Farmakoepidemiologinių ir farmakoekonominių tyrimų svarba, skatinant racionalią mažos molekulinės masės heparinų vartojimo politiką Lietuvoje

Abstract

Aim of this research – to investigate the significance of pharmacoeconomic and pharmacoepidemiologic research data promoting rational low-molecular-weight heparins utilization policy. Methodology – drug utilization research was based on WHO ATC/DDD (Defined Daily Dose) methodology; pharmacoeconomic cost-minimization research was based on reference pricing methodology; prospective biomedical research was conducted to investigate the practical aspects of heparins prescription and administration at the in-patient setting. Results – utilization of heparins in Lithuania increased for 40.12 DDD/1000 hospitalization days (HD) in 2003 up to 309.60 ADD/1000 HD in 2011. Total expenditures on heparins increased from 1,088 thousand LTL in 2003 up to 10,284 thousand LTL in 2011, i.e. more than nine-fold during the nine-year period. Setting the reference price of 2.75 LTL (lowest Dalteparin single DDD price) for low-molecular-weight heparins group would result in total savings of 3,218–4,679 thousand LTL in Lithuania yearly (as per 2008 - 2011 data). Reference pricing implementation would enable to decrease the total expenditures on LMWHs by nearly 60%. This potential decrease of expenditures should be considered significant as actual costs of heparins could be reduced more than two-fold. Heparins safety and efficacy monitoring practices at the in-patient setting just partially adhered to international guidelines. Before heparins administration, laboratory data safety monitoring was performed for 39.23% of subjects (n=133). Laboratory data safety monitoring was only performed for 53.98% of subject (n=183) during their treatment course. Conclusions – heparins costs and utilization rates have significantly increased in the last decade. Such a dramatic increase justifies the implementation of pharmacoeconomic models and policies for costs management. Heparins safety and efficacy monitoring practices just partially adhered to international recommendations, thus national treatment guidelines and medical auditing should be prioritized promoting the rational use of heparins in the country.