From American Journal of Health-System Pharmacy October 1, 2002
(Volume 59, Number 19)
Cost-Efficacy Analysis of Ondansetron Regimens for Control of Emesis Induced
by Noncisplatin, Moderately Emetogenic Chemotherapy
Lachaine J, Laurier C American Journal of Health-System Pharmacy. 2002;59(19):1837-1846
Most of the available literature surrounding optimal dosing and cost-effectiveness
of ondansetron therapy highlights the use of highly emetogenic chemotherapy. In
this study, clinical efficacy and cost data for controlling emesis associated
with noncisplatin, moderately emetogenic chemotherapy were compiled and analyzed.
The authors accessed MEDLINE and retrieved clinical efficacy results from the
literature available between January 1966 and December 2000. Only direct antiemetic
treatment costs were considered.
A total of 30 articles were identified from the primary literature as meeting
the needs of this analysis from a potential of 436. Twenty-two different ondansetron-based
antiemetic regimens were identified. The efficacy of the regimens ranged from
24.2% to 90.4%, and costs ranged from $20 (Canadian) to $413 (Canadian). The authors
conclude, from their review of the literature, that a regimen that includes a
corticosteroid and twice daily administration of ondansetron is supported by both
clinical and cost-effectiveness data. Treatment with ondansetron should be limited
to 4 days.
Editor's Comment
Managing the adverse effects of chemotherapy is important to patient satisfaction
with therapy. Treatment options are often costly and varied, as noted by the 22
different regimens identified in this analysis. Most of the accepted data is based
on highly emetogenic chemotherapy regimens. This data analysis is valuable to
patients and caregivers who are being treated with moderately emetogenic chemotherapy.
The authors were unable to determine a single regimen that was most effective
clinically and with regard to cost, but the treatment parameters that were identified
as most effective can be translated into clinical practice.
From The Annals of Pharmacotherapy October 2002 (Volume 36, Number 10)
Effect of Number of Medications on Cardiovascular Therapy Adherence
Shalansky SJ, Levy AR The Annals of Pharmacotherapy. 2002;36(10):1532-1539
Potential participants in this retrospective study were identified from acute
care wards and 2 clinics at a large hospital in Canada. Potential participants
must have received either a 3-month prescription for an angiotensin-converting
enzyme inhibitor or lipid-lowering therapy or both during a 2-year period. A total
of 888 patients were approached to participate; 367 met inclusion criteria after
the database review. Patients were surveyed by means of phone or in person. The
survey was designed to identify patient characteristics that would potentially
influence adherence and included all drug use, use of compliance aids, perceived
need for the medication, perceived health, living situation, and adverse drug
reactions, as well as demographic information. Manual review of patient profiles
in the prescription claims database was done, and information was used to calculate
adherence.
In this study, 12% of patients (n = 45) were categorized as nonadherent. These
patients took fewer regularly scheduled medications per day (4.1 ± 2.7 vs
5.9 ± 3.4, P < .001). They also took fewer pills per day (5.3 ±
3.6 vs 9.2 ± 7.1, P < .001). In addition, patients categorized
as nonadherent had fewer administration times per day (1.8 ± 0.7 vs 2.4 ±
0.9, P = .001).
Editor's Comment
Prior information regarding the link between adherence and the complexity of the
drug regimen has been contradictory. These data suggest that there is not a link
between drug regimen complexity and adherence, at least for patients with cardiovascular
diseases. Pharmacists can use this information in discussions with prescribers
who might be reluctant to add additional therapies to patients with cardiovascular
disease.
From Journal of the American Pharmaceutical Association September/October 2002 (Volume 42, Number 5)
Clinical Pharmacy Services in the Home: Canadian Case Studies
MacKeigan LD, Marshman JA, Kruk-Romanus D, et al. Journal of the American Pharmaceutical Association. 2002;42(5):735-742
In Canada, the elderly are the primary consumers of both home healthcare services
and medications. Access to clinical pharmacy services has traditionally not been
provided as a home health service, despite that the homebound elderly person is
frequently on a large number of medications and has little contact with a pharmacist.
Using a case study approach, the authors of this study set out to describe homecare
services being provided by pharmacists.
As defined in this study, a clinical homecare practice must include pharmacist
home visits conducted for clinical purposes beyond routine prescription counseling,
at least 1 home visit was conducted per week, and documentation of services provided.
Practices were identified, and 20 case descriptions were selected for inclusion
that allowed for a description of diverse services representative of many regions.
A total of 16 practices were included in the final analysis; unwillingness to
participate (n = 3) and lack of permission from the homecare agency (n = 1) were
cited as reasons for nonparticipation. Reasons for home visits included visual
or hearing impairment, adverse drug reaction, repeat hospitalizations/emergency
visits, cognitive impairment, living alone, complex medication regimen, noncompliance,
and various others. Marketing of these services included the Internet, brochure,
and physician office visits.
Editor's Comment
Despite the limitations of a purely descriptive case-study approach, this report
offers some insight into the potential benefits of clinical pharmacy service provision
to consumers of healthcare along with identification of some of the barriers.
As healthcare continues to be provided outside of the traditional inpatient environment,
it will be important for pharmacy services to continue to evolve so that all patients
can benefit from them.
From Journal of Clinical Pharmacology October 2002 (Volume 42, Number 10)
Lack of Correlation Between the Steady-State Plasma Concentrations of Haloperidol
and Risperidone
Yasui-Furukori N, Kondo T, Mihara K, et al. Journal of Clinical Pharmacology. 2002;42(10):1083-1088
Haloperidol and risperidone are used in the treatment of schizophrenia. The efficacy
of risperidone is equal to or greater than that of haloperidol. Patients who do
not respond adequately to haloperidol may be switched to risperidone. This study
was conducted to determine the correlation between steady-state plasma concentrations
of haloperidol and risperidone with the effects of CYP2D6 status on the plasma
concentrations of both drugs.
Twenty-two patients with a diagnosis of schizophrenia who were otherwise healthy
adults were included in the study. Eleven patients received risperidone 6 mg/day
and were then switched to haloperidol 12 mg/day. The remaining 11 patients received
the medications in an opposite sequence. A 2- to 8-month interval occurred between
the 2 treatments. Patients were switched to the second drug over a 4-week period.
Study drugs were given in 2 equally divided doses 12 hours apart. Blood samples
were collected at least 2 weeks after the initiation of each drug. CYP2D6 genotyping
was done on each patient.
There was no significant correlation between the steady-state plasma concentrations
of haloperidol, risperidone, or the active moiety of risperidone.
Editor's Comment
This study, in a small population of patients with schizophrenia indicates that
the plasma concentrations of haloperidol cannot be used to estimate the plasma
concentration of risperidone in the same individual. Metabolism by CYP2D6 may
play a role in the differences in plasma concentration. The efficacy of risperidone
has not been tied to plasma concentrations, although the plasma concentration
of the active metabolite of risperidone has been linked to parkinsonian symptoms.
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