DRUG UTILIZATION AND ECONOMIC IMPACT OF ANTICOAGULANTS IN UNSTABLE ANGINA/ NON- ST ELEVATION MYOCARDIAL INFARCTION IN KARACHI
Keywords:Drug utilization, Economics, Anticoagulants, Unstable anginaNSTEMI
Objective: The present study was designed to evaluate drug utilization and the economic impact of anticoagulants for the treatment of unstable angina (UA)/non-ST elevation myocardial infarction (NSTEMI) in Karachi.
Methods: A prospective study of prescriptions was conducted in private and public tertiary care hospitals (University of medical education and research) situated in Karachi. The purpose of prescriptions review was to examine the utilization and cost analysis of anticoagulants (enoxaparin, dalteparin and fondaparinux) in hospitalized patients of UA/ NSTEMI during treatment course of 2-8 days. Information of prescribed drugs was obtained from the medical records whereas patient demographics and socioeconomic status were reported through patients/relatives interviews. Data of 487 UA/NSTEMI patients admitted were analyzed during the study period of 2013-2014.
Results: Data of 487 UA/NSTEMI hospitalizations demonstrated the increased number of prescriptions for enoxaparin, it was found to be widely used anticoagulant in the public and private organizations in Karachi. Enoxaparin attributed by 70% of drug utilization comparative to 24.8% fondaparinux and 5.1 % dalteparin. Though, economic contribution was in favor of fondaparinux by reducing total drug cost of $ 21 with enoxaparin and $ 32 in contrast of dalteparin on the basis of once daily dose in the conservative management of unstable angina/non-ST elevated myocardial infarction.
Conclusion: In patients with unstable angina (UA)/non-ST elevation myocardial infarction (NSTEMI), enoxaparin was found to be most widely prescribed low molecular weight heparin (LMWH) among other available alternatives. However, economic assessment considered fondaparinux as cost saving therapeutic agent for initial conservative management of 2-8 days, added financial benefits over current therapies in the treatment of UA/NSTEMI.
Soumerai SB, Avorn J. Efficacy and costcontainment in hospital pharmacotherapy: state of the art and future directions. Milbank Mem Fund Q Health Soc 1984;62:447-74.
Soumerai SB, McLaughlin TJ, Avorn J. Improving drug prescribing in primary care: a critical analysis of the experimental literature. Milbank 1989;67 Suppl 2:268-317.
Braunwald E, Antman EM, Beasley JS, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA practice guidelines. ACC/AHA guidelines for the management of patients with unstable angina and nonâ€“ST-segment elevation myocardial infarction: executive summary and recommendations. Circulation 2000;102:1193-209.
Stewart S, Murphy N, Walker A, McGuire A, McMurray JJV. The current cost of angina pectoris to the National Health Service in the UK. Heart 2003;89 Suppl 8:848â€“53.
Groce J. Anticoagulation management strategies, guide for community pharmacist. University Tennessee Adv Studies Pharm 2007;4 Suppl 9:247-52.
Chandra KK, Malhotra S, Gupta M, Grover A, Sharma N, Pandhi P. Changing trends in the hospital management of unstable angina: a drug utilization analysis. Int J Clin Pharmacol Ther 2004;42 Suppl 10:575-80.
Daniel MB, Patricia CA, Berkowitz D, Davidson LR, DeLong ER, Turpie AGG, et al. Economic assessment of low-molecular-weight heparin (Enoxaparin) versus unfractionated heparin in acute coronary syndrome patients: results from the ESSENCE randomized trial. Circulation 1998;97:1702-7.
Mark D. When innovative therapies make economic sense: economic analysis of enoxaparin versus unfractionated heparin in the ESSENCE trial--an overview. Efficacy and safety of subcutaneous in non-q wave coronary events. Can J Cardiol 1998;14:24-7.
Zed PJ. Low-molecular-weight heparins in the management of acute coronary syndromes. Arch Intern Med 1999:1849-57.
Balen RM, Marra CA, Zed PJ, Cohen M, Frighetto L. Cost-effectiveness analysis of enoxaparin versus unfractionated heparin for acute coronary syndromes. A Canadian hospital perspective. Pharmacoeconomics 1999;16(5, Suppl 2):533-42.
Malhotra S, Grover A, Verma NK, Bhargava VK. A study of drug utilization and cost of treatment in patients hospitalised with unstable angina. Eur J Clin Pharmacol 2000;56(9, Suppl 10):755-61.
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. ACC/AHA task force member. ACC/AHA guideline revision. ACC/AHA 2007 Guidelines for the management of patients with unstable angina/Nonâ€“ST-elevation myocardial infarction executive summary. J Am Coll Cardiol 2007;50 Suppl 7:652-726.
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. ACCF/AHA 2007 Guidelines for the management of patients with unstable Angina/Nonâ€“ST-Elevation. Circulation 2013;127:663-828.
Alam, Naqvi SBS, Bano N, Jabeen A, Fayyaz TB. Pharmacoeconomics of low molecular weight heparin in unstable angina: a critical review. Int J Basic Med Sci Pharm (IJBMSP) 2013;3 Suppl 2:60-3.
Merli GJ, Groce JB. Pharmacological and clinical differences between low-molecular-weight heparin implications for prescribing practice and therapeutic interchange. Pharm Ther 2010;35 Suppl 2:95-105.
Hennessy S, Strom BL, Lipton HL. Drug utilization review. Pharmacoepidemiology, 3rd ed. John Wiley, Sons Ltd: New York; 2000. p. 505-23.