Impact of reimbursement program "Аflbrdable Medicines" on consumptiom of beta-blockers in Ukraine in 2017-2020

Размещено на http://www.allbest.ru/

Impact of reimbursement program “Аflbrdable Medicines” on consumptiom of beta-blockers in Ukraine in 2017-2020

Gonchar Anton1, Sholoiko Natalia2

1 Ph.D. student, Department of Economy and Organization of Pharmacy, Bogomolets National Medical University, Kyiv, Ukraine.

2 Candidate of pharmaceutical sciences, Associate Professor of the Department of Economy and Organization of Pharmacy, Bogomolets National Medical University, Kyiv, Ukraine.

Abstract

The article presents the results of the study of impact of the reimbursement program “Affordable medicines” on consumption of beta-blockers in Ukraine, usedfor treatment of cardiovascular diseases. Analysis was conducted based on analytical data of Ukrainian pharmaceutical market research system “PharmXplorer” of the company “Proxima Research”, with current legislation taken into account. It was estimated, that in 2021, according to international non-proprietary name and 5th level of ATC classification - two non-selective beta-blockers: propanolol (ATC code C07AA05) and sotalol (C07AA07); six selective beta-blockers: metoprolol (C07AB02), atenolol (C07AB03), betaxolol (C07AB05), bisoprolol (C07AB07), esmolol (C07AB09) and nebivolol (C07AB12); and one beta-blocker from alpha and beta blocking agents group - carvedilol (C07GA02) are allowed for medical use in Ukraine. From the beginning, when reimbursement program “Affordable medicines” was implemented (April 1st, 2017), only 4 beta-blockers were included in the reimbursement list. Consumption patterns were analyzed in terms of defined daily dose, and it was estimated that bisoprolol was the leader among all beta-blockers in terms of consumption in period from 2016 to 2020. The findings show, that among beta-blockers, that were included in the reimbursement list, the major annual growth of consumption was detected for bisoprolol and carvedilol, although the growth of consumption of metoprolol and atenolol was noted only within the first year offunctioning of the reimbursement program “Affordable medicines”, and beginning from 2018, the consumption of these two beta-blockers was declining annually. Among beta-blockers, that were not included in the reimbursement list, the increase in annual growth of consumption was spotted for nebivolol and sotalol. DDD/1000 inhabitants/day indicators were calculated for each beta-blocker. It was found, that throughout the years the biggest value of this indicator was for bisoprolol - 8,46 in 2016; 11,74 in 2017; 15,28 in 2018 ; 16,88 and 17,48 in 2019 and in 2020 respectfully. The growth of this indicator can give evidence about positive effect of the reimbursement program “Affordable medicines” on consumption of bisoprolol and its affordability for population in Ukraine in 2017-2020.

Key words: cardiovascular agents, drug utilization, pharmacoepidemiology, incentive.

Анотація

reimbursement program beta blockers

Вплив програми реімбурсації «доступні ліки» на споживання лікарських засобів класу бета-блокаторів в Україні в 2017-2020 роках

Гончар Антон1, Шолойко Наталія2

1 Аспірант кафедри організації та економіки фармації, Національного медичного університету імені О.О. Богомольця, м. Київ, Україна

2 Канд.фарм.наук, доцент кафедри організації та екноміки фармації, Національного медичного університету імені О.О. Богомольця, м. Київ, Україна

В статті представлено результати дослідження впливу програми відшкодування вартості лікарських засобів «Доступні ліки» в Україні, на споживання лікарських засобів класу бета-блокаторів для лікування серцево-судинних захворювань. Аналіз проводився на основі аналітичної системи дослідження фармацевтичного ринку України «PharmXplorer» компанії «Проксіма Рісерч» з урахуванням чинної нормативно-правової бази. Встановлено, що у 2021 році в Україні дозволено до медичного застосування (зареєстровано) за міжнародною непатен- тованою назвою (МНН) 2 неселективних бета-блокатори, 6 селективних бета-блокаторів та 1 бета-блокатор класу блокаторів а- і Р-адренорецепторів. З початку дії державної програми «Доступні ліки» (квітень 2017 року) до переліку лікарських засобів, що підлягають відшкодуванню було включено лише 4 бета-блокатори. Аналіз структури споживання проводився за показником добової дози лікарського засобу (defined daily dose, DDD) та було встановлено, що лікарські засоби бісопрололу були лідером в споживанні серед всіх бета-блокаторів в період з 2016 по 2020 роки. Виявлено, що серед бета-блокаторів, вартість яких підлягали відшкодуванню, відзначався значний щорічний приріст у споживанні бісопрололу та карведилолу, а збільшення використання препаратів на основі метопрололу та атенололу відзначалось лише в перший рік функціонування програми «Доступні ліки», та починаючи з 2018 року відбувалось подальше щорічне зниженням споживання цієї групи бета-блокаторів. Серед бета-блокаторів, вартість яких не підлягала відшкодуванню, збільшення щорічного приросту споживання відмічалось лише у препаратів небівололу та соталолу. Було розраховано показник DDD/1000 мешканців/на день. Виявилось, що найбільшим цим показником протягом всіх років був у препаратів бісопроло- лу - 8,46 в 2016 році; 11,74 в 2017; 15,28 в 2018 ; 16,88 та 17,48 в 2019 та 2020 роках відповідно. Зростання цього показника може свідчити про позитивний вплив програми «Доступні ліки» на споживання препаратів бісопрололу та їх доступність для населення України в 2017-2020 роках.

Ключові слова: бета-блокатор, серцево-судинні препарати, споживання ліків, фармакоепі- деміологія, реімбурсація, стимулювання.

Introduction

It was determined that cardiovascular diseases (CVD) are the main cause of death and disability worldwide. In 1990, the concept of Global Burden of Disease (GBD) was introduces with the aim to give a worldwide view on human health, and 2020 published GBD data points out that disability became the major burden on the global health care system: in 1990 disability was accountable for 21% of total burden of diseases, and in 2019 it was accountable for more than a third (34%) of overall burden of diseases. (Mu- ray et al., 2019) CVDs are currently increasing worldwide, and the number of deaths, caused by CVD, has increased up to 18,6 million in 2019, and have doubled the global disability, measured by DALYs and YYLs trends (Roth et al., 2020).

CVD are chronical, and in most cases, require a long-term treatment and and consumption of medicines. (Husain et al., 2020) A lot of medicines are still not affordable to many patients due to high prices, especially to the lowest-paid workers. (Zaputko et al., 2017) (Sarayani, Rashidian & Gholami, 2014). In Europe, expenditures for CVD are estimated to be around 210 billion Euro annually. (Mitkova & Petrova, 2021) Chronic disease treatment requires a steady long-term consumption of two or more medicinal drugs, and as a result - may increase the cost of treatment. This issue can a have an impact on affordability and medication adherence. (Curtler at al., 2017) Therefor, many countries worldwide implement reimbursement programs for CVD treatment, because high cost of medicines creates a risk of poor affordability of medicines for patients, and as a consequence, has a negative impact on public health. (Vogler et al., 2018)

Beta-blockers are widely used in family practice medicine to manage a variety of chronical cardiovascular conditions, such as hypertension and heart failure. (Fekadu et al., 2020) In arterial hypertension treatment, beta-blockers are considered at any point of treatment, if the patient has a specific indication for their use, such as heart failure, angina pectoris, atrial fibrillation and others. (Visseren et al., 2021)

Since April 1th 2017, a state government program “Affordable medicines” is functioning in Ukraine (Huz, Zaliska & Maksymovych, 2020), which provides a fullor parti alreimbursementofthe costs for medicines for CVD treatment according to the approved list, which includes the following beta-blockers (BB): bisoprolol, metoprolol, atenolol, carvedilol (Piniazhko, Zaliska & Ilyk, 2018). It was estimated that 7.2 million patients with cardiovascular diseases benefited from the program in 2017, despite its recent implementation. (Olga, G.,Babar, Z. U. D, 2020). On the 1st of

April 2019, National Health Service of Ukraine, which is managing the program, has implemented the e-prescription into the program. (Zaliska, Huz, & Maksymovych,2020).

Analysis of changes in consumption patterns, which arise under the influence of reimbursement programs can be considered as one of the indicators of increased affordability of medicines for the population and can be used to evaluate the effectiveness of such programs.

Aim

Study the impact of reimbursement program “Affordable medicines” on consumption of beta-blockers in Ukraine in period of 2017-2020.

To achieve the aim of the study, the following stages were planned:

I - To determine the list of beta-blockers, according to the international non-proprietary name (INN) and the 5th level of ATC classification, which are allowed for medical use in Ukraine.

II - Determine the consumption patterns of beta-blockers in Ukraine, in defined daily dose (DDD) terms, in period from 2016 to 2020.

III - To study the impact of the reimbursement program on consumption of beta-blockers in Ukraine, based on the analysis of calculations of indicators of annual growth of consumption in DDD terms, and indicators of DDD/1000 inhabitants/day for each beta-blocker in period from 2017 to 2020.

Materials and methods

The objects of the study were the regulatory framework governing the circulation, use and re-imbursement of medicines in Ukraine, ATC Index guidebook, analytical data of Ukrainian pharmaceutical market research system “PharmXploreU of the company “Proxima Pesearch”. (Proxima Research, 2021) The methods of content analysis, comparative and logical analysis were used in this study.

Results and discussion

Current data of the State register of medicines of Ukraine (State expert center of Ukraine, 2021) shows that according to INN and the 5th level of ATC classification - two non-selective beta-blockers: propanolol (ATC code C07AA05) and sotalol (C07AA07); six selective beta-blockers: metoprolol (C07AB02), atenolol (C07AB03), betaxolol (C07AB05), bisoprolol (C07AB07), esmolol (C07AB09) and nebivolol (C07AB12); and one beta-blocker from the alpha and beta blocking agents group - carvedilol (C07GA02) are allowed for medical use in Ukraine.

Analytical retail sales data, provided by Ukrainian pharmaceutical market research system “PharmXplorer” of the company “Proxima Pesearch” was used to determine the consumption patterns of beta-blockers in Ukraine, except temporarily occupied territories of Crimea, Lu- hansk and Donetsk regions. Consumption patterns were measured in DDD terms, which is in line with WHO Collaboration Centre of Drug statistics guidelines, for each beta-blocker in period from 2016 to 2020. The analysis included only beta-blockers with oral route of administration. Esmolol was excluded from the study due to its parenteral route of administration. The consumption patterns of beta-blockers in Ukraine in 20162020, in DDD terms, are presented in table 1.

Table.1. Consumption patterns of beta-blockers in Ukraine in 2016-2020, in DDD terms.

Using the data from table 1, indicators of annual growth of consumption in DDD terms, for each beta-blocker were calculated. Results of calculations are presented in table 2.

Table 2. Annual growth of consumption of beta-blockers in Ukraine, in DDD terms, in period 2017-2020.