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Practice Trends
Genotyping May Change Therapies for Arthritis Scientists now believe that genotyping patients with rheumatoid arthritis (RA)-a crippling disease that in its most severe forms reduces life expectancy by a decade or more-soon will be a clinical option to predict the course of the disease and guide treatment. Aggressive anti-inflammatory and immunosuppressive medications, such as methotrexate, can provide signillcant help to patients with severe RA, but these drugs have such serious side effects that physicians are reluctant to prescribe them until the disease has progressed to an advanced stage. In many instances, however, treatment then is too late to signillcantly alter the course of the disease. For two decades, a major goal of research in RA has been to fmd a way to distinguish between patients who are likely to have an aggressive form of the disease and those who are likely to have only milder forms. This distinction would allow physicians to select appropriate treatment for each type of patient. In their gene research, immunologists focused on the major histocompatibility complex (MHC) alleles, which playa major role in immune system responsiveness. Within the last five years, scientists have identified several alleles that deter-
vol. NS33, No.4
Apri11993
mine both an individual's susceptibility to RA and the probable severity of the disease. In a recent retrospective study of patients with severe RA who had been referred to the Mayo Clinic, 90% were found to carry these alleles. Many questions still remain, however, about the role of these alleles in the disease process. "The most important current work regarding genotyping is in prospective studies," said Gerald T. Nepom, MD, PhD, scientillc director of the Virginia Mason Research Center in Seattle, Wash. In these studies, patients are genotyped and then followed to see how well the genotyping predicts the course of the disease. The goal of studies is to identify the types of patients who can benefit most from being genotyped. According to Nepom, several prospective trials are in progress and should be completed within two years. "It is likely that the appropriate population to test will be patients with RA symptoms who are at some intermediate stage of diseasenot necessarily very early, but at some point where the difference between a predicted erosive course and a predicted remitting course may lead to different types of therapy," he said. "If these prospective trials conform to our expectations based on the retrospective studies, I anticipate widespread use of genotyping to determine risk."
Health Care Teams vvith Pharmacists Decrease Costs A recent study at Walter Reed Army Medical Center confIrms what pharmacists have long known: the close integration of pharmacists within the health care team leads to more efficient and effective patient care and to improved patient outcomes. "To say that pharmaceuticals, when well-managed, are the most cost-effective mode of therapy available for acute and chronic disease is almost a cliche," said Lucinda Maine, senior director of the pharmacy affairs division at the American Pharmaceutical Association (APhA). "But it is true-with the emphaSis on well-managed. "
The results of the one-year controlled study at Walter Reed, reported on at a recent clinical meeting of the American Society of Hospital Pharmacists, showed that if pharmacists become integral members of the health care team and participate in the decision-making process, overall costs of patient care are signillcantly reduced. The study included 3,081 patients and a total of eight health care teams in medicine and surgery. Of the five medicine teams, three were control groups and two were "intervention teams" with clinical pharma-
III
cists on them. The surgery teams included two control groups and one intervention team. The pharmacists on all three intervention teams were experienced clinical pharmacists holding PharmD degrees. The researchers looked at three outcomes: drug cost per admission, length of stay, and mortality. The results showed that the average length of stay for patients in the clinical pharmacist (intervention) groups was 7.6 days, compared with 8.2 for the control groups. The average drug cost in the pharmacist groups was $140 per patient, compared to $168 per patient in the control groups. Differences in mortality between the groups were not statistically signillcant. Investigators reported that the savings in drug costs alone will not pay for the pharmacists' participation on the teams. However, the drug costs may only be a small factor in the overall cost-benefit analysis, because appropriate drug therapy leads to decreased length of stays, and therefore to an overall reduction in cost and resource use. The pharmacists on these treatment teams typically did not make specillc recommendations to the physicians against or in favor of the use of specillc drugs. Rather, their role was more as an educator, on hand to answer AMERICAN PHARMACY
PHARMACY NEWS
PRACTHE TYRENDS
Continued from previous page '-'"
physicians' questions and thereby participate collaboratively in the management of drug therapy. Although the Walter Reed research reflects only the value of pharmacist intervention in an institutional setting, a similar study in a community setting is currently under way in Minnesota, according to Maine. "It's a very large, three-year study costing $1.2 million and involving several hundred pharmacists," said Maine. "We're all anxious to see the results."
Average Industry Salary $70,000, AAPS Study Finds According to the American Association of Pharmaceutical Scientists' (AAPS) ftfth annual salary and employment status survey, published in the December 1992 issue of Pharmaceutical Technology, the average salary of AAPS members employed in the pharmaceutical industry was $70,000 in 1991. The survey was distributed to all 4,714 AAPS members in March 1992. A total of 1,766 members, or 37.5%, responded. The typical respondent to the survey was a 41-year-old male who holds a PhD degree, works in industry, and has had 14 years of experience. Almost AMERICAN PHARMACY
""'"
Area of Employment (0/0 of Respondents) Private Irtldustry (80o/~)
$70,000
+5.6%
Academia (17%)
$66,400
+5.2%
Full professor
$83,000
+6.4%
Associate professor
$59,400
+ 4.2%
Assistant professor
$43,900
+ 1.8%
$62,500
+9.1%
Government employees « 2%)
all (98%) of the respondents were employed full time. The study found that the current average starting salary for AAPS members beginning their career in 1991 was $43,500, a figure that was essentially unchanged from 1990. Overall, industry salaries exhibited an upward trend from 1986 to 1991, but the rate of increase varied conSiderably by degree and years of experience. Holders of MS, PharmD, and PhD degrees enjoyed the largest percentage increase in total compensation for the year. A breakdown of salaries by individual degrees revealed the following average salaries: clinical pharmacology-$90,500; physical chemistry-$80,700; pharmacology-$73,000; microbiology-$61,700; and toxicology-$60,400. The largest salary increases during the five years of the study were in the fields of physical chemistry, pharmacokinetics, and pharmacognosy.
APhA's National Pharmacists' Compensation Survey 1990-1991 Practice Setting
Base Salary
Chain pharmacy
$46,131
Independent pharmacy
$44,585
Hospital pharmacy
$44,516
Other patient care
$45,678
Industry
$51,695
Other settings
$47 r 789
According to the survey, the average salary of industry employees who hold a BS degree was $56,500 for men and $45,700 for women. For holders of PharmD degrees the average salary was $78,900 for men and $63,900 for women, and for PhDs the average was $79,700 for men and $64,300 for women. A second salary study commissioned by the American Pharmaceutical Association (APhA), which covers roughly the same period, found that the average salary
of pharmacists employed in industry in 1990-91 was $51,695. The National Pharmacists' Compensation Survey, designed and conducted by the Pharmaceutical Economics Research Center at Purdue University, was sent to 2,927 licensed pharmacists. The response rate was 55.4%, with a total of 1,623 usable responses. Overall, the APhA study revealed that pharmacists' base salary across all settings averaged $46,661 for males and $42,668 for females. The total pharmacy compenApril 1993
Vol. NS33, No.4
vol. NS33, No.4
Apri11993
mine both an individual's susceptibility to RA and the probable severity of the disease. In a recent retrospective study of patients with severe RA who had been referred to the Mayo Clinic, 90% were found to carry these alleles. Many questions still remain, however, about the role of these alleles in the disease process. "The most important current work regarding genotyping is in prospective studies," said Gerald T. Nepom, MD, PhD, scientillc director of the Virginia Mason Research Center in Seattle, Wash. In these studies, patients are genotyped and then followed to see how well the genotyping predicts the course of the disease. The goal of studies is to identify the types of patients who can benefit most from being genotyped. According to Nepom, several prospective trials are in progress and should be completed within two years. "It is likely that the appropriate population to test will be patients with RA symptoms who are at some intermediate stage of diseasenot necessarily very early, but at some point where the difference between a predicted erosive course and a predicted remitting course may lead to different types of therapy," he said. "If these prospective trials conform to our expectations based on the retrospective studies, I anticipate widespread use of genotyping to determine risk."
Health Care Teams vvith Pharmacists Decrease Costs A recent study at Walter Reed Army Medical Center confIrms what pharmacists have long known: the close integration of pharmacists within the health care team leads to more efficient and effective patient care and to improved patient outcomes. "To say that pharmaceuticals, when well-managed, are the most cost-effective mode of therapy available for acute and chronic disease is almost a cliche," said Lucinda Maine, senior director of the pharmacy affairs division at the American Pharmaceutical Association (APhA). "But it is true-with the emphaSis on well-managed. "
The results of the one-year controlled study at Walter Reed, reported on at a recent clinical meeting of the American Society of Hospital Pharmacists, showed that if pharmacists become integral members of the health care team and participate in the decision-making process, overall costs of patient care are signillcantly reduced. The study included 3,081 patients and a total of eight health care teams in medicine and surgery. Of the five medicine teams, three were control groups and two were "intervention teams" with clinical pharma-
III
cists on them. The surgery teams included two control groups and one intervention team. The pharmacists on all three intervention teams were experienced clinical pharmacists holding PharmD degrees. The researchers looked at three outcomes: drug cost per admission, length of stay, and mortality. The results showed that the average length of stay for patients in the clinical pharmacist (intervention) groups was 7.6 days, compared with 8.2 for the control groups. The average drug cost in the pharmacist groups was $140 per patient, compared to $168 per patient in the control groups. Differences in mortality between the groups were not statistically signillcant. Investigators reported that the savings in drug costs alone will not pay for the pharmacists' participation on the teams. However, the drug costs may only be a small factor in the overall cost-benefit analysis, because appropriate drug therapy leads to decreased length of stays, and therefore to an overall reduction in cost and resource use. The pharmacists on these treatment teams typically did not make specillc recommendations to the physicians against or in favor of the use of specillc drugs. Rather, their role was more as an educator, on hand to answer AMERICAN PHARMACY
PHARMACY NEWS
PRACTHE TYRENDS
Continued from previous page '-'"
physicians' questions and thereby participate collaboratively in the management of drug therapy. Although the Walter Reed research reflects only the value of pharmacist intervention in an institutional setting, a similar study in a community setting is currently under way in Minnesota, according to Maine. "It's a very large, three-year study costing $1.2 million and involving several hundred pharmacists," said Maine. "We're all anxious to see the results."
Average Industry Salary $70,000, AAPS Study Finds According to the American Association of Pharmaceutical Scientists' (AAPS) ftfth annual salary and employment status survey, published in the December 1992 issue of Pharmaceutical Technology, the average salary of AAPS members employed in the pharmaceutical industry was $70,000 in 1991. The survey was distributed to all 4,714 AAPS members in March 1992. A total of 1,766 members, or 37.5%, responded. The typical respondent to the survey was a 41-year-old male who holds a PhD degree, works in industry, and has had 14 years of experience. Almost AMERICAN PHARMACY
""'"
Area of Employment (0/0 of Respondents) Private Irtldustry (80o/~)
$70,000
+5.6%
Academia (17%)
$66,400
+5.2%
Full professor
$83,000
+6.4%
Associate professor
$59,400
+ 4.2%
Assistant professor
$43,900
+ 1.8%
$62,500
+9.1%
Government employees « 2%)
all (98%) of the respondents were employed full time. The study found that the current average starting salary for AAPS members beginning their career in 1991 was $43,500, a figure that was essentially unchanged from 1990. Overall, industry salaries exhibited an upward trend from 1986 to 1991, but the rate of increase varied conSiderably by degree and years of experience. Holders of MS, PharmD, and PhD degrees enjoyed the largest percentage increase in total compensation for the year. A breakdown of salaries by individual degrees revealed the following average salaries: clinical pharmacology-$90,500; physical chemistry-$80,700; pharmacology-$73,000; microbiology-$61,700; and toxicology-$60,400. The largest salary increases during the five years of the study were in the fields of physical chemistry, pharmacokinetics, and pharmacognosy.
APhA's National Pharmacists' Compensation Survey 1990-1991 Practice Setting
Base Salary
Chain pharmacy
$46,131
Independent pharmacy
$44,585
Hospital pharmacy
$44,516
Other patient care
$45,678
Industry
$51,695
Other settings
$47 r 789
According to the survey, the average salary of industry employees who hold a BS degree was $56,500 for men and $45,700 for women. For holders of PharmD degrees the average salary was $78,900 for men and $63,900 for women, and for PhDs the average was $79,700 for men and $64,300 for women. A second salary study commissioned by the American Pharmaceutical Association (APhA), which covers roughly the same period, found that the average salary
of pharmacists employed in industry in 1990-91 was $51,695. The National Pharmacists' Compensation Survey, designed and conducted by the Pharmaceutical Economics Research Center at Purdue University, was sent to 2,927 licensed pharmacists. The response rate was 55.4%, with a total of 1,623 usable responses. Overall, the APhA study revealed that pharmacists' base salary across all settings averaged $46,661 for males and $42,668 for females. The total pharmacy compenApril 1993
Vol. NS33, No.4