Earticle

Cost-effectiveness is basically based on the principle of health maximization. A decision based on cost per QALY has an ethical implication that 1 QALY incurred by everyone is of equal value. However, many literatures found that the public preferences depend on who the beneficiaries are, and therefore the social values of a QALY are not equal to everyone. This study focuses on the age among the factors that determine the social value of a QALY. It examines the philosophical and theoretical debate that considers age as a criterion of priority setting, including the concept of “fair inning” and outlines the direction of social preference found in empirical studies. In addition, this paper will briefly examine how the prioritization formula proposed in other countries relates to age, and seek policy implications.

The drug re-examination system that is being used in Korea and Japan is aimed to reconfirm the effectiveness and safety of drugs at the end of the predetermined period after approval. As clinical trials before marketing are difficult to find all potential risks, the post-marketing study is necessary. The Drug Use-Results Survey (DURS) is aimed at patients who prescribed the drugs to collect the effectiveness and safety information of the drugs. However, the survey continued to raise the limitation that there was no comparison group. Recently, Real-World Data (RWD) is being used for post-marketing surveillance worldwide. Japan revised the drug re-examination system to include database study using RWD and postmarketing observational study with primary data collection in the comparative cohort study in 2017. This paper addresses the background and contents of revised Japan's re-examination system and the implications of this change for the post-marketing study in Korea.

BACKGROUNDS Inappropriate use of age-contraindicated drugs can cause serious adverse events (AEs) but information about their AE reports is limited. OBJECTIVE The aim of this study is to investigate current state of AE reports concerned with use of contraindicated drugs for specific ages submitted to pharmacies in 2018. METHODS We conducted a safety surveillance study using spontaneous reports of the Korea Pharmaceutical Association in 2018. Study drugs involved 177 age-contraindicated drugs according to the notification of Ministry of Food and Drug Safety. We calculated the proportion of AE reports induced by study drugs among all AE reports, and described their characteristics. Furthermore, we identified drug-AE pairs evaluated as certain, probable, and/or possible in causality assessment and compared them with the labeling information of Lexicomp. RESULTS Of 23,941 AE reports, 98 (0.4%) were reported with use of study drugs; there were no AE reports for study drugs in over 18 years. Among AE reports for study drugs, aged 6-12 years had the most reports (50.0%) and the proportion of AE reports was higher in male (58.7%) than in female (38.8%). When analyzing drug-AE pairs, dihydrocodeine and its AEs were most frequently reported (73.5%). We also identified 19 drug-AE pairs not included in labeling information of Lexicomp, but they were not significant results. CONCLUSION The proportion of AE reports for age-contraindicated drugs was not substantial; however, the adverse events related to dihydrocodeine were still reported. There is a need to monitor the age-contraindicated drugs where adverse events are frequently reported.

BACKGROUND Medication nonadherence of the schizophrenic puts the patient in harm’s way and may bring the society to dangers. A summary of the existing literature on ways to improve the medication nonadherence would help protect the patient. OBJECTIVE This study aimed 1) to identify the list of reasons of medication nonadherence, 2) the list of strategies to alleviate medication nonadherence among the schizophrenic, and then 3) to assess how effectively each strategy addresses the specific reason of medication nonadherence. METHODS The reasons of medication nonadherence were identified from a most recent study of systematic review. For each identified reason, the strategies for improving the medication nonadherence were identified from a PubMed search of the studies published for the past 5 years. The effectiveness assessment of the strategies in addressing each reason was based on a 5 point-scale. RESULTS The number of reasons of medication non-adherence identified was 11, categorized into intentional vs. non-intentional ones. The number of strategies to improve the nonadherence was categorized into 6; pharmacist intervention, drug formulation, side effects, socio-cognitive behavioral modification, economic incentives and use of technology. While quite a few strategies aimed at addressing the problems of cognitive impairments, social support, and medication belief, few addressed the problems related to insight and social stigma. CONCLUSION This study found that strategies to improve the medication nonadherence work only when they target specific reasons. The study results inform healthcare providers of the importance of tailoring the medication nonadherence improvement strategy to each patient’s needs.

BACKGROUND The number of patients with polypharmacy has been steadily increasing. Since polypharmacy can lead to various drug-related problems, a systematic review and monitoring led by experts is needed. OBJECTIVE National Health Insurance Service(NHIS) started a pilot project for polypharmacy management in 2018. The purpose of this study is to analyze the characteristics of patients with polypharmacy and identify their drug-related problems. METHODS Pilot project was conducted from July 2018 to December 2018. Participants living in community (n=477) were selected using National Health Insurance Claims Data (NHICD) from July 2017 to December 2017. They had taken more than 10 medicines for over 90 days in six months. All people living in two long-term care facilities (n=207) in Seoul and GyeongGi also participated in this project. The pattern of medical utilization, social-demographic factors and clinical characteristics of all patients were identified using NHICD, National Health Check-up Data and Long Term Care Insurance Data from 2014 to 2018. Drug-related problems reported by pharmacists were reorganized. RESULTS Among the community dwellers, there were more men than women and their average age was 71.7. 19.7% of participants were living alone, and 25.8% of them were disabled. 51.2% of people visited more than six medical institutions for six months, and 40.3% of them have been hospitalized at that time. In long-term care facilities there were more women and the average age was 83. 24.2% of total were one person household and 33.3% of them were disabled. All patients had taken 11 medicines in average. People living in community showed overdose and duplication of analgesic anti-inflammatory drug, digestive medicine, tranquilizer, while duplication of central nervous system medicine among people in long- term care facilities were mainly reported. CONCLUSION To effectively manage polypharmacy, standardized counseling manual focusing on high risk medicine is necessary. Also, a policy is needed to handle drug-related problems in cooperation with doctors and pharmacists.

BACKGROUND Various types of hemostatic agents are used for bleeding management during surgery. Gelatin- thrombin based active flowable hemostatic matrix (FLOSEAL®) is used in bleedings not effectively controlled or uncontrollable by ligature or general procedures. OBJECTIVES This study was performed to compare economic outcome of FLOSEAL® alone(F) use to gelatin/thrombin+FLOSEAL®(G/T+F) combined use for hemostasis during spinal surgery. METHODS A cost-consequence model was used from a medical institution perspective in Korea. Clinical outcome parameters were derived from US-based observational study literature. Costs included in this analysis were direct medical cost such as hemostatic agents, hospitalization and blood transfusion costs and opportunity cost of operating room. Cost difference between groups were presented, and one-way sensitivity analyses for variability of clinical input parameters were performed. RESULTS F group reduced the length of hospitalization by 0.45 days and operating time by 39 minutes compared to G/T+F group. Consequently the volume of hemostatic agents and the number of patients requiring transfusions are reduced as well. The clinical outcomes resulted in cost savings approximately ￦642,620 per spinal surgery in F group compared to G/T+F group in a tertiary hospital base. CONCLUSIONS F alone use is dominant strategy comparing to G/T+F combined use for the purpose of hemostasis during spinal surgery process.