Antihypertensive drug procurement trends from 1995 to 2004: transition over a decade

ABSTRACT

To evaluate antihypertensive procurement trends in Bahrain from 1995 to 2004. Pharmacology and Therapeutics, Arabian Gulf University/Directorate of Material Management, Ministry of Health. A retrospective audit study based on the data from the Directorate of Material Management, Ministry of Health [MOH], Bahrain. A review of the annual antihypertensive drug procurement data from 1995 to 2004 was performed. The procurement rate of angiotensin converting enzyme inhibitors [ACEIs], diuretics and alpha-blockers, significantly increased while the rate of calcium channel blockers [CCBs], methyldopa and hydralazine declined during this decade. Beta-blockers were the top-ranked agents in both 1995 and 2004. Significant interclass changes were evident increase in procurement of long-acting ACEIs, CCBs and indapamide associated with a decline in short-acting ACEIs, CCBs and thiazide and thiazide-like diuretics in 2004. Angiotensin-II receptor blocker [ARB] - valsartan was introduced in 1999. The procurement of fixed-dose combinations [FDCs] increased from 0.9% in 1995 to 3.4% in 2004, associated with a significant decline in Moduretic and Brinerdin and by introduction of Co-Diovan, Preterax and Bi-Preterax. High cost due to renin-angiotensin-aldosterone inhibitors [ACEIs and ARBs] accounted for approximately half of the total antihypertensive drugs budget. According to Ministry of Health budget, the annual drug budget for antihypertensive drugs increased from 6.7% in 1995 to 14.1% in 2004. During that decade, there was a rapid annual growth rate for diuretics, CCBs and FDCs. The antihypertensive procurement strategy has qualitatively improved; there is a shift towards selection of more rational long-acting antihypertensives and FDC products. Analysis of drug procurement trend should be a critical component of national drug policy