Research and Discussion on Flipped Classroom Combined with Case-Based Learning in Pharmacoeconomics Teaching

Objective:To explore the application effect of flipped classroom combined with case-based learning teaching methods in pharmacoeconomics teaching.Methods:The students majoring in clinical pharmacy in 2019 were selected as the study subjects,and the cost-effectiveness analysis of different dosage forms of Yinzhihuang in the treatment of neonatal jaundice was selected as the teaching case.The flipped classroom combined with case-based learning teaching method was used to carry out theoretical teaching to the students.After the course,questionnaires were distributed through the Sojump platform to evaluate the teaching effect.Results:The results of the questionnaire showed that 85.71%of the students believed that the flipped classroom combined with case-based learning teaching method was helpful in mobilizing the learning enthusiasm and initiative,and improving the comprehensive application ability of the knowledge of pharmacoeconomics.92.86%of the students think that it is conducive to the understanding and memorization of learning content,as well as the cultivation of teamwork,communication,etc.Conclusion:Flipped classroom combined with case-based learning teaching method can improve students’knowledge mastery,thinking skills,and practical application skills,as well as optimize and improve teachers’teaching levels.

Effects of Branched-chain Amino Acids on Nutritional Metabolism and Pharmacoeconomics in Patients with Severe Abdominal Trauma

Objective:To observe the influences of branched-chain amino acids(BCAAs)on nutrition metabolism and prognosis of patients with severe abdominal trauma;at the same time,to analyze and evaluate the pharmacoeconomics of it.Methods:A total of 75 severe abdominal trauma patients were recruited from June 2016 to December 2017 and randomly divided into control group and observation group.After surgery and basic treatment,parenteral nutrition support therapy with iso-nitrogen and iso-calorie of both groups was administered.Meanwhile,an equivalent of 8.5%(18AA-Ⅱ)and 10%(20AA)compound AA injection was administrated to the control and observation groups,respectively.The nitrogen balance,serum protein level and plasma amino spectrum of the patients were observed before and after treatment.Besides,the hospital stay,survival rate,complications,adverse reactions and hospitalization costs were also compared.Results:After a 7-day course treatment,the nitrogen balance level of the two groups was significantly improved,but no significant difference was found between them.In addition,the serum protein level and plasma amino spectrum of the two groups was generally improved when compared to before treatment.Compared with the control group,the level of albumin and transferrin in the observation group was improved significantly after treatment,while no difference in plasma amino spectrum was found between the two groups.Moreover,the cost analysis showed remarkably reduced hospitalization costs in the observation group.Conclusion:To a certain degree,BCAAs could improve the nutritional metabolism and prognosis of patients with severe abdominal trauma,and have good cost-effectiveness.

Importance of Pharmacoeconomics in the Pharmacovigilance for National Health Systems

The objective of this study is to conduct a literature review to assess the importance of pharmacoeconomics in developing pharmacovigilance activities as a working tool to guide the process of decision making in the health field. The authors have done a literature review in order to find information about pharmacovigilance and their relationship with the pharmacoeconomics field, as an important element to assess the economic and health consequences because of the use of drugs in health systems. From this study, it can be found that pharmaeoeconomics applied to the pharmacovigilance activities should be considered as an aspect that contributes to improving the rational use of medicines, because it allows to compare the costs and consequences （beneficial and detrimental） with the use of different pharmacotberapeutic alternatives, in order to assess the negative effects due to ADRs （adverse drug reactions）, which directly increase the morbidity and mortality in patients, increase the direct health costs and indirectly decrease the productivity labors. It can be also concluded that pharmacoeconomics constitutes an important aspect to the pharmacovigilance activity in the health systems, in order to evaluate the negative impact of ADR, both on patient health as its economic implications, due to associated costs with these adverse effects.

Cost-Effectiveness Analysis of Renalof® versus Extracorporeal Shockwave Lithotripsy (ESWL) for the Treatment of Kidney Stones ≤ 1 cm in Nicaragua

Objectives: To assess the efficiency in terms of cost-effectiveness (CE) of oral Renalof® treatment versus extracorporeal shockwave lithotripsy (ESWL) in the treatment of kidney stones ≤ 1 cm in Nicaragua. Methods: A cost-effectiveness economic evaluation was carried out based on the results obtained in the randomised, prospective, observational, single-blind, prospective, phase 2 clinical trial. Cost-effectiveness and the incremental cost-effectiveness ratio (ICER) were calculated. Economic data were obtained from the Economics Department of Clínica Senior in Managua, Nicaragua. The monetary cost was expressed in US dollars (USD). Results: Treatment with Renalof® yielded a CE of $1,323.08/% remission, while ESWL was $9,498.54/% remission. The ICER shows that, in order to achieve a high percentage of kidney stone remission with ESWL, an extra $4,734.70 per patient must be invested. Conclusions: The use of Renalof® is shown to be a more cost-effective option than ESWL. It is recommended for the treatment of kidney stones ≤ 1 cm in size.

Overview of extended release tacrolimus in solid organ transplantation

Tacrolimus(Prograf?, Astellas Pharma Europe Ltd, Staines, United Kingdom; referred to as tacrolimusBID) is an immunosuppressive agent to prevent and treat allograft rejection in kidney transplant recipients in combination with mycophenolate mofetil, corticosteroids,with or without basiliximab induction. The drug has also been studied in liver, heart and lung transplant; however, these are currently off-label indications. An extended release tacrolimus formulation(Advagraf?, Astagraf XL?) allows for once-daily dosing, with the potential to improve adherence. Extended release tacrolimus has similar absorption, distribution, metabolism and excretion to tacrolimus-BID. Phase Ⅰ pharmacokinetic trials comparing extended release tacrolimus and tacrolimus-BID have demonstrated a decreased maximum concentration(C max) and delayed time to maximum concentration(t max) with the extended release formulation; however, AUC0-24 was comparable between formulations. Overall extended release tacrolimus has a very similar safety and efficacy profile to tacrolimus-BID. It is not recommended in the use of liver transplant patient's due to the increased risk of mortality in female recipients. There has been minimal data regarding the use of extended release tacrolimus in heart and lung transplant recipients. With the current data available for all organ groups the extended release tacrolimus should be dosed in a 1:1 fashion, the exception may be the cystic fibrosis population where their initial dose may need to be higher.

How Safe Is Conversion from Tacrolimus to Its Generic Drug?—A Single Center Experience

Background: Generically produced cyclosporine has long been approved in the treatment of organ transplant recipients and several publications have dealt with its use. For tacrolimus, however, very few data exist for safety and efficacy after conversion to its generic in kidney transplant recipients. Methods: In this single-center observational study, 14 kidney transplant carriers were converted to generic tacrolimus as part of aftercare, and graft function, fasting tacrolimus levels and the daily tacrolimus dose was pursued for up to 95 weeks. Results: Average drug doses changed from 3.64 ± 1.88 mg/day with the original to 3.33 ± 1.72 mg/day after conversion to generic tacrolimus (p = 0.33). Tacrolimus fasting levels were 6.23 ± 1.68 ng/ml before and 5.89 ± 1.15 ng/ml after conversion (p = 0.66). Average serum creatinine values of 2.26 ± 1.08 mg/dl after conversion did not differ from previous values of 1.99 ± 0.74 mg/dl (p = 0.15). Conclusions: These data support the assumption, that it is safe to convert stable kidney transplant patients from the original galenic formulation under close scrutiny to the generically produced substance. Conversion is easy to be implemented in the routine follow-up and thus represents an option in the therapy with calcineurin inhibitors, which will contribute to cost reduction in the health system.

Oral Xeloda plus bi-platinu two-way combined chemotherapy in treatment of advanced gastrointestinal malignancies

AIM： To compare the effect, adverse events, cost-effectiveness and dose intensity （DI） of oral Xeloda vs calcium folinate （CF）/5-FU combination chemotherapy in patients with advanced gastrointestinal malignancies, both combined with bi-platinu two-way chemotherapy.METHODS： A total of 131 patients were enrolled and randomly selected to receive either oral Xeloda （X group） or CF/5-FU （control group）. Oral Xeloda 1 000 mg/m^2 was administered twice daily from d 1 to 14 in X group, while CF 200 mg/m^2 was taken as a 2-h intravenous infusion followed by 5-FU 600 mg/m^2 intravenously for 4-6 h on d 1-5 in control group. Cisplatin and oxaliplatin were administered in the same way to both the groups： cisplatin 60-80 mg/m^2 by hyperthermic intraperitoneal administration, and oxaliplatin 130 mg/m^2 intravenouslyfor 2 h on d 1. All the drugs were recycled every 21 d, with at least two cycles. Pyridoxine 50 mg was given t.i.d. orally for prophylaxis of the hand-foot syndrome （HFS）. Then the effect, adverse events, cost-effectiveness and DI of the two groups were evaluated.RESULTS： Hundred and fourteen cases （87.0%） finished more than two chemotherapy cycles. The overall response rate of them was 52.5% （X group） and 42.4% （control group） respectively. Tumor progression time （TTP） was 7.35 mo vs5.95 too, and 1-year survival rate was 53.1% vs 44.5%. There was a remarkable statistical significance of TTP and 1-year survival between the two groups. The main Xelocla-related adverse events were myelosuppression, gastrointestinal toxicity, neurotoxicity and HFS, which were mild and well tolerable. Therefore, no patients withdrew from the study due to side effects before two chemotherapy cycles were finished. Both groups finished pre-arranged DI and the relative DI was nearly 1.0. The average cost for 1 patient in one cycle was ￥9 137.35 （X group） and ￥8 961.72 （control group）, or US ＄1 100.89 in X group and ＄1 079.73 in control group. To add 1% to the response rate costs ￥ 161.44 vs ￥210.37 respectively （US ＄19.45 vs ＄25.35）. One-month prolongation of TTP costs ￥1 243.18 vs ￥1 506.17 （US ＄149.78 vs ＄181.47）. Escalation of 1% of 1-year survival costs ￥172.74 vs ￥201.64 （US ＄20.75 vs ＄24.29）. CONCLUSION： Oral Xeloda combined with bi-platinu two-way combination chemotherapy is efficient and tolerable for patients with advanced gastrointestinal malignancies; meanwhile the expenditure is similar to that of CF/5-FU combined with bi-platinu chemotherapy, and will be cheaper if we are concerned about the increase of the response rate, TTP or 1-year-survival rate pharmacoeconomically.

Trend Analysis of Combined Drugs Creation （for Example Acetylsalicylic Acid）

The pharmaceutical market of Ukraine in January 2015 was registered 71 drug based acetylsalicylic acid （ASA）, for which 52% combined. The most common combinations of ASA with acetaminophen and caffeine （45.9%）, magnesium hydroxide （18.9%）, bisoprolol （10.8%）, ascorbic acid （8.1%）, clopidogrel （5.4%）. Comparing markets combined drugs ASA of Ukraine, the Russian Federation, 28 EU countries, Norway, Switzerland, India, Syria, Australia and the USA identified the active pharmaceutical ingredients, combined with ASA in a single dosage form. The analysis of questionnaires 40 pharmacists pharmacies Temopil, Khmelnytsky and Kyiv regions of Ukraine noted that the biggest demand is mono-drugs ASA, Citramon, Askofen and Cardiomagnyl Methods of pharmacoeconomic studies proved efficient use Upsaryn UPSA with vitamin C tabl. spike, tuba in box number 20 BMS （France）, Citramon tablets number 6 PJSC ＂Monfarm＂ （Ukraine） and Cardiomagnyl tabl. film-coated shell 75 mg in bottle number 100 Nycomed Austria （Austria）. On the basis of six State Forms of drugs in Ukraine （2009-2014） was found that the combination of drugs based on ASA is recommended to use of ascorbic acid （Aspiryn C, Asprovit C, Upsarin UPSA with vitamin C）, dipyridamole （Agrenox）, magnesium hydroxide （Cardiomagnyl, Cardiomagnyl Forte）. Some of the standard combination of ASA （combination of paracetamol and caffeine） are not in form. For optimize State Form of drugs by improving health system in Ukraine can be useful pharmacoeconomic analysis of combination therapies with the current official system to note the combination of ASA with statins, esomeprazole, isosorbide.

Pharmacoeconomic Evaluation of Rituximab (Hanlikang) for Patients with Rheumatoid Arthritis

Objective To provide reference for clinical medication and drug policy formulation for patients with rheumatoid arthritis.Methods A Markov model was established for patients with moderate and severe rheumatoid arthritis.The model period was 6 months and the simulation time was the average life expectancy of Chinese residents(76 years).The cost-utility analysis method was used to analyze the effect of Hanlikang combined with methotrexate and Yisaipu combined with methotrexate from the perspective of the whole society.The economy of Hanlikang was evaluated and the robustness of the results was verified by sensitivity analysis.Results and Conclusion For the patients with moderate and severe rheumatoid arthritis,compared with Yisaipu,Hanlikang could save 69228 yuan and gain 0.837 quality adjusted of life years(QALYs)in the whole life cycle with great economic advantages.The results of sensitivity analysis were consistent with those of basic analysis,and the results of probability sensitivity analysis showed that when the willingness to pay was the per capita GDP(64644 yuan),the economic probability of Hanlikang group reached 79.3%.

Comparative Evaluation of Antitumor Chinese Patent Medicine Injections Based on Evidence-Based Medicine and Markov Model

Objective: The objective of this study was to explore the safety, efficacy, economy, and other aspects of frequently-used antitumor Chinese patent medicine injections through a comprehensive evaluation of evidence-based medical research to provide scientific information and decision-making basis for drug selection, rational drug use, public awareness of safe drug use, and medical insurance. Materials and Methods: The names of five frequently used antitumor Chinese patent medicine injections were used as search terms, including the compound Sophora flavescens injection, Kangai injection, Aidi injection, Kanglaite injection, and Brucea javanica oil emulsion injection. Relevant evidence-based medical research was extracted from the databases. A descriptive evaluation was conducted, and the Markov model was used for the cost-benefit analysis. Finally, the above injections are ranked by comprehensive scores using the multi-criteria decision analysis and Delphi method. Results: The five injections had their own advantages in enhancing the effectiveness of anti-tumor treatments, improving the quality of life for cancer patients, and reducing the incidence of adverse reactions. From the perspective of economy and other attributes, compound S. flavescens was superior to B. javanica oil, Aidi, Kangai, and Kanglaite. After a comprehensive evaluation of the above five injections, the compound S. flavescens injection received the highest score. Conclusions: Compound S. flavescens, Kangai, Aidi, B. javanica oil, and Kanglaite have their own advantages in effectiveness and no significant difference in safety. Compound S. flavescens injection has the highest comprehensive score. Clinical attention should be paid to monitoring the initial stage of medication and special groups.

Guideline for Postmarketing Chinese Medicine Pharmacoeconomic Evaluation

Pharmacoeconomics is an important part of the postmarketing Chinese medicine （CM） evaluation, and postmarketing pharmacoeconomic evaluation can reveal the clinical and market value of CM. The purpose of establishing the guideline for pharmacoeconomic evaluation is to make the evaluation process and results regarding Chinese patent medicines both scientific and fair. Every country＇s guidelines for pharmacoeconomic evaluation act as reference guidelines, we have already drawn up the guideline that takes into account the special characteristics of CM; and these are in preparation for the postmarketing CM pharmacoeconomic evaluation.