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Biomedical subjects

Lee C Vermeulen

Publications and source records attributed to Lee C Vermeulen.

6 recordsLinked to original sources
PubMed2003

Patient outcomes after therapeutic interchange of dolasetron for granisetron.

The impact of using therapeutic interchange (TI) of dolasetron for granisetron for the prevention of chemotherapy-induced nausea and vomiting (CINV) was evaluated. An outcomes evaluation was conducted in two cohorts of adult outpatients who had not previously received chemotherapy. Before the interchange, 20 patients were enrolled in a granisetron cohort, and after the interchange to dolasetron, 42 patients were matched to the initial cohort. Evaluations using the modified Functional Life Index--Emesis (MFLIE) compared changes in functional status before and after treatment. Nausea and vomiting frequency, satisfaction with antiemetics, reported adverse effects, changes in antiemetic therapy, and the use of antiemetics postchemotherapy were also evaluated. Success, defined as no vomiting and less than a 2.5-unit change in MFLIE score, was demonstrated in 45% of granisetron patients and 40% of dolasetron patients (p = 0.461). While functional status declined in both groups in response to chemotherapy, the changes in MFLIE scores did not differ between agents (-16.8 +/- 20.16 versus -19.39 +/- 26.36 in granisetron and dolasetron patients, respectively) (p = 0.650). Patients were equally satisfied with their prescribed antiemetic therapy, although less than half of patients achieved antiemetic success in the 72-hour study period. Self-reported adverse events attributed to serotonin type 3-receptor antagonist use were minimal and not significantly different between groups. The TI did not negatively affect patient outcomes and produced savings of $143,534 in the first year of the program. TI of dolasetron for granisetron for CINV did not affect functional status, nausea control, or patient satisfaction with antiemetic therapy.

Adult↗
PubMed2003

Projecting future drug expenditures--2003.

Drug expenditure projections for 2003 and factors likely to influence drug costs are discussed. The United States continues to face the challenge of increased growth in health expenditures, and drug expenditures are continuing to increase faster than the growth in total health care expenditures. These increases can be largely attributed to an increase in the average age of the U.S. population and technological advancement. On the basis of price inflation and non-price inflationary factors, including increases in volume, shifts in patient and therapeutic intensity, and expected approval of new drugs, a 10-12% increase in drug expenditures in 2003 for the inpatient setting and a 13.5-15.5% increase for ambulatory care settings are forecasted. While few new drugs are expected to greatly influence expenditures in 2003, the continued diffusion of recently approved drugs such as drotrecogin alfa and nesiritide will have a dramatic impact on total drug expenditures and must be carefully considered in the budgeting process. An agent likely to have a significant impact on HIV treatment is enfuvirtide, the first in a new class of antiretrovirals (fusion inhibitors), but its high cost ($10,000-$15,000 per year) may limit patients' access to this medication. An expanded user's guide is provided to assist the reader in appropriate application of this information in the drug budgeting process. Technological, demographic, and market-based changes and changes in public policy will continue to influence pharmaceutical expenditures in the coming year. An understanding of the overall drivers of medication expenditures and vigilance in monitoring pharmaceutical innovation are critical in the effective management of these resources.

Drug Approval↗
PubMed2003

Evidence of the economic benefit of clinical pharmacy services: 1996-2000.

We sought to summarize and assess original evaluations of the economic impact of clinical pharmacy services published from 1996-2000, and to provide recommendations and methodologic considerations for future research. A systematic literature search was conducted to identify articles that were then blinded and randomly assigned to reviewers who confirmed inclusion and abstracted key information. Results were compared with those of a similar review of literature published from 1988-1995. In the 59 included articles, the studies were conducted across a variety of practice sites that consisted of hospitals (52%), community pharmacies and clinics (41%), health maintenance organizations (3%), and long-term or intermediate care facilities (3%). They focused on a broad range of clinical pharmacy services such as general pharmacotherapeutic monitoring (47%), target drug programs (20%), disease management programs (10%), and patient education or cognitive services (10%). Compared with the studies of the previous review, a greater proportion of evaluations were conducted in community pharmacies or clinics, and the types of services evaluated tended to be more comprehensive rather than specialized. Articles were categorized by type of evaluation: 36% were considered outcome analyses, 24% full economic analyses, 17% outcome descriptions, 15% cost and outcome descriptions, and 8% cost analyses. Compared with the studies of the previous review, a greater proportion of studies in the current review used more rigorous study designs. Most studies reported positive financial benefits of the clinical pharmacy service evaluated. In 16 studies, a benefit:cost ratio was reported by the authors or was able to be calculated by the reviewers (these ranged from 1.7:1-17.0:1, median 4.68:1). The body of literature from this 5-year period provides continued evidence of the economic benefit of clinical pharmacy services. Although the quality of study design has improved, whenever possible, future evaluations of this type should incorporate methodologies that will further enhance the strength of evidence of this literature and the conclusions that may be drawn from it.

Cost-Benefit Analysis↗
PubMed2002

Projecting future drug expenditures--2002.

Drug-cost projections for 2002 and factors likely to influence drug costs are discussed. The United States continues to face the challenge of increased growth in health expenditures, and pharmaceutical expenditures continue to increase significantly faster than the growth in total health care expenditures. These increases can be largely attributed to a combination of general inflation, an increase in the average age of the U.S. population, and the increased use of new technologies. On the basis of price inflation and nonprice inflationary factors, including increases in volume, shifts in patient and therapeutic intensity, and the expected approval of new drugs, we forecast a 15.5% increase in drug expenditures in 2002 for hospitals and clinics and an 18.5% increase for ambulatory care settings. One of the most substantial contributors to the rise in pharmaceutical expenditures over the past decade is the successful introduction and rapid diffusion of new pharmaceuticals. Data about many new drugs on the horizon are provided. One agent likely to have the highest impact on hospitals in the next year is drotrecogin alfa for the treatment of sepsis. The cost of this agent is expected to range from $3,000 to $10,000 per patient per course of therapy. Other factors influencing medication costs, including generic medications, legislative initiatives, and the recent acts of terrorism committed against the United States, are also discussed. Technological, demographic, and market-based changes, and possibly public policy changes, will have a dramatic influence on pharmaceutical expenditures in the coming year. An understanding of what is driving the changes is critical to the effective management of these resources.

Drug Approval↗
PubMed2002

Factors influencing decisions regarding influenza vaccination and treatment: a survey of healthcare workers.

Surveys conducted in our healthcare facility evaluated factors associated with acceptance of influenza vaccination and opinions regarding influenza prevention and treatment and willingness to pay. Avoiding lost work and low risk were primary reasons for vaccine recipients and non-recipients, respectively. One-third of vaccine recipients would refuse vaccination if asked to pay at least $10.

Adolescent↗