停用治疗的门诊药房患者中未使用的口服抗癌药物和生物改善病情抗风湿药物的数量和经济价值。

Quantity and economic value of unused oral anti-cancer and biological disease-modifying anti-rheumatic drugs among outpatient pharmacy patients who discontinue therapy.

机构信息

Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574 NA, Nijmegen, The Netherlands; Department of Clinical Pharmacy, Division Laboratories and Pharmacy, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.

Department of Clinical Pharmacy, Division Laboratories and Pharmacy, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.

出版信息

Res Social Adm Pharm. 2019 Jan;15(1):100-105. doi: 10.1016/j.sapharm.2018.03.064. Epub 2018 Mar 24.

DOI:10.1016/j.sapharm.2018.03.064

PMID:29610051

Abstract

BACKGROUND

Patients sometimes discontinue the use of expensive oral anti-cancer drug (OACD) or biological disease-modifying anti-rheumatic drug (bDMARD) therapies early, leading to medication waste if the patient has not used all dispensed medication.

OBJECTIVE

To determine the proportion of patients who have unused OACDs or bDMARDs after therapy discontinuation, and the quantity and economic value of these unused medications. Furthermore, patients' reasons for therapy discontinuation and their disposal method for unused medications were determined.

METHODS

In a retrospective follow-up study using a Dutch outpatient pharmacy database, patients (≥18 years) who did not refill an OACD or bDMARD prescription, dispensed between November 2015 and February 2016, within two weeks of the prescription end date were contacted by phone and asked about their unused medication and reasons thereof. The economic value was calculated using Dutch medication prices. Data were descriptively analyzed in STATA13.

RESULTS

The database included 1173 patients, of whom 159 likely had discontinued therapy and were contacted. Of these, 88 patients were excluded (39 refilled, 47 missing, and 2 other). Of the 71 patients who had discontinued therapy, 39 (54.9%) had unused medications, comprising 22 OACD users (mean age 63.0 (SD ± 15.9) years, 50.0% female) and 17 bDMARD users (mean age 50.7 (SD ± 13.5) years, 47.1% female). A total of 59 packages were unused, with a total value of €60,341. Unused OACD packages and bDMARD packages had median values of €179 (IQR €24-2487) and €992 (IQR €681-1093), respectively. Patients primarily discontinued therapy due to adverse or insufficient effects.

CONCLUSIONS

This study illustrates that more than half of patients discontinuing OACD or bDMARD therapies have unused medication. This emphasizes the need for waste-reducing interventions.

摘要

背景

患者有时会过早停止使用昂贵的口服抗癌药物（OACD）或生物改善病情的抗风湿药物（bDMARD）治疗，导致药物浪费，如果患者未使用所有配给的药物。

目的

确定治疗停止后未使用 OACD 或 bDMARD 的患者比例，以及这些未使用药物的数量和经济价值。此外，还确定了患者停止治疗的原因及其未使用药物的处理方法。

方法

在一项使用荷兰门诊药房数据库的回顾性随访研究中，联系了在 2015 年 11 月至 2016 年 2 月期间未续开 OACD 或 bDMARD 处方且在处方结束日期后两周内未再配药的患者（≥18 岁），询问其未使用的药物及其原因。使用荷兰药物价格计算经济价值。在 STATA13 中进行描述性分析。

结果

数据库包括 1173 名患者，其中 159 名可能已停止治疗并被联系。其中，88 名患者被排除在外（39 名已续开处方，47 名缺失，2 名其他）。在已停止治疗的 71 名患者中，39 名（54.9%）有未使用的药物，包括 22 名 OACD 使用者（平均年龄 63.0（SD±15.9）岁，50.0%为女性）和 17 名 bDMARD 使用者（平均年龄 50.7（SD±13.5）岁，47.1%为女性）。共有 59 个包装未使用，总价值为 60341 欧元。未使用的 OACD 包装和 bDMARD 包装的中位数价值分别为 179 欧元（IQR 24-2487）和 992 欧元（IQR 681-1093）。患者主要因不良反应或疗效不佳而停止治疗。