Background: Calcium channel blockers are mainly divided into antihypertensive and antianginal
treatment agents. In 2000 it was estimated that 972 million adults worldwide were
living with hypertension and it is expected to affect 1.56 billion patients by 2025. The
incremental expenditure for the antihypertensive therapeutic group in the United States of
America was estimated at $US 55 billion per annum in 2006.
It was stated that around seven million people in the United States of America suffered from
angina, with around 400 000 new reports every year.
Objective: To determine the prescribing patterns of calcium channel blocker medicine items
during 2005 to 2008 in a section of the private health care sector of South Africa.
Methods: A retrospective quantitative drug utilisation review was done using a medicine
claims database ranging over four years from 1 January 2005 to 31 December 2008. The
total medicine claims database was divided into cardiovascular medicine items and then into
calcium channel blockers. These were analysed according to age as well as gender. Further
analysis included adherence of calcium channel blockers as well as an analysis of
prescribers of these items during the study period.
Results: The total number of patients on the medicine claims database consisted of
1 509 621 patients in 2005. This number decreased to 974 497 patients in 2008. The most
medicine items were dispensed in 2006 (n = 21 113 422) with an average cost of
R 92.82 (SD = 196.42) per medicine item.
It was noted that 16.05% (n = 242 264) of patients used at least one cardiovascular item in
2005. The percentage of cardiovascular medicine item users increased by 4.36% during the
study period to 20.41% (n = 198 847) in 2008. In 2008 the cardiovascular medicine items
dispensed were responsible for 19.18% (R 342 565 308.41) of the total cost of all medicine
items claimed.
In 2005 the results revealed that 1.63% (n = 318 258) of all medicine items dispensed were
calcium channel blocker medicine items. The percentage of calcium channel blockers
increased to 2.24% (n = 367 437) of the total number of medicine items in 2008. The cost
prevalence index was calculated for the calcium channel blockers and the value declined
from 1.5 in 2005 to 1.22 in 2008, which indicated that the items dispensed were relatively
expensive, but less than in 2005. An increase of 16.17% in the usage of generic medicine
items were noted from 2005 to 2008.
More female patients than male patients claimed medicine items during the study period. A
higher percentage of male patients used a cardiovascular medicine item as well as calcium
channel blockers during the study period compared to females and a larger percentage of
their medicine expenditure was used on cardiovascular medicine items as well as calcium
channel blockers compared to females.
The usage of cardiovascular medicine items as well as calcium channel blocker medicine
items increased with patient age. In 2008, 17.98% of patients older than 65 years of age
used a calcium channel blocker compared to 0.97% of patients aged > 25 <= 35 years. Only
60.34% of calcium channel blockers items were used with acceptable refill adherence rates
during the study. More than a third of the calcium channel blockers medicine items used had
unacceptable low adherence rates from 2005 to 2008.
In each of the study years the highest potential saving with generic substitution was seen
with amlodipine containing items. It was also observed that some generic substitutions could
be relatively more expensive than the innovator products and an increased cost instead of a
saving through generic substitution may have occurred.
Conclusion: This study highlighted the prescribing patterns and cost implications of calcium
channel blockers in the private health care sector of South Africa.
It is recommended that a more in–depth study of the adherence of calcium channel blockers
be done. This study should also include the cost strategies of generic substitution of calcium
channel blockers in South Africa. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:nwu/oai:dspace.nwu.ac.za:10394/4934 |
| Date | January 2010 |
| Creators | Smit, Ruan |
| Publisher | North-West University |
| Source Sets | South African National ETD Portal |
| Detected Language | English |
| Type | Thesis |
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