Bupropion XL Wellbutrin ; discussed by Dr. Wallen Bupropion XL is another long acting formulation of bupropion. Currently bupropion is generic and recently a sustained release product of bupropion was also released. Bupropion XL has a half-life of 21 9 ; hours which is similar to bupropion SR. Bupropion XL is taken once daily and the maximum daily dose is 450 mg day. Bupropion SR is given twice a day and the maximum recommended dose is 400 mg day. Patients may be switched from one form of bupropion to bupropion XL by giving the same daily dose of bupropion XL. Bupropion XL offers a once a day dosing of bupropion that might increase compliance. There is little evidence that there is any difference between medication adherence for a single daily dose and twice a day dosing. Following discussion, on motion of Dr. McCoy, seconded by Ms. Chadwick, the request to add bupropion XL Wellbutrin XL ; to the formulary was denied. Two members opposed. Quarterly Non-Formulary Drug Justification Report The non-formulary requests for the first quarter were reviewed. Several items requested have since been placed on the Formulary. Non-Formulary Requests Top Ten Requests by Facility At the last meeting, the annual report of the top ten non-formulary requests by volume and dollar volume was reviewed. The Committee requested that these items be reviewed by facility. Dr. Tramonte prepared the information by facility for the last fiscal year. Approximately 21% of the top ten dollar purchases for non-formulary drugs were for celecoxib Celebrex ; and 16% were due to rofecoxib Vioxx ; . Previously, the Committee has declined to add a COX-2 inhibitor to the Formulary. The most requested item was lovastatin Mevacor ; which is now generic. It was noted that most patients fail to achieve and maintain low-density lipoprotein LDL ; cholesterol goals established by the National Cholesterol Education Program NCEP ; . Studies have shown that patients treated with atorvastatin Lipitor ; reached their NCEP goals more frequently, at lower doses and with lower total treatment costs when compared to other HMG Co-A reductase inhibitors. The use of lovastatin to treat to NCEP goals generally required the maximum daily dose and resulted in only about a third of the patients reaching goal. In terms of total treatment costs, lovastatin was one of the most expensive HMG Co-A reductase inhibitors when compared to other agents in the class. Fluticasone salmeterol Addvair ; consisted of 19% of the requests and 10% of the dollars. With changes in the treatment of asthma, it was suggested that the Committee might consider the addition of this product to the Formulary in the near future. It was recommended that facility specific information regarding these non-formulary requests be distributed to the superintendents, clinical medical directors and pharmacy directors. Restrictive Formulary Feedback The Committee did not receive any feedback regarding the possibility of changing the Formulary to a restrictive Formulary. The Committee expressed concern that the field did not have time to respond since the memo was recently sent. The memo will be re-sent to the field. Beta-Blocker Doses for Psychotropic Use At the previous meeting, the Psychotropic Dosage Guideline Tables were reviewed. At that time, it was suggested that the doses for beta-blockers be reviewed. In reviewing the literature, Dr. Still noted that the doses for betablockers vary widely depending on the indication. Therefore, it was recommended to not make any changes to the tables. The Committee agreed with this recommendation. 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The drug significantly increases the risk for birth defects when taken by pregnant women and atarax. Women who experience unusual vaginal bleeding should immediately consult their doctor or healthcare professional. Use of beta-agonists. Additional research is needed to more fully understand how chronic LABA use impacts the use of SABA, for both clinical management and research purposes. The findings of this analysis are in agreement with long-term comparative trials reporting equivalent asthma control for patients treated with fluticasone plus MON or fluticasone plus SAL. Our study sought to strengthen this body of evidence by using the propensity score methodology to correct for baseline differences in groups, thereby examining the relative effectiveness of ICS MON and ICS SAL in comparable patient groups. It should be noted that this study purposely predates the introduction of the fluticasone propionate SAL fixed-dose combination product Xdvair ; . This fixed-dose combination product is recommended for patients not adequately controlled on other asthma controller medications or whose disease severity clearly warrants initiation of treatment with 2 maintenance therapies. Fixed-dose combination products may offer an advantage for patients who need the simplicity and convenience of 2 therapies in 1 device and do not require tapering of the individual medications. The use of 2 separate medications, such as MON with ICSs, allows greater flexibility in dosing than fixed doses. The ability to taper ICS dosage when used concomitantly with MON has been demonstrated.23 Flexibility in dosing allows for convenient step-up in ICS dose, as recommended in the guidelines; this is more difficult with the fixed-dose combination typically used when SAL is chosen as the add-on therapy. The ability to make incremental changes in asthma medication reg.

In patients 4 years of advair inhaler and dispensing fees, membership fees, membership fees, or pharmacist. Improving concordance with the provided services. The cost-effectiveness of assertive outreach compared with other forms of service provision, such as case management and CMHTs, was also of interest. The economic review identified 11 eligible studies, none of which originated in the UK. All studies were based on RCTs, with the exception of one study by Preston & Fazio 2000 ; , which used data from a study with concurrent controls. Five studies adapted simple costing methods Bond et al, 1988; Quinlivan et al, 1995; Hu & Jerrell, 1998; Salkever et al, 1999; Preston & Fazio, 2000 ; and six studies were economic evaluations De Cangas, 1994; Wolff et al, 1997; Essock et al, 1998; Rosenheck & Neale, 1998; Chandler et al, 1999; Lehman et al, 1999 ; . Six studies demonstrated a high risk of bias, and none of the studies used sensitivity analyses to investigate the robustness of their findings. Although the international results are unambiguous, interpretation of them within a UK context should be treated with caution. Six studies compared ACT with `standard care'. Bond et al 1988 ; found discrepancies in the cost-saving characteristics of ACT between the three participating study sites. All the remaining studies demonstrated that ACT was a cost-saving form of service provision Quinlivan et al, 1995 ; or that ACT was more cost-effective than standard care De Cangas, 1994; Rosenheck & Neale, 1998; Chandler et al, 1999; Lehman et al, 1999 ; . Six studies compared ACT with different approaches to case management. The study by Preston & Fazio 2000 ; demonstrated intensive care management to be more cost-saving than ACT, relative to the costs measured in the period before the introduction of these new forms of service provision. However, baseline data suggest a difference between the two comparison groups, and the analysis focused only on narrow cost components. Salkever et al 1999 ; found no significant cost difference between standard case management and ACT, but the study suffered from flaws similar to those of the analysis by Preston et al 2000 ; . A more reliable result by Essock et al 1998 ; showed equal costeffectiveness of the two forms of service provision. Hu & Jerrell 1998 ; demonstrated that ACT was more cost-saving in the long term, while Quinlivan et al 1995 ; also found ACT to be less costly, although the difference was not significant. Another study showed that ACT is equally as costly but more effective than case management Wolff et al, 1997 ; . None of the studies compared ACT with CMHTs. Two studies investigated the cost-effectiveness of ACT specifically for homeless people with severe mental illness, and found that ACT was more cost-effective than standard care Lehman et al, 1999 ; and more cost-effective than case management Wolff et al, 1997 ; . 7.3.6.1 Health economic conclusions There is evidence that assertive community treatment is more cost-effective than standard care, representing a good `value for money' form of service provision. Comparing ACT with case management, the evidence suggests that there is no significant cost difference between the two forms of service provision. There is evidence that ACT is a cost-effective form of service provision for homeless people with severe mental illness, for instance, advair patent expiration.

Children 4 to 11 years of age ; : 1 inhalation advair 100 diskus 50 µ g salmeterol and 100 µ g fluticasone propionate ; twice daily and aldactone.

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