PRESCRIBING TREND AND DRUG COST ANALYSIS OF ORAL HYPOGLYCEMIC AGENTS USING DRUG UTILISATION REVIEW
DOI:
https://doi.org/10.37268/mjphm/vol.20/no.2/art.805Keywords:
Drug Utilization Review, Diabetes Mellitus, Oral Hypoglycemic Agents, Prescribing pattern, Defined Daily DoseAbstract
Drug utilization of oral hypoglycemic agents (OHAs) in a private healthcare setting is useful to examine the prescribing pattern of OHAs, especially the newer fixed dose combination (FDC) products. This study was aimed to evaluate the prescribing pattern of OHAs indicated for Type 2 diabetes mellitus (T2DM), to determine the costs of OHAs prescribed and total cost per prescription in the treatment of T2DM in an outpatient department of a private hospital located in central Malaysia. Retrospective review of electronic medical record (EMR) study design was adopted. Patient’s demographic characteristics, medications prescribed, prescribers’ details and cost per prescription were documented. Defined daily dose (DDD) of OHAs and drug cost were calculated. Research ethics protocol was approved and no personal data was collected. Out of the 396 EMR screened, 135 fulfilled the inclusion criteria and subsequently were analysed. In term of demography, mean age of the sample was 51 years old with 59% were male and ethnicity composition of 71% Malay and 19% Chinese. Metformin and “metformin+dipeptidyl peptidase-4 inhibitor” (DPP-4i) were the most commonly prescribed single-drug and FDC OHA, respectively. Average cost of OHAs and total cost per prescription was less than USD 68 and USD 185, respectively. Meanwhile, FDC covered 28.91% of incidences of prescriptions, but 44.6% of cost and SGTL-2i covered 9% incidences of prescriptions and 16.29% of cost. Prescribing pattern of OHA was appropriate based on patient’s T2DM diagnosis, however, dosage given were not in accordance with WHO DDD.
References
1. Abdelhafiz, Ahmed H., & Sinclair, Alan J. (2013). Management of Type 2 Diabetes in Older People. Diabetes Therapy, 4(1), 13-26. doi: 10.1007/s13300-013-0020-4
2. Abougalambou SSI, Abougalambou AS & Ahmed NO. (2019) Anti-Diabetic Medication Cost of Type 2 Diabetic Patients at Tertiary Center in Malaysia. Int J Diabetes Curr Res, 1(1): 1-9
3. Abu BA, Abdul GA. Non-Communicable Diseases, Risk Factors & Other Health Problems. Institute for Public Health, Ministry of Health Malaysia; (2015). 292p. Report No.: 2.
4. Abu Bakar NS AHJ, Syed Ahmad Yunus SZ, Eliana Musa NS, Abu Sapian R, Abdul Halim NH, Zainuddin NA. Descriptive Analysis of Type 2 Diabetes Mellitus Patients Using Data From Hospital Information System. Malaysian Journal of Medicine and Health Sciences. 2020;16(1).
5. Ahmad NS, Islahudin F. Affordability of essential medicine prices in Malaysia’s private health sector. Patient prefer adherence 2018;12:1231-1237https://doi.org/10.2147/PPA.S151603.
6. Ahmed KA, Muniandy S, Ismail IS, Ali RS, Alhamodi ZH. Evaluation of N ε-(carboxymethyl) lysine and lipid peroxidation in multiethnic Malaysian subjects with type 2 diabetes mellitus. Scientific Research and Essays. 2011;6(9):1957-62.
7. Alex, S. M., Sreelekshmi, B., Smitha, S., Jiji, K., Menon, A. S., & Uma Devi, P. (2015). Drug utilization pattern of anti-diabetic drugs among diabetic outpatients in a tertiary care hospital (Vol. 8).
8. Alti A, Latha SP, Nagarjun GL, Nagaraju G, Gopinath C, Madhav PM. A Study on Drug Utilization Pattern and Effectiveness of Oral Hypoglycemic Agents in Diabetes Mellitus. PharmaTutor. 2015 Jul 1;3(7):31-7.
9. Bahri S, Abdul Aziz AM. Drug Utilization in the Treatment of Diabetes Mellitus in the Ministry of Health Facilities. Pharmaceutical Service Division; (2013). 115p.
10. Bakar S, Ab hamid J, Syed Ahmad Yunus SZ, Abdul Halim N, Zainuddin N. Descriptive Analysis of Type 2 Diabetes Mellitus Patients Using Data From Hospital Information System. 2020;16:94.
11. Dybicz, S. B., Thompson, S., Molotsky, S., & Stuart, B. (2011). Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. Am J Geriatr Pharmacother, 9(4), 212-223. doi:10.1016/j.amjopharm.2011.05.001
12. Feisul, I. M., Azmi, S., Mohd Rizal, A. M., Zanariah, H., Nik Mahir, N. J., Fatanah, I., Goh, A. (2017). What are the direct medical costs of managing Type 2 Diabetes Mellitus in Malaysia? Med J Malaysia, 72(5), 271-277.
13. Hong CY, Chia KS, Hughes K, Ling SL. Ethnic differences among Chinese, Malay and Indian patients with type 2 diabetes mellitus in Singapore. Singapore medical journal. 2004 Apr;45(4):154-60.
14. International Diabetes Federation. Recommendations For Managing Type 2 Diabetes In Primary Care, 2017. www.idf.org/managing-type2-diabetes.
15. Isah AO, Ross-Degnan D, Quick J, Laing R, Mabadeje AF. The development of standard values for the WHO drug use prescribing indicators. International conference on improving use of medicines (ICIUM). INRUD—Nigeria1, Support Group 2008 (Vol. 2).
16. Kamarudin NA, Omar AM, Clinical Practice Guideline of Management of Type II Diabetes Mellitus. Ministry of Health; (2015).
17. Kannan S, Arshad, Senthil K. A study on drug utilization of oral hypoglycemic agents in type-2 diabetic patients. Asian J Pharm Clin Res. 2011; 4:560–4.
18. Karim SA, Pillai G, Ziqubu-Page TT, Cassimjee MH, Morar MS. Potential savings from generic prescribing and generic substitution in South Africa. Health policy and planning. 1996 Jun 1;11(2):198-202.
19. Kautzky-Willer, Alexandra, Harreiter, Jürgen, & Pacini, Giovanni. (2016). Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocrine Reviews, 37(3), 278-316. doi: 10.1210/er.2015-1137.
20. Kuritzky L, Samraj GP. Enhanced glycemic control with combination therapy for type 2 diabetes in primary care. Diabetes Therapy. 2011 Sep 1;2(3):162.
21. Okoro RN, Nmeka C, Erah PO. Utilization study of antidiabetes medicines at a tertiary care hospital in Nigeria. Future Journal of Pharmaceutical Sciences. 2018;4(2):109-15.
22. Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes care. 2006 Mar 1;29(3):725-31.
23. Ramachandran G, Rohith V, Topno I. Evaluation of prescribing pattern of anti-diabetic drugs using WHO prescribing indicators in a tertiary care hospital in Puducherry: A cross-sectional study. The Pharma Innovation. 2015 Jul 1;4(5, Part B):76.
24. Rampal S, Rampal L, Rahmat R, Zain AM, Yap YG, Mohamed M, Taha M. Variation in the prevalence, awareness, and control of diabetes in a multiethnic population: a nationwide population study in Malaysia. Asia Pacific Journal of Public Health. 2010 Apr;22(2):194-202.
25. Saqib A, Atif M, Scahill S. Drug utilization evaluation among an elderly population: a retrospective cross?sectional study in a tertiary care hospital in Pakistan. Journal of Pharmaceutical Health Services Research. 2018 Jun;9(2):123-32.
26. Shimizu F, Ishii Y, Ogawa M, Takao T, Matsuoka K. Age and Gender Influence Differently on Various Foods Intakes, Body Mass Index (BMI), and Levels of Various Plasma Parameters in Young and Old Men and Women in Japan. Obes Open Access. 2017;3(3).
27. Siti Fauziah A, Kamarudin A, Nik Nor Aklima NO. Malaysian Statistics on Medicines 2009 & 2010. Malaysia: Pharmaceutical Services Division and Clinical Research Centre, Ministry of Health. 2014 Dec.
28. Syed Ahmad Yunus SZ, Abu Bakar NSb, Musa NSEb, Abu Sapian R, Azahar A, Zainuddin NAb. Anti-diabetic drugs utilization pattern and its cost in managing Type 2 Diabetes patients in hospitals in Selangor, Malaysia. Informatics in Medicine Unlocked. 2018;13:21-5.
29. Weant KA, Bailey AM, Baker SN. Strategies for reducing medication errors in the emergency department. Open access emergency medicine: OAEM. 2014; 6:45
2. Abougalambou SSI, Abougalambou AS & Ahmed NO. (2019) Anti-Diabetic Medication Cost of Type 2 Diabetic Patients at Tertiary Center in Malaysia. Int J Diabetes Curr Res, 1(1): 1-9
3. Abu BA, Abdul GA. Non-Communicable Diseases, Risk Factors & Other Health Problems. Institute for Public Health, Ministry of Health Malaysia; (2015). 292p. Report No.: 2.
4. Abu Bakar NS AHJ, Syed Ahmad Yunus SZ, Eliana Musa NS, Abu Sapian R, Abdul Halim NH, Zainuddin NA. Descriptive Analysis of Type 2 Diabetes Mellitus Patients Using Data From Hospital Information System. Malaysian Journal of Medicine and Health Sciences. 2020;16(1).
5. Ahmad NS, Islahudin F. Affordability of essential medicine prices in Malaysia’s private health sector. Patient prefer adherence 2018;12:1231-1237https://doi.org/10.2147/PPA.S151603.
6. Ahmed KA, Muniandy S, Ismail IS, Ali RS, Alhamodi ZH. Evaluation of N ε-(carboxymethyl) lysine and lipid peroxidation in multiethnic Malaysian subjects with type 2 diabetes mellitus. Scientific Research and Essays. 2011;6(9):1957-62.
7. Alex, S. M., Sreelekshmi, B., Smitha, S., Jiji, K., Menon, A. S., & Uma Devi, P. (2015). Drug utilization pattern of anti-diabetic drugs among diabetic outpatients in a tertiary care hospital (Vol. 8).
8. Alti A, Latha SP, Nagarjun GL, Nagaraju G, Gopinath C, Madhav PM. A Study on Drug Utilization Pattern and Effectiveness of Oral Hypoglycemic Agents in Diabetes Mellitus. PharmaTutor. 2015 Jul 1;3(7):31-7.
9. Bahri S, Abdul Aziz AM. Drug Utilization in the Treatment of Diabetes Mellitus in the Ministry of Health Facilities. Pharmaceutical Service Division; (2013). 115p.
10. Bakar S, Ab hamid J, Syed Ahmad Yunus SZ, Abdul Halim N, Zainuddin N. Descriptive Analysis of Type 2 Diabetes Mellitus Patients Using Data From Hospital Information System. 2020;16:94.
11. Dybicz, S. B., Thompson, S., Molotsky, S., & Stuart, B. (2011). Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. Am J Geriatr Pharmacother, 9(4), 212-223. doi:10.1016/j.amjopharm.2011.05.001
12. Feisul, I. M., Azmi, S., Mohd Rizal, A. M., Zanariah, H., Nik Mahir, N. J., Fatanah, I., Goh, A. (2017). What are the direct medical costs of managing Type 2 Diabetes Mellitus in Malaysia? Med J Malaysia, 72(5), 271-277.
13. Hong CY, Chia KS, Hughes K, Ling SL. Ethnic differences among Chinese, Malay and Indian patients with type 2 diabetes mellitus in Singapore. Singapore medical journal. 2004 Apr;45(4):154-60.
14. International Diabetes Federation. Recommendations For Managing Type 2 Diabetes In Primary Care, 2017. www.idf.org/managing-type2-diabetes.
15. Isah AO, Ross-Degnan D, Quick J, Laing R, Mabadeje AF. The development of standard values for the WHO drug use prescribing indicators. International conference on improving use of medicines (ICIUM). INRUD—Nigeria1, Support Group 2008 (Vol. 2).
16. Kamarudin NA, Omar AM, Clinical Practice Guideline of Management of Type II Diabetes Mellitus. Ministry of Health; (2015).
17. Kannan S, Arshad, Senthil K. A study on drug utilization of oral hypoglycemic agents in type-2 diabetic patients. Asian J Pharm Clin Res. 2011; 4:560–4.
18. Karim SA, Pillai G, Ziqubu-Page TT, Cassimjee MH, Morar MS. Potential savings from generic prescribing and generic substitution in South Africa. Health policy and planning. 1996 Jun 1;11(2):198-202.
19. Kautzky-Willer, Alexandra, Harreiter, Jürgen, & Pacini, Giovanni. (2016). Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocrine Reviews, 37(3), 278-316. doi: 10.1210/er.2015-1137.
20. Kuritzky L, Samraj GP. Enhanced glycemic control with combination therapy for type 2 diabetes in primary care. Diabetes Therapy. 2011 Sep 1;2(3):162.
21. Okoro RN, Nmeka C, Erah PO. Utilization study of antidiabetes medicines at a tertiary care hospital in Nigeria. Future Journal of Pharmaceutical Sciences. 2018;4(2):109-15.
22. Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes care. 2006 Mar 1;29(3):725-31.
23. Ramachandran G, Rohith V, Topno I. Evaluation of prescribing pattern of anti-diabetic drugs using WHO prescribing indicators in a tertiary care hospital in Puducherry: A cross-sectional study. The Pharma Innovation. 2015 Jul 1;4(5, Part B):76.
24. Rampal S, Rampal L, Rahmat R, Zain AM, Yap YG, Mohamed M, Taha M. Variation in the prevalence, awareness, and control of diabetes in a multiethnic population: a nationwide population study in Malaysia. Asia Pacific Journal of Public Health. 2010 Apr;22(2):194-202.
25. Saqib A, Atif M, Scahill S. Drug utilization evaluation among an elderly population: a retrospective cross?sectional study in a tertiary care hospital in Pakistan. Journal of Pharmaceutical Health Services Research. 2018 Jun;9(2):123-32.
26. Shimizu F, Ishii Y, Ogawa M, Takao T, Matsuoka K. Age and Gender Influence Differently on Various Foods Intakes, Body Mass Index (BMI), and Levels of Various Plasma Parameters in Young and Old Men and Women in Japan. Obes Open Access. 2017;3(3).
27. Siti Fauziah A, Kamarudin A, Nik Nor Aklima NO. Malaysian Statistics on Medicines 2009 & 2010. Malaysia: Pharmaceutical Services Division and Clinical Research Centre, Ministry of Health. 2014 Dec.
28. Syed Ahmad Yunus SZ, Abu Bakar NSb, Musa NSEb, Abu Sapian R, Azahar A, Zainuddin NAb. Anti-diabetic drugs utilization pattern and its cost in managing Type 2 Diabetes patients in hospitals in Selangor, Malaysia. Informatics in Medicine Unlocked. 2018;13:21-5.
29. Weant KA, Bailey AM, Baker SN. Strategies for reducing medication errors in the emergency department. Open access emergency medicine: OAEM. 2014; 6:45
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Published
2020-10-01
How to Cite
Nivethita Chanthran, Long Chiau Ming, Ching Siang Tan, Shashidharan Menon, H. Jaasminerjiit Kaur, Anandarajagopal Kalusalingam, … Mohamed Mansor Manan. (2020). PRESCRIBING TREND AND DRUG COST ANALYSIS OF ORAL HYPOGLYCEMIC AGENTS USING DRUG UTILISATION REVIEW . Malaysian Journal of Public Health Medicine, 20(2), 261–267. https://doi.org/10.37268/mjphm/vol.20/no.2/art.805
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