Results of the clinical and economic analysis of the state of pharmaceutical provision of patients with dementia in Alzheimer’s disease in Ukraine
DOI:
https://doi.org/10.24959/sphhcj.22.260Keywords:
clinical and economic analysis; medical prescriptions; drug consumption; Alzheimer’s disease; pharmaceutical support for psychoneurological patients.Abstract
Aim. To conduct the clinical and economic analysis of the state of pharmaceutical provision of patients with dementia in Alzheimer’s disease in Ukraine.
Materials and methods. Both general theoretical (historical, analytical-comparative, systemic, graphical, logical, hypothetical-deductive) and applied (clinical-economic, mathematical-statistical) research methods were used.
Results. It was found that the vast majority of patients belonged to socially unprotected segments of the population. Thus, the proportion of pensioners was 71.0 %, and 40 patients (20.0 %) had disability groups. All patients, without exception, had a burdened anamnesis. On average, patients were treated in specialized medical institutions for 43.8 bed-days. The sum of 548,714.5 UAH (19,072.45 USD) was spent on drug provision for these patients, which amounted to 2,743.57 UAH (95.36 USD) per one patient. For one bed-day, patients used drugs for only 62.64 UAH (2.18 USD). Physicians wrote 2,487 prescriptions (12.4 per a patient) and used 128 drugs under international non-proprietary names or 218 drugs taking into account all their trade names. In the structure of medical prescriptions, there was a significant duplication of drugs represented by international non-proprietary names. According to the first level of the ATC classification system, the highest rates of prescription frequency were for group N – Drugs affecting the nervous system (861 prescriptions or 34.62 %), and according to the second level, there were drugs from group C01 – Cardiac therapy group (375 prescriptions or 15 .08 %). At the same time, the second and third positions by the number of prescriptions were occupied by drugs from groups N05 – Psycholeptics (363 prescriptions or 14.60 %) and N06 – Psychoanaleptics (309 prescriptions or 12.42 %). It was found that physicians prescribed 617 (24.81 %) drugs recommended by the Clinical Protocol for the treatment of cognitive and non-cognitive behavioral disorders in patients with dementia due to Alzheimer’s disease. Of the drugs in group N06D – Anti-dementia drugs, the drugs in group N06DX – Other drugs for the treatment of dementia had the highest prescribing rates (191 physicians), while drugs of group N06DA – Cholinesterase inhibitors were prescribed by physicians only 43 times. The highest prescription rates in the structure of pathogenetic therapy were drugs of group N06DX01 – Memantine (188 prescriptions or 30.47 %). Then, drugs of group N06DA03 – Rivastigmine (34 prescriptions or 5.51 %) and N06DA02 – Donepezil (6 prescriptions or 0.97 %) followed by a significant margin. The drugs of group N06DX01 – Memantine also occupied leading positions in the structure of drug consumption. Thus, the volume of their consumption was equal to 84,420.2 UAH (2,934,314 USD), which accounted for 15.39 % of the total cost of drug provision for patients and 91.76 % of drug consumption in group N06D – Medicines for use in dementia.
Conclusions. A significant financial burden associated with the need to use pathogenetic therapy drugs in patients with dementia in Alzheimer’s disease requires the development and implementation of effective models of resource provision for pharmacotherapy and social support of neuropsychiatric patients in Ukraine.
References
Devi G., Scheltens P. Heterogeneity of Alzheimer’s disease: consequence for drug trials? Alzheimer’s Research & Therapy. 2018. Vol. 10, No. 122. URL: https://alzres.biomedcentral.com/articles/10.1186/s13195-018-0455-y.
On the path to 2025: understanding the Alzheimer’s disease continuum / P. S. Aisen et al. Alzheimer’s Research & Therapy. 2017. Vol. 9 (60) URL: https://link.springer.com/article/10.1186/s13195-017-0283-5.
Cognitive subtypes of probable Alzheimer’s disease robustly identified in four cohorts / N. Scheltens et al. Alzheimers Dement. 2017. No. 13. P. 1226-1236. DOI: 10.1016/j.jalz.2017.03.002.
Drug development in Alzheimer’s disease: the path to 2025 / J. Cummings et al. Alzheimer’s Research & Therapy. 2016. Vol. 8. DOI: 10.1186/s13195-016-0207-9.
Treatment for mild cognitive impairment: a systematic review and meta-analysis / D. Fitzpatrick-Lewis et al. CMAJ Open. 2015. No. 3 (4). P. 419-427. DOI: 10.9778/cmajo.20150057.
Sadiq M. U., Kwak K., Dayan E. Model-based stratification of progression along the Alzheimer disease continuum highlights the centrality of biomarker synergies. Alzheimer’s Research & Therapy. 2022. Vol. 14, No. 16. DOI: 10.1186/s13195-021-00941-1.
Musiek E. S., Morris J. C. Possible consequences of the approval of a disease-modifying therapy for Alzheimer disease. JAMA Neurol. 2021. Vol. 78 (2). Р. 141-142. DOI: 10.1001/jamaneurol.2020.4478.
The identification of cognitive subtypes in Alzheimer’s disease dementia using latent class analysis / N. Scheltens et al. J Neurol Neurosurg Psychiatry. 2016. Vol. 87 (3). P. 235–243. DOI: 10.1136/jnnp-2014-309582.
Areosa S. A., Vernooij R. W., Gonzalez-Colaco H. M., Martinez G. Effect of the treatment of Type 2 diabetes mellitus on the development of cognitive impairment and dementia. Cochrane Database of Systematic Reviews. 2017. Vol. 6 (6). DOI: 10.1002/14651858.
Barreto P. S., Demougeot L., Vellas B., Rolland Y. Exercise training for preventing dementia, mild cognitive impairment, and clinically meaningful cognitive decline: a systematic review and meta-analysis. Journals of Gerontology Series A: Biological Sciences & Medical Sciences. 2017. Vol. 73, Iss. 11. P. 1504-1511. DOI: https://doi.org/10.1093/gerona/glx234.
Федотова М. С., Панфілова Г. Л., Цурікова О. В., Блажієвська О. В. Дослідження епідеміології деменції та хвороби Альцгеймера в Україні. Вісник фармації. 2021. № 2 (102). С. 50-58. DOI: https://doi.org/10.24959/nphj.21.58.
Association between fish consumption and risk of dementia: a new study from China and a systematic literature review and meta-analysis / Bakre A. T. et al. Public Health Nutrition. 2018. Vol. 1 (10). P. 1921-1932. DOI: https://doi.org/10.1017/S136898001800037X.
Fish P. V., Steadman D., Bayle E. D., Whiting P. New approaches for the treatment of Alzheimer’s disease. Bioorganic & Medicinal Chemistry Letters. 2019. Vol. 29, Iss. 2. P. 125-133. DOI: 10.1016/j.bmcl.2018.11.034.
Ilomaki J., Jokanovic N., Tan C. K. E., Lönnroos E. Alcohol consumption, dementia and cognitive decline: an overview of systematic reviews. Current Clinical Pharmacology. 2015. Vol. 10 (3). P. 204-212. DOI: 10.2174/157488471003150820145539.
Understanding disease progression and improving Alzheimer’s disease clinical trials: Recent highlights from the Alzheimer’s Disease Neuroimaging Initiative / Veitc Dalla P. et al. Alzheimer’s & Dementia. 2019. Vol. 15, Iss. 1. P. 106-152. DOI: https://doi.org/10.1016/j.jalz.2018.08.005.
Alzheimer’s disease: a review from the pathophysiology to diagnosis, new perspectives for pharmacological treatment / L. C. Dos Santos Picanco et al. Curr Med Chem. 2018. Vol. 25 (26). P. 3141-3159. DOI: 10.2174/0929867323666161213101126.
Обсяг ринку препаратів для лікування хвороби Альцгеймера сягне 12,9 млрд дол. США у 2028 р. Щотижневик «Аптека». 2020. URL: https://www.apteka.ua/article/552579.
Dementia prevention, intervention, and care / G. Livingston et al. Lancet. 2017. Vol. 390 (10113). P. 2673-2734. DOI: 10.1016/S0140-6736(17)31363-6.
The prevalence and incidence of dementia due to Alzheimer’s disease: a systematic review and meta-analysis / G. Livingston et al. Can J Neurol Sci. 2016. Vol. 43 (Suppl. 1). P. S51-S82. DOI: https://doi.org/10.1017/cjn.2016.36.
Tau PET patterns mirror clinical and neuroanatomical variability in Alzheimer’s disease / R. Ossenkoppele et al. Brain. 2016. Vol. 139 (5). P. 1551-1567. DOI: 10.1093/brain/aww027.
The Effectiveness of Vitamin E Treatment in Alzheimer’s Disease / A. Lloret et al. Int. J. Mol. Sci. 2019. Vol. 20 (4). Р. 879. DOI: 10.3390/ijms20040879.
Evidence for benefit of statins to modify cognitive decline and risk in Alzheimer’s disease / N. Geifman et al. Alzheimer’s Research & Therapy. 2017. Vol. 9 (10). P. 1. DOI: 10.1186/s13195-017-0237-y.
Modifiable lifestyle factors in dementia: a systematic review of longitudinal observational cohort studies / L. Y. Di Marco et al. Journal of Alzheimer’s Disease. 2014. Vol. 42 (1). P. 119–135. DOI: 10.3233/JAD-132225.
Про затвердження Уніфікованого клінічного протоколу первинної, вторинної (спеціалізованої), третинної (високоспеціалізованої) та паліативної медичної допомоги. Деменція : Наказ МОЗ України № 736 від 19.07.2016. URL: https://www.dec.gov.ua/wp-content/uploads/2019/11/2016_736_ykpmd_dem.pdf.
Програма медичних гарантій-2022: що включено до переліку безоплатних медичних послуг. URL: https://dn.gov.ua/news/programa-medichnih-garantij-2022-shcho-vklyucheno-do-pereliku-bezoplatnih-medichnih-poslug.
Mohammed S. A., Workneh B. D. Critical Analysis of Pharmaceuticals Inventory Management Using the ABC-VEN Matrix in Dessie Referral Hospital, Ethiopia. Integrated Pharmacy Research and Practice. 2020. Vol. 9. Р. 113–125. DOI: 10.2147/IPRP.S265438.
Handbook of Medical Statistics / ed. by Ji-Qian Fang. China : Sun Yat-Sen University, 2017.
Національний перелік основних лікарських засобів : Постанова Кабінету Міністрів України від 25 березня 2009 р. № 333 (в редакції постанови Кабінету Міністрів України від 13 грудня 2017 р. № 1081). URL: https://moz.gov.ua/uploads/0/3799-nacperelic_dodatok_web.pdf.
Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis / J. M. Northey et al. Br J Sport Med. 2018. Vol. 52 (3). P. 154-160. DOI: 10.1136/bjsports-2016-096587.
Orgeta V., Mukadam N., Sommerlad A., Livingston G. The Lancet Commission on dementia prevention, intervention, and care: a call for action. Ir J Psychol Med. 2019. Vol. 36. P. 85-88. DOI: 10.1017/ipm.2018.4.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 National University of Pharmacy
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
