Consumption of three strong opioids (morphine, oxycodone and fentanyl) in seven European countries during seven years (2003-2009).

PURPOSE: The aim was to analyse the consumption of selected strong opioid analgesics during a seven-year period of 2003-2009 in order to compare Slovak consumption with that in six other European countries and to determine our position. METHODS: Drug consumption data from the State Institute for Drug Control in Slovak Republic were used. As to the data from other countries, annual health statistics published on websites were used in comparison. RESULTS: Obviously the consumption of one of studied opioid drugs with transdermal aplication route, particularly fentanyl, tended to increase in all countries during the observed period. Oxycodone tends to yield a rapid increase in consumption as well. As opposed to the latter drugs, the consumption of morphine was decreasing throughout the observed period. The consumption of these drugs in Slovakia remains low (except for that of fentanyl). CONCLUSION: Our analysis confirmed a clear shift from oral to transdermal therapy as well as usage of newer drugs. Drug consumption data are a relatively new source of information for health research. Our analysis showed increasing trends in fentanyl (patch opioid) consumption in all compared countries as well as an increasing consumption of oxycodone and decreasing consumption of morphine (Fig. 3, Ref. 17).

Costs related to medical treatment for common cardiovascular risk factors.

AIM: The aim of this study was to evaluate the direct and indirect costs of selected cardiovascular diseases, namely hypertension (HT), metabolic syndrome (MS) and diabetes mellitus (DM) in the Slovak Republic. METHODS AND RESULTS: This study analyzes the data of 1,000 patients, randomly selected from NEMESYS database (10,300 patients). Average direct pharmacotherapeutic costs of hypertension per year were 257 Euros in men and 264 Euros in women. Costs of metabolic syndrome were 334 Euros in men and 321 Euros in women. Finally, the costs of diabetes mellitus were 392 Euros in men and 384 Euros in women. The most expensive pharmacotherapy was used in patients with a combination of all three diagnoses (HT+MS+DM), namely 452 Euros in men and 455 Euros in women. Indirect costs represent an even more serious financial burden. The highest indirect costs were in patients with diabetes mellitus, namely 5,227 Euros in men and 5,365 Euros in women. CONCLUSIONS: The study proved the assumption of increasing the direct pharmacotherapeutic costs in correlation with the increased severity of disease. The gender differences on the other hand, were smaller in patients with more serious conditions. The indirect costs represented the greatest financial burden, and were 13 to 17 times higher than the direct pharmacotherapeutic costs (Tab. 4, Ref. 17).

5 most consumpted opioid analgesics in Slovakia in the year 2006--comparison to five other countries (Finland, Norway, Denmark, Spain, Australia).

INTRODUCTION: Opioid analgesics are drugs of choice in the treatment of moderate and severe malignant or noncancer pain. Consumption data helps us to evaluate the status of country's public health. METHODS: We analysed the consumption of opioid analgesics from ATC class N02A in Slovakia in the year 2006 and compared it with five other countries -- Finland, Norway, Denmark, Spain and Australia. We then calculated drugs that accounted for 90% of the total volume of DDDs in the year 2006. RESULTS: Slovakia showed a dominance of tramadol consumption that constituted three quarters of the total group consumption. Tramadol is the commonest consumed opioid analgesic in all observed countries (in Norway it constituted only 35% of total group consumption, whereas in Slovakia it was 72%). DISCUSSION: Opioid consumption in Slovakia is increasing, but comparison with the Nordic countries, Spain and Australia showed a significantly lower consumption. Exception is tramadol with the highest consumption in Slovakia. CONCLUSION: Observed trends in consumption indicate a well known accent of the Nordic countries on treatment of pain. Opiod consumption in Slovakia continues to stay low (Tab. 1, Fig. 1, Ref. 10). Full Text (Free, PDF) www.bmj.sk.

Comparison of NSAID consumption in Slovakia, Finland and Norway.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) belong to most frequently used drugs worldwide. NSAIDs belong to the family of drugs that represent the biggest drug risk as to the number of adverse drug reactions (ADRs), as well as to the number of deregistered drugs. METHODS: We analysed the whole consumption of NSAIDs from ATC class M01 in Slovakia during 1996-2007. RESULTS: Most frequently used NSAIDs in Slovakia were ibuprofen and diclofenac. There was a marked increasing trend in piroxicam, meloxicam, ibuprofen and especially nimesulide medicines. CONCLUSION: Prescription habits of doctors in Slovakia reflect the drug risk only partially, nevertheless the total consumption of dangerous medicines is decreasing and substances with safer profile remain being more used. In the prescribing process the patients' risk factors together with the differences in drug characteristics should be considered. Nevertheless some of these drugs are OTC, and their consumption is strongly influenced by pharmacists and advertisement (Tab. 2, Fig. 1, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

[Pharmacoeconomic profile of antibiotics used in the treatment of lower respiratory tract infections in geriatric patients]. / Farmakoekonomický profil antibiotík pouzitých v liecbe infekcií dolných dýchacích ciest u geriatrických pacientov.

The paper aims to evaluate the pharmacoeconomic profile of antibiotics (ATB) used in the treatment of lower respiratory tract (LRT) infections and thus contribute to rationalization of therapeutic procedures. Of 2870 patients hospitalized at the Geriatric Clinic of the Medical Faculty of Comenius University from 1 January 1999 to 31 December 2001, 189 patients with acute infections of the LRT were included in the retrospective study. For pharmacoeconomic evaluation, cost effectiveness analysis was employed, the principal parameter of which, cost effectiveness coefficient, was the ratio of the price of ATB treatment in Slovak crowns (SK) and the criterion of effectiveness (E), the number of asymptomatic days in a month. The authors separately evaluated ATBs administered perorally (p.o.); intravenously (i.v.), and sequentially, and they also compared i.v. and the corresponding sequentially administered ATBs. Statistical comparison revealed significant differences in the prices and cost effectiveness coefficients of individual alternatives of ATB treatment. Employed ATBs did not significantly differ in the criteria of effectiveness. According to the cost effectiveness coefficient (SK/asymptomatic day), fluoroquinolones were less expensive (median price/E: pefloxacin: p.o. 19.3; i.v. 29.1; sequentially administered 26.0, and ciprofloxacin: p.o., 14.7, i.v., 54.1, sequentially administered, 31.7). Sequential administration of ATBs (ampicillin-sulbactam, cefuroxime, amoxicillin-klavulanate, ciprofloxacin) was significantly cheaper in comparison with i.v. administration. With therapeutic equivalence, the total pharmacoeconomic profile of ATB treatment depended on the price parameter. In the selection of ATB it is also necessary to consider the price of the drug.

Trends in consumption of opioid analgesics in Slovak Republic during 1998-2002.

OBJECTIVE: To describe the patterns of consumption in an opioid analgesic group in Slovakia between 1998 and 2002, to determine prescription habits, and to compare the results with those from selected countries. METHODS: A drug utilization study using WHO methodology [Anatomical-Therapeutic-Chemical classification/defined daily doses (ATC/DDD)] was made. The wholesale data from the State Institute of Drug Control in the Slovak Republic and drug safety reports from the National Centre for Supervision of Adverse Drug Reaction were collected. Utilization was calculated as the DDDs per 1000 inhabitants per day. RESULTS: Consumption of opioid analgesics (ATC class N02AA-N02AX) in Slovakia was still growing during the study with dominance of tramadol. In comparison with other countries in 2001, consumption of morphine (as a representative of analyzed ATC class) in Slovakia (0.17 DDD/1000 inhabitants per day) is still very low, in contrast with Denmark, Austria or Canada (1.80, 1.61 and 1.58 DDD/1000 inhabitants per day, respectively). The collected safety reports contained only a few reported adverse reactions to the opioid analgesics. CONCLUSION: Despite recent increases, the consumption of opioid analgesics in the Slovak republic remains low. We have tried to present an overall picture of prescription of opioid analgesics in Slovakia and to focus attention on this topic.

Factors influencing the spontaneous reporting of adverse drug reactions--the experience of the Slovak Republic.

The system of adverse drug reaction (ADR) monitoring in the Slovak Republic is greatly influenced by changes taking place in the current health care delivery system. Under-reporting and reporting biases due to selective ADR reporting provide very serious problems in pharmacovigilance. In the year 2001, the number of reported ADRs increased due to reports of angiotensin converting enzyme (ACE) inhibitor-induced cough; this coincided with limits being imposed on the use of angiotensin-II receptor antagonists. These factors provide an example of selective ADR reporting, deforming the quality of drug safety monitoring. They also indicate that administrative strategies can significantly affect spontaneous reporting activities.

Cost-effectiveness analysis of switching from intravenous to oral administration of antibiotics in elderly patients.

OBJECTIVE: The aim of the introduced work was to evaluate pharmacoeconomic advantages of timely switching from intravenous to oral administration of antibiotics (ATB). METHODS: The evaluated group was selected out of 2870 patients, who were hospitalised at the Clinic of Geriatric Medicine of the Faculty of Medicine of Comenius University in Bratislava from January 1st 1999 to December 31st 2001. In our retrospective study we analysed 96 patients with community-acquired pneumonia successfully treated by ATB. In 43 of them ATB were given intravenously and in 53 the therapy was switched, i.e. the intravenous administration was used at the beginning and oral administration when the condition improved. We applied a cost-effectiveness analysis to the pharmacoeconomic evaluation. The cost-effectiveness coefficient was calculated as the ratio of ATB price (Slovak Crowns) to the effectiveness criterion (number of asymptomatic days in month). RESULTS: According to the cost-effectiveness coefficient, the switch therapy was significantly less expensive in all evaluated ATB (except for pefloxacin) in comparison with intravenous administration: ampicillin-sulbactam 93.9 vs 168.1; cefuroxime 90.0 vs 123.3; amoxicillin-clavulanate 74.0 vs 116.3; ciprofloxacin 31.7 vs 54.1. CONCLUSIONS: A timely switching from intravenous to oral administration of ATB in a suitable patient is an effective way to save financial resources. (Tab. 5, Ref: 21.)

[Pharmacoeconomics in the therapy of peptic ulcer]. / Farmakoekonomika v terapii peptických vredov.

The great prevalence and chronic nature of peptic ulcers traditionally represent a great economic load for the system of health care. The exponentially growing therapeutic and diagnostic possibilities of the treatment of peptic diseases are under a strong economic pressure from health-insurance companies. The use of an economic model for the management of peptic diseases aims to maximize health benefit from limited sources of the health services. It can be said already now that the detection of the Helicobacter pylori infection ranks among the most important discoveries of the 20th century. Elimination of the Helicobacter pylori infection can produce a dramatic reduction in relapses of peptic ulcers, which is reflected not only in the improved quality of life but also in a subsequent economic contribution. The present authors paid attention to the financial costs of the combined therapy for eradication of the Helicobacter pylori infection in the course of the years 1998-2001.

[Pharmacotherapy of osteoporosis in ambulatory practice and its pharmaceutical aspects]. / Farmakoterapia osteoporózy v ambulantnej praxi a jej farmaceutické aspekty.

Within the framework of studies of pharmacotherapy of the diseases of the muscular and skeletal system, the paper aimed to analyze the pharmacotherapy of osteoporosis. The significance of the problems in the field of research of epidemiology of osteoporosis requires the use of all available methods. With regard to the fact that the epidemiological situation in osteoporosis is also reflected in the consumption of drugs, the paper aimed to contribute to the solution of the problem by means of an analysis of the pharmacotherapy of osteoporosis. The results of the analysis have confirmed the relationship between the prevalence of the disease of osteoporosis and drug consumption. The paper demonstrated an increase in the total consumption of drugs prescribed for osteoporosis in 1998 and 1999 in comparison with 1997 as well as an increase in the consumption according to the age and sex. A statistically significant difference was recorded in the consumption of drugs prescribed for osteoporosis with regard to women. The analysis showed changes in the assortment of prescribed drugs as well as changes in the management of the therapy of osteoporosis.