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The cost of inadequate prescriptions for hypolipidaemic drugs. VICAF Group
L C Ballesteros1, M I Fernández San Martín, T Sanz Cuesta
1Primary Healthcare Management, Getafe, Madrid, Spain. lcabello@gapm10.insalud.es
Insights
High rates of inadequate hypolipidaemic drug prescriptions among pensioners led to significant costs. Interventions are needed to improve prescribing quality in primary care and specialist settings.
Area of Science:
- Pharmacoeconomics
- Public Health
- Clinical Pharmacy
Background:
- High consumption of hypolipidaemic agents necessitates evaluating costs associated with suboptimal prescribing.
- Understanding the economic impact of inadequately prescribed medications is crucial for healthcare resource allocation.
Purpose of the Study:
- To quantify the economic burden of unnecessary hypolipidaemic drug prescriptions within a primary care setting over one year.
- To identify patterns and sources of inadequate prescribing for lipid-lowering medications.
Main Methods:
- A cross-sectional study analyzed hypolipidaemic drug prescriptions for pensioners in Madrid, Spain.
- Prescription adequacy was assessed based on clinical parameters (Level 1) versus less stringent criteria (Level 2).
- Inadequate expenditure was calculated per physician, initiating doctor type, and drug class.
Main Results:
- Inadequate prescriptions for hypolipidaemic drugs cost $116,480.60 (Level 1) and $37,893.37 (Level 2).
- Statins accounted for 78.2% of the total inadequate expenditure, with 88% of fibrate prescriptions being inadequate (Level 1).
- Specialists initiated 35.3% of the total inadequate prescription expenditure.
Conclusions:
- Approximately 67% of hypolipidaemic medicine prescriptions were deemed inadequate in the pensioner population, representing substantial financial waste.
- Inadequate prescription rates and costs were higher when specialists initiated treatment.
- Implementing pharmaceutical prescription quality programs involving both primary care physicians and specialists is essential to mitigate these costs.
Background:
The high consumption of hypolipidaemic agents warrants the study of the costs caused by these medicines being inadequately prescribed.
Objective:
To quantify the economic cost generated in 1 year in primary care by inadequate (or unnecessary) prescriptions for hypolipidaemic drugs.
Methods:
A cross-sectional study based on hypolipidaemic drug prescriptions for a population of pensioners ordered during 1 year by 49 family physicians from 4 health areas in Madrid, Spain. Each doctor completed a data collection sheet for each patient for whom a hypolipidaemic agent was prescribed. The adequacy of each prescription was evaluated according to 2 quality levels: for level 1, it was necessary to have knowledge of the following parameters: total cholesterol level at the start of treatment, low density lipoprotein cholesterol (LDL-C) level, whether dietary intervention preceded pharmacological treatment, patient age and risk factors; for level 2, it was not necessary to have knowledge of either diet before pharmacological treatment or LDL-C levels. Inadequate expenditure was quantified by physician, by type of doctor who initiated the pharmacological treatment (the family physician, specialist, other doctor), therapeutic group and agent.
Study Perspective:
Primary healthcare management of 4 public health areas.
Results:
The cost of inadequate prescriptions for hypolipidaemic drugs reached 116,480.60 US dollars ($US; 1997 values) for quality level 1 and $US37,893.37 for level 2. 12.3% of the health professionals ordered all their prescriptions inadequately (level 1). Of the total inadequate prescription expenditure, 20.4% represented treatments initiated by family physicians and 35.3% by specialists (level 1). Statins made up 78.2% of the total cost; the inadequate expenditure for this therapeutic group reached $US88,797 (level 1). Of the prescriptions for fibrates, 88% were inadequate (level 1).
Conclusions:
In this study, 67% of prescriptions for hypolipidaemic medicines were ordered inadequately in the pensioner population, which represents a considerable pharmacological expenditure. This percentage and the mean cost per inadequate prescription was higher if a specialist was the professional initiating the treatment. Therefore, it is necessary to run pharmaceutical prescription quality programmes with both primary care physicians and specialists involved.
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