INTERNATIONAL RESEARCH & OPINION

News in brief ...

• Metformin is more cost effective than insulin in patients with type 2 diabetes mellitus who are inadequately controlled by sulfonylurea therapy, report US-based investigators. Blood glucose levels were significantly reduced in metformin recipients (n =59) but not in patients treated with insulin (39). * Furthermore, a larger proportion of patients achieved successful blood glucose control with metformin (44 vs 33%, respectively). Therefore, although the drug acquisition cost of metformin is higher than that of insulin, the cost-effectiveness ratio for metformin was better than that for insulin ($US240 vs $US402 per successfuiiy-treated patient). This retrospective study was conducted at the Department of Veterans Affairs Medical Center- a 300-bed tertiary-care hospital in Portland, Oregon, US. *Patients (mean age 62 years) who were inadequately controlled by a sulfonylurea received add-on therapy with metformin or insulin, or were switched to insulin therapy.

Brown RR. Cost-effectiveness and clinical outcomes of metformin or insulin add-on therapy in adults with type 2 diabetes. American Journal of Health-System Pharmacy 55 (Suppl. 4): 24-27, 15 Dec 1998 soo736J68

• A pharmacist-managed programme for IV calcitriol in haemodialysis patients with hyperpara­thyroidism resulted in an annual cost saving of almost SUS44 000 in a 180-patient haemodialysis centre at Hartford Hospital, US. The number of patients with hyperparathyroidism decreased from 67 (42%) before implementation of the programme to 55 (31%) 1 year later. Notably, the number of patients with moderate to severe hyperparathyroidism was halved to 7% under the programme. The cost of IV calcitriol administered by dialysis nurses from single-dose vials prior to the programme was SUS 104 624. Following implemen­tation of the pharmacist-managed programme, which involved use of unit-dose syringes, the cost of IV calcitriol was reduced to $US60 638.

Pharmacist-run program optimally manages secondary hyperparathyroidism. Formulary 33: 1217-1218, Dec 1998 8007362-<1

• An improvement in the delivery and admini­stration of preoperative antibacterials was achieved by a multidisciplinary approach at a 1 000-bed US hospital. A multidisciplinary team standardised the medication-use process to achieve preoperative antibacterial administration within 3{}-60 minutes prior to surgery. One year after the redesign and staff­education process, the percentage of patients receiving perioperative antibacterials within 3{}-60 minutes before surgery had increased from 39% at baseline to 61 %; cases receiving antibacterials < 30 minutes before surgery had decreased from 31 to 18%. The study authors say that such changes should improve patient outcomes and result in 'tremendous cost savings' by reducing the number of surgical site infections.

Welch L, et al. A quality management approach to optimizing delivery and administration of preoperative antibiotics. Clinical Performance and Quality Health Care 6: 168-171. Oct-Dec 1998 8007J?sso

1173-5503/99/0201-0009/$01.00° Adie International Limited 1999. All rights reserved

• Buruli ulcer* has significant socioeconomic implications in Ghana, report researchers in that country. The total treatment costs** over a 3-year period ( 1994-1996) for 102 patients with this disease were estimated to be $US79 893 or $US783.27/ patient.t Indirect costs (totalling $US 56 04 7 or $US549.49/patient) contributed 70% of the total cost, with feeding costs (for the patient and the attending relative) being the largest cost component of indirect costs. Among the direct costs (totalling $US23 846 or $US233.78/patient), drugs were the largest component, followed by dressings and inpatient costs. The average duration of hospital stay was 186 days in 1994, 103 days in 1995 and 102 days in 1996. Early detection and treatment could achieve considerable savings, conclude the researchers.

*a skin disease caused by Mycobacterium ulcerans commonly found in tropical countries **Costs included both direct costs (those associated with hospitalisation, surgery, dressings, laboratory tests and drug acquisition) and indirect costs (those associated with feeding and lost productivity)_ t Annual per-capita income in Ghana is around $US200.

Asiedu K. et a!. Socioeconomic implications of Buruli ulcer in Ghana: a three-year review. American Journal of Tropical Medicine and Hygiene 59: 1015-1022, Dec 1998 800732lll

PharmacoEconom1cs & Outcomes News 27 Feb 1999 No. 201

9