CLINICAL ECONOMIC ANALYSIS OF THE FINANCIAL COSTS FOR THE PHARMACOTHERAPY OF ACUTE TONSILLITIS IN THE CONDITIONS OF THE HOSPITAL
DOI:
https://doi.org/10.11603/2312-0967.2016.4.7121Keywords:
acute tonsillopharyngitis, frequency analysis, ABC-analysis, VEN-analysis, hospital-based treatment.Abstract
Introduction
Acute tonsillitis (J03 for ICD-10) is one of the most common respiratory diseases in children [1]. According to the medical protocol approved by the Ministry of Health ofUkraine, patients with catarrhal form of acute tonsillitis are provided ambulatory care, but patients with follicular and lacunar tonsillitis forms are treated in a hospital [2].
In the latest data of the State Committee of Statistics, 41.1% of the funds in the structure of health care costs are citizens’ private funds [3]. These funds covered 99.6% of the costs for the purchase of pharmaceutical products for outpatient treatment, and 86.7% costs for treatment in a hospital [4]. In addition, it should take note of the low purchasing power of patients, as 36.1% of them are unable to buy the medicines prescribed by a doctor [5].
In view, the high rates of morbidity, constantly growing treatment costs and low purchasing power of patients, the purpose of our research was to investigate the expediency of the financial expenses for pharmacotherapy of acute tonsillitis based on the results of retrospective clinical and economic analysis of hospital medical history forms.
Materials and methods
The material of our study were doctors’ prescription sheets (form №003-4/o) of 290 patients with acute tonsillitis aged 2–18 years who were hospitalized in healthcare institutions of Dnipropetrovsk region for the period 2013–2015. Overall, we analyzed 1709 medications. Propriety of medical prescriptions was determined by comparing them to the current Ukrainian medical protocol of care for patients with acute tonsillitis [2] and the Ukraine State Drug Formulary [6]. The expediency of the financial costs for pharmacotherapy of acute tonsillitis was assessed by method the integrated frequency/VEN/ABC analysis [7].
Results and discussion
The criterions for classifying medicines to category «V» (vital) were their presence in the medical protocol of care for patients with acute tonsillitis [2] and the the Ukraine State Drug Formulary [6]. The category of «N» (non-essential) included medicines that have been absent at any of the above regulatory documents.
Results of the integrated frequency/VEN/ABC-analysis showed that the most costly group A included 15.04% (257 of 1709) medicines category V and 11.29% (193 of 1709) medicines category N. It was found that the basic financial funds had been used for ceftriaxone (J01DD04), local antiseptics (R02AA20) and cefuroxime (J01DC02), among which the most costly ceftriaxone had been prescribed for the largest number of patients. Despite the fact that ceftriaxone is recommended by national standard treatment of acute tonsillitis [2], but it is not the drug of choice for the treatment of this nosology. Ceftriaxone is rational to replace by penicillin or cephalosporin first generation, which have the same clinical efficacy against Streptococcus pyogenes and less cost [11].
The frequency of non-essential medicine prescriptions were dominated by the vital medicines. However, the financial costs for vital medicines were slightly greater than for the non-essential medicines, which amounted to 55.66% and 44.34% respectively. Excessive costs for the third-generation cephalosporin pharmacotherapy of acute tonsillitis can be explained by the doctors' intention to protect their patients from clinical failures associated with the penicillin destruction by β-lactamases of tonsils co-pathogenic microorganisms [12].
Conclusions
- Basic funds were not spent for essential medicines for the treatment of acute tonsillitis. The most often prescribed costly medicine may have been replaced by cheaper ones with similar clinical efficacy.
- Economically more rational begin pharmacotherapy of acute tonsillitis with penicillins. Сephalosporins second- or third generation and inhibitor-protected penicillins, as antibiotics for second-line therapy, should be prescribed only in cases of recurrent tonsillitis [5].
- Local antiseptics, probiotics, corticosteroids and dietary supplements had been widely used by doctors. Removal these pharmaceutical products from doctors’ prescription sheets would reduce the financial expenses for pharmacotherapy of acute tonsillitis without affecting its quality.
References
Masheiko A.N. Acute pharyngitis and tonsillitis: epidemiology of incidience / A.N. Masheiko, O.V. Makarenko // Pharmacoeconomics in Ukraine: state and prospects of development: materials of VІІ science and practical internet-conference. – Kharkiv, 2014. – pp. 64–65.
The medical protocol of care for patients with catarrhal, follicular and lacunar tonsillitis (J03 for ICD-10) : Decree of the Ministry of Health of Ukraine dated March 24, 2009 №181 About the approval the protocols of medical care for specialty "otolaryngology" // Ministry of Health of Ukraine : Official Web Portal. – Available at: http://www.moz.gov.ua/ua/portal/dn_20090324_181.html
National Health Accounts of Ukraine in 2013 [stat. bulletin]. – Kyiv : State Statistics Committee of Ukraine, 2015. - 213 p. // State Statistics Service of Ukraine : Official Web Portal. – Available at: https://ukrstat.org/uk/druk/publicat/Arhiv_u/15/Arch_nroz_bl.htm
Lekhan V.M. The development strategy of the health system: Ukrainian Dimension / V.M. Lekhan, G.O. Slabkyi, M.V. Shevchenko // Ukraine. Health of the Nation. – 2010. – №1. – pp. 5–23.
Ryvak T.B. Evaluation of public opinion about the quality of medical treatment / T.B. Ryvak, A.B. Zimenkovskyi // Сlinical pharmacy, pharmacotherapy and medical standardization. – 2012. – № 3. – рр. 9–15.
Ukraine State Drug Formulary (eighth edition) : Decree of the Ministry of Health of Ukraine dated March 14, 2016 №183 About the approval of the eighth edition of Ukraine State Drug Formulary and ensuring its availability // Ministry of Health of Ukraine : Official Web Portal. – Available at: http://www.moz.gov.ua/ua/portal/dn_20160314_0183.html
Evaluation of clinical and economic expediency of the medicines use in the healthcare institutions (support of formulary system): Guidelines / A.M. Morozov, L.V. Yakovlieva, N.V. Bezditko [and others] – Kyiv, 2013. – 36 p.
van Driel M.L. Different antibiotic treatments for group A streptococcal pharyngitis. / van Driel M.L., De Sutter A.I., Keber N., Habraken H., Christiaens T. // Cochrane Database of Systematic Reviews. – 2013. – № 4. – pp. 1–70.
Search Engine «Register of wholesale prices of medicines» // Ministry of Health of Ukraine : Official Web Portal. – Available at: http://www.moz.gov.ua/ua/portal/register_prices_drugs/
Search Engine «Average retail price of medicines in Ukraine". – Available at: http://compendium.com.ua/prices.
Shulman S.T. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America / Shulman S.T., Bisno A.L., Clegg H.W., Gerber M.A., Kaplan E.L., Lee G., Van Beneden C. // Clinical Infectious Diseases. – 2012. – V. 55, № 10. – pp. e86 – e102.
Dronov I.A. The problems of choice of antibiotic therapy of streptococcal tonsillopharyngitis in children / I.A. Dronov, N.A. Geppe, U.S. Malyavina // The Practitioner. – 2014. – № 1. – рр. 7–10.
Downloads
Published
How to Cite
Issue
Section
License
The authors who publish their materials in this journal agree with the following terms:
- Authors reserve the right to authorship of their work and assign to the journal the right to first publish this work under the terms of the Creative Commons Attribution License, which allows other persons to freely distribute the published work with a mandatory reference to the authors of original work and the first publication of work in this journal
. - Authors have the right to make independent extra-exclusive work agreements in the form they are published by this journal (for example, posting work in an electronic repository of an institution or publishing as part of a monograph), provided that the link to the first publication of the work in this journal is maintained.
Journal policy allows and encourages publication of manuscripts on the Internet (for example, in institutions repositories or on personal websites), both before the publication of this manuscript and during its editorial review, as it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the citation of the published work (see The Effect of Open Access).
