A large number of people all over the world suffer from skin conditions. Dermatological problems comprise about 10 % of a general practitioner's caseload and probably more for pharmacists. The literature furthermore emphasises that skin diseases are becoming a significant problem in the developing world. There is a need to establish an effective method to achieve good health and quality of life for patients with dermatological problems. The general objective of this study was to investigate the usage patterns and cost of dermatological products in the private health care sector of South Africa by using a medicine claims database. The focus was specifically on dermatological products with a prevalence of more than 10 % in the database. A quantitative retrospective drug utilisation research design was used to evaluate the usage patterns and costs of dermatological products in three four-monthly intervals of 2001 and 2004. Data were analysed by using the Statistical Analysis System, 9.1 (SAS). The dermatological product groups for this study were antibacterial and antifungal drugs, corticosteroids and anti-acne products and were analysed according to the MIMS classification. Of all analysed prescriptions issued only 8.57 % (n = 126 447) during 2001 (N = 1 475 380) and 6.82 % (n = 177 122) during 2004 (N = 2 595 254) consisted of dermatological products. Of the total number of products prescribed, the dermatological products constituted 4.77 %I (n = 140 701) for 2001 (N = 2 95 1 326) and 3.77 % (n = 199 976) for 2004 (N = 5 305 882). The total cost of the dermatological products was 4.98 % (n = R18 913 889.92) of the total cost of all medicine products during 200 1 (N = R379 708 489). During 2004 (N = R66 1 223 146) the total cost of dermatological products was 4.09 % (n = R27 025 540.48) of the total cost of all medicine products in the database. The cost-prevalence index for 2001 and 2004 respectively showed that the dermatological products were relatively expensive with values of 1.03 and 1.09. The antibacterial and antifungal drugs, corticosteroids and anti-acne products represented 91.92 % (n = 129 336) and 87.97 % (n = 175 9 16) of all dermatological products during 2001 (N = 140 701) and 2004 (N = 199 976), respectively. These dermatological groups named above represented 91.57 % (n = R17 319 645.61) and 85.85 '% (n = R23 200 594.71), respectively, of the total cost of dermatological products during 200 1 (N = R18 9 13 889.92) and 2004 (N = R27 025 540.48). It was further found that the majority of dermatological products prescribed during the research periods was innovator products. The prevalence of innovator products for 2001 was 86.17 % (n = 12 1 249) with a total cost representing 94.16 % (n = R17 809 603.12). For 2004 the prevalence was 82.33 % (n = 164 640) with a total cost representing 91 .O1 '% (n = R24 594 923.72) of all the dermatological products prescribed. The number of innovator and generic products claimed during 2001 amounted to 86.17 % (n = 12 1 249) and 13.83 % (n = 19 452) respectively of the total number of products claimed (N = 140 701). During 2004 the number of innovator and generic products represented respectively 82.33 % (n = 164 640) and 17.67 O/o (n = 35 336) of the total number of products claimed (N = 199 976). The prevalence in the use of the dermatological products during 2004 increased with 55.25 % from January to April versus September to December. The cost-prevalence index indicated that the dermatological products were relatively expensive during January to August 2004. During September to December 2004 the cost-prevalence decreased and indicated that dermatological products became inexpensive. The average cost of dermatological products during the 2004 study period showed that the cost decreased. January to April (before implementation of the new single exit price structure) was compared to September to December (after implementation of the new single exit price structure). This comparison indicated that the average cost decreased by 22.88 %. It can be summarised that the average cost in the last study period decreased due to the changed price structure. The innovator products' prevalence was high and therefore more generics are needed in dermatology. If more generics are used the total cost of dermatological products might also decrease. The number of dermatological prescriptions increased towards 2004, but this may be because of more members or more medical aids claiming through this database. / Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2006.

A large number of people all over the world suffer from skin conditions. Dermatological problems comprise about 10 % of a general practitioner's caseload and probably more for pharmacists. The literature furthermore emphasises that skin diseases are becoming a significant problem in the developing world. There is a need to establish an effective method to achieve good health and quality of life for patients with dermatological problems. The general objective of this study was to investigate the usage patterns and cost of dermatological products in the private health care sector of South Africa by using a medicine claims database. The focus was specifically on dermatological products with a prevalence of more than 10 % in the database. A quantitative retrospective drug utilisation research design was used to evaluate the usage patterns and costs of dermatological products in three four-monthly intervals of 2001 and 2004. Data were analysed by using the Statistical Analysis System, 9.1 (SAS). The dermatological product groups for this study were antibacterial and antifungal drugs, corticosteroids and anti-acne products and were analysed according to the MIMS classification. Of all analysed prescriptions issued only 8.57 % (n = 126 447) during 2001 (N = 1 475 380) and 6.82 % (n = 177 122) during 2004 (N = 2 595 254) consisted of dermatological products. Of the total number of products prescribed, the dermatological products constituted 4.77 %I (n = 140 701) for 2001 (N = 2 95 1 326) and 3.77 % (n = 199 976) for 2004 (N = 5 305 882). The total cost of the dermatological products was 4.98 % (n = R18 913 889.92) of the total cost of all medicine products during 200 1 (N = R379 708 489). During 2004 (N = R66 1 223 146) the total cost of dermatological products was 4.09 % (n = R27 025 540.48) of the total cost of all medicine products in the database. The cost-prevalence index for 2001 and 2004 respectively showed that the dermatological products were relatively expensive with values of 1.03 and 1.09. The antibacterial and antifungal drugs, corticosteroids and anti-acne products represented 91.92 % (n = 129 336) and 87.97 % (n = 175 9 16) of all dermatological products during 2001 (N = 140 701) and 2004 (N = 199 976), respectively. These dermatological groups named above represented 91.57 % (n = R17 319 645.61) and 85.85 '% (n = R23 200 594.71), respectively, of the total cost of dermatological products during 200 1 (N = R18 9 13 889.92) and 2004 (N = R27 025 540.48). It was further found that the majority of dermatological products prescribed during the research periods was innovator products. The prevalence of innovator products for 2001 was 86.17 % (n = 12 1 249) with a total cost representing 94.16 % (n = R17 809 603.12). For 2004 the prevalence was 82.33 % (n = 164 640) with a total cost representing 91 .O1 '% (n = R24 594 923.72) of all the dermatological products prescribed. The number of innovator and generic products claimed during 2001 amounted to 86.17 % (n = 12 1 249) and 13.83 % (n = 19 452) respectively of the total number of products claimed (N = 140 701). During 2004 the number of innovator and generic products represented respectively 82.33 % (n = 164 640) and 17.67 O/o (n = 35 336) of the total number of products claimed (N = 199 976). The prevalence in the use of the dermatological products during 2004 increased with 55.25 % from January to April versus September to December. The cost-prevalence index indicated that the dermatological products were relatively expensive during January to August 2004. During September to December 2004 the cost-prevalence decreased and indicated that dermatological products became inexpensive. The average cost of dermatological products during the 2004 study period showed that the cost decreased. January to April (before implementation of the new single exit price structure) was compared to September to December (after implementation of the new single exit price structure). This comparison indicated that the average cost decreased by 22.88 %. It can be summarised that the average cost in the last study period decreased due to the changed price structure. The innovator products' prevalence was high and therefore more generics are needed in dermatology. If more generics are used the total cost of dermatological products might also decrease. The number of dermatological prescriptions increased towards 2004, but this may be because of more members or more medical aids claiming through this database. / Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2006.

Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

More people living with HIV/AIDS reside in South Africa than any other country in the world, and the nation faces colossal challenges in broadening its response to the now-mature and widespread HIV epidemic (WHO, 2005:1). According to South Africa's Medical Research Council, HIV/AIDS has now become the single largest cause of death in South Africa (Dorrington et a/., 2001:6) and has triggered a prominent transferal in the pattern of mortality from the elderly to the young, particularly among young women (Dorrington, 2001:4). The routine treatment of HIV/AIDS with antiretroviral drugs has transformed HIV-infection from an unvaryingly rapidly terminal illness to a somewhat expensive treatable, chronic disease. Triple therapy or highly active antiretroviral therapy (three-drug combinations of ARVs or HAART) in particular have had paramount impacts on HIV-related morbidity and mortality in settings where these drugs are generally accessible. Objectives of ARV treatment are "maximum, durable suppression of viral load, restoration and/or preservation of immune function, improvement of quality of life and reduction of HIV related morbidity and mortality" (Martinson et a/., 2003:236; Martinez et a/., 2007:251; Hellinger, 2006:1; Kumarasamy, 2004:3). The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that a total of 111 827 South Africans were accessing free antiretroviral treatment in the 200 public health sector facilities across 53 districts and a further 60 000 via the private sector by late December 2005 (UNAIDS, 2005:1). The objective of this study was to review, analyse and interpret the usage and prescribing patterns of antiretroviral drugs in a section of the South African private health care sector for the period 1 January 2005 to 31 December 2006 by utilising a medicine claims database of a pharmacy benefit management company, and to investigate the costs associated with these drugs by performing a quantitative, retrospective drug utilisation review. It was found that the prevalence as well as the total medicine cost of ARV medicine items had increased during the study period but the average number of ARV medicine items per prescription as well as both the average cost per ARV medicine item and the average cost per ARV prescription decreased during the study period. Original innovator ARV medicine items and original ARV medicine items with no generic were found to be relatively expensive in comparison with ARV medicine items in general. Conversely, generic ARV medicine items were ascertained to be relatively inexpensive with reference to ARV medicine items in general. It was perceived that the average cost of ARV medicine items and prescriptions for both genders decreased from 2005 to 2006, while there was an increase in the prevalence of medicine items and prescriptions claimed for both female and male patients. The prevalence and cost of all types of ARV medicine items were found to be higher for female patients in general. It was also established that the prevalence of patients receiving antiretroviral treatment in the private health care sector peaks at the age of >30 to 244 years, in comparison with the lower age of >25 to 239 years in the public health care sector. ARV medicine items claimed for patients in the age group >35 to 239 years represented the highest percentage of the total medicine cost incurred during both study years for all ARV medicine types. The majority of ARV medicine items were prescribed by general medical practitioners, and most ARV medicine items were dispensed by community or private institutional pharmacies. It was determined that combinations of 2NRTI + NNRTI were prescribed with the highest frequency, which is compliant with traditional HAART or 'triple therapy' regimens. Lastly, it was found that none of the top 20 prescriptions for one, two and six ARV medicine items were compliant with the National Antiretroviral Treatment (ART) Guidelines. The majority of the top 20 prescriptions for three ARV medicine items (92.67 per cent during 2005 and 89.94 per cent during 2006) were compliant with the National ART Guidelines. Finally, less than half of the top 20 prescriptions for four ARV medicine items (49.60 per cent during 2005 and 36.11 per cent during 2006) were compliant with the National ART Guidelines. Only 5.56 per cent and 3.92 per cent of the top 16 prescriptions for five ARV medicine items were compliant with the National ART Guidelines during the two study years respectively / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

More people living with HIV/AIDS reside in South Africa than any other country in the world, and the nation faces colossal challenges in broadening its response to the now-mature and widespread HIV epidemic (WHO, 2005:1). According to South Africa's Medical Research Council, HIV/AIDS has now become the single largest cause of death in South Africa (Dorrington et a/., 2001:6) and has triggered a prominent transferal in the pattern of mortality from the elderly to the young, particularly among young women (Dorrington, 2001:4). The routine treatment of HIV/AIDS with antiretroviral drugs has transformed HIV-infection from an unvaryingly rapidly terminal illness to a somewhat expensive treatable, chronic disease. Triple therapy or highly active antiretroviral therapy (three-drug combinations of ARVs or HAART) in particular have had paramount impacts on HIV-related morbidity and mortality in settings where these drugs are generally accessible. Objectives of ARV treatment are "maximum, durable suppression of viral load, restoration and/or preservation of immune function, improvement of quality of life and reduction of HIV related morbidity and mortality" (Martinson et a/., 2003:236; Martinez et a/., 2007:251; Hellinger, 2006:1; Kumarasamy, 2004:3). The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that a total of 111 827 South Africans were accessing free antiretroviral treatment in the 200 public health sector facilities across 53 districts and a further 60 000 via the private sector by late December 2005 (UNAIDS, 2005:1). The objective of this study was to review, analyse and interpret the usage and prescribing patterns of antiretroviral drugs in a section of the South African private health care sector for the period 1 January 2005 to 31 December 2006 by utilising a medicine claims database of a pharmacy benefit management company, and to investigate the costs associated with these drugs by performing a quantitative, retrospective drug utilisation review. It was found that the prevalence as well as the total medicine cost of ARV medicine items had increased during the study period but the average number of ARV medicine items per prescription as well as both the average cost per ARV medicine item and the average cost per ARV prescription decreased during the study period. Original innovator ARV medicine items and original ARV medicine items with no generic were found to be relatively expensive in comparison with ARV medicine items in general. Conversely, generic ARV medicine items were ascertained to be relatively inexpensive with reference to ARV medicine items in general. It was perceived that the average cost of ARV medicine items and prescriptions for both genders decreased from 2005 to 2006, while there was an increase in the prevalence of medicine items and prescriptions claimed for both female and male patients. The prevalence and cost of all types of ARV medicine items were found to be higher for female patients in general. It was also established that the prevalence of patients receiving antiretroviral treatment in the private health care sector peaks at the age of >30 to 244 years, in comparison with the lower age of >25 to 239 years in the public health care sector. ARV medicine items claimed for patients in the age group >35 to 239 years represented the highest percentage of the total medicine cost incurred during both study years for all ARV medicine types. The majority of ARV medicine items were prescribed by general medical practitioners, and most ARV medicine items were dispensed by community or private institutional pharmacies. It was determined that combinations of 2NRTI + NNRTI were prescribed with the highest frequency, which is compliant with traditional HAART or 'triple therapy' regimens. Lastly, it was found that none of the top 20 prescriptions for one, two and six ARV medicine items were compliant with the National Antiretroviral Treatment (ART) Guidelines. The majority of the top 20 prescriptions for three ARV medicine items (92.67 per cent during 2005 and 89.94 per cent during 2006) were compliant with the National ART Guidelines. Finally, less than half of the top 20 prescriptions for four ARV medicine items (49.60 per cent during 2005 and 36.11 per cent during 2006) were compliant with the National ART Guidelines. Only 5.56 per cent and 3.92 per cent of the top 16 prescriptions for five ARV medicine items were compliant with the National ART Guidelines during the two study years respectively / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2008.

Health is a fundamental human right. Access to health care, which includes providing a population with safe, effective, good quality drugs at the least possible cost, is a prerequisite to realising that right. Drugs or medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. Drugs also constitute a major recurrent expense in both state-run and private sector health care. To ensure that health care workers prescribe the most cost-effective drugs through the essential drugs list, training, as well as evaluation and monitoring systems must be regarded as important elements of containing costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR), evidence-based medicine and disease management have emerged as tools to ensure cost-effective selection and use of drugs, particularly for chronic diseases. These managed care tools are often investigated to determine whether new technologies or interventions are appropriate and have "value". Affordable prices of medicines, on their own, however, do not ensure access to medicines. Also important are reliable procurement, distribution and storage systems, and appropriately trained personnel to manage these components of drug management. Poorly regulated drug supply systems can have serious consequences such as antibiotic resistance, problems with safety or quality and most importantly wastage, as it is believed that a significant proportion of drugs purchased by the state in South Africa find their way into the private sector market through a "grey market". The general objective of this study was to review and analyse the cost and medicine usage of the "top twenty" pharmaceutical products according to the monthly pharmaceutical purchasing reports of the Department of Health in the North West Province. The research can be classified as retrospective and quantitative. The data used for the analysis were obtained over a two-year study period (1 Apr 2000 - 28 Feb 2002) from the private provider operating the medical stores in the North West Province. The results of the empirical investigation, showed the total number of "top twenty" products appearing during the study period amounted to 460 different products having a total purchasing cost of R 66,263,674.51 representing 37.2% (n = R 178,163,061.50) of all pharmaceutical products purchased during the two-year period. Through analysis it was found, when classified according the Anatomical Therapeutic Chemical (ATC) therapeutic main group, antihypertensives had the highest quantity purchased for year one (20.69%; n = 134,515,640) with cough and cold preparations revealing the highest purchasing quantity for year two (40.55%; n = 103,567,031) of all "top twenty" pharmaceuticals during the study period. Antibacterials for systemic use presented with the highest cost percentages for both years, representing 20.68% (n = R35, 568,221.31) and 16.72% (n = R 31,370,435.51) respectively. Hydrochlorothiazide presented with the highest purchasing quantity for both years when classified according to chemical substance with, Methyldopa having the highest purchasing cost for year one followed by vaccine Hib-DTP 10 dose vial (Haemophilus influenzae type B vaccine-diphtheria, pertusis and tetanus vaccine) for year two. Furthermore it was also found that the majority of the "top twenty" products were in the oral dosage form. Finally it was concluded that drugs used in the treatment of hypertension and cardiac failure were the most utilised in comparison to other "top twenty" products during the study period. Possible misappropriation based on the defined daily dose of the "top twenty" products might have occurred. In completion of this study, recommendations for future research were made. / Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2004.

Health is a fundamental human right. Access to health care, which includes providing a population with safe, effective, good quality drugs at the least possible cost, is a prerequisite to realising that right. Drugs or medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. Drugs also constitute a major recurrent expense in both state-run and private sector health care. To ensure that health care workers prescribe the most cost-effective drugs through the essential drugs list, training, as well as evaluation and monitoring systems must be regarded as important elements of containing costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR), evidence-based medicine and disease management have emerged as tools to ensure cost-effective selection and use of drugs, particularly for chronic diseases. These managed care tools are often investigated to determine whether new technologies or interventions are appropriate and have "value". Affordable prices of medicines, on their own, however, do not ensure access to medicines. Also important are reliable procurement, distribution and storage systems, and appropriately trained personnel to manage these components of drug management. Poorly regulated drug supply systems can have serious consequences such as antibiotic resistance, problems with safety or quality and most importantly wastage, as it is believed that a significant proportion of drugs purchased by the state in South Africa find their way into the private sector market through a "grey market". The general objective of this study was to review and analyse the cost and medicine usage of the "top twenty" pharmaceutical products according to the monthly pharmaceutical purchasing reports of the Department of Health in the North West Province. The research can be classified as retrospective and quantitative. The data used for the analysis were obtained over a two-year study period (1 Apr 2000 - 28 Feb 2002) from the private provider operating the medical stores in the North West Province. The results of the empirical investigation, showed the total number of "top twenty" products appearing during the study period amounted to 460 different products having a total purchasing cost of R 66,263,674.51 representing 37.2% (n = R 178,163,061.50) of all pharmaceutical products purchased during the two-year period. Through analysis it was found, when classified according the Anatomical Therapeutic Chemical (ATC) therapeutic main group, antihypertensives had the highest quantity purchased for year one (20.69%; n = 134,515,640) with cough and cold preparations revealing the highest purchasing quantity for year two (40.55%; n = 103,567,031) of all "top twenty" pharmaceuticals during the study period. Antibacterials for systemic use presented with the highest cost percentages for both years, representing 20.68% (n = R35, 568,221.31) and 16.72% (n = R 31,370,435.51) respectively. Hydrochlorothiazide presented with the highest purchasing quantity for both years when classified according to chemical substance with, Methyldopa having the highest purchasing cost for year one followed by vaccine Hib-DTP 10 dose vial (Haemophilus influenzae type B vaccine-diphtheria, pertusis and tetanus vaccine) for year two. Furthermore it was also found that the majority of the "top twenty" products were in the oral dosage form. Finally it was concluded that drugs used in the treatment of hypertension and cardiac failure were the most utilised in comparison to other "top twenty" products during the study period. Possible misappropriation based on the defined daily dose of the "top twenty" products might have occurred. In completion of this study, recommendations for future research were made. / Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2004.

South African prescribers have a large choice of combination analgesic preparations available for prescribing. According to Desmeules et al. (2003:8) the advantages of combining analgesics include increasing the duration of analgesia, widening the spectrum of efficacy, improved patient compliance and reduced parenteral abuse potential. According to McMahon (1975:13) one of the principle arguments against fixed-dose combinations is that the physician surrenders flexibility in managing his patient. Combination analgesics may expose patients to ingredients not necessary for pain relief in their particular condition (Beaver, 1984). Rigas (1997:454) explains that the value of pharmaco-economics in providing cost-effective pharmacologic treatment for pain must not only be seen as a containment effort, but rather as a valuation effort. Meaningful economic analyses based on empiric information about cost and a range of subjective and objective outcomes are needed to minimise cost without compromising care. The objective of this study was to review and interpret the prescribing patterns of combination analgesics and the cost associated with their usage for the period 2001-2006 in a section of the private healthcare sector in South Africa. This research can be classified as a quantitative, retrospective drug utilisation review study. Data were obtained from a medicine claims database, and the study population consisted of all combination analgesic prescriptions (Mims® category 3.3) for the period 1 January 2001 to 31 December 2002 and 1 January 2004 to 31 December 2006. Prescribing Patterns of Combination Analgesics in the Private Health Care Sector. Firstly pain and the treatment thereof with combination analgesics were investigated from the literature to understand the disease and to determine the prevalence and treatment thereof. Secondly, managed health care, drug utilisation review, pharmacoeconomics and pharmaco-epidemiology were investigated from the literature to understand these concepts. The influence of the South African government on the medicine pricing regulations was discussed. Thirdly, through the empirical investigation the utilisation patterns of combination analgesics were reviewed, analysed and interpreted. It was determined that combination analgesic drugs represented 8.87% (n=261 907) of all medicine claimed during 2001 (N=2 951 326), decreased to 7.20% (n=381 809) during 2004 (N=5 305 846) after which it increased to 7.92% (n=187 745) in 2006 (N=2 370 572). Between 2001 (N=R379 708 489.00) and 2006 (N=R279 160 832.00) the cost percentage of the combination analgesic drugs decreased from 4.95% (n=R18 798 202.42) to 3.15% (n=R8 791 228.57). The average cost per combination analgesic drugs decreased from R71.77 ± 61.67 to R46.83 ± 43.41 between 2001 and 2006. This decrease was of no practical significance (d<0.8). The average number of combination analgesics per prescription stayed relatively constant varying between 1.01 ± 0.11 in 2001 and 1.02 ± 0.13 in 2006. The percentage generic combination analgesic drugs claimed increased from 29.63% (n=77 608) in 2001 to 66.37% (n=124 600) in 2006 (N=261 907 for 2001 and N=187 745 for 2006) even though generic medicine items claimed by the total database only increased from 26.79% (n=790 548) in 2001 to 40.27% (n=954 561) during 2006 (N=2 951 326 for 2001 and N=2 370 572 for 2006). The combination of ibuprofen 200mg, paracetamol 250mg and codeine phosphate 10mg (e.g. Myprodol® capsules, Mybulen® capsules, Gen-payne® capsules and Ibupain Forte® capsules) represented the active ingredient combination with the highest prevalence for the entire study period, increasing from 28.44% (n=74 483) in 2001 to 33.08% (n=62 100) in 2006 of all combination analgesics prescribed (N=261 907 for 2001 and N=187 745 for 2006). Generic substitution influenced the prevalence of the innovator medicine item, Myprodol® Capsules dramatically, causing a decrease from 23.16% (n=60 631) in 2001 to 3.77% (n=7 084) in 2006 representation of all combination analgesic prescribed. In 2006, the generics of Myprodol® Capsules e.g. Dentopain Forte®, Mybulen® Capsules, Gen-payne® and Ibupain Forte® represented 23.79% (n=44651) of all combination analgesics claimed. Recommendations were derived regarding certain aspects of the clinical and economical management of pain e.g. the implication of generic substitution with regard to cost and prescribing patterns, and the decreasing cost of combination analgesics which might encourage abuse, needs further investigation. South African prescribers have a large choice of combination analgesic preparations available for prescribing. According to Desmeules et al. (2003:8) the advantages of combining analgesics include increasing the duration of analgesia, widening the spectrum of efficacy, improved patient compliance and reduced parenteral abuse potential. According to McMahon (1975:13) one of the principle arguments against fixed-dose combinations is that the physician surrenders flexibility in managing his patient. Combination analgesics may expose patients to ingredients not necessary for pain relief in their particular condition (Beaver, 1984). Rigas (1997:454) explains that the value of pharmaco-economics in providing cost-effective pharmacologic treatment for pain must not only be seen as a containment effort, but rather as a valuation effort. Meaningful economic analyses based on empiric information about cost and a range of subjective and objective outcomes are needed to minimise cost without compromising care. The objective of this study was to review and interpret the prescribing patterns of combination analgesics and the cost associated with their usage for the period 2001-2006 in a section of the private healthcare sector in South Africa. This research can be classified as a quantitative, retrospective drug utilisation review study. Data were obtained from a medicine claims database, and the study population consisted of all combination analgesic prescriptions (Mims® category 3.3) for the period 1 January 2001 to 31 December 2002 and 1 January 2004 to 31 December 2006. Prescribing Patterns of Combination Analgesics in the Private Health Care Sector. Firstly pain and the treatment thereof with combination analgesics were investigated from the literature to understand the disease and to determine the prevalence and treatment thereof. Secondly, managed health care, drug utilisation review, pharmacoeconomics and pharmaco-epidemiology were investigated from the literature to understand these concepts. The influence of the South African government on the medicine pricing regulations was discussed. Thirdly, through the empirical investigation the utilisation patterns of combination analgesics were reviewed, analysed and interpreted. It was determined that combination analgesic drugs represented 8.87% (n=261 907) of all medicine claimed during 2001 (N=2 951 326), decreased to 7.20% (n=381 809) during 2004 (N=5 305 846) after which it increased to 7.92% (n=187 745) in 2006 (N=2 370 572). Between 2001 (N=R379 708 489.00) and 2006 (N=R279 160 832.00) the cost percentage of the combination analgesic drugs decreased from 4.95% (n=R18 798 202.42) to 3.15% (n=R8 791 228.57). The average cost per combination analgesic drugs decreased from R71.77 ± 61.67 to R46.83 ± 43.41 between 2001 and 2006. This decrease was of no practical significance (d<0.8). The average number of combination analgesics per prescription stayed relatively constant varying between 1.01 ± 0.11 in 2001 and 1.02 ± 0.13 in 2006. The percentage generic combination analgesic drugs claimed increased from 29.63% (n=77 608) in 2001 to 66.37% (n=124 600) in 2006 (N=261 907 for 2001 and N=187 745 for 2006) even though generic medicine items claimed by the total database only increased from 26.79% (n=790 548) in 2001 to 40.27% (n=954 561) during 2006 (N=2 951 326 for 2001 and N=2 370 572 for 2006). The combination of ibuprofen 200mg, paracetamol 250mg and codeine phosphate 10mg (e.g. Myprodol® capsules, Mybulen® capsules, Gen-payne® capsules and Ibupain Forte® capsules) represented the active ingredient combination with the highest prevalence for the entire study period, increasing from 28.44% (n=74 483) in 2001 to 33.08% (n=62 100) in 2006 of all combination analgesics prescribed (N=261 907 for 2001 and N=187 745 for 2006). Generic substitution influenced the prevalence of the innovator medicine item, Myprodol® Capsules dramatically, causing a decrease from 23.16% (n=60 631) in 2001 to 3.77% (n=7 084) in 2006 representation of all combination analgesic prescribed. In 2006, the generics of Myprodol® Capsules e.g. Dentopain Forte®, Mybulen® Capsules, Gen-payne® and Ibupain Forte® represented 23.79% (n=44651) of all combination analgesics claimed. Recommendations were derived regarding certain aspects of the clinical and economical management of pain e.g. the implication of generic substitution with regard to cost and prescribing patterns, and the decreasing cost of combination analgesics which might encourage abuse, needs further investigation. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.

Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2008.