Issue: Vojnosanit Pregl 2016; Vol. 73 (No. 6)
Patterns of prescription antihypertensive drug utilization and adherence to treatment guidelines in the city of Novi Sad
Authors:
Ana Tomas*, Zdenko Tomić*, Boris Milijašević*, Milica Ban†, Olga Horvat*, Saša Vukmirović*, Ana Sabo*
Background/Aim. Hypertension is one of the leadingcauses 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 their, 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 a 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 beta-blockers. The
consumption of diuretics and angiotensin receptor antagonists
was low within all the 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 this 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 overuse 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.
