Hyprrtension

Background/Aim. Hypertension is one of the leading
causes of cardiovascular morbidity and mortality and more
than a half of all health insurance expenditures for reimbursed
medicines are allocated to antihypertensive drugs in
Serbia. The aim of this study was to identify the antihypertensive
drug utilization patterns among hypertensive outpatients
in the city of Novi Sad, Serbia, determine the adherence
to clinical guidelines and address the economic aspects
of current prescribing practices. Methods. This retrospective
observational study was conducted in Novi Sad over a
period of six months. The data on the number of packages,
size of packages, and retail price of antihypertensives issued
on prescription in outpatients with the diagnosis of essential
arterial hypertension was collected from all state-owned
pharmacies in Novi Sad. Drug consumption was analyzed
using the Anatomical Therapeutic Chemical (ATC)/ defined
daily dose (DDD) methodology. Results. Total consumption
of antihypertensives issued on prescription over 6
month period in the city of Novi sad, Serbia was 283,48
DDD per 1,000 inhabitans per day (DID). Angiotensin converting
enzyme inhibitors (ACEi) were most commonly
prescribed drugs, and were used 3 times more often than
calcium channel blockers and 5 times more than betablockers.
The consumption of diuretics and angiotensin
receptor antagonists was low within all groups of outpatients.
Both national and international guidelines state superiority
and effectiveness of diuretics in treatment of hypertension
in the elderly, but their consumption was unreasonable
low despite the fact that over 70% of all antihypertensive
drugs in the city of Novi Sad were dispensed
in people aged > 60. The use of more expensive ACEi was
observed, despite the guidelines deeming all the drugs of
these class equally effective in treatment of hypertension.
Conclusion. Large differences in utilization of different
groups of antihypertensive agents were noted in this study.
Underutilization of valuable, efficacious, and cost-effective
thiazide diuretics and over use of expensive ACE inhibitors
is unjustifiable. There is a potential for large savings
with switching to low-price ACEi, modeling the practice
of Scandinavian countries.
Key words:
antihypertensive agents; serbia; cost-benefit analysis;
economics, pharmaceutical; drug utilization review.
Apstrakt
Hipertenzija je jedan od vodećih uzroka kardiovaskularnog
morbiditeta i mortaliteta u Srbiji, te više od polovine troškova
za lekove na teret osiguranja odlazi na antihipertenzivne lekove.
Cilj ove studije bio je analiza strukture upotrebe antihipertenzivnih
lekova kod hipertenzivnih vanbolničkih pacijenata u
Novom Sadu, usklađenosti sa farmakoterapijskim uputstvima i
ekonomskih aspekta trenutne prakse propisivanja. Metode.
Podaci o prometu i potrošnji antihipertenzivnih lekova
propisanih kod vanbolničkih pacijenata sa dijagnozom esencijalne
arterijske hipertenzije u šestomesečnom periodu
prikupljeni su u državnim apotekama u Novom Sadu. Lekovi
su klasifikovani prema anatomsko-terapijsko-hemijskoj klasifikaciji
lekova i izračunate su definisane dnevne doze na hiljadu
stanovnika na dan (DID). Rezultati. Ukupna potrošnja antihipertenzivnih
lekova izdatih na recept u periodu od šest meseci
u Novom Sadu bila je 283,48 DID. Najčešće korištena
grupa lekova bili su inhibitori angiotenzin konvertujućeg enzima
(ACEi), koji su propisivani tri puta češće od kalcijumskih
antagonista i pet puta više od beta blokatora. Iako uputstva za
lečenje hipertenzije navode da su svi ACEi jednako efikasni,
primećena je upotreba skupljih ACEi. Upotreba diuretika i
antagonista receptora angiotenzina bila je niska u posma-
Page 2 VOJNOSANITETSKI PREGLED
Tomas A, et al. Vojnosanit Pregl 2016; Online First March (00): 47–47.
tranom periodu. Farmakoterapijska uputstva naglašavaju
prednost i efikasnost diuretika u lečenju hipertenzije kod
starijih osoba, ali njihova potrošnja bila je neopravdano niska,
uprkos činjenici da je preko 70% svih antihipertenzivnih
lekova u Novom Sadu propisana pacijentima starijim od 60
godina. Zaključak. Ovo ispitivanje pokazalo je velike razlike
u propisivanju različitih grupa antihipertenzivnih lekova. Nedovoljno
korišćenje tiazidnih diuretika, lekova sa najboljim
odnosom koristi i troškova i upotreba skupih ACE inhibitora
je neopravdana. Postoji mogućnost za značajne uštede sa racionalnijom
upotrebom ACEi, po uzoru na Skandinavske
zemlje.
Ključne reči:
antihipertenzivi; srbija; troškovi-korist, analiza;
farmakoekonomika; lekovi, korišćenje, izveštaji.