Economic implications of resistance to antimalarial drugs

The widespread evolution of drug resistance in malarial parasites has seriously hampered efforts to control this debilitating disease. Chloroquine, the mainstay of malaria treatment for many decades, is now proving largely ineffective in many parts of the world, particularly against the most severe form of malaria--falciparum. Alternative drugs have been developed, but they are frequently less safe and are all between 50 and 700% more expensive than chloroquine. Choice of drug clearly has important budgetary implications and national malaria control programmes need to weigh up the costs and benefits in deciding whether to change to more effective but more expensive drugs. The growth in drug resistance also has implications for the choice of diagnostic tool. Clinical diagnosis of malaria is relatively cheap, but less specific than some technological approaches. As more expensive drugs are employed, the cost of wasted treatment on suspected cases who do not in fact have malaria rises and the more worthwhile it becomes to invest in more specific diagnostic techniques. This paper presents an economic framework for analysing the various malaria drug and diagnostic tool options available. It discusses the nature of the key factors that need to be considered when making choices of malaria treatment (including treatment costs, drug resistance, the costs of treatment failure and compliance) and diagnosis (including diagnosis cost and accuracy, and the often overlooked costs associated with delayed treatment), and uses some simple equations to illustrate the impact of these on the relative cost effectiveness of the alternatives being considered. On the basis of some simplifying assumptions and illustrative calculations, it appears that in many countries more effective drugs and more specific and rapid diagnostic approaches will be worth adopting even although they imply additional expense.     

Ready or not,here it comes: Direct-to-consumer pharmacogenomic testing and its implications for community pharmacists

ObjectiveTo explore the implications of direct-to-consumer pharmacogenomic testing for community pharmacy practice.SummaryIn October 2018, the U.S. Food and Drug Administration provided approval for direct-to-consumer genetic testing company, 23andMe (Mountain View, CA), to return select pharmacogenomic test results to their customers. Given the community pharmacist’s high accessibility to the public and in-depth knowledge of pharmacology, and the availability of direct-to-consumer genetic testing kits at pharmacies, it is likely that patients will present their pharmacogenomic test results to their pharmacists and expect them to incorporate those results into their care. It is important, therefore, that community pharmacists are aware of the clinical implications of these results, know where to turn for evidence-based clinical pharmacogenomics information, and be mindful of the need for confirmatory testing before changing therapy.ConclusionCommunity pharmacists are at the frontlines of health care, and as such will be at the frontlines of direct-to-consumer pharmacogenomic testing. In the near future, it is likely that community pharmacists will need to counsel patients on the interpretation and appropriate use of direct-to-consumer pharmacogenomic test results.     

住院癌症患者使用麻醉性镇痛药品处方分析

目的：了解本院住院癌症患者麻醉性镇痛药品的使用情况,分析该类药物的用药合理性。方法：统计本院2008年1月～2009年12月住院癌症患者麻醉性镇痛药品处方,了解常用药品及其用法、用量等,并根据世界卫生组织（WHO）推荐的限定日剂量（DDD）值,计算药物的使用频度（DDDs）。结果：收集处方共936张,使用麻醉性镇痛药品共5种,药物的使用频度排在前3位的分别是：硫酸吗啡缓释片、芬太尼注射液、盐酸吗啡注射液。结论：本院住院癌症患者麻醉性镇痛药品用药结构基本合理,并且临床医师把硫酸吗啡缓释片作为癌痛治疗的首选药。     

FDA处方药广告监管方式研究

文中运用比较研究法,通过介绍FDA处方药广告监管的发展历程,处方药广告的监管部门、资金来源、处方药广告类型及监管重点,FDA不良广告计划,总结其经验教训,从而为我国药品广告监管方式的完善提供参考,如采取合理利用药品广告监管资源、确保药品广告信息易于理解、提高医药师及公众对药品广告的认识等措施来加强对药品广告的监管。     

专项处方点评对我院门急诊氟喹诺酮类药物使用的影响分析

目的调查专项处方点评前后门急诊处方氟喹诺酮类药物的使用情况,为临床合理用药及管理提供理论依据。方法调取该院2011年6月和9月含有氟喹诺酮类药物的门急诊处方,分析处方中氟喹诺酮类药物在有无适应症、联合用药、用药金额、用药科室与疾病、不良反应等方面的应用情况。结果专项处方点评后氟喹诺酮类处方占比降低,联合用药处方比例下降,不规范处方数、不良反应显著下降。结论专项处方点评使该院的门急诊处方中氟喹诺酮类抗菌药的临床应用更加合理规范。