Het Nederlands Platform voor Farmaceutisch Onderzoek (NPFO) presenteert onderzoek in de farmaceutische wetenschappen. De nadruk ligt op klinische toepassing zoals medicatieveiligheid, patiëntenzorg, formulering, analyse, farmacologie en casuïstiek.
Developments in pharmacoeconomic research from a historical perspective
BACKGROUND
Economic evaluations in healthcare are continuously being developed and increasingly applied. Health technology assessments provide insights into the health benefits of medical interventions compared to the treatment costs.
OBJECTIVE and DESIGN
This article gives an overview of historical, current and future developments in health economics, with a broader perspective on control of healthcare costs in the Netherlands.
RESULTS
At national level, pharmacoeconomics play a major role when reimbursement is requested for a medical intervention. Pharmacoeconomic outcomes are increasingly used for price negotiations to arrive at a cost-effective price for the Netherlands. New trends are introductions to the market with market access agreements, the inclusion of real world evidence and the exploration of realizing reimbursement of medicines at European level instead of per country.
CONCLUSION
Economic evaluations in healthcare provide insights into costs, savings and health effects of new treatments, and are performed in line with strict national and international requirements. The Dutch government applies these evaluations when deciding on the reimbursement of medical interventions. The aim of the government is to gain maximum health benefits for society within the total healthcare budget.
Cost effectiveness of gastroprotection with proton pump inhibitors in older low-dose acetylsalicylic acid users in the Netherlands
OBJECTIVE
The present study aimed to assess the cost-effectiveness of concomitant proton pump inhibitor (PPI) treatment in low dose acetylsalicylic acid (LDASA) users at risk of upper gastrointestinal (UGI) side effects as compared to no PPI co-medication with attention to the age-dependent influence of PPI-induced side effects.
DESIGN and METHODS
A Markov model was developed to compare the strategy of PPI co-medication to no PPI in older LDASA users at risk of UGI side effects. As PPIs reduce the risk of UGI bleeding and dyspepsia, these risk factors were modelled together with PPI side effects for 60-69, 70-79 (base case) and 80 years and older LDASA users. Incremental cost-utility ratios (ICURs) were calculated as cost per quality-adjusted life year (QALY) gained per age category. Furthermore, a budget impact analysis (BIA) assessed the expected changes in expenditure of the Dutch health care system following the adoption of PPI co-treatment in all LDASA users potentially at risk of UGI side effects.
RESULTS
PPI co-treatment of 70-79-year-old LDASA users, as compared to no PPI, resulted in incremental costs of €100.51 at incremental effects of 0.007 QALYs with an ICUR of €14,671/QALY. ICURs for 60-69-year-old LDASA users were €13,264/QALY and €64,121/QALY for 80 years and older patients. Initiation of PPI co-treatment for all Dutch LDASA users of 60 years and older at risk of UGI side effects but not prescribed a PPI (19%) would have cost €1,280,478 in the first year.
CONCLUSION
PPI co-medication in LDASA users at risk of UGI side effects generally is cost-effective. However, this strategy becomes less cost-effective with higher age, particularly in patients aged 80 and older, mainly due to the increased risks of PPI-induced side effects.
Hiv therapy in the year 2019
BACKGROUND and METHODS
HIV infection has become a chronic infection due to the high efficacy and good tolerability of combination antiretroviral therapy (cART). In contrast to earlier days, cART is now recommended to all HIV-positive persons, for their own health and to prevent transmission of the virus to other persons (“treatment as prevention”).
RESULTS
More recently introduced anti-hiv agents have more favorable pharmacokinetics than older ones. First line regimens usually consist of a backbone of two nucleoside reverse transcriptase inhibitors to which an integrase inhibitor is added as a third drug. Pre-exposure prophylaxis by using two antiretroviral agents (tenofovir DF/emtricitabine) is receiving increased interest for use in hiv-negative people who are at risk for hiv infection.
CONCLUSION
Generic forms of widely-used antiretroviral agents have been introduced in the Netherlands, and make considerable cost savings possible. Drug-drug interactions remain an important safety risk for hiv-positive patients on cART.
Safely prescribing drugs in patients with cirrhosis: a survey among general practitioners
BACKGROUND
Cirrhosis can impact drug pharmacokinetics and pharmacodynamics which increases the risk of adverse drug reactions. In 2016, a website (https://www.drugsinlivercirrhosis.org/) was published with recommendations on safe prescribing of drugs in patients with cirrhosis.
OBJECTIVE
We studied the knowledge of general practitioners (GPs) about the classification for severity of cirrhosis and the website with prescribing recommendations. Also, to assess their expertise in prescribing analgesics and antibiotics in these patients.
DESIGN and METHODS
In May and June 2017, a questionnaire was distributed among GPs in Groningen and surroundings. GPs were asked if they knew the Child-Pugh classification and the website (https://www.drugsinlivercirrhosis.org/). Two cases were presented and we asked the GPs to indicate which analgesic and antibiotic they would prescribe.
RESULTS
Of the 133 GPs invited to participate, 65 returned the questionnaire (49%). One quarter of GPs (26%) knew the Child-Pugh classification and 3% knew the website with recommendations. Most GPs (92%) consulted the Farmacotherapeutisch Kompas before prescribing in cirrhosis. The pharmacist (40%) and gastroenterologist (31%) were also often consulted.
In a patient with cirrhosis and mild pain, most GPs would prescribe paracetamol (56%, n = 33) or non-steroidal anti-inflammatory drugs (NSAIDs; 24%, n = 14). Two thirds of GPs (68%) would act differently for a patient with viral hepatitis B infection when cirrhosis was also present.
CONCLUSION
Most GPs in our study were not familiar with the severity classification of cirrhosis, nor the website with prescribing recommendations. GPs knew that caution is needed when prescribing drugs for cirrhosis patients, but did not always choose for the safest analgesic.