Hyperinflation of Vasopressors (Vasopressin, Norepinephrine, Ephedrine, etc)

Quan, Ashley Thompson; Li, Fanny

doi:10.1177/0897190018770062

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…This is particularly troubling since Pakistan, which has a similar population to Indonesia, has an entire healthcare budget of approximately only $150 million for the fiscal year 2020–2021 ( 29 ). To add to this financial crisis, in the recent years, hyperinflation of vasopressor drugs has drastically occurred, with vasopressin cost in particular increasing by 60-fold in 2017 than it did in 2015 as shown by a study ( 30 ). Although healthcare costs in the United States are covered mostly by medical insurance, in majority of LMICs like Pakistan, very minimal percentage of the population has access to any form of health insurance that covers medicine costs.…”

Section: Discussionmentioning

confidence: 99%

Vasopressin in Conjunction With Norepinephrine in Septic Shock: A Retrospective Cohort Study From a Low Middle-Income Country

Raza

Arshad

Ayaz

et al. 2020

Critical Care Explorations

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Objectives: Guidelines recommend use of norepinephrine as the first-line treatment for fluid-refractory septic shock and if septic shock persists vasopressin may be initiated. Since there are limited data from low middle-income countries with high disease burden of sepsis, we aimed to compare the outcomes of using vasopressin adjunct to norepinephrine in comparison with norepinephrine alone. Design: Retrospective cohort study. Setting: Aga Khan University Hospital, Karachi, Pakistan. Patients: Six-hundred fifty-three patients diagnosed with septic shock from January 2019 to December 2019, with 498 given norepinephrine only and 155 given norepinephrine-vasopressin combination. Interventions: None. Measurements and Main Results: Primary outcome was in-hospital mortality. Secondary outcomes were duration of vasopressor used, length of hospital stay, length of ICU stay, and days on ventilatory support. After adjustment by multivariable logistic regression, it was found that mortality was not significantly associated with the norepinephrine-vasopressin combination (adjusted odds ratio, 0.633 [95% CI, 0.370–1.081]). However, Sequential Organ Failure Assessment score at admission (1.100 [1.014–1.193]), lactate at admission (1.167 [1.109–1.227]), duration of vasopressor used (1.481 [1.316–1.666]), and level of care (3.025 [1.682–5.441]) were found to be independently associated with the adjunct usage of norepinephrine and vasopressin. Conclusions: The use of norepinephrine-vasopressin combination has remained debatable in literature. Our study showed that although there was no difference in mortality between the two groups, admission Sequential Organ Failure Assessment scores and admission lactate levels were found to be significantly higher in the norepinephrine-vasopressin group. Hence, physicians from Pakistan used the norepinephrine-vasopressin combination in resistant septic shock patients who were sicker to begin with. Furthermore, duration of vasopressor therapy and ICU admission were also significantly higher in the combination group. Considering the recent hyperinflation of vasopressors costs and that most healthcare expenditure for patients in Pakistan is out-of-pocket, this can consequently lead to unwarranted financial burden for patients and their families.

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Section: Discussionmentioning

confidence: 99%

Vasopressin in Conjunction With Norepinephrine in Septic Shock: A Retrospective Cohort Study From a Low Middle-Income Country

Raza

Arshad

Ayaz

et al. 2020

Critical Care Explorations

View full text Add to dashboard Cite

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“…Over the past several years, there have been numerous examples of significant price increases affecting long-used drugs for neglected conditions. [1][2][3][4] One category of generic drugs that has seen marked price increases is anthelmintics, medications used to treat parasitic worm infections. In the United States, the prices of many prescription anthelmintic agents-which can often be acquired for a few dollars or less in many other countries-have skyrocketed in the past decade.…”

Section: Introductionmentioning

confidence: 99%

Impact of Anthelmintic Price Increases on Practice Patterns of Healthcare Providers Caring for Immigrant and Refugee Populations in the United States

Fleit

Volkman

Alpern

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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In the United States, prices of long-established, generic anthelmintic medications have markedly risen. In the past decade, albendazole and mebendazole have increased in price by > 8,000%, whereas praziquantel has increased by > 500%. To determine the effect of these price increases on the practice patterns of healthcare providers, we conducted a cross-sectional electronic survey of clinics in the United States that primarily care for immigrant and refugee patient populations. Among 32 clinics, 53.1% reported that price increases impacted how providers diagnosed and treated helminth infections. A third (34.4%) of clinics reported that price increases have left them unable to treat known helminth infections. Other ways in which price increases impacted practice patterns included prescribing anthelmintics other than albendazole, mebendazole, or praziquantel when possible (34.4%); avoiding screening asymptomatic patients for helminth infections (15.6%); advising patients to acquire medications from another country (15.6%) or the patient’s home country (9.4%); reducing anthelmintic dosing regimens to fewer pills (9.4%); and advising patients to purchase medications on the Internet (6.3%). These findings suggest price increases have negatively impacted the diagnosis and treatment of helminth infections in this population, and have resulted in the inability to treat known helminth infections. These findings have significant implications for the morbidity and mortality of infected individuals, as well as for public health in the United States.

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Cost-effectiveness of second-line vasopressors for the treatment of septic shock

Lam

Barreto

Scott

et al. 2020

Journal of Critical Care

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Hyperinflation of Vasopressors (Vasopressin, Norepinephrine, Ephedrine, etc)

Abstract: The steep increase in medications is expected to continue, and mitigation strategies to reduce waste and select the most cost effective therapy to offset the price increase is crucial for healthcare systems.

Cited by 4 publications

References 28 publications

Vasopressin in Conjunction With Norepinephrine in Septic Shock: A Retrospective Cohort Study From a Low Middle-Income Country

Vasopressin in Conjunction With Norepinephrine in Septic Shock: A Retrospective Cohort Study From a Low Middle-Income Country

Impact of Anthelmintic Price Increases on Practice Patterns of Healthcare Providers Caring for Immigrant and Refugee Populations in the United States

Cost-effectiveness of second-line vasopressors for the treatment of septic shock

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