A Cheikh

Evaluation of the cost of cervical cancer at the National Institute of Oncology, Rabat

Introduction The Cervical Cancer (CC) is one of the heavy and costly diseases for the population and the health system. We want to know through this study, the first in Morocco, the annual cost of the treatment of this disease at the National Institute of Oncology (NIO) in Rabat, we also want to explore the possibility of flat-rate management of this disease in order to standardize medical practices and improve reimbursement by health insurance funds. Methods 550 patients were treated for their cervical cancer in the Rabats NIO. Data of all of medical and surgical services offered to patients were collected from the NIO registry. The cost of care was assessed using the method of micro-costing. We will focus to the total direct cost of all the services lavished to patients in NIO. Results The global cost was about US

Cost of Treatment of Cerebral Aneurysm Embolization: Study of Associated Factors.

1,429,673 with an average estimated at US

Interactions between injectable anticancer drugs and polyvinyl chloride bags: Evaluation of the adsorption phenomenon after reconstitution

2,599 ± US

4CPS-005 The cost of routine sequential treatment in children with digestive symptoms and positive helicobacter pylori

839. Radiotherapy accounts for 55% of total costs, followed by brachytherapy (27%) and surgery (7%). This three services plus chemotherapy influence the overall cost of care (p <0.001). Other services (radiology, laboratory tests and consultations) represent only 10%. The overall cost is influenced by the stage of the disease, this cost decreased significantly evolving in the stage of CC (p <0.001). Conclusion The standardization of medical practices is essential to the equity and efficiency in access to care. The flat-rate or lump sum by stage of disease is possible and interesting for standardizing medical practices and improving the services of the health insurance plan.

Endovascular treatment of acute aortic isthmian ruptures: case study

BackgroundSurgical clipping or endovascular coiling are the main procedures used in the treatment of cerebral aneurysms, with a preference for endovascular coiling. In Morocco, the number of patients needing endovascular coiling is growing, but many of them do not have access to this technique. The aim of this study was to determine the main parameters associated with variations in the total cost of this procedure in order to establish the amount (lump sum) that may be reimbursed by health insurance funds.MethodsOne hundred and seventeen patients with 124 aneurysms were admitted for treatment of one or more intracranial aneurysms between January 2010 and December 2015. The overall cost of hospitalization was assessed by using the micro-costing technique. The calculation was based on the tariffs of medical procedures as defined by the Ministry of Health in Morocco. A regression analysis was used to define the correlation between the overall cost and the various parameters.ResultsUnivariate linear regression showed that the total cost was influenced by overall duration of hospitalization, ICU duration of hospitalization and size of aneurysm. On the other hand, univariate linear regression showed that the total cost was not influenced by sex, localization of aneurysm, and size of the aneurysm’s neck. However, multivariate linear regression showed that the total cost was influenced by one type of insurance health, overall duration of hospitalization, ICU duration of hospitalization, size of the aneurysm, and size of the aneurysm’s neck.ConclusionSetting a rate for reimbursement of patients who have had coiling treatment for a cerebral aneurysm should take into account the results of our study in order to limit the costs borne by patients. The parameters that influence the overall cost must be reimbursed in each case while the parameters that do not influence treatment costs could be included in a lump sum.

PP-030 The influence of the dead volume of the closed system (spike–connector–syringe) on the reconstitution of injectable drugs

Introduction During the reconstitution of a drug and during its storage, there are risks of interactions between the drug and the bag used for the preparation. Polyvinyl chloride is a material used in the manufacture of a large part of chemotherapy infusion bags. It is subject to many interactions like sorption of drugs and release of phthalate additives. Material and Methods Seven anticancer drugs used in pediatric oncology were involved in our study. After reconstitution of the anticancer agents in polyvinyl chloride bags, the adsorption phenomenon between the container and the contents is evaluated by infrared spectroscopy by analyzing the inner surface of the polyvinyl chloride. Subsequently, for the anticancer agents which exhibited an adsorption–container–content, the analysis was carried out by ultraviolet–visible spectrophotometry in order to examine the kinetics of the concentration of reconstituted anticancer drugs. Results All the polyvinyl chloride bags gave a spectrum identical to the spectrum of the reference bag, except the bags used to reconstitute etoposide whose spectra showed 12 additional peaks. With the absorbances measured by ultraviolet–visible spectrophotometry at different times, the analysis of variance statistical analysis shows that there is a significant difference in absorbances between t0 and all the other measurement times. Conclusion This study testifies to the existence of a container–content interaction between etoposide and polyvinyl chloride. Thus, reconstitution of etoposide for intravenous infusion into a polyvinyl chloride bag should be used immediately. For etoposide preparations intended for storage beyond 24 h, it is recommended to use a container other than the polyvinyl chloride bag.

GM-028 Contribution of hospital pharmacy iso certification 9001 v 2008 on improving performance indicators: experience of pharmacy of a paediatric hospital

Background Helicobacter pylori (HP) infection has become one of the most common infections in adults and children. In children, the principal symptoms are the epigastralgia, with a repercussion on growth and epigastric sensibility on palpation. The presence of HP multiplies the risk of developing gastric cancer. The diagnosis of HP infection is made by high digestive endoscopy (which targets gastritis and/or peptic ulcer), allowing biopsies to be taken at the antropharmic level. Other non-invasive screening tests such as serology are used for epidemiological studies and not for the diagnosis of acute infection. Purpose The objective of this work is to evaluate the cost of sequential treatment in children with epigastralgic symptoms and having a positive serology at HP, and to compare it with the cost of the usual procedure, which consists of digestive endoscopy plus anatomopathological examination. Material and methods A search for anti-HP antibodies was carried out in all children who visited the paediatric hospital and had digestive symptoms of HP in addition to endoscopic and anatomopathological examination. A questionnaire was completed by conducting a direct interview with the parents of the patients in order to get an idea of the socio-economic level of these children and explore the family antecedents. We then calculated the cost of a sequential treatment and the cost of the endoscopic and pathological examination. Statistical analysis were performed with SPSS 13.0. Results One hundred and six children were included in this study. Anti-HP antibodies were found in 72% of symptomatic children. The comparason between serological and anatomopathological examination was significant (88% of children with positive anatomopathological examination results have anti-HP antibodies, p<0. 001). The cost of sequential treatment was estimated at around €25 compared with €125 for the endoscopic and anatomopathological examination per child. Conclusion The peptic ulcer caused by the presence of HP has become a real public health concern due to the heavy economic and health consequences. The introduction of systematic sequential treatment in symptomatic children with a positive serology can be a cost-effective solution, especially in low- and middle-income countries where human and material resources are not always available. References and/or Acknowledgements Acknowledgements to microbiology team No conflict of interest

DD-007 Contribution of electronic prescriptions on time management at the hospital pharmacy

Traumatic rupture of the aortic isthmus is a rare lesion occurring in patients subjected to violent deceleration. Because of the forces involved, it is frequently associated with concomitant life-threatening injuries. The endovascular intervention has been described to be a feasible and efficient technique which may be proposed as a therapeutic option for patients with multiple traumas instead of delayed classical surgical repair after stabilization. We report the case of an adult who has had an accident with a traumatic rupture of the aortic isthmus associated with other lesions, our patient received endovascular treatment. The aortic prosthesis was imported from France and the surgery was done 3 days after the patients admission. This procedure was performed for the first time in Morocco in our hospital with a multidisciplinary team. The prosthesis was implemented successfully and the result was very satisfactory on the heart level.

CP-066 Appreciation of reduction of drug prices by policyholders of health insurance and its impact on access to drugs

Background The closed system is designed, first, to protect patients and clinicians against exposure to hazardous drugs during the preparation of cytotoxic drugs and secondly, to protect the drugs against any exposure to external microbiological and physical contaminants. Purpose The aim of this study was to determine the dead volume of spike–connector–syringe system used for the reconstitution of cytotoxic drugs and its impact on the variation of prepared doses. Material and methods The spike, connector and syringe (10 or 20 mL) were weighed using an analytical balance before and after passing a solution of distilled water. Taking into account the density of water, we can thus determine the dead volume remaining in every material. For each measurement, the test was performed 30 times for each medical device. Results The table shows that the dead volumes were different for the three devices: spike, connector and syringes (p<0.001). There was no significant differences between the dead volumes of the two syringes tested (10 and 20 mL) (p> 0.05). Dead volume Vial adapter (spike) Connector Syringe 10 mL Syringe 20 mL Mean (mL) 0.1192 0.2043 0.0702 0.0596 Conclusion Reconstitution of cytotoxic drugs is influenced by several factors, some of which are controllable and others are unpredictable. The dead volumes can cause overdose or underdose, especially for preparations of low volume and expensive drugs. This phenomenon is important for connectors and spikes where the dead volume is about 0.2 mL and 0.1 mL, respectively. For syringes, the dead volume is not very important and does not vary with the volume of the syringe. This study showed that we must take into account the dead volume on reconstitution of cytotoxic drugs. Thus it would be highly advisable to use connectors whose dead volume is negligible compared with the prepared final volume. References and/or acknowledgements Acknowledgements to the analytical chemistry team. No conflict of interest

CP-068 Evaluation of antibacterial consumption in a paediatric hospital from 2009 to 2014

Background Quality is a tool for clarification of the missions and relationships within the hospital pharmacy and units of care. It is a tool for standardisation of customer–supplier relationships within the institution by contracting; it is also a guarantee of continuous improvement of services provided to patients. Purpose Our goal was to present the experience of our hospital pharmacy in the implementation of a quality management system which received ISO 9001 v 2008 certification. Material and methods After implementation of the quality management system in the pharmacy, the effectiveness of internal and external processes was evaluated through several indicators. Results The results of the key indicators before and after certification are summarised in the table. Indicator Before (%) After (%) The shortage rate of drugs 7 1 The shortage rate of medical devices 24 2 The pre-emption rate of drugs 0.6 0.01 The pre-emption rate of medical devices 0.08 0 The drug and medical devices deterioration rate 0 0 The effectiveness rate for immediate action 40 75 The response rate to patient complaints 40 100 The drug needs satisfaction 62 97 The medical devices needs satisfaction 45 95 The rate of compliance of commitments to purchase drugs 81 98 The rate of compliance of commitments to purchase medical devices 53 89 Rate of satisfaction with training requests 100 100 Rate of satisfaction with recruitment requests 67 80 Conclusion The pharmacy certification process has improved several indicators of performance (drug and medical devices needs satisfaction, rate of compliance of commitments to purchase drugs and medical devices, etc) and has maintained a high level for other indicators (drug and medical devices deterioration rate and rate of satisfaction with training requests). Improving these indicators has allowed repositioning of the pharmacy in other hospital units and a significant improvement in the quality of pharmaceutical services within the hospital. The success was the result of the involvement of management and hospital staff. The aim is to respond positively to the growing needs of a population of vulnerable children. References and/or acknowledgements Acknowledgements to the director and team of the paediatric hospital. No conflict of interest