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841 artikelen gevonden

17 jun 2019

Ontwikkelingen van farmaco-economisch onderzoek vanuit historisch perspectief

  • Rubriek:
    Overzichtsartikel
  • Identificatie:
    2019;4:a1699
  • Auteur(s):
    L. Westerink ab*, E. Dvortsin b en M.J. Postma ac

Ontwikkelingen van farmaco-economisch onderzoek vanuit historisch perspectief

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.

04 jun 2019

De kosteneffectiviteit van maagbescherming met protonpompremmers bij gebruikers van laaggedoseerde salicylaten

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1707
  • Auteur(s):
    Sek Hung Chau a†*, Reinier L. Sluiter b†, Wietske Kievit c, Michel Wensing cd, Martina Teichert cef en Jacqueline G. Hugtenburg a

De kosteneffectiviteit van maagbescherming met protonpompremmers bij gebruikers van laaggedoseerde salicylaten

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.

22 mei 2019

Hiv-behandeling anno 2019: stand van zaken

  • Rubriek:
    Overzichtsartikel
  • Identificatie:
    2019;4:a1698
  • Auteur(s):
    David Burger a*, Piter Oosterhof b, Hylke Waalewijn c, Pauline Bollen d en Matthijs van Luin e

Hiv-behandeling anno 2019: stand van zaken

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.

14 mei 2019

Het veilig voorschrijven van geneesmiddelen bij levercirrose: een vragenlijstonderzoek onder huisartsen

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1700
  • Auteur(s):
    R.A. Weersink ab*, J.M.A. Beekwilder ac, M. Bouma d, A. Otroshi e, K. Taxis b en S.D. Borgsteede a

Het veilig voorschrijven van geneesmiddelen bij levercirrose: een vragenlijstonderzoek onder huisartsen

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.

08 mei 2019

Medicatieoptimalisatie bij psychogeriatrische verpleeghuispatiënten: succesvol aanpassen van medicatie is mogelijk

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1697
  • Auteur(s):
    Audrey A.M. Blenke a*, Rob J. van Marum bc, Annemieke M.A. Vermeulen Windsant-van den Tweel a, Walter A.J.J. Hermens a en Hieronymus J. Derijks cd

Medicatieoptimalisatie bij psychogeriatrische verpleeghuispatiënten: succesvol aanpassen van medicatie is mogelijk

Deprescribing in newly admitted psychogeriatric nursing facility patients

OBJECTIVE

To determine whether advised changes as a result of structured medication reviews in psychogeriatric patients were implemented and implemented changes were maintained.

DESIGN

We performed a prospective cohort study in three nursing homes in The Netherlands.

METHODS

After admission, newly admitted psychogeriatric residents were subjected to a structured medication review – performed by a pharmacist and physician – resulting in a treatment plan, which was approved by the patient’s legal representative and effectuated. Main outcome measures were the percentage of advised changes approved (= approval rate) and the percentage of implemented medication changes still present 90 days after approval (= 90-day implementation rate).

RESULTS

A total of 45 patients were included who used a total number of 333 drugs (mean ± SD = 7.4 ± 3.3 drugs). Changes were advised for 159 medications used by 42 patients. Of these changes 150 were approved (approval rate = 94.3%). Finally, 105 were implemented and 89 were still implemented after 90 days (90-day implementation rate = 84.8%). Overall, 59.7% of the advised changes concerned deprescribing, 22.6% concerned an adjustment of a drug (dose, pharmaceutical form, administration time, frequency of dosing or a combination) and 11.9% concerned starting a drug. The proportion of advised changes implemented was similar for symptom-modifying and risk-modifying drugs, namely, almost 85%. Overall, 55.3% of the recommended changes to deprescribe or reduce dose concerned 10 drug groups.

CONCLUSION

Medication could be successfully deprescribed from psychogeriatric patients after structured medication reviews, performed by pharmacists and nursing home physicians. More than 50% of the advised changes to deprescribe or reduce dose involved 10 drug groups, which raises the question whether the structured medication review can be performed more efficiently by focusing on the most common problems.

30 apr 2019

De optimale dosering voor een continu infuus flucloxacilline bij niet-kritisch zieke patiënten

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1696
  • Auteur(s):
    S. Wilkes a*, I. van Berlo b, J. ten Oever c, F. Jansman d en R. ter Heine e

De optimale dosering voor een continu infuus flucloxacilline bij niet-kritisch zieke patiënten

The optimal dosage for continuous infusion of flucloxacillin in non-critically ill patients

BACKGROUND

Flucloxacillin is approved for intermittent dosing. The antibacterial activity of flucloxacillin is time dependent so continuous infusion is probably more effective. Furthermore, for some patients continuous dosing can have practical benefits. Currently, the optimal flucloxacillin dosage for continuous infusion is unknown.

OBJECTIVE

To determine the optimal dosage for continuous flucloxacillin infusion in non-critically ill patients.

METHODS

Unbound flucloxacillin levels of 30 patients receiving intravenous flucloxacillin were analysed using non-linear mixed effects modelling. A Monte-Carlo simulation was used to assess the dosage needed to treat bacteria with a MIC of 0.25-2 mg/L in > 90% of the population.

RESULTS

A dosage of 4 g/24 hours was sufficient for 93.4% of the population to obtain a target of 100% fT > MIC of 0.5 mg/L. In 88.9% of the population a dosage of 12 g/24 hours was sufficient for a MIC of 2 mg/L, being the clinical breakpoint for S. aureus.

CONCLUSION

This simulation study showed that 4 g/24 hours is sufficient to reach unbound flucloxacillin levels exceeding 0.5 mg/L, the most common MICs found for S. aureus, in non-critically ill patients. In case of toxicity or if patients are not responding to a regular dosage, we advise to alter the dosage based on unbound flucloxacillin levels and the MIC.

24 apr 2019

Het effect van toevoeging van een biological DMARD aan de behandeling met een synthetische DMARD op lange termijn gewrichtsschade door reumatoïde artritis

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1693
  • Auteur(s):
    S. Baghban a*, L. Krens a, M.J. Henstra a, L.M. Vermeer b, K.C.M. van der Elst a en H.J. Bernelot Moens c

Het effect van toevoeging van een biological DMARD aan de behandeling met een synthetische DMARD op lange termijn gewrichtsschade door reumatoïde artritis

The effect of addition of biological DMARD to synthetic DMARD on the long term articular damage by rheumatoid arthritis

OBJECTIVE and DESIGN

This study examines the effects of biological DMARDs (bDMARDs) on joint damage after 5 or more years since rheumatoid arthritis (RA) diagnosis. Long term joint damage is compared in patients who have never used bDMARDs and patients who have used bDMARDs. Joint damage is measured with the Rheumatoid Arthritis Articular Damage (RAAD) score, a non-radiographic method in a retrospective cohort study.

METHODS

RA patients > 18 years who were diagnosed with RA from 1 January 2004 to 31 December 2011 by the rheumatologist in the Hospital Group Twente were included. Further inclusion criteria were prescription for a DMARD, a minimum follow-up of 5 years, and at least one RAAD score available. Exclusion criteria were discarding RA diagnosis during follow-up and receiving a DMARD for any other indication than RA. The exposure of interest was the type of treatment: synthetic (sDMARD) or biologic DMARD.

RESULTS

305 patients were included in this cohort, of which 101 used a bDMARD. Baseline characteristics were not significantly different in terms of prognostic factors for joint damage progression, with the exception of age; patients in the bDMARD group were significantly younger. During follow-up, the highest disease activity score (DAS28) was significantly higher in the bDMARD group (median = 5.0, IQR = 4.2 – 5.8 versus 4.3, 2.9 – 5.1; P < 0.001).

No significant differences in long term joint damage were observed (b = –0.15, 95% CI = –0.9 – 0.6; P = 0.69), even after adjusting for potential confounders like DAS28, gender, age, rheumatoid factor and smoking habits (b = –0,26, 95% CI = –1.9 – 1.4; P = 0.76).

CONCLUSION

Long term joint damage by RA was not significantly different between patients who were treated with sDMARDs and patients who had an addition of a bDMARD to the treatment with a sDMARD.

18 apr 2019

Het optreden van neutropenie na docetaxelblootstelling bij patiënten met gemetastaseerde castratieresistente prostaatkanker

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1683
  • Auteur(s):
    András Vermes

Het optreden van neutropenie na docetaxelblootstelling bij patiënten met gemetastaseerde castratieresistente prostaatkanker

10 apr 2019

Farmacokinetiek en tolerantie van eenmaal daagse verneveling van de dubbele dosis tobramycine bij cystische fibrose: vergelijking tussen PARI-LC Plus- en AKITA-vernevelaar

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1694
  • Auteur(s):
    A.J. van Velzen a*, A.C. Bos bc, D.J. Touw d, H.A.W.M. Tiddens bc, H.G.M. Heijerman e en H.M. Janssens b

Farmacokinetiek en tolerantie van eenmaal daagse verneveling van de dubbele dosis tobramycine bij cystische fibrose: vergelijking tussen PARI-LC Plus- en AKITA-vernevelaar

Pharmacokinetics and tolerability of once daily double dose tobramycin inhalation in cystic fibrosis using controlled and conventional nebulization: comparison between PARI-LC Plus and AKITA nebulizer

OBJECTIVE

Better treatment outcomes in cystic fibrosis (CF) may be expected by changing standard twice daily tobramycin inhalation with the conventional PARI-LC Plus nebulizer to once daily inhalation of the double dose with the controlled-inhalation AKITA nebulizer. We aimed to determine pharmacokinetics (PK) and safety of once daily inhalation of the double recommended tobramycin dose with the AKITA in patients with CF. Systemic absorption can be used as surrogate for safety.

DESIGN and METHODS

In a randomized open-label crossover pilot study, PK of inhaled tobramycin in 10 adult CF patients was assessed following inhalation of the double recommended dose with the AKITA (300 mg fill dose) and PARI-LC Plus (600 mg fill dose). Blood samples were drawn until 24 hours after inhalation.

RESULTS

No significant differences were found in the maximum and trough serum levels, time to maximum level and area under the curve (0-24 hours). Both maximum and trough levels were well below their toxic limits for both nebulizers and for all patients. Both inhalations were well tolerated and no serious adverse events occurred. Nebulization time was 33% shorter with AKITA.

CONCLUSION

Once daily inhalation of the double tobramycin dose with the controlled-inhalation AKITA nebulizer resulted in safe serum levels, with comparable systemic exposure to once daily PARI-LC Plus inhalation and higher peak levels compared to the standard twice daily dosing regimen. Inhalation with both nebulizers was well tolerated. Nebulization time was significantly shortened, less side effects were reported and a higher degree of satisfaction was attained with the AKITA nebulizer.

08 apr 2019

Speeksel als potentiële alternatieve matrix voor het bepalen van levofloxacine bij tuberculosepatiënten

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1682
  • Auteur(s):
    András Vermes

Speeksel als potentiële alternatieve matrix voor het bepalen van levofloxacine bij tuberculosepatiënten

04 apr 2019

Evaluatie van een nieuwe Nederlandse vancomycinedoseerrichtlijn en populatiefarmacokinetiek van vancomycine bij preterme en a terme neonaten

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1695
  • Auteur(s):
    L. Koedood ab*, T.R. de Haan c, C.J. Hodiamont d, I.M.M. van Haelst a en R.A.A. Mathôt b

Evaluatie van een nieuwe Nederlandse vancomycinedoseerrichtlijn en populatiefarmacokinetiek van vancomycine bij preterme en a terme neonaten

Evaluation of a new Dutch guideline for vancomycin dosing and population pharmacokinetics of vancomycin for preterm and term neonates

OBJECTIVE

In May 2015 the Dutch pediatric formulary (Kinderformularium) introduced a new guideline for dosing of vancomycin in neonates. The primary aim of this study was to validate this guideline by assessing the percentage of therapeutic initial trough serum concentrations in a cohort of (pre)term neonates. The secondary aim of this study was to describe the population pharmacokinetics (PPK) of vancomycin in (pre)term neonates.

METHODS

In this prospective study, (pre)term neonates were included when admitted to the Neonatology department of the Academic Medical Center, Amsterdam from May 2015 to June 2017. Vancomycin dosing was performed according to the new guideline. Serum concentrations were measured prior to the administration of the fifth dose. Trough levels in the range of 10 to 15 mg/L were considered therapeutic. PPK parameters were estimated by nonlinear mixed-effects modeling.

RESULTS

Forty patients were included for the primary aim and 42 patients for the secondary aim of this study. The main category of patients were premature neonates with a postnatal age of 1 to 4 weeks (n = 27, 68%). In this group 15 patients (56%) had a subtherapeutic vancomycin serum level, while therapeutic and supratherapeutic levels were found in 7 (26%) and 5 (19%) of the patients, respectively. The PPK were best described by an allometric, one-compartment model. Inter-patient variability in clearance could be explained by variation in renal function and postmenstrual age.

CONCLUSION

The new dosing guideline does not produce therapeutic vancomycin concentrations in the majority of premature neonates from 1 to 4 weeks old. Further research is needed to optimize dosing of vancomycin in neonates.

28 mrt 2019

Specifiekere signalen nodig voor ondersteuning apothekers bij medicatiebeoordeling

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1681
  • Auteur(s):
    Sander Borgsteede

Specifiekere signalen nodig voor ondersteuning apothekers bij medicatiebeoordeling

21 mrt 2019

Relevantere signalen mogelijk door prospectief onderzoek naar QTc-verlenging

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1680
  • Auteur(s):
    Sander Borgsteede

Relevantere signalen mogelijk door prospectief onderzoek naar QTc-verlenging

15 mrt 2019

Redenen van patiënten om geen laxans te gebruiken bij opioïden

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1678
  • Auteur(s):
    Marcel Kooij

Redenen van patiënten om geen laxans te gebruiken bij opioïden

07 mrt 2019

Therapeutic drug monitoring van adalimumab bij patiënten met inflammatoire darmziekten

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1692
  • Auteur(s):
    W. van ’t Geloof a*, P.J. Boekema b, L.P.L. Gilissen c, M.A.C. Broeren d en L.J.J. Derijks a

Therapeutic drug monitoring van adalimumab bij patiënten met inflammatoire darmziekten

Therapeutic drug monitoring of adalimumab in inflammatory bowel disease patients

OBJECTIVE

Adalimumab (ADA) trough levels correlate with clinical remission. Despite suggestions that therapeutic drug monitoring of ADA can optimize treatment in this population, it is not yet implemented in clinical practice. This study was conducted to provide more insight in ADA trough levels and antibodies to adalimumab (ATA) in an inflammatory bowel disease (IBD) population already treated with adalimumab.

DESIGN

We carried out a prospective cohort study in IBD outpatients already treated with adalimumab.

METHODS

Patient demographics were collected from the electronic hospital information system. Blood was drawn for determination of ADA trough levels and ATAs. Disease activity indices for Crohn’s disease and ulcerative colitis and quality of life scores were obtained by a questionnaire.

RESULTS

A total of 92 patients was included. ADA levels varied from < 0.1 to 20.2 mg/L. Mean ADA level was 7.7 mg/L (SD = 4.5), 4 patients developed ATAs. ADA levels ≤ 5 mg/L were demonstrated in 27 patients (29%). The ADA level was not significantly associated with remission (P = 0.391). Quality of life score correlated with ADA level (P = 0.031).

CONCLUSION

Therapeutic drug monitoring in inflammatory bowel disease outpatients revealed large interindividual differences in adalimumab trough levels. These levels were subtherapeutic in nearly a third of patients. We think, despite no significant correlation was found between adalimumab trough level and disease activity, therapeutic drug monitoring has the potential to individualize treatment in inflammatory bowel disease patients using adalimumab.

28 feb 2019

Nierfunctie en ernstige bloedingen bij patiënten behandeld met cumarines

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1691
  • Auteur(s):
    Eline Houben a*, Elisabeth Smits a, Jetty A. Overbeek ab, dr. Fernie J.A. Penning-van Beest a, dr. Ron M.C. Herings a, dr. Myrthe P.P. van Herk-Sukel a, dr. Martina Teichert cde en prof. dr. Peter A.G.M. de Smet cd

Nierfunctie en ernstige bloedingen bij patiënten behandeld met cumarines

No evidence for an association between renal function and serious bleeding events in patients treated with coumarins

BACKGROUND

Although anticoagulation therapy is closely monitored in the Netherlands, coumarin-induced serious bleeding events are still observed. Current literature suggests that renal impairment may contribute to this.

OBJECTIVE

To explore the association between renal function and bleeding events during coumarin treatment.

DESIGN

A nested case-control study was conducted using data from the PHARMO Database Network.

METHODS

Patients hospitalised for a bleeding event during coumarin treatment were selected as cases and matched on sex, birth year, and geographic region with a maximum of two controls using coumarins without hospitalisation for bleeding. All values of estimated glomerular filtration rates (eGFRs) in the year before index date (case hospitalisation date) were selected and compared between cases and controls using logistic regression analyses.

RESULTS

In total, 2224 cases were matched to 4398 controls (61% male; mean age ± SD = 75 ± 11 and 78 ± 11 years for cases and controls, respectively). Availability of eGFR values was higher among cases compared with controls (mean eGFR values ± SD = 4.5 ± 7.1 versus 3.2 ± 5.5), reflected in the significantly shorter time since last eGFR value (at index date, mean ± SD = 2.7 ± 3.0 versus 3.8 ± 3.1 months; odds ratio [OR] = 0.91, 95%CI = 0.89-0.92). No statistically significant difference was found for the mean eGFR value in the year before index date (mean ± SD 65.7 ± 22.8 versus 64.6 ± 20.9 mL/min/1.73 m; OR per 10 units = 0.99, 95%CI = 0.96-1.02).

CONCLUSION

No association between renal function and serious bleeding events during coumarin treatment was observed.