\u201cDrugs to avoid\u201d to improve quality use of medicines: how is Australia faring?

Agnes Vitry,Barbara Mintzes

doi:10.1186/s40545-021-00346-3

Agnes Vitry, Barbara Mintzes

Open Access

https://doi.org/10.1186/s40545-021-00346-3

Copy DOI

Abstract

BackgroundEach year, the French independent bulletin Prescrire publishes a list of medicines, “Drugs to avoid”, that should not be used in clinical practice as their risk-to-benefit ratio is unfavourable. This study assessed the market approval, reimbursement and use of these medicines in Australia.MethodsThe approval status of the medicines included in 2019 Prescrire “Drugs to avoid” list was assessed by searching the Australian Register of Therapeutic Goods website. Funding status was assessed on the Pharmaceutical Benefits Scheme (PBS) website, the Australian public insurance system. Use levels were determined by examining governmental reports on prescribing rates including the Australian Statistics on Medicines (ASM) reports, drug use reports released by the Drug Utilisation Sub Committee (DUSC) and PBS statistics.ResultsOf the 93 medicines included in the Prescrire 2019 “Drug to avoid” list included, 57 (61%) were approved in Australia in 2019 including 9 (16%) that were sold as over-the-counter medicines, 35 (38%) were listed on the PBS, 22 (24%) were registered but not listed on the PBS. Although most of these medicines were used infrequently, 16 (46%) had substantial use despite serious safety concerns. Dipeptidyl peptidase-4 (DPP-4) inhibitors were used by 22% of patients receiving a treatment for diabetes in 2016. More than 50,000 patients received an anti-dementia medicine in 2014, a 19% increase since 2009. Denosumab became the 8th medicine, in terms of total sales, funded by the Australian Government in 2017–2018.ConclusionsPrescrire’s assessments provide a reliable external benchmark to assess the current use of medicines in Australia. Sixteen “drugs to avoid”, judged to be more harmful than beneficial based on systematic, independent evidence reviews, are in substantial use in Australia. These results raise serious concerns about the awareness of Australian clinicians of medicine safety and efficacy. Medicines safety has become an Australian National Health Priority. Regulatory and reimbursement agencies should review the marketing and funding status of medicines which have not been shown to provide an efficacy and safety at least similar to alternative therapeutic options.

Highlights

Each year, the French independent bulletin Prescrire publishes a list of medicines, “Drugs to avoid”, that should not be used in clinical practice as their risk-to-benefit ratio is unfavourable
In April 2019, 57 (61%) of these medicines were registered in Australia, 35 (38%) were listed on the Pharmaceutical Benefits Scheme (PBS) (Table 1), 22 (24%) were registered but not listed on the PBS (Table 2), 36 (39%) were not registered in Australia and 9 (16%) of these 57 were sold as OTC medicines
In 2015, four of the antidepressants included in Prescrire list, citalopram, escitalopram, venlafaxine and duloxetine accounted for 44% (42.2 DDD/1000 population/day) of use of new antidepressants in Australia [17]

Summary

Introduction

The French independent bulletin Prescrire publishes a list of medicines, “Drugs to avoid”, that should not be used in clinical practice as their risk-to-benefit ratio is unfavourable. A number of tools have been developed to identify inappropriate medications [4] such as the Beers criteria or the STOPP/START criteria [5], most tools target inappropriate use in population subgroups such as older people or focus on specific drug classes such as anticholinergic drugs. In this context, the approach proposed by Prescrire is unique as it proposes a list of “Drugs to avoid” by everyone. The quality and thoroughness of Prescrire’s assessments are well recognised in France but internationally and their findings are used in international studies [7]

Methods

Results

Discussion

Conclusion