Long-term trends in the utilization of beta-blocking agents in the Czech Republic

Spotřeba betablokátorů (ATC C07) se zřetelem na vliv reformy zdravotnictví v roce 1992 na dostupnost léků

Celostátní spotřeba byla vyjádřena (I) v definovaných denních dávkách na 1000 obyvatel a den (DDD/TOD), spotřeba ve Fakultní nemocnici Ostrava (FNO) (II) v DDD na 100 ošetřovacích dnů (DDD/100OD). ATC/DDD index: 2004. Pro metipranolol použit ekvivalent 10 mg. Zdroje dat: I. SÚKL (údaje od distributorů), ÚZIS (recepty), II. lékárenské žádanky. Období: 1985-2007. Statistická analýza podílu selektivních betalytik (C07AB) byla rozdělena do dvou částí: a) SÚKL x FNO (1985–2007), b) SÚKL x FNO, SÚKL x ÚZIS, ÚZIS x FNO (1998-2005). Statistické testy: Pearsonův korelační koeficient r, vzájemná korelační funkce pro časové řady pro posunutí dopředu i dozadu o 3 roky, párový t-test.

(I) Spotřeba C07A dle SÚKL kolísala mezi 39,3 (1992) a 51,2 DDD/TOD (1998). Poté vzestoupila až na 80,6 DDD/TID (2007). Z ÚZIS obdobné údaje na nižší hladině. (II) Spotřeba C07 ve FNO oscilovala mezi 20-26 DDD/100OD až do 1988. V 1989 stoupla na 69,7 DDD/100OD, následně poklesla na 7,6 DDD/100OD (1998). Mezi 1999-2004 byla ustálená: 10-14 DDD/100OD, poté slabý vzestup na 16,8 v posledních třech letech. Spotřeba alfa a betablokátorů byla velmi nízká. Mezi všemi třemi páry dat byla vysoká korelace v procentuální spotřebě C07AB, P = 0,000; r = 0,995 SÚKL x OUH (1985–2007). V období 1998-2005 SÚKL x FNO r = 0,966, SÚKL x ÚZIS r = 0,997, ÚZIS x FNO r = 0,976. Posun časových řad byl v obou obdobích nulový. T-test ukázal statisticky významně větší podíl C07AB ve FNO, P < 0,05.

Selektivní betablokátory postupně nahradily neselektivní, zastoupené zvl. domácí metipranololem a jejich spotřeba stoupá. Nejužívanějšími byl metoprolol, betaxolol, atenolol a acebutolol.

Klíčová slova:
DDD – spotřeba – betablokátory – trend

Authors: B. Kořístková ¹; M. Grundmann ¹; D. Šalounová ²
Authors place of work: Ostrava University, Department of Clinical Pharmacology, Hospital and Faculty of Health Sciences ¹; VSB-Technical University Ostrava, Department of Mathematical Methods in Economy, Faculty of Economics ²
Published in the journal: Čes. slov. Farm., 2010; 59, 23-30
Category: Původní práce

Summary

To study long term trends in the utilization of beta-blockers (ATC group C07) with regard to a possible influence of the health reform in 1992 on the availability of drugs.

Method:
The utilization of C07 was expressed in the defined daily doses per thousand inhabitants and a day (DDD/TID) in the Czech Republic (I), and in DDD per 100 bed days (DDD/100 BD) in the University Hospital (OUH) Ostrava (II). ATC/DDD index: 2004. 10 mg was used as the DDD equivalent for metipranolol. The sources of data were: I. The SUKL database (wholesale data), the UZIS database (prescriptions), and II. The hospital request forms. Observed period: 1985-2007. The statistical analysis of the utilization of the portion of the C07AB group was divided into two parts. a) SUKL x OUH (1985–2007). b) SUKL x OUH, SUKL x UZIS and UZIS x OUH (1998–2005). Statistical tests used: Pearson Correlation r. Cross-Correlations Function for lags forward and backward from 1 to 3 years for time series, and paired T-test.

(I) The utilization of plain beta-blockers (C07A) ranged between 39.3 in 1992 and 51.2 DDD/TID in 1998 (SUKL data). Thereafter there has been an increasing trend to up to 80.6 DDD/TID in 2007. The UZIS data give similar outcomes generally on a lower level. (II) The utilization of C07 in OUH ranged between 20-26 DDD/100 BD till 1988. In 1989 there was an amplitude of 69.7 DDD/100 BD, followed by a decrease to 7.6 DDD/100 BD in 1998. During 1999-2004 the utilization was stabilized on the level of 10-14 DDD/100 BD followed by a slight increase to 16.8 during the last three years. The utilization of alpha- and beta-blocking agents was low. The correlation in the utilization of the C07AB portion between all three pairs of data was significantly high at the level of significance P = 0.000: SUKL x OUH in the period of 1985–2007: Pearson Correlation r = 0.995. In the period of 1998-2005 SUKL x OUH r = 0.966, SUKL x UZIS r = 0.997, UZIS x OUH r = 0.976. The shift of the time series was zero (both periods). The T-test showed a significantly higher proportion of C07AB in OUH, P < 0.05.

The selective compounds step-wise replaced the non-selective ones, mainly presented by the domestic metipranolol. The utilization of the selective beta-blocking agents has been still increasing; the most widely utilized ones were metoprolol, betaxolol, atenolol and acebutolol. The utilization of alpha- and beta-blocking agents was low.

Key words:
DDD – utilization – beta-blockers – trends

Address for correspondence:

PharmDr. Blanka Koristkova, Ph.D.

Department of Clinical Pharmacology, Ostrava University Hospital and Faculty of Health Sciences, University of Ostrava

17. listopadu 1790, 708 52 Ostrava, Czech Republic

e-mail: blanka.koristkova@seznam.cz

Zdroje

1. Vlcek, J., Dalecka, R., et al.: Základy farmakoepidemiologie, farmakoekonominy a farmakoinformatiky (Basics of pharmacoepidemiology, pharmacoeconomics, pharmacoinformatics [in Czech]). 2nd ed. Praha: Remedia 2005.

2. Gorecka, K., Vlcek, J., Walker, R.: Comparison of utilization of cardiovascular drugs in the Czech Republic and in Wales [in Czech]. Vnitr. Lek., 2003; 49, 592–597.

3. Jackevisius, C. A., Tu, K., Filate, W. A., Brien, S. E., Tu, J. V.: Trends in cardiovascular drug utilization and drug expenditures in Canada between 1996 and 2001. Can. J. Cardiol. 2003; 19, 1359–1366.

4. Liu, S. Z., Romeis, J. C.: Changes in drug utilization following the outpatient prescription drug cost-sharing program – evidence from Taiwan’s elderly. Health Policy, 2004; 68, 277–287.

5. Lurk, J. T., Dejong, D. J., Woods, T. M., Knell, M. E., Carroll, C. A.: Effects of changes in patient cost sharing and drug sample policies on prescription drug costs and utilization in a safety-net-provider setting. Am. J. Health-Syst. Pharm. 2004; 61, 267–272.

6. Vlahovic-Palcevski, V., Palcevski, G., Mavric, Z., Francetic, I.: Factors influencing antimicrobial utilization at a university hospital during a period of 11 years. Int. J. Clin. Pharm. Ther. 2003; 41: 287–293.

7. State Institute for Drug Control. Informace o poskytování údajů o spotřebách léčivých přípravků. [The information about rules for providing of data about drug utilization – in Czech], Praha, http://www.sukl.cz/_ download/cs11registrace/spotreba.doc (accessed 25 October 2005).

8. WHO Collaborating Centre for Drug Statistics Methodolology. ATC index 2004, Oslo, January 2004. http://www.whocc.no/atcddd (accessed 21 January 2004).

9. State Institute for Drug Control. Seznam registrovaných lecivych pripravku a pripravku, kterym byla povolena vyjimka MZ CR. [Register of Medicinal Products – in Czech]. Praha, http://www.sukl.cz/cs02leciva/#srlp (accessed 4 November 2005).

10. Czech Statistical Office. Population. Praha, http://www.czso.cz (accessed 4 November, 2005).

11. Australian Statistics on Medicenes 1991. Department of Health, Housing and Community Services: Canberra, Commonwelth of Australia, 1992.

12. Australian Statistics on Medicenes 1993. Commonwealth Department of Human Services and Health: Canberra, Commonwelth of Australia, 1995.

13. Australian Statistics on Medicenes 1994. Commonwealth Department of Human Services and Health: Canberra, Commonwelth of Australia, 1996.

14. Suomen Lääketilasto, Finish Statistics on Medicines 1987. The Finish Committe on drug and Statistik: Helsinki, Finland, 1988.

15. Suomen Lääketilasto, Finish Statistics on Medicines 1988. The Finish Committe on drug and Statistik: Helsinki, Finland, 1989.

16. Suomen Lääketilasto, Finish Statistics on Medicines 1989. The Finish Committe on drug and Statistik: Helsinki, Finland, 1990.

17. Suomen Lääketilasto, Finish Statistics on Medicines 1991. The Finish Committe on drug and Statistik: Helsinki, Finland, 1992.

18. Suomen Lääketilasto, Finish Statistics on Medicines 1992. National agency for Medicines and The Social Insurance Institution: Helsinki, Finland, 1993.

19. Suomen Lääketilasto, Finish Statistics on Medicines 1993. National agency for Medicines and The Social Insurance Institution: Helsinki, Finland, 1994.

20. Suomen Lääketilasto, Finish Statistics on Medicines 1994. National agency for Medicines and The Social Insurance Institution: Helsinki, Finland, 1995.

21. Suomen Lääketilasto, Finish Statistics on Medicines 1995 National agency for Medicines and The Social Insurance Institution: Helsinki, Finland, 1996.

22. Ledemiddelforbruket i Norge 1984 – 1988. Norsk Medisinaldepot: Oslo, Norway, 1989.

23. Ledemiddelforbruket i Norge 1989 – 1993. Norsk Medisinaldepot: Oslo, Norway, 1994.

24. Ledemiddelforbruket i Norge 1990 – 1994. Norsk Medisinaldepot: Oslo, Norway, 1995.

25. Ledemiddelforbruket i Norge 1996 – 2000. WHO Collaborating Centre for Drug Statistics Methodology Oslo: Oslo, Norway, 2000.

26. Svensk Läkemedelsstatistik 1985. Apoteksbolaget: Stockholm, Sweden, 1986.

27. Svensk Läkemedelsstatistik 1988. Apoteksbolaget Farmaceutiska Sektorn, Stockholm, Sweden, 1989

28. Svensk Läkemedelsstatistik 1994. Apoteksbolaget Statistikenheten Sektor Farmaci: Stockholm, Sweden, 1995

29. Svensk Läkemedelsstatistik 1999. Apoteket AB, Sektor Farmaci/Marknad: Stockholm, Sweden, 2000

30. Trcka, V., Vanecek, M., Helfert, I., Macova, S.: A comparative study of the effect of the metipranolol, propranolol, alprenolol, oxprenolol, pindolol and practolol on the circulation in the experimental animals. Acta Univ. Carol. (med.), 1980; 26, 239–258.

31. Cifkova, R., Horky, K., Widimsky, J. sr, et al.: Recommendations for diagnostics and treatment of arterial hypertension-version 2004. Recommendations of the Czech Society for Prevention of Hypertension [in Czech]. Vnitr. Lek. 2004; 50, 709–714.

32. Koristkova, B., Grundmann, M.: [The consumption of antiepileptics in 1993–2004 using various methods]. Article in Czech, abstract in English. Ces. slov. Farm. 2006; 55, 18–23.

33. Gorecka, K., Linhartova, A., Vlcek, J., Tilser, I.: Cardiovascular drug utilisation and socio-economic inequalities in 20 districts of the Czech Republic. Eur. J. Clin. Pharmacol. 2005; 61, 417–423.

34. Tiwari, H., Kumar, A., Kulkarni, S. K.: Prescription monitoring of antihypertensive drug utilisation at the Panjab University Health Centre in India. Singapore Med. J., 2004; 45, 117–120.

35. Jassim Al Khaja, K. A., Sequeira, R. P., Abdul Wahab, A. W. M., Mathur, V. S.: Antihypertensive drug prescription trends at the primary health care centres in Bahrain. Pharmacoepidemiol. Drug Saf., 2001; 10, 219–227.

36. Yusuff, K. B., Balogun, O. B.: Pattern of drug utilization among hypertensives in a Nigerian teaching hospital. Pharmacoepidemiol. Drug Saf., 2005; 14, 69–74.