ETD Collection

Permanent URI for this collectionhttps://wiredspace.wits.ac.za/handle/10539/104


Please note: Digitised content is made available at the best possible quality range, taking into consideration file size and the condition of the original item. These restrictions may sometimes affect the quality of the final published item. For queries regarding content of ETD collection please contact IR specialists by email : IR specialists or Tel : 011 717 4652 / 1954

Follow the link below for important information about Electronic Theses and Dissertations (ETD)

Library Guide about ETD

Browse

Filters

2014 - 20182

Settings

Subject: search.filters.subject.Drug Costs

Search Results

Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Effects of antimicrobial stewardship policy in improving antibiotic utilisation and reducing drug costs in a public hospital in Gauteng Province, South Africa
    (2018) Bashar, Muhammad Augie
    Antimicrobial stewardship (AMS) programmes along with infection and prevention control measures have been shown to reduce the burden of antimicrobial resistance (AMR) in hospitals. There is a global campaign by infectious diseases physicians and other stakeholders for hospitals to implement AMS programmes. In Africa, there have been a limited number of AMS studies conducted although South African private hospitals have published some outcomes on initiation of these programmes in the continent, with the aim of improving patients’ clinical outcomes and reducing the development of resistance to prescribed antibiotics. A formal AMS programme is yet to be implemented in the surgery departments of the Charlotte Maxeke Johannesburg Academic Hospital. This study was conducted in two surgical wards of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). It was a quantitative study combining a prevalence cross-sectional observational stage, and an intervention study. It involved a retrospective review of patient records in the baseline stage followed by an intervention which took the form of a weekly antibiotic round led by an infectious diseases specialist. The appropriateness of antibiotic prescriptions was assessed using the criteria developed by Gyssens and colleagues, while the appropriateness of surgical prophylaxis was determined based on the recommendations of the South African Antibiotic Stewardship Programme (SAASP) and current Standard Treatment Guidelines and Essential Medicines Lists for South Africa. The prices of the antibiotics used were obtained from the central pharmacy of the CMJAH and Masters Price Catalogue list of the National Department of Health, while the prices of laboratory tests were obtained from the Tariff database. The volume of antibiotics consumed was determined by Defined Daily Doses (DDDs)/1000 patient days. In both stages of the study amoxicillin/clavulanic acid was the most frequently used agent. The intravenous route was the most commonly used route of drug administration in both stages of the study. There was a reduction in the proportion of patients who were treated with antibiotics for more than seven days in the intervention stage, from 6.19% in the baseline stage to 2.07% in the intervention stage. A significant reduction in the duration of antibiotic therapy for two days and more was observed from 4.74 ± 4.58 days in the baseline stage compared to 3.96 ± 2.04 days in the intervention stage (p = 0.01). A shift from empiric to culture directed therapy was also observed in the intervention stage compared to the baseline stage. There was a significant reduction in the volume of antibiotic consumption from a total of 739.30 DDDs/1000 patient days in the baseline stage to 564.93 DDDs/1000 patient days in the intervention stage (p = 0.038). Overall, there was a significant reduction of inappropriate antibiotic utilisation from 35% in the baseline stage to 26% in the intervention stage (p = 0.006). A high percentage of inappropriate surgical prophylaxis was found which was mostly due to the incorrect choice of agent with 64.75% and 61.54% in the baseline and intervention stages, respectively. The average antibiotic cost per patient was reduced from R 268.23 ± 389.32 to R 228.03 ± 326.88 in the Vascular Surgery Ward compared to the General Surgery Ward where there was an increase in average cost per patient from R 219.80 ± 400.75 in the baseline stage to R 284.06 ± 461.28 in the intervention stage. Gram-negative bacteria were the most prevalent pathogens in both stages of the study at 53% in the baseline and 54% during the intervention stage. The findings of this study show an improvement in the appropriateness of antibiotic utilisation, reduction in antibiotic consumption and cost reduction in one of the study wards, following implementation of an AMS programme. Also, there was an improvement in culture directed therapy, requests for an appropriate biological specimen for culture, with a consequent increase in the cost of laboratory investigations per patient during the intervention stage, which was due to increases in culture request. Rational antimicrobial prescribing habits, strong AMS interventions along with infection and prevention control measures, sound government policies and surveillance of resistant organisms in Africa will go a long way in preserving our antibiotics and preventing the spread of multidrug-resistant pathogens.
  • No Thumbnail Available
    Item
    Utilization patterns and potential cost savings of generic cardiovascular medications at private community pharmacies in the Johannesburg area: an analysis of medical claims retrospectively.
    (2014-04-24) Govender, Sagel; Research Report submitted for partial fulfillment of the requirements for the degree Master of Science in Medicine MSc (Med) in Pharmaceuticalor Affairs, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of Witwatersrand. September 2013
    Cardiovascular disease is a leading cause of death worldwide (Kishore et al., 2011), therefore how to prevent and treat this condition is of great importance to health care professionals and patients. Patients struggle to afford these medications which can ultimately influence their health outcome. Treatment of cardiovascular disease conditions may require several drugs and this causes an increase in health cost to the patient (Burapadaja Siriporn et al., 2007).The promotion of the use of generic medication and generic substitution is seen as one of the approaches to improve access to cardiovascular medications (Kishore et al., 2011; Kesselheim et al., 2008). Generic medications play an important role in reducing health care costs and in increasing access to healthcare. A large number of branded or innovator drugs and molecules are no longer protected by their patents or will be reaching patent expiration soon. Therefore there is an increased interest in research on generic drug competition and its effect on the market. Once generics enter the market, they have many effects on areas such as market share, prices and quantities sold (Gonzalez et al., 2008). The objective of this study was to determine the usage patterns of generic cardiovascular medications and possible cost savings that can be achieved by maximum generic substitution in the private community pharmacy health care environment in the Johannesburg area. Ten oral solid drug pairs experiencing generic substitution were investigated at four private community pharmacies that provided pharmaceutical products and services. The study was a quantitative, retrospective study of medical claims. Data on computerized drug claims were provided by a South African pharmaceutical service provider. Data was extracted and analysed of patients who receive one or more cardiovascular drugs for the period of June 2009 to May 2011. The results of this study showed that the cardiovascular (CVS) medications under study accounted for 21 817 of the total number of 282 109 items dispensed at all pharmacies for the study period which equals to 7.7%. Of the total of 21 817, the innovator CVS drugs accounted for a volume of 6 527 (29.9%) and the generics 15 290 (70.1%) of all the study CVS items dispensed. There was a decline in terms of percentage of innovator products (9.7%) and a corresponding increase in generic products by the same percentage from beginning to end of the study period in terms of items dispensed. The total cost of the study CVS innovator and generic drugs was R3 249k. This accounted for 7.4% of the total cost of all items dispensed for all the study pharmacies which was R43 672k. Of the total of R3 249k, a cost of R1 240k (38.2%) accounted for the innovator items and R2 009k (61.8%) accounted for the generic items. The average cost per CVS item for the entire study period was R149. The innovator average cost per item dispensed was R190 (±R93.28) and for generic R131 (±R59.55). There was a 9.9% decrease in percentage of innovator total cost and a corresponding 9.9% increase in percentage of generic cost from the beginning until end of the study period. The following was also revealed: the average cost per item decreased by R18 (from R156 during P1 to R138 for P6). The average cost per innovator item dispensed decreased by R10 (from R191 during P1 to R181 for P6) and the average cost per generic item decreased by R14 (from R138 during P1 to R124 for P6). The cost prevalence index (CPI) for innovator items was fairly expensive compared to generic medicine because the value of CPI was larger than 1. Potential cost savings of R576k would have been achieved if the least expensive generic was substituted during each period for the entire study period. If the most expensive generic was substituted, the potential cost savings would have been R448k. (Note: k =1000). Recommendations in this field of study for future research were also done.