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A clinical audit of high‐cost and off‐label drug use in dermatology
Author(s) -
Ong Natalie,
McMeniman Erin,
Pillans Peter,
Soyer H Peter
Publication year - 2017
Publication title -
australasian journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.67
H-Index - 53
eISSN - 1440-0960
pISSN - 0004-8380
DOI - 10.1111/ajd.12392
Subject(s) - medicine , infliximab , audit , adalimumab , drug , dermatology , off label use , thalidomide , intensive care medicine , pharmacology , disease , management , multiple myeloma , economics
Background/Objectives The use of high‐cost, off‐label, unsubsidised drugs has become valuable in the management of dermatology patients with challenging conditions unresponsive to conventional therapy. Currently, there is no dedicated funding and a paucity of evidence for such drugs. The aim of this audit was to review outcomes and costs. Methods A retrospective clinical audit of high‐cost off‐label dermatology drug applications to the H igh C ost D rug's S ubcommittee was undertaken at a tertiary public hospital in B risbane, Q ueensland, between 2002 and 2013. Results Of 28 applications, 25 were approved. The medications included thalidomide, mycophenolate mofetil, cyclosporin, infliximab, rituximab and adalimumab. Over 70% of patients responded to treatment. Individual annual costs for these medications ranged from $2068 to $36 984. Adverse effects resulted in drug withdrawal in five cases. Conclusions Despite the absence of dedicated funding for high‐cost drugs and a rigorous committee approval process, most applications were approved, of which >70% benefited from treatment. This audit provides useful clinical experience with off‐label use of high‐cost drugs in difficult dermatological conditions.