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Nakano LA, Cançado ELR, Chaves CE, Madeira MCV, Katayose JT, Nabeshima MA, Fossaluza V, Uhrigshardt GG, Liting Z, Pinto VB, Carrilho FJ, Ono SK. A randomized crossover trial to assess therapeutic efficacy and cost reduction of acid ursodeoxycholic manufactured by the university hospital for the treatment of primary biliary cholangitis. BMC Gastroenterol 2020; 20:253. [PMID: 32758152 PMCID: PMC7406387 DOI: 10.1186/s12876-020-01399-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background Health care costs are growing faster than the rest of the global economy, according to the World Health Organization (WHO). Countries’ health expenditures include paying for general medicine, diagnostic procedures, hospitalizations and surgeries, as well as medications and prescribed treatment. Primary biliary cholangitis (PBC) is a rare autoimmune liver disease and the first line available treatment is ursodeoxycholic acid (UDCA), however, direct and indirect treatment costs are expensive. Main aim of this trial was to assess if the therapeutic efficacy of UDCA manufactured by the university hospital is equivalent to that of standard UDCA and treatment cost reduction in patients with PBC. Methods It is a prospective, interventional, randomized, and crossover study in patients diagnosed with PBC. UDCA 300 mg tablets and capsules were developed and manufactured by the university hospital. Thirty patients under treatment with standard UDCA, in stable doses were randomized in sequence A and B, 15 patients in each arm. The groups were treated for 12 weeks and after, the UDCA formulation was changed, following for another 12 weeks of continuous therapy (tablets and capsules / capsules and tablets). Laboratory tests were performed at time T0 (beginning of treatment), T1 (at the 12 week-therapy, before the crossing-over) and T2 (end of treatment). The evaluation was done by comparing the hepatic parameters ALP, GGT, ALT, AST and total bilirubin, also considering the adverse events. The comparison of costs was based on price of the manufactured UDCA and standard UDCA price of the hospital. Results Hospital reduced 66.1% the PBC treatment costs using manufactured UDCA. There were no differences in the biochemical parameters between sequence (A and B) and tablets or capsules of UDCA formulations applied in the treatment of PBC. Conclusions The study showed that there was no significant difference between manufactured UDCA (capsule and tablet) and standard UDCA. Hospital reduced the PBC treatment costs using the manufactured UDCA by the university hospital. Trial registration ClinicalTrials.gov: NCT03489889 retrospectively registered on January 12th, 2018; Ethics Committee approved the study (ID: 1.790.088) on October 25th, 2016.
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Affiliation(s)
- Larissa Akeme Nakano
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, University of São Paulo School of Medicine, Av. Dr. Enéas Carvalho de Aguiar, 255, ICHC, 9th Floor, office 9159, São Paulo, SP 05403-000, Brazil
| | - Eduardo Luiz Rachid Cançado
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, University of São Paulo School of Medicine, Av. Dr. Enéas Carvalho de Aguiar, 255, ICHC, 9th Floor, office 9159, São Paulo, SP 05403-000, Brazil.,Laboratory of Medical Investigation LIM 06, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Cleuber Esteves Chaves
- Division of Pharmacy of Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Maria Cristina Vaz Madeira
- Division of Pharmacy of Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jéssica Toshie Katayose
- Division of Pharmacy of Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Mariana Akemi Nabeshima
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, University of São Paulo School of Medicine, Av. Dr. Enéas Carvalho de Aguiar, 255, ICHC, 9th Floor, office 9159, São Paulo, SP 05403-000, Brazil
| | - Victor Fossaluza
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | | | - Zheng Liting
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Vanusa Barbosa Pinto
- Division of Pharmacy of Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flair José Carrilho
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, University of São Paulo School of Medicine, Av. Dr. Enéas Carvalho de Aguiar, 255, ICHC, 9th Floor, office 9159, São Paulo, SP 05403-000, Brazil
| | - Suzane Kioko Ono
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, University of São Paulo School of Medicine, Av. Dr. Enéas Carvalho de Aguiar, 255, ICHC, 9th Floor, office 9159, São Paulo, SP 05403-000, Brazil.
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Marin MLDM, Oliveira BBDC, Cipriano SL, Suslik CA, Faintuch J. Oseltamivir compounding in the hospital pharmacy during the (H1N1) influenza pandemic. Clinics (Sao Paulo) 2010; 65:1081-6. [PMID: 21243276 PMCID: PMC2999699 DOI: 10.1590/s1807-59322010001100004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 08/02/2010] [Indexed: 11/21/2022] Open
Abstract
AIMS Pandemics impose large demands on the health care system. The supply of appropriate chemotherapeutic agents, namely oseltamivir solution, presented a serious challenge in the recent influenza pandemic. This study reports on the rational series of pharmacotechnical steps that were followed to appropriately handle bulk oseltamivir powder to meet the increased demand. METHODS During a six-week period in August and September of 2009, a task force was created in the Central Pharmacy of Hospital das Clínicas to convert imported oseltamivir phosphate into ready-to-use solution for utilization by physicians and public health authorities. The protocol included dissolution, physico-chemical tests and the bottling of a liquid microdose formulation for emergency room and outpatient dispensing with adequate quality control during all phases. RESULTS The successful production routine was based on a specially designed flowchart according to which a batch of 33210 g of oseltamivir powder was converted into 32175 solution units during the aforementioned period with a net loss of only 2.6%. The end products were bottles containing 50 ml of 15 mg/mL oseltamivir solution. The measured concentration was stable and accurate (97.5% - 102.0% of the nominal value). The drug was prescribed as both a prophylactic and therapeutic agent. DISCUSSION Hospital pharmacies are conventionally engaged in the manipulation of medical prescriptions and specialty drugs. They are generally responsible for only small-scale equipment used for manufacturing and quality-control procedures. The compounding of oseltamivir was a unique effort dictated by exceptional circumstances. CONCLUSION The shortage of oseltamivir solution for clinical use was solved by emergency operationalization of a semi-industrial process in which bulk powder was converted into practical vials for prompt delivery.
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Affiliation(s)
- Márcia Lúcia de Mário Marin
- Pharmacy Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Magarinos-Torres R, Osorio-de-Castro CGS, Pepe VLE. [Pharmaceutical services for inpatients provided by hospital pharmacies in Brazil: a review of the literature]. CIENCIA & SAUDE COLETIVA 2007; 12:973-84. [PMID: 17680156 DOI: 10.1590/s1413-81232007000400019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Accepted: 02/13/2007] [Indexed: 11/22/2022] Open
Abstract
This paper discusses the literature on hospital pharmacy services for in-patients in Brazil, seeking a broader view of its characteristics and priorities. Seventeen papers were located in the Medline and Lilacs databases that complied with the pre-defined inclusion/exclusion criteria. Most of them were related to teaching and research, logistics and compounding, based on observations in public hospitals in Southeast Brazil. Few studies focused on core activities such as management and selection. The academic syllabus through which pharmacy students are trained may underlie the perception that compounding is the preponderant aspect of hospital pharmacy services, although this is required in only a few institutions. Added to this is poor compliance by pharmacy activities with established norms and standards and the lack of an indexed Brazilian publication in this field. As there were far more studies of the public sector than its private counterpart, it seems as though there is either greater freedom of action in the former or less scientific output in the latter, quantified by published studies.
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Affiliation(s)
- Rachel Magarinos-Torres
- Núcleo de Assistência Farmacêutica, DCB-ENSP/Fiocruz, Centro Colaborador da OPAS/OMS em Política de Medicamentos Av Brasil 4036, s/ 915 e 916, Manguinhos. 21040-361 Rio de Janeiro RJ.
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