Hyperinflation of Nitroprusside

2018 ◽  
Vol 31 (4) ◽  
pp. 382-389
Author(s):  
Alex Cobb ◽  
Luciana Thornton
Keyword(s):  
Hypertensive Crisis ◽  
Antihypertensive Agents ◽  
Cost Savings ◽  
Similar Efficacy ◽  
Evidence Base ◽  
Adverse Outcomes ◽  
Channel Blockers ◽  
Acute Hypertension ◽  
Therapeutic Interchange ◽  
The Cost

Sodium nitroprusside (SNP) is a generically available and rapid-acting intravenous (IV) vasodilator that has been used clinically for decades. Prior to 2013, the cost of SNP was relatively low, and SNP was an affordable option for the treatment of acute hypertension. However, from 2013 to 2017, average wholesale prices for SNP rose to as high as $900 per vial, earning the drug its status as a “hyperinflation drug.” Hyperinflation drugs such as SNP pose a significant challenge for pharmacy departments. A multidisciplinary effort involving stakeholders from many backgrounds, including pharmacists, physicians, and nurses, is key to developing an effective plan to address the problem. A therapeutic interchange, wherein a drug with similar efficacy is substituted for another, is often an appropriate strategy in this scenario. Fortunately, alternative drugs with a solid evidence base exist for the management of acute hypertension. The dihydropyridine calcium channel blockers, clevidipine and nicardipine, are IV titratable antihypertensive agents with favorable pharmacokinetic and safety profiles. Various studies indicate that clevidipine and nicardipine are effective alternatives to SNP for indications including hypertensive crisis and postoperative hypertension. Some hospitals have reported significant cost savings without adverse outcomes by substituting clevidipine or nicardipine for SNP. This article is intended to serve as a review of the evidence for clevidipine and nicardipine as potential substitutes for SNP and to provide strategies to successfully implement this therapeutic interchange.

Sodium Nitroprusside as a Hyperinflation Drug and Therapeutic Alternatives

2018 ◽  
Vol 31 (4) ◽  
pp. 374-381 ◽  
Author(s):  
Alex Cobb ◽  
Luciana Thornton
Keyword(s):  
Sodium Nitroprusside ◽  
Hypertensive Crisis ◽  
Antihypertensive Agents ◽  
Cost Savings ◽  
Similar Efficacy ◽  
Evidence Base ◽  
Adverse Outcomes ◽  
Channel Blockers ◽  
Acute Hypertension ◽  
Therapeutic Interchange

Sodium nitroprusside (SNP) is a generically available and rapid-acting intravenous (IV) vasodilator that has been used clinically for decades. Prior to 2013, the cost of SNP was relatively low, and SNP was an affordable option for the treatment of acute hypertension. However, from 2013 to 2017, average wholesale prices for SNP rose to as high as US$900 per vial, earning the drug its status as a “hyperinflation drug.” Hyperinflation drugs pose a significant challenge for pharmacy departments. A multidisciplinary effort involving stakeholders from many backgrounds, including pharmacists, physicians, and nurses, is key to developing an effective cost containment strategy. A therapeutic interchange, wherein a drug with similar efficacy is substituted for another, is often an appropriate strategy to address rising drug costs. Fortunately, alternative drugs with a solid evidence base exist for the management of acute hypertension. The dihydropyridine calcium channel blockers, clevidipine and nicardipine, are IV titratable antihypertensive agents with favorable pharmacokinetic and safety profiles. Various studies indicate that clevidipine and nicardipine are effective alternatives to SNP for indications including hypertensive crisis and postoperative hypertension. Some hospitals have reported significant cost savings without adverse outcomes by substituting clevidipine or nicardipine for SNP. This article is intended to serve as a review of the evidence for clevidipine and nicardipine as potential substitutes for SNP and to provide strategies to successfully implement this therapeutic interchange.

scholarly journals Cost–effectiveness and cost-benefit analysis of oliceridine in the treatment of acute pain

2021 ◽  
Author(s):  
Kit N Simpson ◽  
Michael J Fossler ◽  
Linda Wase ◽  
Mark A Demitrack
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Cost Effective ◽  
Adverse Outcomes ◽  
Protein Signaling ◽  
Opioid Receptor Agonist ◽  
Cost Effective Alternative ◽  
Μ Opioid Receptor ◽  
The Cost

Aim: Oliceridine, a new class of μ-opioid receptor agonist, is selective for G-protein signaling (analgesia) with limited recruitment of β-arrestin (associated with adverse outcomes) and may provide a cost-effective alternative versus conventional opioid morphine for postoperative pain. Patients & methods: Using a decision tree with a 24-h time horizon, we calculated costs for medication and management of three most common adverse events (AEs; oxygen saturation <90%, vomiting and somnolence) following postoperative oliceridine or morphine use. Results: Using oliceridine, the cost for managing AEs was US$528,424 versus $852,429 for morphine, with a net cost savings of $324,005. Conclusion: Oliceridine has a favorable overall impact on the total cost of postoperative care compared with the use of the conventional opioid morphine.

scholarly journals Fits, faints, falls and funny turns: cost and capacity savings in Queensland from the accelerated transient attack pathway initiative (ATAP)

2019 ◽  
Vol 48 (5) ◽  
pp. 745-750
Author(s):  
Robin Blythe ◽  
Sanjeewa Kularatna ◽  
Nicole White ◽  
Nicholas Graves ◽  
Kevin Clark ◽  
...  
Keyword(s):  
Emergency Department ◽  
Monte Carlo ◽  
Cost Savings ◽  
Monte Carlo Analysis ◽  
Adverse Outcomes ◽  
Large Hospital ◽  
Admission Rates ◽  
Transient Ischaemic Attacks ◽  
Before And After ◽  
The Cost

Abstract Background falls, seizures, syncope and transient ischaemic attacks (TIA) are common presentations to emergency departments sharing overlapping clinical features and diagnostic uncertainties. These transient attacks can be markers of serious adverse outcomes and are associated with high admission rates. We evaluated the effects of an integrated suite of pathways for transient attacks designed to improve adherence to best practices and reduce costs through fewer admissions. Methods a suite of clinician-designed pathways based on initial presenting diagnosis was developed to support ambulant care in a large hospital in Queensland, Australia. We performed a set of regression analyses to identify the differences in total cost and length of stay (LOS) before and after implementation. We conducted a Monte Carlo simulation to estimate the cost savings of the freed capacity in the patient cohort. Results pathway implementation was associated with reduced admitted LOS and costs. Falls patients admitted LOS declined by 32.5%, and admission costs by 19.5%. Syncope, seizure, and TIA patients admitted LOS declined by 22% with no change in admitted costs. Despite a small increase in 90-day representations, total emergency department LOS was unchanged. Emergency department costs were similar between falls and non-falls patients. The Monte Carlo analysis showed that the most likely outcome was a cost savings in freed capacity of $71 per patient episode. Conclusion the ATAP suite of pathways was associated with reduction in LOS, release of capacity and reduction in costs. Further study is needed to evaluate mechanisms and clinical outcomes in this vulnerable population.

scholarly journals Era of biosimilars in rheumatology: reshaping the healthcare environment

RMD Open ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e000900 ◽  
Author(s):  
Josef S Smolen ◽  
Joao Goncalves ◽  
Mark Quinn ◽  
Fabrizio Benedetti ◽  
Jake Yongkwon Lee
Keyword(s):  
Cost Saving ◽  
Negative Impact ◽  
Cost Savings ◽  
Physicochemical Characteristics ◽  
Similar Efficacy ◽  
Biological Drugs ◽  
Equivalent Efficacy ◽  
The Cost ◽  
Rheumatology Practice

Compared with the original approved biological drug on which it is based, a biosimilar has highly similar physicochemical characteristics and biological activity, as well as equivalent efficacy and no clinically meaningful differences in safety and immunogenicity. Before they are approved, biosimilars must undergo a rigorous development process using state-of-the-art technologies to establish biosimilarity to the reference biological product. After approval, biosimilars must comply with good pharmacological practices for biological drugs. Several biosimilar disease-modifying antirheumatic drugs (bsDMARDs) based on the tumour necrosis factor inhibitors adalimumab, etanercept and infliximab have been approved for use in patients with rheumatic diseases. Substantial cost savings can be made if biological-naive patients begin treatment with bsDMARDs, and patients receiving original biological DMARDs (bDMARDs) are switched to bsDMARDs. Despite the consistently similar efficacy, safety and immunogenicity of bsDMARDs relative to their respective original bDMARDs, switching from a reference bDMARD to a bsDMARD can result in nocebo responses, such as subjective increase of disease activity and pain-related adverse events. This may have a negative impact on adherence to bsDMARDs in clinical trials and clinical practice. To ensure optimal and rational integration of bsDMARDs into rheumatology practice and realise the full cost-saving efficacy of these drugs, rheumatologists must be aware that careful communication of the cost-saving efficacy and safety of bsDMARDs to their patients is the key to a successful long-term switch to bsDMARD therapy.

scholarly journals Prescribing Patterns and Cost of anthihypertensive Drugs in A North Indian Internal Medicine Clinic

2004 ◽  
Vol 3 (3) ◽  
pp. 74
Author(s):  
D Hota ◽  
Dalbir Singh ◽  
A Sachdev
Keyword(s):  
Current Issue ◽  
Beta Blockers ◽  
Antihypertensive Agents ◽  
Prescribing Patterns ◽  
Channel Blockers ◽  
Clear Indication ◽  
Elevated Blood ◽  
Hypertension Clinic ◽  
Internal Medicine Clinic ◽  
The Cost

Choice of antihypertensive agents depend on their efficacy to control elevated blood pressure and prevent antecedent morbidity and mortality. However, the cost of therapy also remains an important factor in deciding a particular agent. Randomly selected 300 prescriptions were analysed in a hypertension clinic. The cost were compared from the current issue of MIMS - India. Beta-blockers remain the most common agent (46.7%) fallowed by calcium channel blockers (34.3%) and ACE Inhibitors (30.0%). Diuretics were used only in 13% of prescriptions. Amongst individual agents, atenolol (36.0%), amlodipine (29.3%) and enalapril (23.0%) were most common. There is a wide variation in the annual acquisition cost for atenolol (61.4%), amlodipine (110.0%) and enalapril (55.5%). The results of the study emphasize the need for prescribing more economical brands available. Moreover, newer (and expensive) brands can be prescribed only when there is a clear indication.

Exploration-Stage Implementation Variation

2014 ◽  
Vol 222 (1) ◽  
pp. 37-48 ◽  
Author(s):  
Stephanie Romney ◽  
Nathaniel Israel ◽  
Danijela Zlatevski
Keyword(s):  
Parent Training ◽  
Average Cost ◽  
Cost Savings ◽  
Training Group ◽  
Group Differences ◽  
Triple P ◽  
Community Based ◽  
Parent Training Program ◽  
A Site ◽  
The Cost

The present study examines the effect of agency-level implementation variation on the cost-effectiveness of an evidence-based parent training program (Positive Parenting Program: “Triple P”). Staff from six community-based agencies participated in a five-day training to prepare them to deliver a 12-week Triple P parent training group to caregivers. Prior to the training, administrators and staff from four of the agencies completed a site readiness process intended to prepare them for the implementation demands of successfully delivering the group, while the other two agencies did not complete the process. Following the delivery of each agency’s first Triple P group, the graduation rate and average cost per class graduate were calculated. The average cost-per-graduate was over seven times higher for the two agencies that had not completed the readiness process than for the four completing agencies ($7,811 vs. $1,052). The contrast in costs was due to high participant attrition in the Triple P groups delivered by the two agencies that did not complete the readiness process. The odds of Triple P participants graduating were 12.2 times greater for those in groups run by sites that had completed the readiness process. This differential attrition was not accounted for by between-group differences in participant characteristics at pretest. While the natural design of this study limits the ability to empirically test all alternative explanations, these findings indicate a striking cost savings for sites completing the readiness process and support the thoughtful application of readiness procedures in the early stages of an implementation initiative.

REKAYASA NILAI HARGA PEMBUATAN TERHADAP EFEKTIFITAS PENGGUNAAN BAHAN PADA PEMBANGUNAN PERUMAHAN TIRTO PENATARAN ASRI TIPE 70/135 KECAMATAN NGLEGOK KABUPATEN BLITAR

2017 ◽  
Vol 7 (1) ◽  
pp. 43-52
Author(s):  
Mochamad Tamim Ma’ruf
Keyword(s):  
Engineering Application ◽  
Cost Savings ◽  
Comparison Method ◽  
Value Engineering ◽  
Design Work ◽  
Housing Projects ◽  
Initial Design ◽  
A Value ◽  
The Cost ◽  
Design Proposal

One-solving methods and techniques necessary to avoid inefficiencies and not economic costs as well as reduce the cost of housing construction is the method of Value Engineering. Value engineering is a method and cost control techniques to analyze a function to its value at the lowest cost alternative (most economical) without reducing the quality desired.At the writing of this study used a comparison method by comparing the initial design to the design proposal of the author. In the housing projects Upgrading Tirto Penataran Asri type 70, the application of Value Engineering conducted on the job a couple walls and roofs pair by replacing some work items with a more economical alternative but does not change the original function and high aesthetic level and still qualify safe. For that performed the step of determining a work item, the alternative stage, the analysis stage, and the stage of recommendations to get a Value Engineering application and cost savings against the wall a couple of work items and partner roof.The proposed design as compared to the initial design. Work items discussed was the work of a couple wall having analyzed obtained savings of Rp. 2,747,643.56 and the work of the roof pair obtained savings of Rp. 2,363,446.80. Thus the total overall savings gained is Rp 5,111,090.36 or savings of 0048%.

Cost-minimization analysis of drugs used in the treatment of Asthma and COPD diseases in India

2020 ◽  
Vol 15 ◽  
Author(s):  
Billu Payal ◽  
Anoop Kumar ◽  
Harsh Saxena
Keyword(s):  
Generic Drugs ◽  
Cost Minimization ◽  
Cost Savings ◽  
Chronic Obstructive ◽  
Pulmonary Medicine ◽  
Potential Cost ◽  
Maximum Cost ◽  
Cost Minimization Analysis ◽  
Cost Variation ◽  
The Cost

Background: Asthma and Chronic Obstructive Pulmonary Diseases (COPD) are well known respiratory diseases affecting millions of peoples in India. In the market, various branded generics, as well as generic drugs, are available for their treatment and how much cost will be saved by utilizing generic medicine is still unclear among physicians. Thus, the main aim of the current investigation was to perform cost-minimization analysis of generic versus branded generic (high and low expensive) drugs and branded generic (high expensive) versus branded generic (least expensive) used in the Department of Pulmonary Medicine of Era Medical University, Lucknow for the treatment of asthma and COPD. Methodology: The current index of medical stores (CIMS) was referred for the cost of branded drugs whereas the cost of generic drugs was taken from Jan Aushadi scheme of India 2016. The percentage of cost variation particularly to Asthma and COPD regimens on substituting available generic drugs was calculated using standard formula and costs were presented in Indian Rupees (as of 2019). Results: The maximum cost variation was found between the respules budesonide high expensive branded generic versus least expensive branded generic drugs and generic versus high expensive branded generic. In combination, the maximum cost variation was observed in the montelukast and levocetirizine combination. Conclusion: In conclusion, this study inferred that substituting generic antiasthmatics and COPD drugs can bring potential cost savings in patients.

Pound Wise and Penny Foolish? Weight Loss and The Dynamics of Health Care Spending

2011 ◽  
Vol 14 (2) ◽  
Author(s):  
Thomas G Koch
Keyword(s):  
Weight Loss ◽  
Cost Savings ◽  
Cost Effective ◽  
Economic Consequences ◽  
Health Care Spending ◽  
Order Of Magnitude ◽  
Dynamic Measures ◽  
The Cost ◽  
The Impact ◽  
The Relationship

Current estimates of obesity costs ignore the impact of future weight loss and gain, and may either over or underestimate economic consequences of weight loss. In light of this, I construct static and dynamic measures of medical costs associated with body mass index (BMI), to be balanced against the cost of one-time interventions. This study finds that ignoring the implications of weight loss and gain over time overstates the medical-cost savings of such interventions by an order of magnitude. When the relationship between spending and age is allowed to vary, weight-loss attempts appear to be cost-effective starting and ending with middle age. Some interventions recently proven to decrease weight may also be cost-effective.

scholarly journals Is an integrated model of school eye health delivery more cost-effective than a vertical model? An implementation research in Zanzibar

2021 ◽  
Vol 6 (1) ◽  
pp. e000561
Author(s):  
Ving Fai Chan ◽  
Fatma Omar ◽  
Elodie Yard ◽  
Eden Mashayo ◽  
Damaris Mulewa ◽  
...  
Keyword(s):  
Implementation Research ◽  
Cost Savings ◽  
Cost Effective ◽  
Integrated Model ◽  
Health Screening ◽  
High Coverage ◽  
Health Delivery ◽  
Screening Cost ◽  
Eye Health ◽  
The Cost

ObjectiveTo review and compare the cost-effectiveness of the integrated model (IM) and vertical model (VM) of school eye health programme in Zanzibar.Methods and analysisThis 6-month implementation research was conducted in four districts in Zanzibar. Nine and ten schools were recruited into the IM and VM, respectively. In the VM, teachers conducted eye health screening and education only while these eye health components were added to the existing school feeding programme (IM). The number of children aged 6–13 years old screened and identified was collected monthly. A review of project account records was conducted with 19 key informants. The actual costs were calculated for each cost categories, and costs per child screened and cost per child identified were compared between the two models.ResultsScreening coverage was 96% and 90% in the IM and VM with 297 children (69.5%) from the IM and 130 children (30.5%) from VM failed eye health screening. The 6-month eye health screening cost for VM and IM was US$6 728 and US$7 355. The cost per child screened for IM and VM was US$1.23 and US$1.31, and the cost per child identified was US$24.76 and US$51.75, respectively.ConclusionBoth models achieved high coverage of eye health screening with the IM being a more cost-effective school eye health delivery screening compared with VM with great opportunities for cost savings.

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