A clinical audit of high-cost and off-label drug use in dermatology

Ong, Natalie, McMeniman, Erin, Pillans, Peter and Soyer, H. Peter (2017) A clinical audit of high-cost and off-label drug use in dermatology. Australasian Journal of Dermatology, 58 1: 30-34. doi:10.1111/ajd.12392


Author Ong, Natalie
McMeniman, Erin
Pillans, Peter
Soyer, H. Peter
Title A clinical audit of high-cost and off-label drug use in dermatology
Journal name Australasian Journal of Dermatology   Check publisher's open access policy
ISSN 1440-0960
0004-8380
Publication date 2017-02-01
Year available 2015
Sub-type Article (original research)
DOI 10.1111/ajd.12392
Open Access Status Not yet assessed
Volume 58
Issue 1
Start page 30
End page 34
Total pages 5
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject 2708 Dermatology
Abstract Background/Objectives: The use of high-cost, off-label, unsubsidised drugs has become valuable in the management of dermatology patients with challenging conditions unresponsive to conventional therapy. Currently, there is no dedicated funding and a paucity of evidence for such drugs. The aim of this audit was to review outcomes and costs. Methods: A retrospective clinical audit of high-cost off-label dermatology drug applications to the High Cost Drug's Subcommittee was undertaken at a tertiary public hospital in Brisbane, Queensland, between 2002 and 2013. Results: Of 28 applications, 25 were approved. The medications included thalidomide, mycophenolate mofetil, cyclosporin, infliximab, rituximab and adalimumab. Over 70% of patients responded to treatment. Individual annual costs for these medications ranged from $2068 to $36 984. Adverse effects resulted in drug withdrawal in five cases. Conclusions: Despite the absence of dedicated funding for high-cost drugs and a rigorous committee approval process, most applications were approved, of which >70% benefited from treatment. This audit provides useful clinical experience with off-label use of high-cost drugs in difficult dermatological conditions.
Formatted abstract
Background/Objectives: The use of high-cost, off-label, unsubsidised drugs has become valuable in the management of dermatology patients with challenging conditions unresponsive to conventional therapy. Currently, there is no dedicated funding and a paucity of evidence for such drugs. The aim of this audit was to review outcomes and costs.

Methods: A retrospective clinical audit of high-cost off-label dermatology drug applications to the High Cost Drug's Subcommittee was undertaken at a tertiary public hospital in Brisbane, Queensland, between 2002 and 2013.

Results: Of 28 applications, 25 were approved. The medications included thalidomide, mycophenolate mofetil, cyclosporin, infliximab, rituximab and adalimumab. Over 70% of patients responded to treatment. Individual annual costs for these medications ranged from $2068 to $36 984. Adverse effects resulted in drug withdrawal in five cases.

Conclusions: Despite the absence of dedicated funding for high-cost drugs and a rigorous committee approval process, most applications were approved, of which >70% benefited from treatment. This audit provides useful clinical experience with off-label use of high-cost drugs in difficult dermatological conditions.
Keyword Adalimumab
Biologic agent
Clinical audit
Cyclosporin
Dermatology
Drug
Infliximab
Mycophenolate mofetil
Rituximab
Thalidomide
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Medicine Publications
Admin Only - School of Clinical Medicine
Admin Only - UQ Diamantina Institute
 
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