Khalid M. Kamal

Determinants of Adult Influenza and Pneumonia Immunization Rates

OBJECTIVES To determine national adult immunization rates for influenza and pneumonia and assess the effect of various predisposing factors on immunization status for both diseases. DESIGN Retrospective, cross-sectional, random national sample data from the Centers for Disease Control and Preventions 1999 Behavioral Risk Factor Surveillance System survey. Data extraction and analysis were conducted using SPSS and STATA, with adjustments made for weighted data. PARTICIPANTS Individuals aged 65 years and older and individuals aged 50 to 64 years (for influenza only). RESULTS Immunization rates in the 65 and older age group were 66.7% for influenza and 53.8% for pneumonia; immunization rate for influenza in the 50 to 64 age group was 35.6%. Predisposing factors such as race (white) and education (high school and above) positively influenced immunization status. Enabling factors such as income, health insurance, and physician visits and need-related factors such as health status and comorbidities exhibited a strong relationship with influenza and pneumonia vaccination status in both study populations. Health care coverage (odds ratio [OR] = 1.76 for influenza and OR = 1.66 for pneumonia in the 65 years and older group; OR = 1.80 for influenza in the 50 to 64 years age group) and physician visit in the last year (OR = 2.00 for influenza and OR = 1.87 for pneumonia for 65 years and older group; OR = 1.86 for influenza in the 50 to 64 years age group) were strong positive predictors of vaccination status. Individuals with comorbidities and those who perceived their health as being poor had high vaccination rates. CONCLUSION Understanding the positive and negative influences on adult immunization status will allow pharmacists to better identify and target prospective recipients of immunization services.

Asthma hospitalization risk and costs for patients treated with fluticasone propionate vs montelukast

BACKGROUND Inhaled corticosteroids have been shown to reduce rates of hospitalization and emergency department use compared with leukotriene receptor antagonists. OBJECTIVE To examine differences in the probability of asthma-related hospitalizations, probability of switching or augmentin, with another therapy, and costs for patients treated with fluticasone propionate vs montelukast. METHODS The study involved a 24-month retrospective analysis of patients with claims for asthma treatment (primary diagnosis International Classification of Disease, Ninth Revision code of 493.xx) between January 1, 1997, and June 30, 2000, and at least I outpatient pharmaceutical claim for fluticasone propionate (44 microg) or montelukast (5 or 10 mg). Univariate and multivariate analyses were used to determine the probability of asthma-related hospitalizations and switching or augmenting to another therapy, asthma costs, and total health care costs. Sensitivity analyses were conducted by replicating all of the analyses by age strata (ages 4-17 years and > or = 18 years) and varying lengths of follow-up. RESULTS Patients receiving fluticasone propionate had a 62% lower risk of experiencing an asthma-related hospitalization within 1 year and a 44% lower risk of switching or augmenting to another asthma controller medication compared with montelukast. Asthma-related health care expenditures for montelukast patients were dollar 339 higher than for fluticasone propionate users (P < .001). Overall health care expenditures (asthma and nonasthma) were also dollar 1,197 higher in the montelukast group. CONCLUSIONS Compared with montelukast-treated patients, patients treated with low-dose fluticasone propionate had a significantly lower risk of experiencing an asthma-related hospitalization, a lower risk of switching or augmenting with another controller, and significantly lower asthma and total health care costs.

The Impact of Elective Active-Learning Courses in Pregnancy/Lactation and Pediatric Pharmacotherapy

Objective. To implement and evaluate the impact of 2 elective courses, Pregnancy & Lactation and Pediatrics on student acquisition of knowledge and development of lifelong learning skills related to these special populations. Design. Two 3-credit elective courses were implemented using various student-driven learning techniques, such as case-based exercises, group presentations, pro-con debates, and pharmacist “grab bag” questions. Strong emphasis was placed on medication literature retrieval and analysis, and a wiki was used to create an electronic resource for longitudinal use. Assessment. Pre- and post-course tests showed significant improvement in knowledge related to pregnancy, lactation, and pediatrics. Pre- and post-course confidence and ratings on satisfaction survey tools also revealed significant improvement in several domains relating to lifelong-learning skills, knowledge related to medication use within these special populations, use of technology to enhance learning, and overall course design. Conclusion. The combination of student-directed learning techniques used in 2 pediatric-concentration courses is an effective teaching model.

Evaluating the cost-effectiveness of tiotropium versus salmeterol in the treatment of chronic obstructive pulmonary disease

Objective: To assess the cost-effectiveness of 3 treatments (tiotropium, salmeterol, and no treatment) in patients with moderate chronic obstructive pulmonary disease (COPD). Methods: A Markov model with a time horizon of 1 year was developed. A hypothetical cohort of 100,000 subjects with moderate COPD with mean age of 65 years, smoking history of 50 pack-years, and disease duration of 9.5 years were included in the model. The efficacy and withdrawal data were taken from published randomized clinical trials. The effectiveness measure was exacerbations avoided per patient per year. Incremental cost-effectiveness ratio (ICER) was calculated as additional cost per patient to prevent 1 exacerbation, compared with the next most expensive option. A payer’s perspective was used and only direct costs were included in the study. Sensitivity analyses were conducted to test the robustness of the baseline estimates and study assumptions. Results: The mean annual costs for the no treatment, salmeterol, and tiotropium groups were

Content Analysis of FDA Warning Letters to Manufacturers of Pharmaceuticals and Therapeutic Biologicals for Promotional Violations

392.1,

Use of electronic medical records for clinical research in the management of type 2 diabetes

1268.7, and

Variations in blood pressure and lipid goal attainment in primary care

1408.6, respectively. The ICER of tiotropium compared with no treatment was

Association between Obesity and Therapeutic Goal Attainment in Patients with Concomitant Hypertension and Dyslipidemia

1817.36 per exacerbation avoided, while the ICER of salmeterol compared with no treatment was

Factors Associated With Therapeutic Goal Attainment in Patients With Concomitant Hypertension and Dyslipidemia

2454.48 per exacerbation avoided. Thus, in patients with moderate COPD, tiotropium is more cost-effective than salmeterol and no treatment.

A Systematic Review of Economic Analyses Studying Rituximab in R-CHOP Therapy in Patients with Non-Hodgkin Lymphoma

Manufacturers of pharmaceuticals use advertising and promotion as key marketing activities to foster the success of their products. These activities, however, have to comply with FDA regulations; failure to do so results in FDA enforcement actions such as issuance of warning letters and notices of violation. The purpose of this study is to critically evaluate the content of FDA letters to manufacturers for promotional violations. Two judges formally trained in content analysis procedures critically evaluated the content of publicly available letters from 2000 to 2006. A total of 249 letters described 806 violations from 107 manufacturers. Media most frequently cited in letters were print (n −67), sales aids (n = 42), and television (n = 39). Violations were most frequently related to lack of fair balance (n = 131), misleading claims of efficacy (n = 102), misleading superiority claims (n = 92), and omission of risk information (n = 89). Inter-rater reliabilities between the two judges were exceptional, ranging from 0.89 to 1.00. The marketing of prescription drugs has a significant impact on the medication use process. Managed care policymakers and pharmacists should remain abreast of promotional strategies and claims, particularly those deemed problematic by the FDA, which may spur requests for additional information, prescriptions, or formulary status changes for the drugs promoted.