Introduction:

The Anti-Vitamin K (AVK) are used in the treatment of thromboembolic diseases. their effectiveness is inseparable from their major risks: the thrombosis and haemorrhage, sometimes severe, and therefore increase the burden and the cost of treatment [1]. Indeed, the AVK hold an important place in the iatrogenic medications. the investigation ENEIS 1 and 2 shows in particular that the AVK are ranked first in France of drugs responsible for serious iatrogenic accidents.

The Emir study confirms the previous data showing that The AVK still correspond to the highest incidence of hospitalization for side effects. This translates into 12 to 13% of hospitalizations for side effect has approximately 17000 hospitalizations and approximately 5000 haemorrhagic accidents of fatal evolution by year [2]. This is why, the fact of the iatrogenic potential, Pharmaceutical Interventions (PI) have become necessary to Improve the safety of care and to reduce the costs of loads [3].

Objectives:

The objective of this study is to evaluate the pharmacoeconomic impact of PI of patients treated by acenocoumarol, and evaluate the economic rating of direct drug costs avoided or induced by the pharmaceutical intervention.

Materials and Methods:

It is a retrospective study, of a duration of 2 years, from the month of June 2016 in the month of June 2018. The analysis of the prescriptions was made using a pharmaceutical intervention sheet (SFPC), This tool contains the following information’s: the date of the intervention; the sex and the age of the patient; the service of hospitalization; the drug prescription; the type of drug problem identified (10 items and 25under items); the type of intervention formulated (7 items); the fate of the PI (the acceptance); the details relating to this intervention [4] (See Figure 1).

The total avoided costs were calculated using the prices of drugs recovered of pharmacies, and represented in the following (table1).

The listed prices are according to the Algerian market in June 2018.

The pharmacologist performs an pharmaco therapeutic analysis, to check for the presence of the drug interactions, for this it relies on bases of drug data (Vidal 2016 Expert, guide prescribe 2017, Thériaque) which allow him to deepen his study.

For the analysis of the results of the study, the data have been processed by Excel software., of which the table has 4 parts: name of the patient, the amount of the prescription, type of the PI, and the pharmaco economic impact of the PI (See Table 2).

For all the selected PI,the calculation of the costs  has been performed according to the following formula [5].

With

UP           :  Unit Price. 

MPS       :  Medicinal product stopped.

NDDP     :  New Daily Dosage Prescribed.

NDP        :  New Drug prescribed

Results and Discussion:

Prescriptions:

During the study, we analyzed 97 prescriptions of 40 patients treated by the Acenocoumarol, followed at the service of pharmacovigilance EHU of Oran Algeria.

Problems detected and pharmaceutical intervention:

The types of therapeutic problems the most detected were of dosage adjustments (62.24%), and drugs interactions (37.76%). The PI were mainly adaptations dosages, substitutions and even the stop of treatment (See Figure2)

Economic impact:

We had estimated that 74% of proposed PI had an economic impact on drug costs (see figure 3).

Among the PI with pharmaco economic impact,77% caused a reduction in costs, while 23% entail an increase on the costs (see figure 4).                                

After having excluded all PI without economic impact, we have determined that the 23% of IP resulted in an increase in support costs of medication of 23.58€, while The 77% caused a reduction of 127.48€ of these expenditures, in total an economy of 103.9 € / month has been or (2.6 €/Patient/month).

The comparison of the results of our study with the study of Thomas Gorse [5] shows that they are probably under-estimated.

This may be explained by the lack of the calculation of the indirect costs of PI in terms of extension of hospitalization and complementary examinations, however the calculation of these costs will require human and technical means more important [6].

Conclusion:

Our study has shown that the PI realized by the pharmacologist clearly allow for savings on the expenditure of the drug. The direct costs avoided drug by pharmaceutical interventions have a concrete impact on the drug expenditures and the extrapolation of these economies to the whole of our structure allows to realize their significance. It is preferable to have in our establishment of care a contractualisation and an analytical accounting for each patient (pricing to the activity) [ 7].

Figure 1: Pharmaceutical Intervention Sheet (SFPC).

Figure 2: the types of problems.

Figure 3: the distribution of PI.

Figure 4: The impact of PI on the costs.

Table 1: The price of drugs.

Table 2: The analysis of the results.

1.                   The anticoagulants in France in 2012: State of the places and monitoring, report of the MSNA.

2.                   Agnès Lillo-Le Louët, oral anticoagulants and iatrogenic, Georges Pompidou European Hospital, AP-HP, Paris, 2016.

3.                   Thomas Ameye, formulation of pharmaceutical interventions to the hospital, University of Picardie Jules Verne, 2016.

4.                   Nathalie Sylvoz. Typology of pharmaceutical interventions and acceptance by prescribers: about the National Observatory of the French Society of Clinical Pharmacy. Pharmaceutical Sciences, 2010.

5.                   Thomas Gorce, Evaluation of the economic impact of the pharmaceutical analysis of drug prescriptions: application has two services of digestive surgery of the CHU Toulouse, 2013.

6.                   Hubault, economic impact of pharmaceutical interventions in rehabilitation services, neurological rehabilitation services neurological, Henry Hospital Gabrielle, Hospices Civils Lyon, 2016.

7.                   https://lib.dr.iastate.edu/cgi/viewcontent.cgi?referer=https://www.google.co.in/&httpsredir=1&article=1131&context=ccee_pubs