Further Potential Savings Attributable to Maximum Generic Substitution of Antidepressants in South Africa: a Retrospective Analysis of Medical Claims

The main objective of the study was to calculate potential cost savings that could have been generated by maximum generic substitution of antidepressants within the private health care sector of South Africa from 2004 to 2006. Data on computerized medicine claims of patients receiving one or more antidepressants during three consecutive years (i.e. 2004; 2005 and 2006) were elicited from a South African pharmaceutical benefit management company. The total study population consisted of 292 071 items (N = 5 982 869) on 273 673 prescriptions (N = 5 213 765) at a total cost of R56 183 697.91 (N = R1 346 210 929.00). A quantitative; retrospective drug utilization review was conducted; and data were analyzed using the Statistical Analysis Systemr programme. Potential cost savings were computed for criteria-eligible substances in the study population. Generic medicine constituted 58.7(N = 292 071) of all antidepressants claimed; at a total cost of 28.2(N = R1 346 210 929.00) of all incurred costs. With total substitution of the average price of all criteria-eligible innovators; a potential saving of 9.3(N = R56 183 697.91) of the actual antidepressant cost over the study period was calculated. In developing countries with limited health care resources; generic medicines can be cost-saving treatment alternatives

Prescribing patterns of medicine classified as 'antidepressants' in South African children and adolescents

The main objective of this study was to characterise prescribing patterns of medicine classified as 'antidepressants' (hereafter simply referred to as antidepressants) in children and adolescents in the private health care sector of South Africa. A retrospective drug utilisation design was used to identify patients aged 19 years and younger from a South African pharmaceutical benefit management company's database; whom were issued at least one antidepressant between 1 January 2006 and 31 December 2006. Prescribed daily dosages (PDDs) were calculated using the Statistical Analysis Systemr program. A total of 1 013 patients received a mean number of 2.88 (SD 3.04) prescriptions per patient. Females received more prescriptions than their male counterparts; with the highest prevalence in the 15 = 19 years age group. The pharmacological groups most prescribed were the selective serotonin reuptake inhibitors (43.0) and the tricyclics (42.7); with imipramine (22.04) and amitriptyline (19) as the most commonly prescribed drugs. Approximately 30(n = 2 300) of all antidepressants in the study population were prescribed off-label. Amitriptyline and clomipramine were prescribed at daily dosages higher than recommended in children and adolescents aged 9 = 15 years. Lithium; trimipramine; trazodone and sulpiride were prescribed at sub-therapeutic dosages in adolescents. This study provided insight in the prescribing patterns of medicine classified as antidepressants in South African children and adolescents. These drugs; however; have many indications. Further research is needed to determine reasons why specific drugs are prescribed in this population

Prevalence of Drug-Drug Interactions of Antiretroviral Agents in the Private Health Care Sector in South Africa

Human immunodefiency virus (HIV) infection can be effectively treated with highly active antiretroviral therapy (HAART); requiring concomitant administration of three to four different agents; often with a high potential for drug-drug interactions (DDIs). This study aimed to determine the prevalence of possible DDIs between antiretrovirals (ARVs) themselves and other drugs. Design. Retrospective drug-utilisation study using data from from a national medicine claims database for the period 1 January to 31 December 2004. Setting. A section of the private healthcare sector in South Africa. Subjects. All ARV prescriptions (N=43482) claimed during 2004. The possible DDIs found were classified according to a clinical significant rating as described by Tatro7 (2005) in his book; Drug Interactions Facts and comparisons. Results. A total of 5305882 medicine items were prescribed; of these; 1.92(N=101 938) accounted for ARVs. Of the total number of 2595254 prescriptions; 1.68(N=43 482); were ARVs. A total number of 18035 DDIs (81 different types) were identified; of these; 83.89; (n=15130) were DDIs between ARVs and other drugs; while 16.11(n=2905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major; n=17) and 2 (moderate; n=1436) represented 8.06(n=1 453) of the total number of identified interactions. Conclusions. Since concomitant use of ARVs and other drugs used to treat HIV complications is increasing; there is a great need of understanding and anticipating these DDIs; overcoming them by dose adjustments and patient education by pharmacists; so that they are not life threatening to HIV/AIDS patients

Antimicrobial Prescribing Patterns in a Group of Private Primary Health Care Clinics in South Africa

The aim of this study was to investigate the prescribing of antimicrobials in private primary health care in South Africa. A retrospective drug utilisation study was conducted on data obtained from the database of nine private primary health care clinics for the year 2001. Antimicrobials were classified pharmacologically and their usage analysed according to number of patients and consultations; age groups; gender; diagnoses and cost. Of the 83 655 patients; 49 772 (59.50) were female and 33 650 (40.22) males. No gender was indicated in 233 (0.28) of the cases. Medicine items (n = 515 976) were prescribed costing R1 716 319. Of these; 18.69 (n = 96 421) were antimicrobials costing R1 045 108 (60.89). Antimicrobials were prescribed in 72 of the consultations. The antimicrobials that were the most often prescribed were penicillins (38.17); sulphonamides (22.49); antiprotozoals (9.88) and tetracyclines (9.34) for diagnoses such as viral-influenza; upper-respiratory infections; acute-bronchitis and acute-sinusitis. Antibiotics prescribed for viral diseases indicated inappropriate use because these infections are caused by non-bacterial agents; and thus are self-limiting. Therefore antibiotics were neither necessary nor appropriate. Further investigations should be done on standard antimicrobial treatment-guidelines in private primary health care settings in South Africa

Investigation into the Prescribing Patterns and Cost of Antidiabetic Medicine in South Africa

"The general objective of this study was to investigate the prescribing patterns and cost of antidiabetic medicine in the private health care sector in South Africa by using a medicine claims database. A quantitative; retrospective drug utilisation study was performed on data for the year 2004. Oral antidiabetic medicine accounted for 81 (n =143 447) and 39 (R29 734 360.61) respectively of the total prevalence and cost of all antidiabetic products prescribed. Metformin was the most frequently prescribed oral antidiabetic medicine; with an average cost of R58.42 (SD = 31.78). The three most frequently prescribed classes of insulin (insulin lispro; soluble insulin and isophane; and soluble insulin aspartame and protamine) together accounted for 63 of all the insulin prescribed; and 67 of the total cost of prescribed insulin. Almost 39 (n = 62 717) of the ""combination therapy"" prescriptions were for a sulfonylurea in combination with a biguanide plus at least one other antidiabetic product. A trend towards combination therapy away from monotherapy was observed. Prescribed Daily Doses (PDDs) calculated for oral antidiabetic medicines were more or less in line with recommended treatment guidelines. Drug utilisation review studies thus provide valuable insight into the treatment of diabetes - indicating areas of possible over- and under usage; providing decision-makers with critical information to curb unnecessary costs."

Prescribing Patterns of Antiretroviral Drugs in a Section of Private Health Care Sector of South

The general objective of this study was to investigate the prescribing patterns and cost of antiretroviral (ARV) drugs in the private health care sector in South Africa by using a medicine claims database. A quantitative; retrospective drug utilisation review was performed on data retrieved from 2001; 2002 and 2004 records. Antiretroviral drugs repre- sented 0.38 (n = 1 475 380) for 2001; 0.72 (n = 2 076 236) for 2002; and 1.68 (n = 2 595 254) for 2004 of all studied prescriptions. The total cost of the ARV drugs represen-ted 1.31 (R379 708 489) for 2001; 3.03 (R601 350 325) for 2002; and increased to 5.25 (R661 223 146) for 2004 of all drugs claimed. All ARV medicine items claimed during 2001 (n = 9 796) and 2002 (n = 35 271) were innovator products. Only 5.23 (n=5 329) of all the ARV medicine items (n = 101 938) claimed during 2004 were generic products. The average cost per ARV medicine item for 2004 increased from R317.93 (SD = R190.80) for the period January to April to R369.20 (SD = R219.50) for the period May to August; and decreased to R324.79 (SD = R212.48) for the period September to December and resulted in a cost saving of R41 044.35 for the period May to August versus September to December. Both the prevalence and cost of ARV drug therapy increased from 2001 to 2002. The prevalence increased from 2002 to 2004; but the cost decreased during 2004. The decrease in the cost of ARV drug therapy is probably a result of the implementation of the new pricing regulations in May 2004