Danijela Štimac

Utilization of cardiovascular drugs in Zagreb 2001-2005

Objective — The purpose of this study was to investigate the outpatient utilization of cardiovascular drugs in Croatia, during the period 2001-2005, using the Anatomical Therapeutic Chemical classification of drugs/Defined Daily Dose (ATC/DDD) methodology. Methods and results — Data on outpatient drug utilization were obtained from the Zagreb Municipal Pharmacy to calculate the number of defined daily dose (DDD), and DDD per 1000 inhabitants per day (DDD/1000/day). The drug utilization 90% (DU90%) method was used on drug prescribing quality assessment. Data on hospital admissions were collected from the inpatient database kept at the Zagreb Institute of Public Health.Total utilization of cardiovascular drugs (ATC group C), was between 402.9 Defined Daily Dose per 1000 inhabitants per day (DDD/TID) and 362.9 DDD/TID in Croatia between 2001 and 2005. Agents acting on the renin-angiotensin system (C09) (104.2 DDD/TID) and calcium channel blockers (C08) (80.5 DDD/TID) accounted for more than 50% of drugs used for the treatment of hypertension in 2005.A great increase in the utilization was observed for statins (78.3%).A markedly increasing utilization was recorded for angiotensin-converting enzyme (ACE) inhibitors in combination with hydrochlorothiazide (HCTZ) (40.5%) and angiotensin II antagonists (278%). Comparison of the DU90% segment between 2001 and 2005 revealed pentoxifylline and amiodarone to be absent, whereas cilazapril and ramipril in combination with HCTZ, bisoprolol, valsartan and losartan alone or in combination with HCTZ were added in 2004 and 2005. The total rate of hospital admissions for major cardiovascular events decreased by 18.2%. Conclusion — The utilization pattern was improved in 2005, showing a decrease in the number of hospital admissions for major cardiovascular events.

Distribution and trends in outpatient utilization of generic versus brand name psychopharmaceuticals during a ten-year period in Croatia

BackgroundDrug costs increasingly pose a burden upon the otherwise inadequate health care resources and rational drug utilization is an important segment of every national health policy. Optimal patient care should be the goal of rational pharmacotherapy, whereby the economic burden of treatment is just one of the elements to be considered on choosing appropriate therapy.The aim of this study was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period.MethodsUsing the World Health Organization Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from pharmacies on the number and size of drug packages. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization.ResultsTotal cost for psychopharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to financial indicators decreased by 9.6% and according to DDD/1000/day by 12%. The greatest decrease was in antidepressants, i.e. by 33.8% according to financial indicators and by 46% according to DDD/1000/day; and in antipsychotics by 30.9% according to DDD/1000/day, while showing an increase by 8.5% according to financial indicators. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day, but increased by 25.1% according to financial indicators.ConclusionsThe lack of uniform national guidelines and the still strong impact of pharmaceutical industry marketing continue favoring the rise in prescribing brand name antidepressants and antipsychotics. Depression, schizophrenia and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic psychopharmaceuticals.

Utilization of generic versus brand name psychopharmaceuticals during a ten-year period in Croatia

R drug utilization is an important segment of every national health policy. The aim was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period. Using the World Health Organization Anatomical-TherapeuticChemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from all Zagreb pharmacies on the number and size of drug packages, during the 2001-2010 period. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization. Total cost for psycho pharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to DDD/1000/day was decreased by 12%. The greatest decrease was in antidepressants, i.e., by 46% according to DDD/1000/day; and in antipsychotics by 30.9%. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day. There is a potential to achieve some savings with generic psychopharmaceuticals. Combining the initiatives to lower the price of generics with demand-side measures to enhance their prescribing is important to maximize prescribing efficiency.

Consumption of Antidepressants in Croatia: Trends in the Rate of Hospitalization for Depression and Suicide (2001-2010)

Background To assess the effect of antidepressant consumption on the rate of hospitalization for depression and suicide. Methods The epidemiological method of descriptive and analytical observation was used in 10-year study. Hospitalization data were collected for every patient hospitalized for depression. Suicide data were obtained from mortality statistics. Data on drug utilization from Zagreb Municipal …