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      Hidden costs of antiretroviral treatment: the public health efficiency of drug packaging

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          While the overall percentage of unused antiretroviral medicines returned to the hospital pharmacy is low, their cost is quite high. Adverse events, treatment failure, pharmacokinetic interactions, pregnancy, or treatment simplification are common reasons for unplanned treatment changes. Socially inefficient antiretroviral packages prevent the reuse of drugs returned to the hospital pharmacy. We defined antiretroviral package categories based on the excellence of drug packaging and analyzed the number of pills and costs of drugs returned during a period of 1 year in a hospital-based HIV unit attending to 2,413 treated individuals. A total of 6,090 pills (34% of all returned antiretrovirals) – with a cost of 47,139.91€ – would be totally lost, mainly due to being packed up in the lowest efficiency packages. Newer treatments are packaged in low-excellence categories of packages, thus favoring the maintenance of these hidden costs in the near future. Therefore, costs of this low-efficiency drug packaging, where medication packages are started but not completed, in high-cost medications are substantial and should be properly addressed. Any improvement in the packaging by the manufacturer, and favoring the choice of drugs supplied through efficient packages (when efficacy, toxicity, and convenience are similar), should minimize the treatment expenditures paid by national health budgets.

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          Most cited references 7

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          Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

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            Returned medicines: waste or a wasted opportunity?

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              Returned medicines in community pharmacies of Barcelona, Spain.

              To monitor the amount of unused drugs and the cost to the public health system. Setting A random sample of community pharmacies in Barcelona, Spain. Method The drugs were collected from 38 community pharmacies over a period of 7 consecutive working days (excluding Sundays). A questionnaire was designed to evaluate each returned medicine. The resulting data were analyzed and evaluated. The number of drugs collected at the pharmacy, the characteristics of the clients and the reasons why they returned the drugs, and finally the economic value of the drugs returned and the cost to the public health system. A total of 227 clients (54.6% women, 64 +/- 20 years-old) returned 1,176 packages to the pharmacy. The number of packages collected in one return ranged from 1 to 121. The number of packages collected per pharmacy ranged from 0 to 188. In more than half of the cases (52.4%) the patients returned their drug in person and in 32.2% of the cases a relative returned it on their behalf. The main reason (28.2%) why drugs were returned was the expiry date. In 24.9% of the cases the patient's condition had improved and there was no further need for the drug. In 20.8% the patient had died. The estimated total cost of the collected drugs was euro8,539.9. Over 75% of this amount (euro6,463.9) had been paid by the public health system. This study confirms the importance of analyzing the return of unwanted medicines to reduce unnecessary health expenditure. It also highlights the inadequacies of the Spanish health system in the areas of prescription, dispensing and use of medicines. Establishing strategies to reduce the wastage of unused medicines is necessary.

                Author and article information

                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                Drug Design, Development and Therapy
                Dove Medical Press
                05 August 2015
                : 9
                : 4287-4290
                [1 ]Pharmacy Department, University Hospital Germans Trias i Pujol, Badalona, Spain
                [2 ]HIV Unit and “Lluita contra la SIDA” Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
                [3 ]Universitat Autònoma de Barcelona, Vic, Barcelona, Spain
                [4 ]Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, Spain
                Author notes
                Correspondence: Josep M Llibre, HIV Unit, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet, s/n08916 Badalona (Barcelona), Spain, Email jmllibre@ 123456flsida.org

                These authors contributed equally to the work

                © 2015 Andreu-Crespo et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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