Vol. 2 No. 1 (2015): Malaysian Journal of Pharmacy


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Published: November 2015

In this issue:

  • Cost Analysis on Ticagrelor Utilisation in the Treatment of Patients with Acute Coronary Syndrome: A Preliminary Study
  • Stability of an Extemporaneously Prepared Alcohol-Free Phenobarbitone Oral Suspension

Supplement

  • Proceedings of the 12th MPS Pharmacy Scientific Conference 2015

Cost Analysis on Ticagrelor Utilisation in the Treatment of Patients with Acute Coronary Syndrome: A Preliminary Study

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    Abstract

    Background: Dual therapy with aspirin and clopidogrel is the standard treatment for acute coronary syndrome (ACS). Dual antiplatelet therapy plays an important role in reducing major acute, short- and long-term adverse clinical outcomes. Currently, the economic evaluation of ticagrelor, a reversible and direct-acting oral antagonist of adenosine diphosphate receptor P2Y12 remains unknown.

    Objective: To compare the annual cost of ticagrelor versus branded clopidogrel in patients with ACS from a Malaysian health care perspective.

    Methods: The data required for this analysis was obtained from a 2007 study carried out by Fong et al. in ACS patients (n=57). Assumptions used for the present analysis were based on data from the Cardiac Rehabilitation Program (CRP) study, the Study of Platelet Inhibition and Patient Outcomes (PLATO) and the National Cardiovascular Disease ACS (NCVD ACS) registry of Malaysia. For all calculations, the Ringgit Malaysia (RM) currency and prices as of 2007 were considered.

    Results: The cost of clopidogrel treatment in post-ACS patients for 30 days was calculated to be RM1,381,340 (n=2072; daily cost=RM5.50) and assuming treatment with ticagrelor, the cost would be RM1,554,000 (daily cost=RM8.70). Based on PLATO and NCVD ACS 2007, it was estimated that major adverse coronary event (MACE) in the form of unstable angina (UA) would occur in an additional 21 patients on clopidogrel, which could have been avoided with ticagrelor. Extrapolating cost data from CRP study, it was estimated that the annual costs for 21 additional cases of UA in terms of annual treatment and readmission would be more than RM400,000. Treatment with ticagrelor would thereby be associated with lesser number of MACE that can be translated in avoiding annual costs of treatment of UA and result in annual cost savings of RM238,856.

    Conclusion: Although direct comparisons were not made, this analysis suggests that ticagrelor therapy may be a more cost-saving alternative to clopidogrel in Malaysian patients with ACS. Keywords: ticagrelor, clopidogrel, acute coronary syndrome, cost analysis, major adverse coronary event.

    Stability of an Extemporaneously Prepared Alcohol-Free Phenobarbitone Oral Suspension

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      Abstract

      Many drugs used in paediatric are often not available in suitable dosage forms and have to be extemporaneously prepared by pharmacists to make them suitable for the body weight, body surface area, or age of the children. Phenobarbitone is the main anti-epileptic drug (AED) for the treatment of seizure in paediatric patients. The objective of this study is to evaluate the physicochemical and microbiological stability of an extemporaneously prepared Phenobarbitone Oral Suspension using commercially available tablets and X-temp Oral Suspension System. The Phenobarbitone Oral Suspension (10mg/ml) was stored at 4oC and 30oC / 75%RH protected from light and were examined at the interval of 0, 1, 2, 3 and 6 months. The content of Phenobarbitone was determined using a validated high-performance liquid chromatography (HPLC) method. The visual appearance, odour, pH and specific gravity remained fairly unchanged throughout the study period and the content of Phenobarbitone remained above 98% of the original concentration throughout the course of the study for both temperatures. The extemporaneous preparation was not susceptible to microbial contamination. The results from the stability studies confirmed that X-temp Oral Suspension is a suitable suspending vehicle for preparing extemporaneous liquid formulation of Phenobarbitone Oral Suspension with the added advantage of alcohol-free, colourant-free and sugar-free. Based on the data collected, the shelf-life of this liquid formulation is at least 6 months when stored at 4oC (refrigeration) and 30oC / 75%RH (room temperature).