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20170125-20170126-fix-ddd-trans-dermal

Summary

  • Fix DDD for drugs with trans-dermal like Estradot
  • Keep in Mind

Commits

Index

Fix DDD for drugs with trans-dermal like Estradot

Creating a unit test for Estradot 25 IKSNR 55976 package 017 for this ATC code the who displays

ATC code  	Name  	DDD 	 U	Adm.R	 Note
G03CA03  	estradiol 	0.3 	mg 	N 	
			2 	mg 	O 	
			1 	mg 	P 	depot short duration
			0.3 	mg 	P 	depot long duration
			5 	mg 	R 	
			50 	mcg 	TD 	patch refer to amount delivered per 24 hours
			1 	mg 	TD 	gel
			25 	mcg 	V 	

			7.5 	mcg 	V 	vaginal ring refers to amount delivered per 24 hours

bin/admin displays the following information

ch.oddb>   $package = registration('55976').package('017')
-> #<ODDB::Package:0x007f301a1901f8>
ch.oddb> $package.price_public.to_s
-> 18.65
ch.oddb> $package.dose
-> 390 g
ch.oddb> $package.parts.size

-> 1
ch.oddb> $package.atc_class
-> Estradiol
ch.oddb> $package.atc_class.ddds.keys
-> Array
ch.oddb> $package.atc_class.ddds.values.first.dose
-> 0.3 mg
ch.oddb> $package.atc_class.ddds.values.last.dose
-> 7.5 mcg
ch.oddb> $package.parts.size
-> 1
ch.oddb> $package.parts.first.size
-> 8 Pflaster
ch.oddb> $package.parts.first.multi
-> 1 
ch.oddb> $package.parts.first.measure
-> 
ch.oddb> $package.parts.first.measure.class
-> NilClass
ch.oddb> $package.parts.first.count
-> 8
ch.oddb> $package.compositions.first.excipiens
-> Excipiens ad Praeparationem pro 2.5 Cm, cum Liberatione 25 g/24 H
ch.oddb> $package.route_of_administration
-> roa_TD
ch.oddb> $package.atc_class.ddds['TD'].dose
-> 1 mg
ch.oddb> $package.atc_class.ddds['TDpatch refer to amount delivered per 24 hours'].dose
-> 50 mcg

In the FI we find

Estradot 25
Transdermale Pflaster zu 0.39 mg.
2.5 cm2 cum liberatione 25 g /24 h.
<..>
Estradot wird als kontinuierliche Behandlung angewendet. Das Pflaster wird alle 3-4 Tage (d.h. zweimal wchentlich) gewechselt.

In oddb2xml/oddb_calc.xml we find 162 occurrences of "Cum Liberatione", e.g. "Excipiens Ad Praeparationem pro 2.5 Cm, Cum Liberatione 25 g/24 H".

First problem is that WHO defines mcg as microgram, whereas we generally use "g". But ruby-units converts @50 mcg@ correctly to @50 ug@ and Unit.new('25 g/24 H') => 1.04167 ug/H, but Unit.new('2.5 Cm') raises ArgumentError: '2.5 Cm' Unit not recognized.

Calculation Estradot using via price / anzahl_pflaster / (50 g/24 H/25 g/24 H), gives in my case 1.17 and not 1.33 as reported by Mr. Wallimann.

Added a debug variable SHOW_PRICE_CALCULATION to minimize verbosity after pushed commit. Run the export_ddd_csv. Found only 9 occurrences where this calculation was taken, why not more often as I found 162 occurrences in oddb_calc.xml. Corrected regular expression to allow also 4.6 mg/h.

After this change I found 34 occurrences. Still way below my expectations. Therefore decided to make this regular expression testable. This are items that I am unable to parse

Excipiens Ad Praeparationem pro 16 Cm Cum Liberatione 50 g Et 170 g/24 H
Excipiens Ad Praeparationem pro 16 Cm Cum Liberatione 50 g Et 250 g/24 H
Excipiens Ad Praeparationem pro 20 Cm Cum Liberatione 150 g Et 20 g/24 H
Excipiens Ad Praeparationem pro 9 Cm Cum Liberatione 50 g Et 140 g/24 H

Looking at GTIN 7680547040627 Estalis 50/140, transdermale Pflaster with ATC-code G03FA01. But this one does not have a WHO DDD. Therefore marking them as allowed_failures. But testing that all other excipiens match and return a value which is compatible with g/h.

We find in oddb_calc.xml 199 occurrences of "Ad Granulatum". I must also add a regular expression test for these.

For "1337003 COLOSAN mite citron Gran 200 g" I get a daily cost of (12.35/(200*0.875/8) = 0.56 and not 0.58 as defined by Mr. Wallimann. Using this for my unit test.

See also that for Buccolam the daily cost are now too high (about 4 times too high), but better than before where they covered only about 5 % of the cost. Must look at this example next week. Pushing my changes with commit Fix calculation of ddd_prices

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Page last modified on January 26, 2017, at 06:20 PM