Utilización de anfotericina B no convencional en el Hospital Clínico de San Carlos

• Published in: Revista española de salud pública Vol. 74; no. 4; pp. 351 - 359
• Main Authors: Laredo Velasco, Leonor, Prieto Yerro, Concepción, Picazo de la Garza, Juan José, Pérez Cecilia, Elisa, Vargas Castrillón, Emilio, Ambit Avila, María Isabel
• Format: Journal Article
• Language: Spanish; English
• Published: Ministerio de Sanidad y Consumo 2000
• Subjects: Amphotericin B; Anfotericina B; Estudio de utilización de medicamentos; Fungal infections; Infecciones fúngicas; Salud; Study of the use of medicines
• ISSN: 1135-5727; 2173-9110

Background: Amphotericin B is the treatment of choice for systemic fungal infections, however, its clínica1 usefulness is limited by its toxicity. The lipid formulations appear to be equally effective and safer, but are more costly. The increase in the consumption of, and expenditure on these formulas led us to undertake a study in order to identify their profile of use (quantitative and qualitative) and to assess the financia1 repercussions when used inappropriately. Methods: A set of rules were developed for the use of amphotericin B, and the quality of the prescription of nonconventional amphotericin B (amphotericin B notC) was evaluated retrospectively together with the financia1 repercussions of its inappropriate use. Results: In 54% of the treatments studied, a poor selection of amphotericin B was made; in 3.5% the use of amphotericin B was not indicated. The excess expenditure derived from the inappropriate use amounted to 42 million pesetas, 35% of the total expenditure on medicines; the expenditure due to unnecessary prescription was 1,720,327 pesetas. Conclusions: The retrospective evaluation has shown that there is a high percentage of treatments that do not conform with the recommendations contained in the prescription rules. The holding of information sessions would assist in achieving a more efficient selection of the amphotericin B notC; this would improve prescription quality, which might also deliver significant financia1 savings. Fundamento: La anfotericina B es el tratamiento de elección de las infecciones fúngicas sistémicas, pero su utilidad clínica está limitada por su toxicidad. Las formulaciones lipídicas parecen igualmente eficaces y más seguras, pero tienen un mayor coste. El incremento del consumo y del gasto de estas formulaciones nos llevo a plantear un estudio para conocer su perfil de utilización (cuantitativo y cualitativo) y evaluar la repercusión económica de su uso inapropiado. Utilisation of non-conventional Amphotericin B in the San Carlos Clinical Hospital Métodos: Se desarrollaron unas normas de uso de la anfotericina B y se evaluó de forma retrospectiva, la calidad de la prescripción de la anfotericina B no convencional (anfotericina B noC) y la repercusión económica de su uso incorrecto. Resultados: En el 54% de los tratamientos se hizo una mala selección de anfotericina B; en el 3.5% no estaba indicada la utilización de anfotericina B. El exceso de gasto derivado de la prescripción incorrecta fue de 42 millones de pesetas, un 35% del gasto total en medicamentos; el gasto por prescripción innecesaria fue de 1.720.327 pesetas. Background: Amphotericin B is the treatment of choice for systemic fungal infections, however, its clínica1 usefulness is limited by its toxicity. The lipid formulations appear to be equally effective and safer, but are more costly. The increase in the consumption of, and expenditure on these formulas led us to undertake a study in order to identify their profile of use (quantitative and qualitative) and to assess the financia1 repercussions when used inappropriately. Methods: A set of rules were developed for the use of amphotericin B, and the quality of the prescription of nonconventional amphotericin B (amphotericin B notC) was evaluated retrospectively together with the financia1 repercussions of its inappropriate use. Conclusiones: La evaluación retrospectiva ha mostrado que existe un elevado porcentaje de tratamientos que no se adecuan a lo recomendado en las normas de prescripción. La puesta en marcha de intervenciones informativas permitiría realizar una selección más eficiente de la anfotericina B noC, mejorando la calidad de la prescrip ción, lo que podría suponer un importante ahorro económico. Results: In 54% of the treatments studied, a poor selection of amphotericin B was made; in 3.5% the use of amphotericin B was not indicated. The excess expenditure derived from the inappropriate use amounted to 42 million pesetas, 35% of the total expenditure on medicines; the expenditure due to unnecessary prescription was 1,720,327 pesetas.