.PurposeTo assess adaptation of pulmonary arterial hypertension (PAH) treatment prescriptions under our hospital protocol and its economic impact, and to describe the clinical results of using a new ERA, macitentan.Material and methodsA use protocol for ERAs was established in September 2016 in our hospital, evaluating cost effectiveness as the main criterion for prescription. Thus bosentan was chosen as the first option for treatment as macitentan had not shown superiority with regard to either efficacy or safety. According to the use protocol, macitentan should be used in naïve patients with liver dysfunction or in those patients treated with bosentan who have developed treatment related hepatic toxicity. Several clinical parameters assessed PAH disease before and after treatment: functional class, baseline oxygen saturation (%SpO2) and NT-proBNP levels.ResultsAfter designing the use protocol for ERAs, 9 prescriptions for macitentan from the respiratory department were registered. 44% of patients (4/9) met the requirements of use of macitentan (increased transaminases before using bosentan). The treatment cost per month with a standard maintenance dose of bosentan 125 mg/12 hours was €414, while the treatment cost per month with a standard dose of macitentan 10 mg/24 hours was €2063. After 4 months of treatment with macitentan, patients with elevated transaminases had returned to normal levels but all patients maintained the same functional class and there were no clinically significant differences in%SpO2 or NT-proBNP (p>0.05).ConclusionIf compliance with the use protocol for ERAs had been 100%, 5 of the patients would have been treated with bosentan, leading to a cost saving of about €1649 for patient per month, a total amount of €74205 so far this year. Implementation of a consensual use protocol for ERAs could enhance the rational use of this drug, but further collaboration with physicians is needed to achieve better optimisation of available resources.No conflict of interest