S. Scott Sutton, Pharm.D . Associate Clinical Professor South Carolina College of Pharmacy

1. An Evaluation of Clinical PharmacistsImpact on Drug Utilization of Traditional NSAIDS and Selective COX-II Inhibitors Statewide Research Activities 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

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

6. NSAIDS • Methods • 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