No abstract

137) of the cases returned negative results, 32% (44) of these patients were irrationally prescribed with anti-malarial drugs sans confirmed diagnosis with injectable artesunate (61%) and chloroquine (32%) for an average of 4 days resulting in 41% overdoses and 38% under doses. Direct cost associated was estimated to be USD 1,167.71. Female bedridden patients with fever and chills ≤ 3 days with normal hematological parameters, liver and renal function tests were more likely prescribed with anti-malarials. These patients had fewer co-morbidities, lower mortality, longer survival rate and longer hospitalization (p< 0.05). ConClusions: Through geriatric pharmaceutical care services, clinical pharmacist can reduce inappropriate prescribing and prevent possible adverse effects without hampering the health related quality of life.objeCtives: Nausea and Vomiting of Pregnancy (NVP) is the most common condition, which affecting up to 80% of all pregnant women to some degree. Serious form of NVP (hyperemesis gravidarum) affects less than 1% of women, but it can be requiring hospitalization and rehydration. Severe NVP have a high prevalence (80% worldwide) and reduce the quality of life, productivity, develop depression.In Ukraine the statistic data about number of NVP are not currently conducted. Methods: Data analysis about effectiveness of drugs for the prevention and treatment of NVP. Sources of information were databases Cochrane, PubMed and publications in Ukrainian medical journals. Results: Currently MoH doesn't collects official statistics on the NVP. Also the medical protocol for NVP treatment in pregnant women is not approved. The analysis showed that some medicines are not registered in Ukraine, that are included in the European recommendations for the NVP treatment. For the treatment of NVP a combination of antihistamines and vitamin B6 often used, but these drugs are absent in Ukraine. In Ukrainian market is registered only one dietary supplement that contains a combination of Gingeng extract and vitamin B6. We analyzed the costs for treatment of NVP per one week by antiemetic drugs from different producers. In Ukraine the costs for NVP treatment range from 8249,0 UAH (293 EUR) to 149,1 UAH (5290 EUR) per 100 woman/week (1 EUR = 28,20 UAH on 01.06.2016). At present, these costs are financed out of pocket by patient, having a significant impact on quality of life and outcomes. ConClusions: We have established that it is necessary to introduce the official statistics of NVP, especially with hyperemesis gravidarum in pregnant. We determined that combined drugs for the NVP treatment are necessary for market access. Also the state should finance these medications for pregnant women to improve their quality of life and reducing the cost of hospitalization.objeCtives: Unintended pregnancy promotes a negative social impact worldwide and it represents a significant economic burden to the health system. According to a Brazilian study the total medical costs of an UP for SUS was estimated at BRL4.1 billion annually. Adol...

OBJECTIVES: Analyses of real world data are widely used in pharmaceutical research. Retrospective analysis was used to support the design of the 5-years Insights to Model Alzheimer's Progression in real life study (iMAP) that studies the clinical meaningfulness of early changes in cognitive test scores (Alzheimer's Prevention Initiative Cognitive Composite (APCC), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Clinical Dementia Rating Sum of Boxes (CDR-SB)) through all stages of Alzheimer disease (AD). METHODS: To determine sample sizes, we sampled from observational cohort studies. The inclusion/exclusion criteria of iMAP study were applied to mimic the study population. A set of simulations was conducted for each of the iMAP cohorts, respectively (unimpaired participants, mild cognitive impairment (MCI), and dementia due to AD). The whole records of subjects were sampled from databases to preserve the correlation among the variables. Required sample size was determined when the regression coefficient for change from baseline to year 1 in APCC or CDR-SB was significantly different from zero (corresponding 99% confidence intervals (CI) do not include 0). RESULTS: For the cohort of unimpaired participants, a Cox model was used. The sample size of 300 participants was sufficient to achieve non-zero 99% CI of APCC change. For the MCI cohort, the linear regression model was implemented. A sample size of 120 participants was sufficient to achieve a non-zero 99% CI of APCC change. For the dementia cohort, a Cox model was used. A sample size of 140 participants was sufficient to achieve a non-zero 99% CI of CDR-SB change. To account for additional uncertainty and potential higher variability, additional discounts were introduced. CONCLUSIONS: Complex prospective studies require careful planning with estimation of optimal number of participants. Patient-level simulations of study populations by sampling from existing real world datasets were successfully used to inform the study design. 1 Children's psychoneurological treatment-reabilitatsionny center "Hope", Tyumen, Russian Federation, 2 Restorative traumatology and orthopedics, the Russian Research Center. Academician G.A. Ilizarov, Kurgan, Russian Federation, 3 Tyumen State Medical University, Tyumen, Russian Federation OBJECTIVES: conduct a comparative economic analysis of the comprehensive rehabilitation with and without abobotulinumtoxinA injections in children with cerebral palsy (CP). METHODS: 149 children with spastic CP (GMFCS II-IV): 78 boys and 71 girls aged 2-14 years (108 children received abobotulinumtoxinA injections and 41 children received similar comprehensive treatment without injections) were followed up. When conducting an economic analysis, the prime direct costs were taken into account: the cost of BTA injections, the cost of rehabilitation care and the cost of surgical intervention. RESULTS: Children with cerebral palsy in the study group needed a primary surgical correction at the age of 10.5 ± 2.8 years, 4.6% (5 ...

As patients advance through the model, their BMD progresses and they are at risk of fracture (hip, vertebral, other) and of death. BMD changes, fracture risks and mortality were all based on the Dubbo Osteoporosis Epidemiology Study (DOES). Utility values were based on the patients fracture status. Evidence for the efficacy of alendronate in the prevention of fracture was the clinical fracture arm of the Fracture Intervention Trial (FIT). RESULTS: The incremental cost per QALY of broadening access to alendronate compared with current practice was $34,808 (incremental costs of $783 per patient with 0.0225 QALYs gained). Broadening access to alendronate resulted in fewer fracture-related deaths (301 per 100,000 population), hip fractures (904), vertebral fractures (259) and other fractures (1098). CONCLUSIONS: Broadening primary prevention treatment of osteoporotic fracture with alendronate to individuals aged Ն70 years with BMD T-scores Յ -2.5 will prevent fractures and save lives at good value-for-money. OBJECTIVES:Increasing real-life adherence to bisphosphonates therapy is important to achieve the clinical benefits of reducing fractures reported in randomized clinical trials (RCTs). The aim of this pharmacoeconomic analysis was to determine the cost-effectiveness of a pharmaceutical care intervention program in community pharmacies, aimed to increase bisphosphonates adherence for the prevention of osteoporotic fractures. METHODS: A decision analytical model was constructed with a time horizon of three years, discounting at 4.0% and 1.5% annually for costs and effects, respectively. A Dutch healthcare provider's perspective was adopted. Adherence and efficacy data were gathered from a Dutch pharmaceutical care program in community pharmacies (the MeMO intervention). The association between bisphosphonate adherence and osteoporotic fractures was modelled using Dutch clinical studies. Recent and upcoming reimbursement policy changes in The Netherlands were modelled with a scenario of therapeutic substitution, characterized by drastically lower drug prices. RESULTS: Adherence to bisphosphonates therapy in The Netherlands was 68.3%. The pharmaceutical care intervention program increased bisphosphonates adherence to 83.9% (PϽ0.001). If the intervention program would be introduced nationwide in community pharmacies, 337 osteoporotic fractures would be prevented and 47 quality-adjusted life years (QALYs) would be gained. Additional medication and intervention costs were €1,738,000; the cost-savings due to reduced fractures were €998,000. The cost-effectiveness of the pharmaceutical care intervention was €16,000 per QALY. When drug prices decline following therapeutic substitution policies, the intervention will be cost-saving. CONCLUSIONS: Pharmaceutical care programs in community pharmacies, such as the MeMO intervention, can improve bisphosphonate adherence, resulting in a considerable number of osteoporotic fractures being prevented. Therapeutic substitution policies that lower drug prices will increase the costeff...

fracture, vertebral fracture, breast cancer, colorectal cancer, ovarian cancer, coronary heart disease, stroke and venous thromboembolic events. Health states were mutually exclusive. Women were followed through a VMS phase and an additional post-VMS phase in order to assess the treatment effects on the LTEs, representing a life-time horizon. Women were assumed to experience VMS and receive treatment for 4 years, additionally, onset of vaginal bleeding or any LTE resulted in treatment discontinuation. The model utilized data for treatment effects (estimated via network meta-analyses), risks, mortality, quality of life (QoL -using EQ5D estimates) and costs, which were identified from a literature review. The main outcome was cost per QALY. Results: Results showed that CE/BZA lead to a gain in QALYs but was associated with higher total costs, resulting in a cost per QALY of $12,949 and $26,066 when compared with CE/MPA and no treatment, respectively. Driven by fewer bleeding events, women on CE/BZA received treatment for a longer duration than women receiving CE/MPA. The LTEs impacted results modestly. Uncertainty analyses indicated that results were robust to changes in key assumptions and input data, however results were most sensitive to changes in QoL associated with VMS and vaginal bleeding. ConClusions: CE/BZA is considered cost-effective for the treatment of VMS in postmenopausal women when compared with either CE/MPA or no treatment in the United States.