Transcript An Evaluation of Clinical Pharmacists Impact on Drug Utilization of

An Evaluation of Clinical Pharmacists
Impact on Drug Utilization of Traditional
NSAIDS and Selective COX-II Inhibitors
Statewide Research Activities
S. Scott Sutton, Pharm.D.
Associate Clinical Professor
South Carolina College of Pharmacy
University of South Carolina & Medical University of South Carolina
WJB Dorn Veterans Administration Medical Center
Columbia, South Carolina
Objectives
• SCSHP Program agenda:
• Describe the various research initiatives
undertaken by pharmacists throughout the
state of South Carolina
Research Team
•
•
•
•
S. Scott Sutton, Pharm.D.
John C. Voris, Pharm.D.
Randall C. Rowen, Pharm.D.
Joe C. Blizzard, R.Ph., Ph.D.
• Medication Optimization Research - Abstracts / Posters:
– An Evaluation of Clinical Pharmacists Impact on Drug Utilization of
Traditional NSAIDS and Selective COX-II Inhibitors
• American College of Clinical Pharmacy
– Alterations in Usage of Atypical Neuroleptics Resulting from an
Educational Series at a VA Hospital and Clinics
• American College of Clinical Pharmacy
– The Impact of a Computerized Order Entry form on Gabapentin
Prescribing in a Veterans Affairs Medical Center
• American College of Clinical Pharmacy
NSAIDS
• Key Concepts
– 60 million prescriptions annually
– Decision
• Non-selective NSAID versus COX-II NSAID
– Clinical Trials
• Similar efficacy for pain
• Less gastrointestinal adverse events
Arch Inern Med 2005;165:171-177
JAMA 2000;284:1247-1255
NEJM 2000;343:1520-1528
NSAIDS
• Purpose:
– Evaluate:
• Effectiveness of drug utilization criteria developed
by pharmacists for NSAIDS and COX-II on:
– Pharmacy Utilization
– Medication Expenditures
NSAIDS
• Methods
– Evaluated utilization over a one year-period.
– Criteria developed, implemented, and
analyzed by pharmacists.
– Each patient must meet criteria to be eligible
for treatment with COX-II.
– Data compared to national trends in COX-II
utilization rates.
COX-II Criteria
•
COX-II Utilization Criteria
–
–
–
–
–
–
1) A patient receiving Aspirin (any daily dose) does not qualify for a Cox-II
selective NSAID.
2) A patient receiving a Proton Pump Inhibitor (Rabeprazole, Lansoprazole,
Omeprazole, etc) does not quality for a COX- II selective NSAID.
3) A patient receiving Misoprostil (Cycotec) does not qualify for a COX- II
selective NSAID.
4) A patient must fail a 30 –day trial (if tolerated) of NSAIDs and be at high risk
for a clinically significant GI event (hemorrhage, perforation, obstruction) to be
considered for a COX- II selective NSAID.
5) A patient receiving Warfarin (Coumadin) who has failed a 30-day trial of
Acetaminophen and Salsalate will be considered for a Cox- II Selective NSAID.
6) Patients receiving a COX-II selective NSAID from a private physician will not
quality for a COX-II selective NSAID unless he/she meets one of the above
listed criterions.
Results
•
Results:
•
Average number of patients receiving NSAIDS or COX-IIs
–
3,202 (2806 – 3431)
•
92.4% received NSAIDs (90.7% - 95.0%)
–
•
7.4% received COX-IIs (5.0% - 9.3%)
–
•
Average cost per month - $2.60 - $7.10
Average cost per month - $47.69 - $95.37
National Utilization rates : 60 million prescriptions
–
–
39% NSAIDs
61% COX-IIs
Results
Utilization of NSAIDs and COX-II Inhibitors
100.00%
90.00%
Percentage of Patients Utilization Rates
80.00%
70.00%
60.00%
NSAIDs
COX-II
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Apr-04
May-04 Jun-04
Jul-04
Aug-04 Sep-04
Oct-04
Nov-04
Dec-04
Jan-05
Feb-05
Mar-05
Results
200,000.00
180,000.00
160,000.00
140,000.00
Cost savings
$157,919
Per month
120,000.00
100,000.00
80,000.00
60,000.00
40,000.00
20,000.00
0.00
NSAIDs
COX-IIs
Cost Based on Current Utilization Data
Total
Projected Cost Based on National Utilization Data
Objectives
• SCSHP Program agenda:
• Describe the various research initiatives
undertaken by pharmacists throughout the
state of South Carolina
• Application / Importance to Clinician