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  1. Article ; Online: Strategies to reduce out-of-pocket medication costs for Canadians with peripheral arterial disease.

    McClure, Graham R / McIntyre, William F / Belesiotis, Peter / Kaplovitch, Eric / Chan, Noel / Bhagirath, Vinai / Chahill, Gurneet / Hayes, Abigail / Sohi, Gursharan / Bordman, Wendy / Whitlock, Richard P / Anand, Sonia S / Belley-Côté, Emilie P

    Canadian journal of surgery. Journal canadien de chirurgie

    2024  Volume 67, Issue 1, Page(s) E1–E6

    Abstract: Background: Given that peripheral arterial disease (PAD) disproportionately affects people of lower socioeconomic status, out-of-pocket expenses for preventive medications are a major barrier to their use. We carried out a cost comparison of drug ... ...

    Abstract Background: Given that peripheral arterial disease (PAD) disproportionately affects people of lower socioeconomic status, out-of-pocket expenses for preventive medications are a major barrier to their use. We carried out a cost comparison of drug therapies for PAD to identify prescribing strategies that minimize out-of-pocket expenses for these medications.
    Methods: Between March and June 2019, we contacted outpatient pharmacies in Hamilton, Ontario, Canada, to assess pricing of pharmacologic therapies at dosages included in the 2016 American College of Cardiology/American Heart Association guideline for management of lower extremity PAD. We also gathered pricing information for supplementary charges, including delivery, pill splitting and blister packaging. We calculated prescription prices with and without dispensing fees for 30-day brand-name and generic prescriptions, and 90-day generic prescriptions.
    Results: Twenty-four pharmacies, including hospital-based, independent and chain, were included in our sample. In the most extreme scenario, total 90-day medication costs could differ by up to $1377.26. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee and delivery cost, if any.
    Conclusion: By opting for prescriptions for 90 days or as long as possible, selecting the lowest-cost generic drugs available in each drug class, and identifying dispensing locations with lower fees, prescribers can minimize out-of-pocket patient medication expenses. This may help improve adherence to guideline-recommended therapies for the secondary prevention of vascular events in patients with PAD.
    MeSH term(s) Humans ; Costs and Cost Analysis ; Drugs, Generic/economics ; Ontario ; Peripheral Arterial Disease/drug therapy ; United States ; Health Expenditures ; Drug Costs
    Chemical Substances Drugs, Generic
    Language English
    Publishing date 2024-01-03
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.003722
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Drivers of the opioid crisis: An appraisal of financial conflicts of interest in clinical practice guideline panels at the peak of opioid prescribing.

    Spithoff, Sheryl / Leece, Pamela / Sullivan, Frank / Persaud, Nav / Belesiotis, Peter / Steiner, Liane

    PloS one

    2020  Volume 15, Issue 1, Page(s) e0227045

    Abstract: Background: Starting in the late 1990s, the pharmaceutical industry sought to increase prescribing of opioids for chronic non-cancer pain. Influencing the content of clinical practice guidelines may have been one strategy industry employed. In this ... ...

    Abstract Background: Starting in the late 1990s, the pharmaceutical industry sought to increase prescribing of opioids for chronic non-cancer pain. Influencing the content of clinical practice guidelines may have been one strategy industry employed. In this study we assessed potential risk of bias from financial conflicts of interest with the pharmaceutical industry in guidelines for opioid prescribing for chronic non-cancer pain published between 2007 and 2013, the peak of opioid prescribing.
    Methods: We used the Guideline Panel Review (GPR) to appraise the guidelines included in the 2014 systematic review and critical appraisal by Nuckols et al. These were English language opioid prescribing guidelines for adults with chronic non-cancer pain published between July 2007 and July 2013, the peak of opioid prescribing. The GPR assigns red flags to items known to introduce potential bias from financial conflicts of interest. We operationalized the GPR by creating specific definitions for each red flag. Two reviewers independently evaluated each guideline. Disagreements were resolved with discussion. We also compared our score to the critical appraisal scores for overall quality from the study by Nuckols et al.
    Results: We appraised 13 guidelines, which received 43 red flags in total. Guidelines had 3.3 red flags on average (out of a possible seven) with range from one to six. Four guidelines had missing information, so red flags may be higher than reported. The guidelines with the highest and second highest scores for overall quality in the 2014 critical appraisal by Nuckols et al. had five and three red flags, respectively.
    Conclusion: Our findings reveal that the guidelines for opioid prescribing chronic non-cancer pain from 2007 to 2013 were at risk of bias because of pervasive conflicts of interest with the pharmaceutical industry and a paucity of mechanisms to address bias. Even highly-rated guidelines examined in a 2014 systematic review and critical appraisal had many red flags.
    MeSH term(s) Bias ; Chronic Pain/drug therapy ; Conflict of Interest/economics ; Drug Industry/economics ; Drug Industry/methods ; Health Impact Assessment ; Humans ; Opioid Epidemic/etiology ; Practice Guidelines as Topic ; Practice Patterns, Physicians'/economics ; Substance-Related Disorders/economics ; Systematic Reviews as Topic
    Language English
    Publishing date 2020-01-24
    Publishing country United States
    Document type Journal Article
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0227045
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis.

    Ahmed, Muneeb / Belley-Coté, Emilie P / Qiu, Yuan / Belesiotis, Peter / Tao, Brendan / Wolf, Alex / Kaur, Hargun / Ibrahim, Alex / Wong, Jorge A / Wang, Michael K / Healey, Jeff S / Conen, David / Devereaux, Philip James / Whitlock, Richard P / Mcintyre, William F

    Journal of clinical medicine

    2023  Volume 12, Issue 13

    Abstract: Background: Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery; it is associated with morbidity and mortality. We undertook this review to compare the effects of rhythm vs. rate control in this population.: ... ...

    Abstract Background: Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery; it is associated with morbidity and mortality. We undertook this review to compare the effects of rhythm vs. rate control in this population.
    Methods: We searched MEDLINE, Embase and CENTRAL to March 2023. We included randomized trials and observational studies comparing rhythm to rate control in cardiac surgery patients with POAF. We used a random-effects model to meta-analyze data and rated the quality of evidence using GRADE.
    Results: From 8,110 citations, we identified 8 randomized trials (990 patients). Drug regimens used for rhythm control included amiodarone in four trials, other class III anti-arrhythmics in one trial, class I anti-arrhythmics in four trials and either a class I or III anti-arrhythmic in one trial. Rhythm control compared to rate control did not result in a significant difference in length of stay (mean difference -0.8 days; 95% CI -3.0 to +1.4, I
    Conclusions: Although atrial fibrillation is common after cardiac surgery, limited low-quality data guide its management. Limited available evidence suggests no clear advantage to either rhythm or rate control. A large-scale randomized trial is needed to inform this important clinical question.
    Language English
    Publishing date 2023-07-07
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12134534
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Diagnostic yield of genome sequencing for prenatal diagnosis of fetal structural anomalies.

    Wang, Yiming / Greenfeld, Elena / Watkins, Nicholas / Belesiotis, Peter / Zaidi, Syed H / Marshall, Christian / Thiruvahindrapuram, Bhooma / Shannon, Patrick / Roifman, Maian / Chong, Karen / Chitayat, David / Stavropoulos, Dimitri James / Noor, Abdul

    Prenatal diagnosis

    2022  Volume 42, Issue 7, Page(s) 822–830

    Abstract: Objective: Genome sequencing (GS >30x) is beginning to be adopted as a comprehensive genome-wide test for the diagnosis of rare disease in the post-natal setting. Recent studies demonstrated the utility of exome sequencing (ES) in prenatal diagnosis, we ...

    Abstract Objective: Genome sequencing (GS >30x) is beginning to be adopted as a comprehensive genome-wide test for the diagnosis of rare disease in the post-natal setting. Recent studies demonstrated the utility of exome sequencing (ES) in prenatal diagnosis, we investigate the potential benefits for GS to act as a comprehensive prenatal test for diagnosis of fetal abnormalities.
    Methods: We performed GS on a prospective cohort of 37 singleton fetuses with ultrasound-identified structural abnormalities undergoing invasive prenatal testing. GS was performed in parallel with standard diagnostic testing, and the prioritized variants were classified according to ACMG guidelines and reviewed by a panel of board-certified laboratory and clinical geneticists.
    Results: Diagnostic sequence variants were identified in 5 fetuses (14%), with pathogenic variants found in NIPBL, FOXF1, RERE, AMMECR1, and FLT4. A further 7 fetuses (19%) had variants of uncertain significance (VUS) that may explain the phenotypes. Importantly, GS also identified all pathogenic variants reported by clinical microarray (2 CNVs, 5%).
    Conclusion: Prenatal GS offered diagnoses (sequence variants and CNVs) in 19% of fetuses with structural anomalies. GS has the potential of replacing multiple consecutive tests, including microarray, gene panels, and WES, to provide the most comprehensive analysis in a timely manner necessary for prenatal diagnosis.
    MeSH term(s) Cell Cycle Proteins ; Female ; Fetus/diagnostic imaging ; Humans ; Pregnancy ; Prenatal Diagnosis ; Prospective Studies ; Ultrasonography, Prenatal ; Whole Exome Sequencing
    Chemical Substances Cell Cycle Proteins ; NIPBL protein, human
    Language English
    Publishing date 2022-02-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 82031-3
    ISSN 1097-0223 ; 0197-3851
    ISSN (online) 1097-0223
    ISSN 0197-3851
    DOI 10.1002/pd.6108
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1625: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Strategies to Reduce Out-of-Pocket Medication Costs for Canadians Living with Heart Failure.

    McIntyre, William F / Belesiotis, Peter / McClure, Graham R / Demers, Catherine / Chahill, Gurneet / Hayes, Abigail / Sohi, Gursharan / Bordman, Wendy / Whitlock, Richard P / Belley-Côté, Emilie P

    Cardiovascular drugs and therapy

    2020  Volume 35, Issue 5, Page(s) 1009–1023

    Abstract: Introduction: Daily medication is the cornerstone of evidence-based therapy to reduce mortality and morbidity in patients with heart failure (HF). Up to 20% of Canadian patients pay for medications out of pocket. We sought to identify strategies that ... ...

    Abstract Introduction: Daily medication is the cornerstone of evidence-based therapy to reduce mortality and morbidity in patients with heart failure (HF). Up to 20% of Canadian patients pay for medications out of pocket. We sought to identify strategies that patients and prescribers can employ to reduce these costs.
    Methods: We collected data from outpatient pharmacies in Hamilton, Ontario. We determined prices for different medications in each of the drug classes recommended for HF with reduced ejection fraction in the Canadian Cardiovascular Society's guidelines. We examined differences in dispensing and delivery fees and inquired about other cost-saving strategies.
    Results: We collected data from 24 different pharmacies, including a selection of hospital-based, independent, and larger chain pharmacies. In the most extreme scenario (i.e., 90-day prescription instead of a 30-day prescription and the least expensive generic drug instead of the most expensive brand name drug), total medication costs can differ by up to $495.56 per month. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee, and delivery cost.
    Conclusions: Prescription content, dispensing practice, and pharmacy choice can remarkably impact out-of-pocket costs for HF medications. Prescribers can reduce costs by writing 90-day prescriptions and choosing the lowest-cost generic drugs in each therapeutic class. Patients should consider the services received for their pharmacy dispensing fees, use free delivery services where needed, and request inexpensive generic drugs. Pharmacists can facilitate cost minimization without compromising therapeutic efficacy.
    MeSH term(s) Canada ; Cardiovascular Agents/economics ; Cardiovascular Agents/therapeutic use ; Drugs, Generic/economics ; Drugs, Generic/therapeutic use ; Heart Failure/drug therapy ; Humans ; Prescription Fees/statistics & numerical data
    Chemical Substances Cardiovascular Agents ; Drugs, Generic
    Keywords covid19
    Language English
    Publishing date 2020-08-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639068-7
    ISSN 1573-7241 ; 0920-3206
    ISSN (online) 1573-7241
    ISSN 0920-3206
    DOI 10.1007/s10557-020-07046-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.B 3057: Show issues Location:
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  6. Article: Strategies to Reduce Out-of-Pocket Medication Costs for Canadians Living with Heart Failure

    McIntyre, William F / Belesiotis, Peter / McClure, Graham R / Demers, Catherine / Chahill, Gurneet / Hayes, Abigail / Sohi, Gursharan / Bordman, Wendy / Whitlock, Richard P / Belley-Côté, Emilie P

    Cardiovasc. drugs ther

    Abstract: INTRODUCTION: Daily medication is the cornerstone of evidence-based therapy to reduce mortality and morbidity in patients with heart failure (HF). Up to 20% of Canadian patients pay for medications out of pocket. We sought to identify strategies that ... ...

    Abstract INTRODUCTION: Daily medication is the cornerstone of evidence-based therapy to reduce mortality and morbidity in patients with heart failure (HF). Up to 20% of Canadian patients pay for medications out of pocket. We sought to identify strategies that patients and prescribers can employ to reduce these costs. METHODS: We collected data from outpatient pharmacies in Hamilton, Ontario. We determined prices for different medications in each of the drug classes recommended for HF with reduced ejection fraction in the Canadian Cardiovascular Society's guidelines. We examined differences in dispensing and delivery fees and inquired about other cost-saving strategies. RESULTS: We collected data from 24 different pharmacies, including a selection of hospital-based, independent, and larger chain pharmacies. In the most extreme scenario (i.e., 90-day prescription instead of a 30-day prescription and the least expensive generic drug instead of the most expensive brand name drug), total medication costs can differ by up to $495.56 per month. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee, and delivery cost. CONCLUSIONS: Prescription content, dispensing practice, and pharmacy choice can remarkably impact out-of-pocket costs for HF medications. Prescribers can reduce costs by writing 90-day prescriptions and choosing the lowest-cost generic drugs in each therapeutic class. Patients should consider the services received for their pharmacy dispensing fees, use free delivery services where needed, and request inexpensive generic drugs. Pharmacists can facilitate cost minimization without compromising therapeutic efficacy.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #32803405
    Database COVID19

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