Jul-Sep, 2012 - Indian Journal of Pharmacy Practice

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Stejin J - Pharmacoeconomic Analysis of Asthma in Pediatric Patients in Tertiary Care Hospital in Keralaal, showed that salbutamol was more cost effective than9formeterol because of its lower acquisition cost. Our studyalso revealed that salbutamol was the most commonlyprescribed drug for pediatric asthma.Krahn et al, showed that increase use of more expensivecombination inhalers have likely contributed to the rising10costs of asthma medications in recent years. Smith et al.,showed that recent data suggest that inhaled beta agonists are11the most frequently used medication , it is expected that thetherapy patterns have shifted towards greater use of inhaledcorticosteroids. This study shows that drugs cost makesapproximately 37% of total direct cost of asthma, andrepresents the major cost for mild-to-moderate asthmaticpatients. More aggressive therapy with inhaledcorticosteroids, inhaled bronchodilators and new therapiessuch as leukotrine antagonist may cause shifting of highmedication cost. Hospital cost is mainly incurred by patientswith moderate to severe asthma, and hospitalization usuallyoccurs when the management of asthma failed to prevent anacute attack, which is expensive to rectify. This study showsthat the cost of one admission to hospital pays for 3 years oftreatment with the inhaled corticosteroids.This study alsoshows that children accounted for a high percentage ofindirect cost, reflecting the importance of time spent by othersto care for children. Our study also reported that indirect costaccounts for almost 12% of the total direct cost of asthma.Indirect cost depends on the patient age and severity ofdisease. The costs of asthma for patient with moderate diseasewere almost twice as high as for mild asthmatic patients. Themean cost consumption was found to be high in severeasthma. This study shows that there is a relationship betweenseverity of disease and increases in both the direct and indirectcost of asthma. This study concluded that as the severityincreases the mean consumption cost of asthma alsoincreased. Mean consumption cost for severe asthma wasfound to be almost thrice as compared to moderate asthma.The drug cost and hospitalization cost was found to be high.The differences in the drug cost between patients with mildand severe asthma were probably because of inhalation drugs.CONCLUSIONThis study revealed the burden of direct cost on the patient'sfamily and on society. For a disease for which effectiveprophylactic therapies exist, much of the cost of asthmarelates to cost which could be avoided or reduced byimproved disease control. Indirect cost is incurred when thedisease is not fully controlled. Direct costs, are amendable toreduction by improved disease control. Study revealed thatthe asthma hospitalization can be decreased as inhalationtherapy use increased. Inhalation drugs can be usedindividually by the patients at home, so the travelling cost, GPvisit cost can be minimized and as a result hospitalization canalso be reduced. Patient education programs showedreduction in hospitalizations, GP visits, emergencyadmissions, and time of work and school and the monetarysavings have always been reported. It is necessary toemphasize the importance of appropriate management of thedisease, with the use of effective continued treatment inaccordance with the level of severity. The patients withmoderate asthma can be treated with monotherpy and in caseof severe disease the combination therapy is required. Thisapproach would probably improve patients quality of life,decreases the number and severity of attacks, and minimizethe cost of asthma.ACKNOWLEDGMENTSThe authors would like to thank Dr.S.Sabarinath, Medicalsuperintendent of the hospital for the help during theconceptual preparation of this study and the guide whohelped in various stages of data collection.REFERENCE1. Sennhauser FH, Braun-Fahrländer C, Wildhaber JH. Theburden of asthma in children: a European perspective. PaediatrRespir Rev 2005; 6(1):2-7.2. Barnes P J, Jonsson B, Klim J B. The costs of asthma. EurRespir J 1996; 9:636–42.3. Freund D, Dittus R. Principles of Pharmacoeconomic Analysisof Drug Therapy. PharmacoEconomics 1992; 1(1):20–31.4. Glynn D. Reimbursement for New Health Technologies:Breakthrough Pharmaceuticals as a 20th Century Challenge.Pharmacoeconomics 2000; 18 (S1):59–67.5. Wilson E A. De-Mystifying Pharmacoeconomics. Drug BenefitTrends 1999; 11(5):56–58, 61–62, 67.6. Belien P. Healthcare systems, A New European Model?.PharmacoEconomics 2000; 18(S1):85–93.7. Weiss K B, Sullivan S D. Understanding the costs of asthma:the next step. CMAJ 1996; 154:841-3.8. Fleisher B, Kulovich M V, Hallman M, Gluck L. Lung profile: sexdifferences in normal pregnancy. Obstet Gynecol 1985;66(3):327-30.9. Sculpher Mark J, Buxton Martin J. The Episode-Free Day as aComposite Measure of Effectiveness: An Illustrative EconomicEvaluation of Formoterol Versus Salbutamol in AsthmaTherapy. Pharmacoeconomics 1993; 4(5):345-52.10. Krahn M D, Berka C, Langlois P and Detsky A S. Direct andindirect costs of asthma in Canada, 1990. Canadian MedicalAssociation Journal 1996;154(6):821-31.11. David HS, Daniel CM, Kenneth AL, Lynn JO, Carmelina B,William BS. A National Estimate of the Economic Costs ofAsthma. Am J Respir Crit Care Med 1997; 156:787–93.Indian Journal of Pharmacy Practice Volume 5 Issue 3 Jul - Sep, 2012 29
Indian Journal of Pharmacy PracticeAssociation of Pharmaceutical Teachers of IndiaA Retrospective Evaluation of the use of Thiazolidinediones in Patients with Diabetes Mellitus ina Private Hospital in Ras Al Khaimah.1 2 3 4Smitha F* , Padma R , Multani SK and Meenakshi J1, 2 Department of Pharmacy Practice, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah,UAE.3Endocrinologist, Al Zahrawi Hospital. Ras Al Khaimah, UAE.4Department of Pathology, RAK College of Medical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE.A B S T R A C TSubmitted: 24/07/2012Accepted: 14/08/2012Diabetes Mellitus is a major public health problem affecting around 800,000 people of United Arab Emirates (about 19.2 per cent of thethpopulation). Thus the country is ranked as the 10 worldwide in terms of highest prevalence rate as per the latest reports of the InternationalDiabetes Federation. Thiazolidinediones (Rosiglitazone and Pioglitazone) are a group of antidiabetic drugs which are commonly used in UnitedArab Emirates among diabetic patients. There are reports about the cardiovascular risks and hepatotoxic effects of thiazolidinediones. Hence thepresent study was undertaken. The aim of the study was to determine the incidence of thiazolidinedione usage, its adverse drug reactions,efficacy and safety in diabetic patients. The present study was undertaken after the approval of the Research and Ethics Committee of RAKMedical and Health Sciences University. This was a retrospective study conducted in the outpatient clinic of the Department of Endocrinology andDiabetes of a private hospital in Ras Al Khaimah, United Arab Emirates, between January to December 2008. The required data was collectedfrom the selected patients and entered into specific patient proforma. The data was analyzed for the following parameters like incidence of usageof thiazolidinediones, its efficacy and adverse drug reactions. A total of 143 patients with diabetes were enrolled in the study, out of which 54patients were on Thiazolidinediones- 48 on Rosiglitazone and 6 on Pioglitazone- in the beginning of the study. At the end, 73 patients were onRosiglitazone and 17 were on Pioglitazone. The most commonly observed adverse effect was pedal edema. No cardiovascular risks wereobserved in any of the patients who were on either Rosiglitazone or Pioglitazone. Though there are reports of cardiovascular risks withThiazolidinediones, throughout our study, none of the patients reported any cardiovascular risk.Keywords: Diabetes Mellitus, Thiazolidinediones, Adverse drug reactions, Utilization evaluation.INTRODUCTIONDiabetes mellitus is the most common of the endocrinedisorders. It is a chronic condition, characterized byhyperglycemia due to impaired insulin secretion with or1without insulin resistance . It is being recognized as a globalepidemic, with the potential to cause a worldwide healthcarecrisis. It is estimated that currently diabetes affects some 200million people worldwide. According to estimates by theInternational Diabetes Federation, this figure is set to increase2to 333 million by the year 2025 .3Diabetes is a major public health problem in UAE . Surveysreleased by the International Diabetic Federation (IDF) in theyear 2011, showed that 19.2 % or 800,000 -people in theUAE live with diabetes leading to UAE being ranked as theAddress for Correspondence:Smitha C Francis, Department of Pharmacy Practice, RAK College ofPharmaceutical Sciences, RAK Medical and Health Sciences University,P O Box11172 Ras Al Khaimah, UAE.E-Mail: smithafrancis2003@yahoo.co.inth10 worldwide in terms of highest prevalence rate. It has beenreported that 17.9% nationals and 13.4% expatriates are4affected with this condition in UAE .Type 2 diabetes patients, due to their progressive beta cellfunction and increasing insulin resistance usually require twoor three drugs to maintain control before ultimately requiringinsulin. Thiazolidinediones (TZDs) have established a5significant role in Type 2 diabetes mellitus therapy . They areknown to increase insulin sensitivity by stimulatingPeroxisome Proliferator Activated Receptor Gamma (PPARγ).Currently only one glitazone, i.e. pioglitazone is availablein the UAE market following the removal of rosiglitazone in62010 .There have been several studies reporting the cardiovascular7, 8risks associated with thiazolidinediones .Studies related to these are lacking in the UAE population.More studies are required to know the adverse effects of thesemedications for a proper and safe usage as these arefrequently prescribed to patients. Hence, the present studywas undertaken.Indian Journal of Pharmacy Practice Volume 5 Issue 3 Jul - Sep, 2012 30
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