Drug-class-specific changes in the volume and cost of antidiabetic medications in Poland between 2012 and 2015.

AIM: to investigate the drug-class-specific changes in the volume and cost of antidiabetic medications in Poland in 2012-2015. METHODS: This retrospective analysis was conducted based on the National Health Fund database covering an entire Polish population. The volume of antidiabetic medications is reported according to ATC/DDD methodology, costs-in current international dollars, based on purchasing power parity. RESULTS: During a 4-year observational period the number of patients, consumption of antidiabetic drugs and costs increased by 17%, 21% and 20%, respectively. Biguanides are the basic diabetes medication with a 39% market share. The insulin market is still dominated by human insulins, new antidiabetics (incretins, thiazolidinediones) are practically absent. Insulins had the largest share in diabetes medications expenditures (67% in 2015). The increase in antidiabetic medications costs over the analysed period of time was mainly caused by the increased use of insulin analogues. CONCLUSIONS: The observed tendencies correspond to the evidence-based HTA recommendations. The reimbursement status, the ratio of cost to clinical outcomes and data on the long-term safety have a deciding impact on how a drug is used.

Evaluation of the effectiveness of a polyhexanide and propyl betaine-based gel in the treatment of chronic wounds.

AIM: The objective of this multicenter observational clinical study was to evaluate the therapeutic effects of a polyhexanide and propyl betaine-based gel in the treatment of patients of every age, affected by chronic skin wounds. METHODS: One hundred twenty-four patients (60% females, from 4-day-old to 91-year-old, mean age 59) were treated with polyhexanide/propyl betaine (Prontosan® Wound Gel, B. Braun) applied directly on the surface of the wound and in the possible undermining, in combination with a secondary dressing. At the baseline visit and at subsequent checks were evaluated the wound diameter and characteristics (the wound bed and the surrounding skin and edges appearance, level and type of exudate) and local pain at dressing change. RESULTS: The assessment and analysis between the initial visit and the final one showed the following results: the wound size and pain characteristics have decreased substantially and significantly (P<0.001) both in the size of the wounds (length: -17.5 ± 21.4 cm, width: -15.5 ± 21.1 cm; area: -8.3 ± 16.7 cm²) and in the intensity of pain perceived by the patient (Visual Analogue Scale [VAS]: -4.67 ± 2.7; Face, Legs, Activity, Cry, Consolability [FLACC] Scale <1 ± 4); for patients younger than 3 years, the scale used was FLACC. Wound bed: it was found a significant increase in the percentage of improvement in patients; 90% of them showed a reduction in the wound size, while 80% of them showed a relative reduction in pain compared with that observed during the baseline visit, with the wound bed cleansed, granulating or re-epithelializing. Just as significant was the decrease in percentage of subjects with wounds with fibrinous and partially necrotic bed, and/or with biofilm. Edges of the wound and periwound skin: the percentage of patients who have shown during the treatment an improvement in the clinical condition both of the wound edges and the surrounding skin has significantly increased, with a number of cases (75%) who have reached complete skin integrity. In a smaller percentage, already at the initial visit, the wound edges (28%) or the peristomal skin (18%) have been found undamaged. Exudate: there was a reduction in the level of exudate, with 74% of patients who showed no exudate at the final visit, compared with 15% of patients with non-exudative wounds at baseline. CONCLUSION: The treatment of chronic skin wounds through the use of a polyhexanide/propyl betaine-based gel, in combination with a secondary dressing, showed significant improvements, such as a 30% reduction of pain at dressing change, the reduction in the size and characteristics of the wounds and a reduction in the levels of exudate. All these factors have contributed to a reduction in the number of dressings, thus reducing the overall cost of treatment.

Trends in the prescription and cost of diabetic medications and monitoring equipment in England 1991-2004.

BACKGROUND: To report the trend in prescriptions and cost of antidiabetic drugs and glucose monitoring equipment in England from 1991 to 2004. METHODS: We analysed data on all community antidiabetic drug prescriptions in England collated from the Prescription Cost Analysis system. RESULTS: The total number of diabetes prescriptions (medicines and monitoring) rose from 7,613,000 (1991) to 24,325,640 (2004) (>300% increase). Meanwhile, total costs increased by 650%. Insulins are the biggest contributor to cost followed by monitoring equipment and then oral medications. Three times as many items of oral tablets are prescribed than insulins. Metformin accounts for 40% of all diabetic drug dispensations but only 7% of the costs. More is spent on glitazones now than on either metformin or sulphonylureas. CONCLUSIONS: There has been a substantial increase in the cost of managing diabetes in the community. Costs are likely to continue to rise in the future, as the prevalence of diabetes increases and through more aggressive identification and management of patients with diabetes in the hope of reducing the even more costly complications. The cost implications of glucose monitoring merits further study.