Long-term trends in the utilization of beta-blocking agents in the Czech Republic
Spotřeba betablokátorů (ATC C07) se zřetelem na vliv reformy zdravotnictví v roce 1992 na dostupnost léků
Celostátní spotřeba byla vyjádřena (I) v definovaných denních dávkách na 1000 obyvatel a den (DDD/TOD), spotřeba ve Fakultní nemocnici Ostrava (FNO) (II) v DDD na 100 ošetřovacích dnů (DDD/100OD). ATC/DDD index: 2004. Pro metipranolol použit ekvivalent 10 mg. Zdroje dat: I. SÚKL (údaje od distributorů), ÚZIS (recepty), II. lékárenské žádanky. Období: 1985-2007. Statistická analýza podílu selektivních betalytik (C07AB) byla rozdělena do dvou částí: a) SÚKL x FNO (1985–2007), b) SÚKL x FNO, SÚKL x ÚZIS, ÚZIS x FNO (1998-2005). Statistické testy: Pearsonův korelační koeficient r, vzájemná korelační funkce pro časové řady pro posunutí dopředu i dozadu o 3 roky, párový t-test.
(I) Spotřeba C07A dle SÚKL kolísala mezi 39,3 (1992) a 51,2 DDD/TOD (1998). Poté vzestoupila až na 80,6 DDD/TID (2007). Z ÚZIS obdobné údaje na nižší hladině. (II) Spotřeba C07 ve FNO oscilovala mezi 20-26 DDD/100OD až do 1988. V 1989 stoupla na 69,7 DDD/100OD, následně poklesla na 7,6 DDD/100OD (1998). Mezi 1999-2004 byla ustálená: 10-14 DDD/100OD, poté slabý vzestup na 16,8 v posledních třech letech. Spotřeba alfa a betablokátorů byla velmi nízká. Mezi všemi třemi páry dat byla vysoká korelace v procentuální spotřebě C07AB, P = 0,000; r = 0,995 SÚKL x OUH (1985–2007). V období 1998-2005 SÚKL x FNO r = 0,966, SÚKL x ÚZIS r = 0,997, ÚZIS x FNO r = 0,976. Posun časových řad byl v obou obdobích nulový. T-test ukázal statisticky významně větší podíl C07AB ve FNO, P < 0,05.
Selektivní betablokátory postupně nahradily neselektivní, zastoupené zvl. domácí metipranololem a jejich spotřeba stoupá. Nejužívanějšími byl metoprolol, betaxolol, atenolol a acebutolol.
Klíčová slova:
DDD – spotřeba – betablokátory – trend
Authors:
B. Kořístková 1; M. Grundmann 1; D. Šalounová 2
Authors place of work:
Ostrava University, Department of Clinical Pharmacology, Hospital and Faculty of Health Sciences
1; VSB-Technical University Ostrava, Department of Mathematical Methods in Economy, Faculty of Economics
2
Published in the journal:
Čes. slov. Farm., 2010; 59, 23-30
Category:
Původní práce
Summary
To study long term trends in the utilization of beta-blockers (ATC group C07) with regard to a possible influence of the health reform in 1992 on the availability of drugs.
Method:
The utilization of C07 was expressed in the defined daily doses per thousand inhabitants and a day (DDD/TID) in the Czech Republic (I), and in DDD per 100 bed days (DDD/100 BD) in the University Hospital (OUH) Ostrava (II). ATC/DDD index: 2004. 10 mg was used as the DDD equivalent for metipranolol. The sources of data were: I. The SUKL database (wholesale data), the UZIS database (prescriptions), and II. The hospital request forms. Observed period: 1985-2007. The statistical analysis of the utilization of the portion of the C07AB group was divided into two parts. a) SUKL x OUH (1985–2007). b) SUKL x OUH, SUKL x UZIS and UZIS x OUH (1998–2005). Statistical tests used: Pearson Correlation r. Cross-Correlations Function for lags forward and backward from 1 to 3 years for time series, and paired T-test.
(I) The utilization of plain beta-blockers (C07A) ranged between 39.3 in 1992 and 51.2 DDD/TID in 1998 (SUKL data). Thereafter there has been an increasing trend to up to 80.6 DDD/TID in 2007. The UZIS data give similar outcomes generally on a lower level. (II) The utilization of C07 in OUH ranged between 20-26 DDD/100 BD till 1988. In 1989 there was an amplitude of 69.7 DDD/100 BD, followed by a decrease to 7.6 DDD/100 BD in 1998. During 1999-2004 the utilization was stabilized on the level of 10-14 DDD/100 BD followed by a slight increase to 16.8 during the last three years. The utilization of alpha- and beta-blocking agents was low. The correlation in the utilization of the C07AB portion between all three pairs of data was significantly high at the level of significance P = 0.000: SUKL x OUH in the period of 1985–2007: Pearson Correlation r = 0.995. In the period of 1998-2005 SUKL x OUH r = 0.966, SUKL x UZIS r = 0.997, UZIS x OUH r = 0.976. The shift of the time series was zero (both periods). The T-test showed a significantly higher proportion of C07AB in OUH, P < 0.05.
The selective compounds step-wise replaced the non-selective ones, mainly presented by the domestic metipranolol. The utilization of the selective beta-blocking agents has been still increasing; the most widely utilized ones were metoprolol, betaxolol, atenolol and acebutolol. The utilization of alpha- and beta-blocking agents was low.
Key words:
DDD – utilization – beta-blockers – trends
Address for correspondence:
PharmDr. Blanka Koristkova, Ph.D.
Department of Clinical Pharmacology, Ostrava University Hospital and Faculty of Health Sciences, University of Ostrava
17. listopadu 1790, 708 52 Ostrava, Czech Republic
e-mail: blanka.koristkova@seznam.cz
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