Abstract
BackgroundThe successful control of cardiovascular diseases at the lowest possible cost requires the use of the most effective and affordable medicines. We aimed to describe the trends in the ambulatory use of medicines for prevention and treatment of cardiovascular diseases [Anatomic Therapeutic Chemical classification system (ATC): C and B01A] in Portugal, between 2004 and 2012, and to estimate the potential for expenditure reduction through changes in patterns of use.MethodsWe analysed sell-out data, expressed as defined daily doses (DDD) and pharmacy retail price (€), from a nationwide database. We estimated potential reduction in expenditures through the increase, up to 90% of the volume of DDD, in the use of generic and essential medicines; the latter were defined according to guidelines from Portugal and another European country.ResultsOverall consumption increased by approximately 50% from 2004 to 2012, reaching nearly 2400 million DDD, whereas expenditure decreased to 753 million € (−31.3% since 2006). Use of generics and essential medicines increased, representing 43.6 and 39.9% of DDD consumption in 2012, respectively. The 40 most used groups of medicines in 2012 accounted for just over 80% of overall consumption; among these, increase in use of generics and essential medicines would have contributed to a saving of 275 million €.ConclusionsChanges in patterns of consumption of medicines towards a more frequent use of generics, a preferential use of essential medicines and a more rational use of fixed-dose combinations may contribute to a more efficient use of health resources.
Highlights
The successful control of cardiovascular diseases at the lowest possible cost requires the use of the most effective and affordable medicines
We aimed to describe the trends in the ambulatory use of medicines for prevention and treatment of cardiovascular diseases in Portugal, between 2004 and 2012, and to estimate the potential for cost reduction by increasing use of generics and essential medicines
The Anatomic Therapeutic Chemical classification system (ATC)/defined daily doses (DDD) system developed by the World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology was used to define the DDD, which correspond to the assumed average daily maintenance dose for its main indication use in adults
Summary
The successful control of cardiovascular diseases at the lowest possible cost requires the use of the most effective and affordable medicines. Cardiovascular diseases encompass a wide range of clinical situations affecting the circulatory system in different anatomic locations and are the primary cause of mortality worldwide [1,2,3]. They account for over 30% of all deaths, mostly due to ischemic heart disease and stroke, and approximately 10% of the overall number of Disability Adjusted Life Years (DALYs). There is a large margin for a more rational use of these medicines, towards a more effective prevention and control of cardiovascular diseases at the lowest possible cost [13,14,15,16,17]. The Memorandum of Understanding (MoU) with the International Monetary Fund, the European Commission and the European Central Bank in 2011, signed during the recent financial crisis, requires the publication of clinical guidelines for a more rational use of medicines in different clinical situations [27]
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