[Monitoring utilization of hypolipemic agents using an insurance company database]

Databases of health insurance companies can provide information on the motion of a drug in the society. The present paper examines several databases of health insurance companies and analyzes the development of the consumption of hypolipidemic agents in 1994 through 1998. So-called evaluation databases making it impossible to identify a particular patient and the prescribing physician were prepared for the evaluation. They were obtained from the VZP central health insurance office, VZP district health insurance offices in Hradec Králové and Kladno, and the Zamĕstnanecká pojistovna Skoda (Employees Health Insurance Company Skoda). It was not necessary to blind the data in the first cohort, in the second one it was carried out by shortening the identification numbers, and in others by introducing artificial identification codes. The consumption was expressed in DDD and in the relative representation in the group. The consumption of the principal groups of hypolipidemic agents (fibrates, statins, sequestrants of bile acids, and derivatives of nicotinic acid) and the individual medicinal substances was evaluated. Relative values of consumption were obtained by calculation to the magnitude of the denominator--the number of the insured, or the number of patients to whom a hypolipidemic agent was prescribed. The consumption was on the increase in all three databases, in four years increasing from approx. 0.4-4DDD/1000 of the insured/day to 16-24DDD/1000 of the insured/day. At the beginning, the main share in the consumption of hypolipidemic agents was represented by fibrates, approx. 90%, but in four years this share decreased to only 60%, whereas in the period under study the share of statins increased up to 30%. Databases of health insurance companies do not significantly differ in the consumption of hypolipidemic agents, which may give evidence of their validity. In the course of the study, an increase in the consumption of hypolipidemic agents, primarily statins, was found. The shift in the consumption of statins corresponds with the available information about the evidence of their therapeutic effectiveness. The average consumption per one patient does not reach 1DDD, which is a signal that probably very few patients receive long-term treatment and that new patients emerge during the year.