Javier Rejas-Gutiérrez is a Physician, obtained his degree as a General Practitioner at Universidad Complutense of Madrid in 1982 and Doctorate in Public Health at University Rey Juan Carlos (Madrid) in 2003. He completed his Master’s degree in Research Methodology for Health Sciences at Universidad of Barcelona in 2010, an MBA in Pharma Business at EPHOS Business School of Madrid in 1997 and also has Specialist degree in Pharmaceutical Medicine. In his professional career, he worked as a General Practitioner for three years. He has been working in the pharmaceutical industry since 1987 to date in several positions in the field of Clinical Research, Health Economics and Health Outcomes Research. Currently, he is Manager in Health Economics and Outcomes Research (HEOR) department, Market Access & Institutional Relationships Unit at Pfizer Spain.
This post-hoc analysis investigated whether the use of therapeutic doses of pregabalin or gabapentin impact on cost-of-treatment of peripheral neuropathic pain (pNeP) in routine clinical practice. To this end, we analyzed electronic medical records (EMR) of subjects with pNeP followed in primary care centers in Spain. EMR of patients who began treatment with pregabalin (≥150 mgr/day) or gabapentin (≥900 mgr/day) for any health condition causing pNeP during two years within the period lasting from 2008-2012 were included in this analysis and compared with all patients receiving pregabalin or gabapentin irrespectively of doses prescribed. Therapeutic range dose was considered pregabalin 150mg/day or more and gabapentin 900mg/day or more. Health resources utilization and sick leaves along with corresponding costs were computed in year 2015 and compared according with main therapy of pNeP; pregabalin vs. gabapentin. A total of 1163 EMR (pregabalin; N=764, Gabapentin; N=399, 923[79%] within therapeutic range) were analyzed. Mean dose in therapeutic range subgroup were 238.8 (180.1) mgr/day for pregabalin, and 1,210.8 (409.6) mgr/day for gabapentin. Average cost/patient of main medication for pNeP was slightly higher for pregabalin than for gabapentin; 229.2€ vs. 224.2€ (p=0.762) at therapeutic doses, but significantly higher in the whole sample: 214.6€ vs. 157.4€ (p=<0.001). Nonetheless, the average/patient adjusted total cost was lower with pregabalin than with gabapentin; 2,464€ (2,197-2,730) vs. 3,142€ (2,670-3,614), p=0.014 in the therapeutic range analysis, and also in the analysis with the overall sample; 2,413€ (2,119-2,708) vs. 3,201€ (2,806-3,597), p=0.002. These finding may be explained by a significant lower use of concomitant analgesics in the pregabalin subgroup, together with fewer medical visits and days of sick leave. We conclude that treating pNeP with pregabalin is associated with lower-costs in comparison with gabapentin in routine clinical practice in Spain. These findings are observed irrespectively of the range of doses of pregabalin or gabapentin prescribed to patients.
Mike McDonough is a Physician at Footscray Hospital in Melbourne. He specializes in Addiction Medicine & Toxicology. He acts as Chair of the hospital’s ADR committee and has special interest in Medication Safety.
Adverse drug reactions (ADRs) are a common cause of negative health outcomes for patients, often resulting in increase in hospitalization, length of stay and the overall cost. This makes it important to have procedures that minimize risk of inadvertent re-exposure to a drug that has caused the patient an ADR. To evaluate patient receipt and use of ADR warning cards as well as their understanding of ADR information provided, we undertook a retrospective telephone survey of past inpatients who experienced an ADR; this covered the period between January 2013 and April 2016. 82% (89) recalled the ADR event; 55% (49) recalled receiving a temporary ADR warning card and; 73% (65) remember receiving a permanent ADR warning card post-discharge. The ADR warning card was carried by 74% (65) of participants. 85.4% (76) had told their regular GP and 40% (36) had told a pharmacist about their ADR. Overall satisfaction with the current ADR management services was high with 89% (79) agreeing that this adverse drug reaction service was valuable to them. Requiring patients to be responsible for communicating ADRs to all relevant health care professionals outside of this hospital network was not identified as an effective strategy. Patient satisfaction with current ADR management services was high. Many participants still have/use the ADR warning card. Most people were able to participate without reservation.