Open AccessCAN COST OF PHARMACOLOGICAL THROMBOLYTIC THERAPY BE A MEDICATION MANAGEMENT STRATEGY FOR ACUTE CORONARY SYNDROME?
Author(s) -
Vinod Kumar,
Bijoy Kumar Panda
Publication year - 2017
Publication title -
asian journal of pharmaceutical and clinical research
Language(s) - English
Resource type - Journals
eISSN - 2455-3891
pISSN - 0974-2441
DOI - 10.22159/ajpcr.2017.v10i3.16308
Subject(s) - medicine , medical prescription , acute coronary syndrome , myocardial infarction , observational study , emergency medicine , fibrinolytic agent , coronary care unit , cohort , tissue plasminogen activator , pharmacology
Objectives: In Indian health-care system with delayed access to a minimum number of catheter laboratories and rarity of insurance benefits, prehospitaland in-hospital thrombolytic has become the choice for patients with acute coronary syndrome (ACS), where many patients bear the economicburden of pharmacological thrombolytic. The present study was carried out to evaluate the pattern of prescribing of pharmacological thrombolyticagents in hospitalized ACS patients and associated cost burden.Methods: A prospective observational cohort study of prescription was conducted for in-patient admitted to intensive care unit for thrombolytic andantithrombotic drug utilization pattern. The direct cost analysis was performed from patient’s perspective where a direct cost was calculated usingpharmacy bills. All other cost was assumed to be same.Results: Data of 288 patients were collected from which 108 (37.5%) patients were ST-elevation myocardial infarction (STEMI) and 180 (62.5%)patients were non-STEMI. The mean number of drugs prescribed was 11±2 which constitutes a mean of 3.1±0.7 reperfusion drugs. 59% of patientswere prescribed with enoxaparin (0.6 ml/seconds route) for the mean duration of 4 days. The average prescription cost for ACS admission was aroundRs.7159.5±5137.2 (Rs.1101-Rs.22202). The average cost of pharmacological thrombolytic therapy was Rs.4557±3468.3 (Rs. 23-Rs.12542). The meancost of pharmacological thrombolytic therapy was found to be 63% of the total direct cost of drugs borne by the patient. The cost of therapy waspositively correlated with duration of stay (p=0.000) and insignificantly correlated with a number of drugs.Conclusion: Antiplatelets were the most preferred followed by anticoagulants. The mean number of drugs per encounter was high but was rationalas per standard guidelines. The mean cost for pharmacological reperfusion therapy was found to be more than half of mean prescription cost for themanagement of ACS.Keywords: Acute coronary syndrome, Thrombolytic therapy, Cost, Medication management.