pattern of use and pharmacoeconomic impact of antihypertensive drugs in a north indian referral...

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PHARMACOEPIDEMIOLOGY AND PRESCRIPTION Samir Malhotra á R.S. Karan á P. Pandhi á Sanjay Jain Pattern of use and pharmacoeconomic impact of antihypertensive drugs in a north Indian referral hospital Received: 7 March 2001 / Accepted in revised form: 12 June 2001 / Published online: 10 August 2001 Ó Springer-Verlag 2001 Abstract Objective: The current study was designed to investigate drug utilisation and the pharmacoeconomics of hypertension in the hypertension clinic of a tertiary- care hospital. Methods: The study was conducted in patients attending the hypertension clinic of Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandi- garh, India. A survey of prescriptions was carried out, and the information obtained was further corroborated by seeing the medical records as well as patient inter- views. Results: A total of 1076 prescriptions were evaluated. Beta-adrenoceptor-blocking agents 51%), calcium an- tagonists 47%) and angiotensin-converting enzyme in- hibitors 46%) were the most popular drugs. The utilisation of thiazides was less than expected. Combi- nation therapy was used more commonly than mono- therapy 53.8% vs 46.7%). Oral hypoglycaemic agents and lipid-lowering agents were commonly co-prescribed along with antihypertensive medications. About 30% of drugs were prescribed by generic name and 90% were from the national essential drugs list. Of the per capita income, 10.6% was spent on the treatment of hyper- tension. The mean monthly cost of various drugs ranged between US $0.8 and US $6.6. A total of 91 adverse drug reaction ADRs) were encountered in the study; the added cost of treatment of these ADRs was US $211. Conclusion: In general, the treatment guidelines for hypertension were followed in our hospital. The utili- sation of thiazides was an area requiring improvement. The cost of treatment of hypertension was substantial and imparted a signi®cant economic burden on the patients. Keywords Hypertension á Utilisation á Pharmacoeconomics Introduction The bene®cial eects of the optimal control of blood pressure on mortality and cardiovascular morbidity have been con®rmed in epidemiological and interven- tional studies [1, 2]. However, due to the high prevalence of hypertension and the requirement of medications for prolonged periods, the drug-treatment cost represents a major issue in health economics. In developed countries, the expenditure on antihypertensive therapy has in- creased sharply in recent years due to the increasing use of the newer and more expensive drugs [3, 4, 5], such as calcium-channel blocking agents, angiotensin-convert- ing enzyme ACE) inhibitors and angiotensin-receptor antagonists. Furthermore, due to the frequent coexis- tence of hypertension, diabetes mellitus and hyperlip- idaemia [6], the prescription of drugs to treat the associated conditions further increases the treatment costs of these patients. In 1997, the Sixth Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure JNC VI) added calcium-channel antagonists and ACE inhibitors to b-blockers and diuretics as ap- propriate ®rst-line therapies [7]. While there are good indications for the use of calcium antagonists and ACE inhibitors in selected situations, clinical trial evidence such as greater reduction in the risk of heart disease and stroke, greater blood pressure lowering or fewer side eects) that might justify their widespread use is limited [1, 2, 8]. Prescription surveys that have been carried out in the past had several methodological limitations as limited data were collected and rationale for a particular drug or reasons for change in therapy, if any, were not recorded. Eur J Clin Pharmacol 2001) 57: 535±540 DOI 10.1007/s002280100333 S. Malhotra á R.S. Karan á P. Pandhi &) Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India E-mail: [email protected] Tel.: +91-172-747585 Fax: +91-172-744401 S. Jain Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India

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Page 1: Pattern of use and pharmacoeconomic impact of antihypertensive drugs in a north Indian referral hospital

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