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Prasanth CH Pharm D1*, Sathish Kumar V Pharm D1, Akhila M Pharm D1 and Swathi V2
 
1 Department of Pharmacy Practice, Nirmala College of Pharmacy, Mangalagiri, Guntur, AP, India
2 Assist.Professor, Department of Pharmacology, Nirmala College of Pharmacy, Mangalagiri, Guntur, AP, India
 
*Correspondence: Prasanth CH, Pharm D, Department of Pharmacy Practice, Nirmala College of Pharmacy, Mangalagiri, Guntur, AP, India, Email: [email protected]

Citation: Prasanth CH, Sathish Kumar V, Akhila M, Swathi V. Prescribing Pattern and Pharmacoeconomic Evaluation of Antihypertensive Drugs at a Tertiary Care Hospital. J Basic Clin Pharma 2018;9:308-310

This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact [email protected]

Abstract

Aim and Background: The aim of this study is to evaluate anti-hypertensive drug prescription pattern and cost analysis in tertiary care hospital. Hypertension is one of the major chronic diseases resulting in high mortality and morbidity these days. Clinical pharmacists can play a role in pharmaceutical cost management by providing an outlook to the physicians for prescribing cost-effective choices of drugs when it is clinically appropriate. Despite broad dissemination of the JNC guidelines, prescribing practices have long remained discrepant with recommendations.

Methodology: An observational and cross-sectional prospective. Was conducted in General Medicine department in tertiary care hospital for a period of 6 months. The study group consists of 200 patients, both males, and females diagnosed with hypertension and co-morbid conditions.

Results and Discussions: Out of 200 patients, 99 males and 101 females were identified to have prescribed with antihypertensive drugs during the study period. In combination drug therapy, total 59 medications were prescribed. Telmisartan+HCL Thiazide 18 (30.5%), Losartan+Hydrochlorothiazide 12 (20.33%) and Telmisartan+Amlodipine 7 (11.86%) were the most frequently prescribed combinations drugs. Combinational therapy contributes the highest annual cost of (3248.5 ± 401.5 INR) followed by monotherapy drugs from various classes (1956.4 ± 222.65 INR). 5204.9 INR was accounted for the total antihypertensive drugs prescribed. Conclusion: The economic studies state that 70.5% of patients had received monotherapy. The study reveals that majority of patients were treated with diuretics. They can also encourage prescribers to make cost-effective choices of drugs when clinically appropriate.

Keywords

Hypertension, prescription pattern, cost, anti- hypertensive drugs

Context

Aims

The Aim of This Study Is To Evaluate Anti-hypertensive Drug Prescription Pattern And Cost Analysis In Tertiary Care Hospital.

Introduction

Hypertension is one of the major chronic diseases resulting in high mortality and morbidity these days. Poor control of this highly prevalent disease can lead to the development of ischemic heart disease, stroke, and chronic renal failure.[1] Several factors like socioeconomic status, social habits sedentary lifestyle, food and poor self-health maintenance can lead to the development of hypertension.[2] Epidemiological studies demonstrate that prevalence of hypertension is increasing rapidly among urban and rural populations in India.[3-6] Selection of an evidence-based therapy with safety and low cost has important economic implications. Clinical pharmacists can play a role in pharmaceutical cost management by providing an outlook to the physicians for prescribing cost-effective choices of drugs when it is clinically appropriate. Thus, by reducing the economic burden we can enhance the quality of patient care.

The Joint National Committee (JNC) 7 guidelines recommend the appropriate antihypertensive therapy based on the best available evidence. The guidelines recommend to Initiate thiazide, ACEI, ARB, or CCB, alone or in combination. However, most recent published data showed an increased use of the more expensive Calcium Channel Blockers (CCBs) and Angiotensin Converting Enzyme Inhibitors (ACEIs) despite the lack of evidence to support that they are superior to diuretics and beta blockers in reducing morbidity and mortality of cardiovascular diseases. Despite broad dissemination of the JNC guidelines, prescribing practices have long remained discrepant with recommendations. The cost of medications has always been a barrier ineffective treatment. The prescribing pattern among doctors and patient adherence to the treatment are being influenced by the increasing prevalence of hypertension and rising expenses of its treatment.[2,7-9]

Objectives

The 6-month cross-sectional study was designed to assess the prescription pattern and cost of anti-hypertensives therapy in a tertiary care hospital.

Cost of the drug was obtained from the current index of medical specialties (CIMS)/ 1mg.com

To study the prescribing pattern of anti-hypertensive drugs through a data entry format.

Settings and Design

Study design

Observational and cross-sectional prospective.

Study period

Six months (July-Dec 2017).

Methods and Materials

Study population

The study group consists of 200 patients, both males, and females diagnosed with hypertension and co-morbid conditions.

S.no Age Male Female No. of Patients Percentage
1 21-30 0 1 1 0.5
2 31-40 11 8 19 4
3 41-50 24 10 34 5
4 51-60 32 28 60 14
5 61-70 18 33 51 16.5
6 71-80 11 19 30 9.5
7 81-90 3 2 5 1

Table 1: Distribution of patients according to gender

Agegroups ACEI ARB CCB BB DU NSBB A1B
n % n % n % n % n % n % n %
21-30 0 0 0 0 0 0 1 0.32 0 0 2 0.65 2 0.65
31-40 1 0.32 6 1.95 3 0.97 12 3.9 2 0.65 0 0 0 0
41-50 1 0.32 17 5.95 13 4.23 19 6.19 14 4.66 0 0 0 0
51-60 5 1.62 28 9.12 21 6.84 16 5.62 30 9.78 2 0.65 2 0.65
61-70 2 0.65 18 5.86 7 2.28 17 5.95 16 5.62 2 0.65 2 0.65
71-80 0 0 16 5.21 14 4.56 11 3.57 11 3.57 0 0 0 0
81-90 0 0 1 0.32 1 0.32 0 0 3 0.97 0 0 0 0

Table 2: Frequency of distribution of drugs according to Age groups

S.no Generic Brand Total Percentage        Cost/Day In INR
1. Amlodipine T.Amlong, T.Stamlo, T.Amlong, T.Amlo. 20 9.80                    2.65 ± 0.00
2. Cilidipine T.Cilidin, T.Cinod, T.Ciladuo. 27 13.23                   4.68 ± 0.60
3. Diltiazeem T.Dilzem, T.Angizem. 3 1.47                    2.49 ± 0.07
4. Furosemide T.Lasix (6), Inj.Lasix(5) 11 5.39                     0.5 ± 0.00
5. Torsemide T.Dytor(21), Inj.Dytor.(9) 30 14.70                   7.63 ± 0.00
6. Metolazone T.Metoz 1 0.49                   10.66 ± 0.00
7. Telmisartan T.Telvas, T.Telma, T.Telsartan, T.Telmikind, T.Telista. 21 10.29                   5.61 ± 0.71
8. Enalapril T.Enam 1 0.49                    3.25 ± 0.00
9. Losartan T.Losar, T.Repace 7 3.43                    5.71 ±0.25
10. Metoprolol T.Prolomet Xl, T.Met Xl, T.Starpress Xl, T.Supermet Xl. 38 18.62                   3.67 ± 0.42
11. Ramipril T.Cardace, T.Ramistar. 5 2.45                    5.03 ± 0.02
12. Atenolol T.Aten. 16 7.84                    1.81 ± 0.00
13. Spironolactone T.Aldactone 5 2.45                    1.93 ± 0.00
14. Olmesartan T.Olmezest 6 2.94                      9 ± 0.00
15. Propranolol Inderal, Inderal La 3 1.47                    2.45 ± 0.32
16. Clonidin T.Arkamine 2 0.98                    1.51 ± 0.00
17. Nebivolol T.Nebistar 2 0.98                     6.3 ± 0.00
18. Carvidolol T.Carviflo 6 2.94                     7.5 ± 0.00
19. Prazocin T. Minipress Xl,T. Prazocip Xl . 2 0.98                    8.11 ± 3.29

Table 3: Cost of various brands monotherapy

S.no Generic Name Brand Name Total Percentage Cost/Day In INR
1 Amlodipine+Atenolol  T. Amlokind At, T. Amlosafe At 2 3.38 3.65 ± 1.54
2 Furosemide+Spironolactone  T. Lasilactone  2 3.38 3.60 ± 0.00
3 Telmisartan+Hcl Thz T.Telma H, Telpres H,
T.Telvas H,
T.Tellzy H,
Telista H
18 30.5 13.34 ± 0.49
4 Telmisartan+Amlodipine T.Venpress Am, T.Telmikind Am, T.Cresar Am. 7 11.86 5.73 ± 0.83
5 Telmisartan+Metoprolol T.Tellzy Mt, T.Telmax 5 8.47 14.06 ± 0.00
6 Telmisartan+Chlorthalidone T.Tellzy Ch 5 8.47 12.2 ± 0.00
7 Amlodipine+Hcl Thiazide T.Amlong H, T.Stamlo D. 2 3.38 5.66 ± 0.26
8 Metoprolol+Ramipril T.Prolomet R 1 1.69 12.8 ± 0.00
9 Metoprolol+Amlodipine T.Amlong Mt 2 3.38 6.93 ± 0.00
10 Cilidipine+Metoprolol T.Cilidin M 1 1.69 7.99 ± 0.00
11 Olmesartan+Amlodipine T.Olmezest Am 2 3.38 11.5 ± 0.00
12 Losartan+Hcl Thiazide T.Losar H, T.Cosart H 12 20.33 9.325 ± 1.225

Table 4: Cost of various Brands combinational therapy

S.no Type of Therapy Total Cost/Day in INR Cost/Day in INR
1 Monotherapy 204 5.36 ± 0.61 1956.4 ± 222.65
2 Combinational therapy 59 8.90 ± 1.10 3248.5 ± 401.5
      Total 5204.9

Table 5: Distributions of patients according to therapy

Drug acquisition costs were calculated, using the cost with respect to prescribed branded drugs and the most commonly prescribed dosage, for each drug on a daily and annual basis.[10-12]

Data collection

Ward round participation

Daily regular ward rounds were carried out in the study site during the study period. Prior to data collection, taken the consent of the patient/bystander Patient bystander was also well informed about the study, its objective etc.

Statistical analysis used

Data analyzed also included the results of patient‘s demographics [Age, Gender, etc.] And the cost per day and cost per year by using appropriate statistical stools.

Results and Discussion

Angiotensin-converting enzyme inhibitors (ACEIs) contributed 2.75% of total cost (28.4 INR), Angiotensin receptor blockers (ARBs) contributed 20.52% of total cost (211.78INR), Beta blockers contributed 21.90% of total cost (226.02INR), Diuretics contributed 33.04% of total cost (340.96 INR), Alpha-adrenergic blockers (AABs) contributed 1.57% of total cost (16.2 INR), Centrally acting agents contributed only 0.29% of total cost (3.02 INR). Alpha-adrenergic blockers and centrally acting agents (CAA) were the least prescribed. Angiotensin-converting enzyme inhibitors (ACEIs) and Angiotensin receptor blockers (ARBs) were the most prescribed.[13]

In combination drug therapy, total 59 medications were prescribed. Telmisartan+HCL Thiazide 18 (30.5%), Losartan+Hydrochlorothiazide 12 (20.33%) and Telmisartan+Amlodipine 7 (11.86%) were the most frequently prescribed combinations drugs. In combination drug therapy, Telmisartan+Metoprolol shows the highest mean cost per day of INR (14.06 ± 0.00) and Amlodipine+Atenolol combination shows the lowest mean cost per day of INR (3.65 ± 1.54).

There was a significant difference in mean cost per day between various drugs in monotherapy as well as combination therapy. Also determined the total costs of antihypertensive drugs prescribed as monotherapy and in combinations during the study period. Combinational therapy contributes the highest annual cost of (3248.5 ± 401.5 INR) followed by monotherapy drugs from various classes (1956.4 ± 222.65 INR). 5204.9 INR was accounted for the total antihypertensive drugs prescribed. The present study shows that most of the patients were stable with monotherapy followed by two drug combination therapies, none of the patient’s required triple-drug therapies.[14]

Conclusion

The economic studies state that 70.5% of patients had received monotherapy. The study reveals that majority of patients were treated with diuretics. Among combination drug therapy, Telmisartan+HCL Thiazide combination was highly prescribed. Considering the pharmacoeconomics, diuretics are more economical. It is suggested that, while starting the drug therapy economic status of the patients should be kept in consideration. Strict lifestyle modifications should be recommended to all patients who are in the pre-hypertensive stage as the cardiovascular risk factors are highly seen in these individuals. Clinical pharmacists are in the position to make suggestions and interventions that can save cost by reducing economic burden and enhance the quality of patient care. They can also encourage prescribers to make cost-effective choices of drugs when clinically appropriate.[15-16]

References