Cost-effectiveness of Oral Versus Intravenous Ibuprofen Therapy in Preterm Infants With Patent Ductus Arteriosus in the Neonatal Intensive Care Setting: A Cohort-based Study

Background The economic benefit of the clinical pharmacist's role in ensuring the optimum use of medicines is potentially considerable, particularly when it comes to cancer management. We sought to evaluate the overall economic impact of clinical pharmacist interventions in the main cancer setting in Qatar. Methods The total economic benefit of the clinical pharmacy interventions were analyzed from the public hospital perspective. Patient records in March 2018, July/August 2018, and January 2019 were retrospectively reviewed at the National Center for Cancer Care and Research, Qatar. The total benefit from interventions was the total cost avoidance due to preventable adverse drug events plus any cost savings associated with therapeutic-based resource use. Sensitivity analyses confirmed the results’ robustness and increased generalizability. Results A total of 1352 interventions based on 281 patients were analyzed. The majority of the drug-related problems were related to the appropriateness of therapy, followed by dosing and administration. The total population benefit over the 3-months study period was QAR 4,879,185 (USD 1,336,763), constituting cost avoidance of QAR 4,234,012 (USD 1,160,003) and negative resource-use cost savings of −QAR 645,174 (−USD 176,760). Projected annual overall benefit was QAR 14,355,354 (USD 3,932,974). The increase in resource use with therapies was mostly because of the addition of other medications. Cost avoidance was mostly driven by recommending additional medications and discontinuation of medications. The uncertainty analysis demonstrated the robustness of outcomes. Conclusions The clinical pharmacist intervention increased resource use and its cost. In overall, however, taking avoided cost of adverse drug events in consideration, it is an economically beneficial practice in the National Center for Cancer Care and Research setting, associated with adverse drug events prevention and substantial economic benefits.

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“…Sensitivity analyses assessed the study conclusion robustness against base-case value uncertainty. 20,21…”

Section: Methodsmentioning

confidence: 99%

“…Sensitivity analyses assessed the study conclusion robustness against base-case value uncertainty. 20,21 One-way sensitivity analysis was performed, with the targeted uncertain input of the cost of the ADE, using an assigned ±20% uncertainty range.…”

Section: Sensitivity Analysismentioning

confidence: 99%

Cost savings and cost avoidance with the inpatient clinical pharmacist interventions in a tertiary cancer care hospital

Abushanab

Gulied

Hamad

et al. 2023

J Oncol Pharm Pract

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“…Subsequently, the remaining articles underwent a thorough review, focusing on indications and outcomes. Finally, six RCTs ( Gokmen et al, 2011 ; Erdeve et al, 2012 ; Cherif et al, 2008 ; Edison et al, 2022 ; Dabas & Khadgawat, 2014 ; Demir et al, 2017 ) and 5 observational studies ( Abushanab et al, 2021 ; Olukman et al, 2012 ; Gover et al, 2022 ; Sancak et al, 2016 ; El-Khuffash et al, 2014 ) were included in this meta-analysis. Characteristics of these studies are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

The impact of the route of administration on the efficacy and safety of the drug therapy for patent ductus arteriosus in premature infants: a systematic review and meta-analysis

Luo,

He,

et al. 2024

PeerJ

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Background This systematic review and meta-analysis aims to explore the potential impact of the route of administration on the efficacy of therapies and occurrence of adverse events when administering medications to premature infants with patent ductus arteriosus (PDA). Method The protocol for this review has been registered with PROSPERO (CRD 42022324598). We searched relevant studies in PubMed, Embase, Cochrane, and the Web of Science databases from March 26, 1996, to January 31, 2022. Results A total of six randomized controlled trials (RCTs) and five observational studies were included for analysis, involving 630 premature neonates in total. Among these infants, 480 were in the ibuprofen group (oral vs. intravenous routes), 78 in the paracetamol group (oral vs. intravenous routes), and 72 in the ibuprofen group (rectal vs. oral routes). Our meta-analysis revealed a significant difference in the rate of PDA closure between the the initial course of oral ibuprofen and intravenous ibuprofen groups (relative risk (RR) = 1.27, 95% confidence interval (CI) [1.13–1.44]; P < 0.0001, I2 = 0%). In contrast, the meta-analysis of paracetamol administration via oral versus intravenous routes showed no significant difference in PDA closure rates (RR = 0.86, 95% CI [0.38–1.91]; P = 0.71, I2 = 76%). However, there was no statistically significant difference in the risk of adverse events or the need for surgical intervention among various drug administration methods after the complete course of drug therapy. Conclusion This meta-analysis evaluated the safety and effectiveness of different medication routes for treating PDA in premature infants. Our analysis results revealed that compared with intravenous administration, oral ibuprofen may offer certain advantages in closing PDA without increasing the risk of adverse events. Conversely, the use of paracetamol demonstrated no significant difference in PDA closure and the risk of adverse events between oral and intravenous administration.

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“…The study was conducted at the NICU in HMC. HMC is the main provider of healthcare in Qatar, which incorporates 13 hospitals and is considered one of the leading corporations providing healthcare services in the Middle East region (Abushanab et al, 2021 ). The HMC tertiary NICU setting includes a total of 120 beds and is the largest and most specialised facility in the country that provides specialised services for neonates who are often admitted within the first 24 h after birth for a variety of reasons, including premature birth, difficulties during delivery, and/or signs of problems during the first few days of life (Abushanab et al, 2021 ; Heyman et al, 2003 ).…”

Section: Methodsmentioning

confidence: 99%

“…Approximately 1.5 million preventable adverse events are reported annually in the United States, incurring a cost of approximately 3.5 billion dollars (Aspden & Aspden, 2007 ). Later studies suggest that the United States spends about 40 billion dollars per year on patients affected by medication errors and more than 21 billion dollars per year on preventable medication errors (Abushanab et al, 2021 ; Arredondo et al, 2021 ). One study found that around 45% of the adverse events were preventable and reported that although medication errors have ranged, to mention a few, from pharmaceutical labelling, route-specific problems due to challenges with medication formulation design, accessibility, and human error (Arredondo et al, 2021 ), the most serious adverse events happened during ordering the medication or while administering it.…”

Section: Introductionmentioning

confidence: 99%

Clinical pharmacists’ interventions for preventing adverse events in critically ill neonates in Qatar: an economic impact analysis

Yakti,

Al-Badriyeh,

Rijims

et al. 2024

Journal of Pharmaceutical Policy and Practice

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Objective This study aimed to assess the overall economic impact of clinical pharmacist interventions in the neonatal ICU (NICU) in Qatar. Methods A retrospective review of neonates’ records was performed over a 3-month duration in the NICU of Qatar to determine the total economic benefit of clinical pharmacist interventions. The total benefit of interventions was calculated by considering the cost avoidance due to preventable adverse drug events (ADEs) and the cost savings associated with the revised resource use due to interventions. Sensitivity analyses were conducted to ensure the robustness and generalizability of the results. Results A total of 513 interventions were analyzed, involving 150 neonates. Most of the drug-related problems were related to therapy dosing, followed by drug choice appropriateness, the addition of prophylactic treatment, and administration frequency. The overall annual benefit was estimated at QAR 4,178,352 (1,147,584), which consisted of cost avoidance of QAR 1,050,680 (USD 288,648) and an overall cost saving of QAR −6091 (USD −1673). Conclusions While the clinical pharmacist interventions led to increased resource utilisation and associated costs, when considering the avoided costs of ADEs, the overall clinical pharmacist practices in the NICU setting were economically beneficial.

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Cost-effectiveness of Oral Versus Intravenous Ibuprofen Therapy in Preterm Infants With Patent Ductus Arteriosus in the Neonatal Intensive Care Setting: A Cohort-based Study

Cited by 10 publications

References 30 publications

Cost savings and cost avoidance with the inpatient clinical pharmacist interventions in a tertiary cancer care hospital

Cost savings and cost avoidance with the inpatient clinical pharmacist interventions in a tertiary cancer care hospital

The impact of the route of administration on the efficacy and safety of the drug therapy for patent ductus arteriosus in premature infants: a systematic review and meta-analysis

Clinical pharmacists’ interventions for preventing adverse events in critically ill neonates in Qatar: an economic impact analysis

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