КЛІНІКО-ЕКОНОМІЧНІ АСПЕКТИ ФАРМАКОТЕРАПІЇ ХВОРИХ НА ВИРАЗКОВУ ХВОРОБУ ШЛУНКА

Анотація

CLINICAL AND ECONOMIC ASPECTS OF GASTRIC ULCER PHARMACOTHERAPY

L. V. Iakovlieva, O.O. Gerasymova, A.S. Gorbacheva,  A.A. Krasiuk

National University ofPharmacy,Kharkov

Summary: The evaluation of pharmacotherapy of patients with the gastric ulcer, who underwent the treatment in a department of gastroenterology in one of health care facilities in Kharkov, has been carried out by means of supplementary clinical and economic methods: ABC-, VEN- and frequency analyses. It has been found that the predominant majority of prescribed medicinal preparations (84.91%) is present in State Formulary of medications ofUkraine. These preparations make up a larger part of prescriptions – 91.76%. The bulk of the funds (87.49%), associated with the pharmacotherapy of patients with the gastric ulcer in this department, has been spent out on them. The approaches to the optimization of gastric ulcer pharmacotherapy and the costs of its carrying out in this health care facilities in Kharkov have been proposed. In general, the prescribed pharmacotherapy may be considered as rational from both clinical and economic points of view.

Key words: gastric ulcer, clinical and economical analysis, ABC-analysis, VEN-analysis, frequency analysis.

Introduction. Peptic ulcer disease is one of the diseases that have an important medico-social significance. Diseases are widely used both inUkraine and all over the world [1-2]. Peptic ulcer disease is one the commonest reasons of the disability development of patients [3], it may be accompanied by complex complications [4] and rather high costs on the treatment [3, 5-7].

The evaluation of pharmacotherapy of patients with peptic ulcer disease both from clinical and economical points of view has become the subject of studies of many domestic scientists [8-13].

The aim of this work is a clinical and economical analysis of gastric ulcer (GU) pharmacotherapy in hospital.

Materials and techniques.  Retrospective analysis of medical prescriptions has been carried out on the basis of 108 histories disease of patients with GU aged from 25 to 63 years (75 men and 33 women), who took the treatment in the  department of gastroenterology of one of health care facilities (HCF) in Kharkov. Research lasted 6 months (from June to November, 2013). The main diagnosis was GU associated with Helicobacter pylori. The average duration of patients’ staying in hospital was 12 days. Clinical and economical analysis of pharmacotherapy at patients with GU in a given HCF inKharkov has been carried out by means of frequency, ABC- and VEN-analyses [14]. VEN-analysis has been carried out according to the “formal feature”, that is, the existence of medicines in current State Formulary of Ukraine (SFU) (the 5-th issue) [15]. To determine the costs on the treatment with medicines, being prescribed to the patients with GU the average price on them in the research period in pharmacy chain ofUkraine was used [16].

Results and their discussion. According to the disease histories of patients with GU 53 trends of medicines (39 international non-patent names) from 23 pharmacological groups have been determined. During the research period, 959 medicines prescriptions to the patients with GU were registered in this department, that is, on average  8.9 medicines per 1 patient and it shows both the existence of polypragmasy and the necessity of rational pharmacotherapy of each individual patient.

According to “formal” VEN-analysis the most part of all medicines which were prescribed to the patients with GU in a given HCF inKharkovwas given in SFU that consisted 84.91 %. Mentioned medicines are of the most part of the quantity of medicines prescriptions – 91.76 %. These medicines are spent the most part of total costs (87.49 %) connected with pharmacotherapy of patients with the GU in this department.

The main directions of pharmacotherapy of patients with GU in this department are an ethiotropic and pathogenic therapy of the main disease that corresponds to the current Clinical Protocol of treating the GU inUkraine[17], as well as a pathogenic therapy of an accompanying gastroenterological pathology.

According to the outcomes of ABC-analysis 5 the most costly medications have been shown: the inhibitor of a proton pump “Proxium”, the stimulator of peristalsis “Cerucal”, the antibacterial medicine  “Azitrox 500”, the solution of electrolytes “Reosorbilact” and “Solcoseril”, which is a representative of the group  “Other medicines influencing the digestion system and metabolic processes”. The total sum of costs for pharmacotherapy of patients using all above-mentioned medicines is 48. 30 % of total sum costs spent on medicines, that is approximately a half of all costs.

The comparison of outcomes of ABC/frequency analysis has shown that the major costs connected with GU treatment in this HCF inKharkovwere spent on the prescribed medicines. The group A medicines were prescribed for about a half of the quantity of all patients (47.42 %).

According to the outcomes of ABC/VEN analysis most medicines of group A (80 %, 12 from 15 medicines) were present in SFU.

Potential variations of the optimization of costs on pharmacotherapy of patients with the GU in this HCF may be the exclusion from the schemes of treatment the medicines which are absent in SFU, and the exchange of medicines of the most costly group A (according to the outcomes of ABC-analysis) that has the index V (according to the outcomes of VEN-analysis) to the medicines-analogues with lower costs on the treatment and those which are present in SFU.

Conclusions. The main directions of pharmacotherapy of patients with GU in the department of gastroenterology in a given HCF inKharkov corresponded to the current Clinical Protocol of treating the GU. According to ABC-, VEN- and frequency analyses the real pharmacotherapy, prescribed to patients with GU in researched HCF ofKharkov, in general, can be considered as rational both from clinical and economical points of view. But the outcomes show the urgency of the further correction of pharmacotherapy of the patients with GU according to SFU as well as the rationalization of medicines prescriptions for one individual patient, which permits to improve the level of medical aid quality for patients.