BACKGROUNDPromising clinical and humanistic outcomes are associated with the use of new oral agents in the treatment of relapsing-remitting multiple sclerosis (RRMS). This is the first cost-effectiveness study comparing these medications in Saudi Arabia.OBJECTIVESWe aimed to compare the cost-effectiveness of fingolimod, teriflunomide, dimethyl fumarate, and interferon (IFN)-β1a products (Avonex and Rebif) as first-line therapies in the treatment of patients with RRMS from a Saudi payer perspective.DESIGNCohort Simulation Model (Markov Model).SETTINGTertiary care hospital.METHODSA hypothetical cohort of 1000 RRMS Saudi patients was assumed to enter a Markov model model with a time horizon of 20 years and an annual cycle length. The model was developed based on an expanded disability status scale (EDSS) to evaluate the cost-effectiveness of the five disease-modifying drugs (DMDs) from a healthcare system perspective. Data on EDSS progression and relapse rates were obtained from the literature; cost data were obtained from King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Results were expressed as incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMB) in Saudi Riyals and converted to equivalent $US. The base-case willingness-to-pay (WTP) threshold was assumed to be $100 000 (SAR375 000). One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to test the robustness of the model.MAIN OUTCOME MEASURESICERs and NMB.RESULTSThe base-case analysis results showed Rebif as the optimal therapy at a WTP threshold of $100 000. Avonex had the lowest ICER value of $337 282/QALY when compared to Rebif. One-way sensitivity analysis demonstrated that the results were sensitive to utility weights of health state three and four and the cost of Rebif.CONCLUSIONNone of the DMDs were found to be cost-effective in the treatment of RRMS at a WTP threshold of $100 000 in this analysis. The DMDs would only be cost-effective at a WTP above $300 000.LIMITATIONSThe current analysis did not reflect the Saudi population preference in valuation of health states and did not consider the societal perspective in terms of cost.

BackgroundThe aim of the study was to evaluate the simplicity, safety, patients’ preference, and convenience of the administration of insulin using the pen device versus the conventional vial/syringe in patients with diabetes.MethodsThis observational study was conducted in multiple community pharmacies in Lebanon. The investigators interviewed patients with diabetes using an insulin pen or conventional vial/syringe. A total of 74 questionnaires were filled over a period of 6 months. Answers were entered into the Statistical Package for Social Sciences (SPSS) software and Excel spreadsheet. t-test, logistic regression analysis, and correlation analysis were used in order to analyze the results.ResultsA higher percentage of patients from the insulin pen users group (95.2%) found the method easy to use as compared to only 46.7% of the insulin conventional users group (P 0.001, relative risk [RR]: 2.041, 95% confidence interval [CI]: 1.178–3.535). Moreover, 61.9% and 26.7% of pen users and conventional users, respectively, could read the scale easily (P 0.037, RR 2.321, 95% CI: 0.940–5.731), while 85.7% of pen users found it more convenient shifting to pen and 86.7% of the conventional users would want to shift to pen if it had the same cost. Pain perception was statistically different between the groups. A much higher percentage (76.2%) of pen users showed no pain during injection compared to only 26.7% of conventional users (P 0.003, RR 2.857, 95% CI: 1.194–6.838).ConclusionThe insulin pen was significantly much easier to use and less painful than the conventional vial/syringe. Proper education on the methods of administration/storage and disposal of needles/syringes is needed in both groups.

Therapeutic duplication alert is one of the Clinical Decision Support Systems (CDSS) that was implemented to help physicians and other healthcare providers in making clinical judgements about the patients' management of therapy and decreasing medication errors. However, there were high override rates of these alerts by physicians as they were deemed to be of non-clinical significance. The quantity of the alerts fired by the system was high leading to "alert fatigue". Thus, the hospital administrators reached an agreement to deactivate it. To assess the validity of this decision, the aim of the study was to analyze the impact of therapeutic duplication alert deactivation on medication errors' rate. This study retrospectively screened a total of 593 electronic Medication Administration Records (e-MAR) of hospitalized patients with 297 e-MARs in the pre-therapeutic duplication alert deactivation period and 296 e-MARs in the post-therapeutic duplication alert deactivation period in a tertiary care hospital in Saudi Arabia. The number and type of duplicate medication errors in each period was documented to determine whether there was a significant difference between the two periods. The results detected 51 out of 297 e-MARs with medication errors in the pre-therapeutic duplication alert deactivation period versus 47 out of 296 in the post alert deactivation therapeutic duplication. Chi square test showed that there was no significant difference in the incidence of medication errors detected among the two periods with a p-value of 0.672. Therefore, we concluded that there was no significant difference on the medication error after the therapeutic duplication alert deactivation. An integration of machine learning into the clinical decision support design was recommended to filter the duplicated and unimportant alerts and reduce the alert fatigue of physicians.