Potential Cost-saving for Liquid-to-Solid Medicines among Paediatric Patients Wei Chern Ang1,2, Mohamad Syafuan Fadzil2*, Chian Khie Lim2, Nur Inani Mohamad Nasir2, Muhammad Asyraf Amir2 1 Clinical Research Centre, Hospital Tuanku Fauziah, Ministry of Health Malaysia 2 Department of Pharmacy, Hospital Tuanku Fauziah, Ministry of Health Malaysia BR-08 NMRR-18-2790-44206 Introduction The World Health Organisation (WHO) recommends that children be treated with oral solid medicines for drugs, especially those require a precise dose titration.1 Problem statement: Factors that can affect a child’s success in swallowing pills include developmental stage, fear, anxiety, intolerance of unpleasant flavors and failure to appreciate the risks associated with the non- compliance. Inadequate dosing flexibility without the need of tablet crushing explained the lack of usage of solid oral formulation in pediatrics.2 The current practices only based on preference of prescribers and patient’s parent/care. Justification of Study: •There are still lack of evidence regarding the solid oral formulation suitability in Malaysia • There is no published study in Malaysia that analyses the cost differences when oral liquid medications were changed to oral solid medications in a hospital outpatient setting. Objective: 1. To examine the association of demographic and solid dosage suitability. 2. To investigate factors affecting prescribing of solid oral dosage dorms. 3. To examine the potential cost savings if patient were prescribed with solid over liquid preparations. Methods This cross-sectional study conducted from October 2018 to March 2019 among patients visiting Paediatric Clinic, Hospital Tuanku Fauziah (HTF), Kangar, Malaysia. Discussions/Conclusions 1. WHO (2008). Report of the informal expert meeting on dosage forms of medicines for children. Geneva, Switzerland.15-6. 2. Patel A et al. (2014). J Pediatr. 135;183 3. EMA (2011) Guideline on Pharmaceutical Dev. of Medicines for Paediatric Use. 4. Lajoinie A et al. (2014). Br J Clin Pharmacol. 78(5); 1080-1089. 5. Jacobsen, L et al.(2016) Tablet/capsule size variation among the most commonly prescribed medication for children in the USA; 65-73. Variable Solid Dosage Suitability p-value Yes No Age (years) 2-5 6-11 >12 Weight (kg, adjusted by age) <13 >13.01 Race Malay Non-Malay Disease condition Acute Chronic Gender Male Female 107 (47.6) 50 (42.0) 10 (37.0) 97 (50.8) 70 (38.9) 162 (45) 5 (45.5) 153 (46.8) 14 (31.8) 96 (46.8) 71 (42.8) 118 (52.4) 69 (58.0) 17 (63.0) 94 (49.2) 110 (61.1) 198 (55) 6 (54.5) 174 (53.2) 30 (68.2) 109 (53.2) 95 (57.2) 0.425* 0.021* 0.976** 0.075** 0.463** References Variable Crude OR (95%CI) p-value Age (years) 2-5 6-11 >12 Weight (kg) Disease condition Acute Chronic Gender Male Female 1.00(ref.) 1.25(0.80,1.96) 1.54(0.67,3.51) 1.04 (1.01,1.07) 1.00 (ref.) 0.53 (0.27,1.04) 1.00 (ref.) 1.18(0.78, 1.78) 0.327 0.303 0.004 0.064 0.435 In conclusion, conversion of liquid to suitable oral solid medications is cost-saving and feasible to be practised. • Most tablets prescribed were in the range of 5-10mm (62.5%) which are only suitable for 6-11 years old.3 However, there is no significance difference between age group and solid dosage suitability (p>0.05). • Most of prescribed medication for paediatrics varied widely in size e.g. paracetamol 500mg tablets ranged from 5 to 22mm, with a median of 15mm. The common paediatric antibiotics were larger with a median diameter of 17mm).5 • Most of our paediatric patients were 2-5 years old (60.6%). However, only a fraction (15.1%) of tablet with size of 3-5mm were only suitable for this age group. Liquid formulation will still be suitable for this group of patients. In our setting, parents/carers may still be afraid for patients to take solid dosage medication in this age. • Suitability of oral solid dosage forms based on size from the EMA3 may not be suitable for Asian population. To the best of our knowledge, there is no consensus or g