Introduction: The objective of this study was to analyze ACE inhibitors (plain and combinations) ... more Introduction: The objective of this study was to analyze ACE inhibitors (plain and combinations) drugs usage (ATC subgroups: C09A and C09B) in two mid European, neighboring countries (Croatia and Slovenia) from 2000 to 2008. Further, the aim was to identify the generic drugs usage in each country, the price for DDD for original and generic drugs, and to identify the most prescribed drugs in each group and changes in the usage of these drugs during the nine-year period. Materials and methods: The data have been obtained from the International Medical Statistics database for Croatia and Slovenia. Drugs usage is presented in defined daily doses per 1000 inhabitants per day (DDD/1000) according to the WHO Methodology. Financial expenditure data are presented in Euros. An average cost per DDD was calculated for each drug group. Results: The total usage of ACE inhibitors is more than 2.3 times higher in Slovenia (173.286 DDD/1000 inhabitants/day) than in Croatia in 2008 (74.969 DDD/1000/inhabitants/day). The total usage of ACE inhibitors in combinations is 1.2 times higher in Croatia (47.373 DDD/1000 inhabitants/day) than in Slovenia in 2008. (38.710 DDD/1000/inhabitants/day). In ATC C09A subgroup the rate of generics in 2008 was 57.81% in Croatia vs. 61.32% in Slovenia. The most prescribed ACE inhibitors in Croatia in 2008 were lizinopril and ramipril, and enalapril in Slovenia. The average cost per 1 DDD for ACE inhibitors decreased in both countries and is lower in Slovenia (0.16 EUR) than in Croatia in 2008 (0.18 EUR). The average cost for ACE inhibitors in combinations is higher than cost of plain ACE inhibitors in both countries, but it also decreased during the investigated period (in 2008 in Slovenia it was 0.33 EUR/DDD and in Croatia 0.30 EUR/DDD). Conclusion: During the investigated period the usage of the ACE inhibitors, both plain and with combinations increased in both countries. The rate of generic prescription among ACE inhibitors (both plain and combinations) decreased during the investigated period in both countries probably due to the entrance of new, innovative drugs. The prescription patterns are different and the prescription of ACE inhibitors is higher in Slovenia. Prescription of ACE inhibitors in combinations was rising higher than the prescription of plain ACE inhibitors. Measures for price description have been successfully implemented in both countries and the outcome is the price decrease, for both original and generic drugs. Although the prescription of the generics is high, it should be further promoted due to their influence on costs savings.
OBJECTIVE: The aim of this study was to investigate influences of new clinical guidelines for LMW... more OBJECTIVE: The aim of this study was to investigate influences of new clinical guidelines for LMWHs therapy and new trends in the usage after introducing oral LMWHs. Oral LMWHs were introduced into the Croatian drug list in 2009. METHODS: The data were obtained from pharmaceutical wholesalers for the ten-year period (2001-2010) (IMS Health database). Financial expenditure data are presented in Croatian Kuna, while drug utilization data are presented in defined daily doses per 1000 inhabitants per day (DDD/1000). We calculated total and hospital consumption of LMWHs and compared shares of oral and subcutaneous LMWHs in hospital and out hospital consumption. RESULTS: In the period 2001-2010 total expenditure increased 3.37 times (11.4 to 38.5 millions) while the related utilization of LMWHs increased 4.66 times (0.42 DDD/1000 to 1.96 DDD/1000). In hospitals 97% of subcutaneous LMWHs were used, while only 46% of oral LMWHs were prescribed in hospitals. A share of oral in total LMWHs us...
PURPOSE Arterial hypertension (AH) is associated with a high economic burden for the individual p... more PURPOSE Arterial hypertension (AH) is associated with a high economic burden for the individual patient and for society in general. The study evaluates antihypertensives and their cost-effectiveness, comparing diuretics (D), beta-blockers (B), angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers (A) and calcium channel blockers (C) with no intervention (NI). METHODS The study included five health states in a Markov model. Cost values included average cost of the drugs used, treatment in hospital and treatment in general practice (collected from Croatian Health Insurance Fund). The study was conducted separately for 65-year old men and women, with an initial probability of cardiovascular death risk of 2% and heart failure risk of 1%. The results were presented in terms of increase in QALYs and associated financial savings or costs in euros (€). RESULTS Results for men (compared with NI): treatment with D resulted in a QALY increase of 0.76 and €886 in savings, treatment with C in an increase of 0.74 QALYs and €767 in savings, treatment with A in an increase of 0.69 QALYs and €834 in savings, treatment with B resulted in an increase of 0.40 QALYs, but with an additional cost of €41. Results for women (compared with NI): treatment with D resulted in an increase of 0.93 QALYs and €987 in savings, treatment with C in an increase of 0.89 QALYs and savings of €855, treatment with A in an increase of 0.86 QALYs and savings of €991, treatment with B in an increase of 0.48 QALYs, but with an additional cost of €148. CONCLUSIONS Treatment of AH with D, C and A is cost effective compared with the no-intervention scenario. Diuretics are the most cost-effective first-line treatment. The scenario with beta-blockers resulted in additional QALY when compared with no intervention, but also additional costs; therefore, based on our results, this therapy would not be recommended as first-line treatment.
Introduction: The objective of this study was to analyze ACE inhibitors (plain and combinations) ... more Introduction: The objective of this study was to analyze ACE inhibitors (plain and combinations) drugs usage (ATC subgroups: C09A and C09B) in two mid European, neighboring countries (Croatia and Slovenia) from 2000 to 2008. Further, the aim was to identify the generic drugs usage in each country, the price for DDD for original and generic drugs, and to identify the most prescribed drugs in each group and changes in the usage of these drugs during the nine-year period. Materials and methods: The data have been obtained from the International Medical Statistics database for Croatia and Slovenia. Drugs usage is presented in defined daily doses per 1000 inhabitants per day (DDD/1000) according to the WHO Methodology. Financial expenditure data are presented in Euros. An average cost per DDD was calculated for each drug group. Results: The total usage of ACE inhibitors is more than 2.3 times higher in Slovenia (173.286 DDD/1000 inhabitants/day) than in Croatia in 2008 (74.969 DDD/1000/inhabitants/day). The total usage of ACE inhibitors in combinations is 1.2 times higher in Croatia (47.373 DDD/1000 inhabitants/day) than in Slovenia in 2008. (38.710 DDD/1000/inhabitants/day). In ATC C09A subgroup the rate of generics in 2008 was 57.81% in Croatia vs. 61.32% in Slovenia. The most prescribed ACE inhibitors in Croatia in 2008 were lizinopril and ramipril, and enalapril in Slovenia. The average cost per 1 DDD for ACE inhibitors decreased in both countries and is lower in Slovenia (0.16 EUR) than in Croatia in 2008 (0.18 EUR). The average cost for ACE inhibitors in combinations is higher than cost of plain ACE inhibitors in both countries, but it also decreased during the investigated period (in 2008 in Slovenia it was 0.33 EUR/DDD and in Croatia 0.30 EUR/DDD). Conclusion: During the investigated period the usage of the ACE inhibitors, both plain and with combinations increased in both countries. The rate of generic prescription among ACE inhibitors (both plain and combinations) decreased during the investigated period in both countries probably due to the entrance of new, innovative drugs. The prescription patterns are different and the prescription of ACE inhibitors is higher in Slovenia. Prescription of ACE inhibitors in combinations was rising higher than the prescription of plain ACE inhibitors. Measures for price description have been successfully implemented in both countries and the outcome is the price decrease, for both original and generic drugs. Although the prescription of the generics is high, it should be further promoted due to their influence on costs savings.
OBJECTIVE: The aim of this study was to investigate influences of new clinical guidelines for LMW... more OBJECTIVE: The aim of this study was to investigate influences of new clinical guidelines for LMWHs therapy and new trends in the usage after introducing oral LMWHs. Oral LMWHs were introduced into the Croatian drug list in 2009. METHODS: The data were obtained from pharmaceutical wholesalers for the ten-year period (2001-2010) (IMS Health database). Financial expenditure data are presented in Croatian Kuna, while drug utilization data are presented in defined daily doses per 1000 inhabitants per day (DDD/1000). We calculated total and hospital consumption of LMWHs and compared shares of oral and subcutaneous LMWHs in hospital and out hospital consumption. RESULTS: In the period 2001-2010 total expenditure increased 3.37 times (11.4 to 38.5 millions) while the related utilization of LMWHs increased 4.66 times (0.42 DDD/1000 to 1.96 DDD/1000). In hospitals 97% of subcutaneous LMWHs were used, while only 46% of oral LMWHs were prescribed in hospitals. A share of oral in total LMWHs us...
PURPOSE Arterial hypertension (AH) is associated with a high economic burden for the individual p... more PURPOSE Arterial hypertension (AH) is associated with a high economic burden for the individual patient and for society in general. The study evaluates antihypertensives and their cost-effectiveness, comparing diuretics (D), beta-blockers (B), angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers (A) and calcium channel blockers (C) with no intervention (NI). METHODS The study included five health states in a Markov model. Cost values included average cost of the drugs used, treatment in hospital and treatment in general practice (collected from Croatian Health Insurance Fund). The study was conducted separately for 65-year old men and women, with an initial probability of cardiovascular death risk of 2% and heart failure risk of 1%. The results were presented in terms of increase in QALYs and associated financial savings or costs in euros (€). RESULTS Results for men (compared with NI): treatment with D resulted in a QALY increase of 0.76 and €886 in savings, treatment with C in an increase of 0.74 QALYs and €767 in savings, treatment with A in an increase of 0.69 QALYs and €834 in savings, treatment with B resulted in an increase of 0.40 QALYs, but with an additional cost of €41. Results for women (compared with NI): treatment with D resulted in an increase of 0.93 QALYs and €987 in savings, treatment with C in an increase of 0.89 QALYs and savings of €855, treatment with A in an increase of 0.86 QALYs and savings of €991, treatment with B in an increase of 0.48 QALYs, but with an additional cost of €148. CONCLUSIONS Treatment of AH with D, C and A is cost effective compared with the no-intervention scenario. Diuretics are the most cost-effective first-line treatment. The scenario with beta-blockers resulted in additional QALY when compared with no intervention, but also additional costs; therefore, based on our results, this therapy would not be recommended as first-line treatment.
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