Lajoinie Audrey, Henin Emilie, Kassai Behrouz, Terry David
EPICIME-CIC 1407 Inserm, Service de Pharmacologie Clinique, Hospices Civils de Lyon Lyon, F-69677, Bron, France; Université Lyon 1, UMR 5558 CNRS, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France.
Br J Clin Pharmacol. 2014 Nov;78(5):1080-9. doi: 10.1111/bcp.12442.
To assess the suitability and potential cost savings, from both the hospital and community perspective, of prescribed oral liquid medicine substitution with acceptable solid forms for children over 2 years.
Oral liquid medicines dispensed from a paediatric hospital (UK) in 1 week were assessed by screening for existence of the solid form alternative and evaluating the acceptability of the available solid form, firstly related to the prescribed dose and secondly to acceptable size depending on the child's age. Costs were calculated based on providing treatment for 28 days or prescribed duration for short term treatments.
Over 90% (440/476) of liquid formulations were available as a marketed solid form. Considering dosage acceptability (maximum of 10% deviation from prescribed dosage or 0% for narrow therapeutic range drugs, maximum tablet divisions into quarters) 80% of liquids could be substituted with a solid form. The main limitation for liquid substitution would be solid form size. However, two-thirds of prescribed liquids could have been substituted with a suitable solid form for dosage and size, with estimated savings being of £5K and £8K in 1 week, respectively based on hospital and community costs, corresponding to a projected annual saving of £238K and £410K (single institution).
Whilst not all children over 2 years will be able to swallow tablets, drug cost savings if oral liquid formulations were substituted with suitable solid dosage forms would be considerable. Given the numerous advantages of solid forms compared with liquids, this study may provide a theoretical basis for investing in supporting children to swallow tablets/capsules.
从医院和社区的角度评估用可接受的固体剂型替代2岁以上儿童口服液体药物的适用性和潜在成本节约情况。
对一家儿科医院（英国）一周内发放的口服液体药物进行评估，首先筛查是否存在固体剂型替代物，然后评估现有固体剂型的可接受性，一方面与规定剂量相关，另一方面与根据儿童年龄确定的可接受尺寸相关。成本是根据提供28天治疗或短期治疗规定疗程来计算的。
超过90%（440/476）的液体制剂有市售固体剂型。考虑剂量可接受性（与规定剂量的最大偏差为10%，窄治疗范围药物为0%，片剂最大可分成四分之一），80%的液体可用固体剂型替代。液体替代的主要限制因素将是固体剂型的尺寸。然而，三分之二的规定液体可以用适合剂量和尺寸的固体剂型替代，根据医院和社区成本估算，一周内分别可节省5000英镑和8000英镑，相当于预计每年节省23.8万英镑和41万英镑（单个机构）。
虽然并非所有2岁以上儿童都能吞咽片剂，但如果用合适的固体剂型替代口服液体制剂，药物成本节约将相当可观。鉴于固体剂型相对于液体剂型有诸多优势，本研究可为投资支持儿童吞咽片剂/胶囊提供理论依据。
