1. An Evaluation of Clinical Pharmacists Impact on Drug Utilization of Traditional NSAIDS and Selective COX-II Inhibitors S. Scott Sutton, Pharm.D. Associate Clinical Professor South Carolina College of Pharmacy University of South Carolina & Medical University of South Carolina WJB Dorn Veterans Administration Medical Center Columbia, South Carolina Statewide Research Activities

2. Objectives SCSHP Program agenda: Describe the various research initiatives undertaken by pharmacists throughout the state of South Carolina

3. Research Team S. Scott Sutton, Pharm.D. John C. Voris, Pharm.D. Randall C. Rowen, Pharm.D. Joe C. Blizzard, R.Ph., Ph.D. Medication Optimization Research - Abstracts / Posters:Medication Optimization Research - Abstracts / Posters: –An Evaluation of Clinical Pharmacists Impact on Drug Utilization of Traditional NSAIDS and Selective COX-II Inhibitors American College of Clinical Pharmacy –Alterations in Usage of Atypical Neuroleptics Resulting from an Educational Series at a VA Hospital and Clinics American College of Clinical Pharmacy –The Impact of a Computerized Order Entry form on Gabapentin Prescribing in a Veterans Affairs Medical Center American College of Clinical Pharmacy

4. NSAIDS Key ConceptsKey Concepts –60 million prescriptions annually –Decision Non-selective NSAID versus COX-II NSAID –Clinical Trials Similar efficacy for pain Less gastrointestinal adverse events Arch Inern Med 2005;165:171-177 JAMA 2000;284:1247-1255 NEJM 2000;343:1520-1528

5. NSAIDS Purpose:Purpose: –Evaluate: Effectiveness of drug utilization criteria developed by pharmacists for NSAIDS and COX-II on: –Pharmacy Utilization –Medication Expenditures

6. NSAIDS MethodsMethods –Evaluated utilization over a one year-period. –Criteria developed, implemented, and analyzed by pharmacists. –Each patient must meet criteria to be eligible for treatment with COX-II. –Data compared to national trends in COX-II utilization rates.

7. COX-II Criteria COX-II Utilization Criteria –1) A patient receiving Aspirin (any daily dose) does not qualify for a Cox-II selective NSAID. –2) A patient receiving a Proton Pump Inhibitor (Rabeprazole, Lansoprazole, Omeprazole, etc) does not quality for a COX- II selective NSAID. –3) A patient receiving Misoprostil (Cycotec) does not qualify for a COX- II selective NSAID. –4) A patient must fail a 30 –day trial (if tolerated) of NSAIDs and be at high risk for a clinically significant GI event (hemorrhage, perforation, obstruction) to be considered for a COX- II selective NSAID. –5) A patient receiving Warfarin (Coumadin) who has failed a 30-day trial of Acetaminophen and Salsalate will be considered for a Cox- II Selective NSAID. –6) Patients receiving a COX-II selective NSAID from a private physician will not quality for a COX-II selective NSAID unless he/she meets one of the above listed criterions.

8. Results Results: Average number of patients receiving NSAIDS or COX-IIs –3,202 (2806 – 3431) 92.4% received NSAIDs (90.7% - 95.0%) –Average cost per month - $2.60 - $7.10 7.4% received COX-IIs (5.0% - 9.3%) –Average cost per month - $47.69 - $95.37 National Utilization rates : 60 million prescriptions –39% NSAIDs –61% COX-IIs

9. Results

10. Results Cost savings $157,919 Per month

11. Objectives SCSHP Program agenda: Describe the various research initiatives undertaken by pharmacists throughout the state of South Carolina Application / Importance to Clinician