著者

加藤 隆寛 岩澤 瞳 甚目 陽子 加藤 顕子 築山 郁人 斎藤 寛子

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.43, no.12, pp.680-690, 2017-12-10 (Released:2018-12-10)

参考文献数

34

被引用文献数

1 2

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The efficacy of pharmaceutical interventions for patients with cardiovascular disease has been reported in several countries. However, the interventions especially for patients with cardiovascular disease have not been evaluated for safety, efficacy and economy. To evaluate pharmaceutical interventions in the cardiovascular ward, we evaluated the economic benefit of pharmaceutical interventions retrospectively. We classified pharmaceutical interventions into 3 items, which included type of intervention, intervention that influences patients' outcome, and intervention according to guidelines. Moreover, we evaluated for economic benefit regarding the prevention of serious adverse drug reactions, and avoidance of drug interaction. We also collected interventions for initiating drugs, and the estimated cost savings by decreasing the risk of hospital readmission by initiating drugs.One hundred and thirteen interventions were accepted and 27 interventions were rejected. It was considered that 48 interventions led to safety. The cost saving associated with pharmaceutical interventions that include the prevention of serious ADRs, avoidance of drug interaction and others was estimated to be about 13 million-yen of financial benefit.In addition, 33 interventions were those for changing medications according to several guidelines. The interventions (drug initiation) cut the medical care cost by about one million yen per year by the decreased risk of hospital readmissions.This is the first study to estimate the economic impact directly associated with various pharmaceutical interventions of pharmacists in cardiovascular disease in Japan. Evaluating the economic impact in relation to the pharmaceutical interventions is an important method for assessing the role of pharmacists.

著者

杉本 智哉 近藤 有 一木 万奈美 荒川 裕貴 間瀬 広樹 牛膓 沙織 佐久間 昌基 小山 佐知子 大島 有美子 宮崎 雅之 築山 郁人 佐藤 由美子 久田 達也 板倉 由縁 山田 清文

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.44, no.9, pp.441-448, 2018-09-10 (Released:2019-09-10)

参考文献数

26

被引用文献数

1

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The objective of this study was to evaluate the cost-effectiveness of pegfilgrastim (Peg-G) and daily filgrastim (Fil-G) for the primary prophylaxis against febrile neutropenia (FN) in patients with non-Hodgkin lymphoma (NHL) who received cyclophosphamide, vincristine, doxorubicin and prednisolone (CHOP) therapy. We developed a decision analytical model reflecting the clinical processes of NHL patients who received first CHOP therapy. The probabilities at each clinical endpoint were obtained from published sources. To estimate the costs and duration of FN treatment, we analyzed the medical records of NHL patients in hospitals participating in this study. The costs of Peg-G and Fil-G were calculated according to the National Health Insurance drug price list. We assessed an incremental cost-effectiveness ratio (ICER) for a single dose of Peg-G versus 11-days of Fil-G from the perspective of health insurance payers. The sensitivity and robustness of this model were validated by the tornado-diagram and Monte Carlo Method. The costs associated with primary prophylaxis with a single dose of Peg-G and 11-days of Fil-G were 109,628 JPY and 109,243 JPY, respectively. The quality adjusted life years (QALYs) associated with the two strategies were 0.0339 QALYs and 0.0337 QALYs, respectively. The ICER for the Peg-G versus Fil-G was 2,788,571 JPY per QALY. The tornado-diagram revealed that the main influential factors included the cost of Peg-G, number of Fil-G doses, and cost of Fil-G. Monte Carlo simulation revealed an 18.3% probability that Peg-G was cost-effective compared with Fil-G. A single dose of Peg-G was cost-effective compared with 11-days of Fil-G.

著者

佐々木 俊則 大島 有美子 三島 江津子 伴 晶子 桂川 健司 永松 秀紹 吉岡 祐貴 築山 郁人 久田 達也 板倉 由縁 水谷 三浩

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

vol.136, no.7, pp.1023-1029, 2016 (Released:2016-07-01)

参考文献数

15

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It is often necessary to modify the dose or schedule of eribulin mesilate (Eri) because of adverse events. Therefore, we retrospectively investigated the optimal approach for Eri dose adjustment and/or dosage interval adjustment. Patients who received Eri at the institutions affiliated with the Division of Oncology of the Aichi Prefectural Society of Hospital Pharmacists between July 2011 and November 2013 were enrolled in this study. We compared the group that underwent dose reduction without changes to their dosage interval (dose reduction group) with the group that had a change in their dosage interval (dose-interval prolongation group). The primary end-point was time to treatment failure (TTF), and the secondary end-points were overall survival (OS), overall response rate (ORR), clinical benefit rate (CBR), and adverse events. The TTF and OS of the dose reduction group were approximately two times longer than those of the dose-interval prolongation group. In addition, the dose reduction group had significantly improved ORR and CBR, which together indicate an antitumor effect (p=0.013 and 0.002, respectively). Although peripheral neuropathy occurred significantly more frequently in the patients in the dose reduction group (p=0.026), it was grade 1 and controllable in most of the cases. There were no differences in the occurrence of other adverse effects between the two groups. Therefore, we suggest that dose reduction with maintenance of the dosage interval is the preferred treatment approach in cases where Eri dose or schedule modification is necessary.