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Study of Drug Utilization Pattern and Cost of Therapy in Patients Undergoing Cholecystectomy in a Tertiary Care Hospital

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Author(s): S.M. Naser | Arnab Naha

Journal: International Journal of Collaborative Research on Internal Medicine & Public Health
ISSN 1840-4529

Volume: 3;
Issue: 3;
Start page: 274;
Date: 2011;
Original page

Keywords: Cholecystectomy | laparoscopic cholecystectomy | drug utilisation in cholecystectomy | cost effectiveness in cholecystectomy | 3rd generation cephalosporins | metronidazole

ABSTRACT
Introduction: In a resource poor country like India, choice of drugs like antibiotics, analgesics should bedone properly to reduce the burden of cost among patient families. Cholecystectomy is one of the mostcommon operation done in our setup, in both forms, i.e open and laparoscopic Cholecystectomy. Thereare no definite guidelines to follow regarding antibiotic and analgesic usage causing indiscriminate use ofthese drugs in a post operative Cholecystectomy case done with complete aseptic measures producingexcess burden of cost on patients. The study was done based on this procedure to generate data regardingcost effectiveness of pharmacotherapy, specially antibiotics and analgesics in open and laparoscopicCholecystectomy and to study the usage pattern of these drugs in the tertiary care hospital setup so that aguideline can be formulated for use in the future.Objectives: 1. To study the pattern of drug usage with special emphasis on antibiotics and analgesics inpost operative Cholecystectomy patients. 2. To study the cost of pharmaco-therapy of the patients basedon duration of stay in the post operative period.Sample Size: The sample size of the study was 67 cases. This study was done for a time period of twomonths. We have included all the admitted cases for surgery of Cholecystectomy (both open andlaparoscopic) in our study within the stipulated 2 months time period.Methodology: An observational, prospective analytical study by collection of data without interventionwas done in Calcutta National Medical College and Hospital, Kolkata, west Bengal, India for a period oftwo month under ICMR’s (Indian Council of Medical Research) short term studentship programme with67 cases of patients. Informed consent and Ethical committee’s approval was duly taken. Data werecollected in the department of general surgery from the bed side tickets of the patients after taking a shorthistory and informed consent from the patient. Patients were followed till discharge and the cost of thetherapy was calculated from CIMS (Current Index of Medical Specialities) and CENTRAL MEDICALSTORES.Result: Open Cholecystectomy done in our setup is 58.20%, in which females are 97.43%. laparoscopicCholecystectomy is done in 41.79% cases, in which again the majority are females with a percentage of85.71%. Among antibiotics, Metronidazole (97.43% in open & 64.28% in laparoscopic cholecystectomy)and Cefoperazone-sulbactam(30.77% in open & 57.14% in laparoscopic cholecystectomy) are used mostcommonly. The other antibiotics used are amikacin (10.25% in open & 25% in laparoscopicCholecystectomy), Ceftriaxone (12.82% in open and 14.28% in laparoscopic cholecystectomy),Cefotaxime (in open Cholecystectomy 12.82% and laparoscopic Cholecystectomy 3.57%), ciprofloxacin(in open Cholecystectomy, 8 % patient were given ciprofloxacin while in laparoscopic Cholecystectomy3.57 % were given ciprofloxacin), ofloxacin (in open cholcystectomy, ofloxacin was not used but inlaparoscopic Cholecystectomy, 17.85% of ofloxacin was used.) Among the analgesics, Diclofenac Sodium (48.71% in open and 57.14% in Laparoscopic cholecystectomy) and aceclofenac-paracetamolcombination (46.15% and 42.85% in open and lap.Cholecystectomy respectively). The average durationof stay in post operative period in open Cholecystectomy was found to be 6-7 days and that inlaparoscopic Cholecystectomy was found to be 3-4 days. Cefoperazone-sulbactam, amikacin, ceftriaxone,ciprofloxacin has the highest cost per day which are Rs. 334.36, Rs. 116.00, Rs. 159.50, Rs. 179.20respectively. The average cost of pharmaco-therapy in case of open Cholecystectomy is Rs. 600-Rs.800and in laparoscopic Cholecystectomy it comes out to be Rs. 400 – Rs.600.Conclusion: Cholecystectomy is performed in major operation theatres of Surgical department ofCalcutta National Medical College under complete aseptic measures, still surgeons use antibiotics asprophylactic measures, also analgesics as and when required. The different group of antibiotics and otherdrugs are used as pick and choose method due to lack of standard treatment protocol. Judicious use ofantibiotics and other drugs may reduce the economic burden on the patients. Open Cholecystectomy isstill performed in higher percentage in this setup, thus increasing the duration of stay in the post operativeperiod. This again increases the cost of the therapy associated with the procedure.Study Limitations:1. The study should be conducted over a longer period of time.2. The number of patient selected for the study should be large enough to generate data for designing astandard guideline for treatment.3. The study was an observational study without any intervention. Intervention with drugs may haveshown a better result regarding cost effectiveness data generation.
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