Total Drug Utilization Research Articles

903. Formulary Edits and Consistent Messaging for Unproven COVID-19 Therapeutics

Abstract Background A challenge the healthcare system faced during the COVID-19 pandemic was ensuring appropriate use of therapeutics. Hydroxychloroquine (HCQ), azithromycin, and ivermectin are FDA-approved for rheumatic, antibacterial, and antiparasitic conditions, respectively. During the pandemic, these drugs were used for COVID-19 treatment, despite unproven benefit and lack of clinical guideline support. Payer-based formulary edits of these agents during the COVID-19 pandemic were reviewed to determine effectiveness in supporting appropriate use. Methods After local discovery of COVID-19 the University of Rochester Medical Center and a local payor in the upstate New York area, Excellus BlueCross BlueShield, disseminated education about the unproven role of these agents in treatment or prevention of COVID-19. In March 2020, May 2020 and February 2021, respectively, Excellus BCBS placed a quantity limit (QL) on prescriptions for HCQ, azithromycin and ivermectin and prior authorization (PA) for ivermectin in October 2021 for all formularies except Medicare. The QL for HCQ and azithromycin were in effect until December 2020. An exception process was available for individuals who required a higher quantity. Data was gathered retrospectively for claims and total drug utilization amongst Excellus BCBS members through February 2022. Results Use of HCQ increased by 56.5% prior to QL implementation. After HCQ QL was implemented, HCQ use returned to near pre-pandemic baseline, and most (88%) claims were processed. For azithromycin, after the QL limit was implemented, while overall usage dropped, most claims (77%) were processed. Prior to QL and PA, ivermectin usage quadrupled. Following implementation of the ivermectin QL, usage was stable and a minority (41%) of ivermectin claims were processed. The month that PA was implemented, usage dropped by 81%, and 9% of claims were processed. Conclusion Formulary edits resulted in returning use of HCQ to pre-pandemic levels despite an initial rise in use. The edits may have curtailed azithromycin use as well. A QL was associated with stabilization in ivermectin use but ultimately usage did not decrease until PA was required. Formulary edits consistent with local messaging appeared to help control use of unproven therapeutics for COVID-19. Disclosures Alyssa Tutino, PharmD, BCGP, Excellus BlueCross BlueShield: Salary Justin Bender, BS, Excellus BlueCross BlueShield: Salary Michelle Sageer, Pharm D, BCACP, Excellus BlueCross BlueShield: Salary Mona Chitre, PharmD, Excellus BlueCross BlueShield: Salary.

Alternative trastuzumab dosing strategies in HER2-positive early breast cancer are associated with patient out-of-pocket savings

Patients with breast cancer frequently experience financial hardship, often due to the high costs of anti-cancer drugs. We sought to develop alternative trastuzumab dosing strategies, compare their pharmacokinetic effectiveness to standard dosing, and assess the expected financial implications of transitioning to them. We extracted clinical data from the records of 135 retrospectively identified patients with HER2-positive early breast cancer at a single, urban comprehensive cancer center who were treated with trastuzumab between 2017 and 2019. We performed pharmacokinetic simulations on a range of trastuzumab dose levels and frequencies, assessing efficacy by trough trastuzumab concentration (Ctrough) and population and individual likelihoods of Ctrough exceeding trastuzumab minimum effective concentration (MEC). We performed deterministic financial modeling to estimate the treatment-associated financial savings from alternative dosing strategies. Trastuzumab maintenance doses of 4 mg/kg every 3 weeks (Q3W) and 6 mg/kg every 4 weeks (Q4W) had nearly identical probabilities of Ctrough being above MEC as standard of care 6 mg/kg every 3 weeks. In the primary financial analysis, both trastuzumab 4 mg/kg Q3W and 6 mg/kg Q4W were associated with significant drug- and administration-related out-of-pocket cost savings over the duration of therapy, ranging from $765 (neoadjuvant, Q4W) to $2791 (adjuvant, Q4W). In particular, Q4W trastuzumab increased savings related to lost wages and travel cost avoidance. Low-dose and reduced frequency trastuzumab in appropriately selected patients may significantly reduce total drug utilization and meaningfully reduce patient financial toxicity. Prospective clinical trials evaluating low-dose or reduced-frequency administration of therapeutic monoclonal antibodies are warranted and needed.

Utilisation Pattern, Safety Profile and Cost Analysis of Antimicrobials Prescribed in an Intensive Care Unit of a Teaching Hospital

BACKGROUND: Critically ill patients admitted to intensive care units (ICUs) are highly susceptible to infections because of predisposing illness and the use of invasive and surgical procedures and are, therefore, exposed to high antimicrobial pressure. Use of antimicrobial in the ICU must follow best clinical practice, if the emergence of resistance to antimicrobials is to be minimized. AIMS AND OBJECTIVES: To assess the utilization pattern, safety profile and cost analysis of antimicrobials in Medical ICU of the institution. MATERIALS AND METHODS: A prospective cross sectional observational study was undertaken from February 2016 to February 2017 in a teaching hospital. Standard case record form was used to collect the information regarding demographic data, clinical data, antibiotic use and adverse drug reactions. Antimicrobial use was analyzed using Anatomical Therapeutic Chemical (ATC) classification/Defined Daily Dose (DDD) system. RESULTS: Totally 123 patients in the ICU were included in the study. These includes 82 men and 41 women. The average age of the patient was 57.7 years. Majority patients were admitted with respiratory infection (23.49%). The average number of drugs prescribed per patient was 7.63. Total drug utilization in terms of DDD/1000 patients in ICU/day was 26.02. Ceftriaxone + metronidazole (15.44%) were the most common empirical regimen used as 2AMAs, whereas with single drug ceftriaxone (21.13%) was most commonly used. The maximum ADRs observed were probable according to WHO causality assessment. CONCLUSION: Majority of patients were prescribed AMAs as monotherapy or combined therapy for control of infections during Intensive Care management. Over all extensive polypharmacy among AMAs was noticed.

Trends in Medicaid fee-for-service outpatient drug utilization, expenditures, and pharmacy reimbursement rates (2010–2012)

Purpose: To assess drug utilization and expenditure trends in Medicaid fee-for-service program during the period 2010 – 2012 in the United States of America. Methods: A retrospective, descriptive analysis of the trend in drug utilization and expenditures in the Medicaid fee-for-service (FFS) program was performed using Medicaid state drug utilization data provided by Centers for Medicare and Medicaid Services (CMS) in the United States. Descriptive analyses were performed for all variables in the study. Association between prescription-drug utilization and reimbursement rate was examined using a linear regression model. Results: The results indicate that prescription-drug utilization of Medicaid FFS program decreased by 20 % during the period (2010 – 2012) as also drug expenditure during the same period. Although constituting nearly 70 % and about 75 % of the total drug utilization in 2010 and 2012, respectively, generics represent only around 18 % of the total drug expenditures. No statistically significant association was found between total expenditures and the reimbursement rate. Conclusion: FFS Medicaid drug expenditures decreased from 2010 to 2012 mainly due to a reduction in the total number of prescriptions as also the prices of generic drugs. Thus, higher utilization of generic drugs may offer substantial savings to Medicaid programs at the state level. Keywords: Fee-for-service programs, Medicaid program, Generic drug utilization; Branded drugs, Patient Protection and Affordable Care Act

Study of drug utilization pattern and adverse drug reactions of psychotropic drugs in psychiatric inpatient department of tertiary care hospital

Background: Mental disorders are now widely recognized as a major contributor to the global burden of disease. The drug use in psychiatric illness is a complex process and because of this the optimal benefits of drug therapy in patient care is not achieved. This often leads to increased cost of medical care, drug resistance, adverse effects and patient mortality. Hence, this study is undertaken to study the drug utilization pattern and adverse drug reactions of psychotropic drugs in psychiatric inpatient department of a tertiary care hospital.Methods: A prospective, observational study was undertaken from 1st February 2015 to 31st July 2016. A total of 250 prescriptions were analysed. Defined daily dose of the drugs were calculated. ADR’s were recorded in the format of the National Pharmacovigilance Programme of India (PvPI).Results: In 250 prescriptions most, common drug prescribed was antipsychotics (48.5%). Total drug utilization in terms of DDD/100 bed days was 669. The total number of adverse drug reactions observed was 8%. Antipsychotics were the most common class of psychotropic drugs causing ADR’s.Conclusions: In conclusion, it has been found that the psychotropic drugs used in our psychiatry department was rational and was based on clinical knowledge, expertise and the guidelines available in the field of psychiatric practice.

Distribution and trends in outpatient utilization of generic versus brand name psychopharmaceuticals during a ten-year period in Croatia.

BackgroundDrug costs increasingly pose a burden upon the otherwise inadequate health care resources and rational drug utilization is an important segment of every national health policy. Optimal patient care should be the goal of rational pharmacotherapy, whereby the economic burden of treatment is just one of the elements to be considered on choosing appropriate therapy.The aim of this study was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period.MethodsUsing the World Health Organization Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from pharmacies on the number and size of drug packages. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization.ResultsTotal cost for psychopharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to financial indicators decreased by 9.6% and according to DDD/1000/day by 12%. The greatest decrease was in antidepressants, i.e. by 33.8% according to financial indicators and by 46% according to DDD/1000/day; and in antipsychotics by 30.9% according to DDD/1000/day, while showing an increase by 8.5% according to financial indicators. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day, but increased by 25.1% according to financial indicators.ConclusionsThe lack of uniform national guidelines and the still strong impact of pharmaceutical industry marketing continue favoring the rise in prescribing brand name antidepressants and antipsychotics. Depression, schizophrenia and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic psychopharmaceuticals.

Drug utilization pattern in critical care unit in a tertiary care teaching hospital in India

Aims:The aim of this study is to evaluate the drug utilization pattern and pharmacoeconomic analysis in critical care unit (CCU).Materials and Methods:Indoor case papers of patients admitted in CCU between January 2008 and December 2010 were analyzed for demographic variables; indications; duration of CCU stay; proportion of common drugs used. Use of antimicrobials was evaluated based on the culture report and empirical regimen used. Defined daily dose (DDD)/100 bed-days were calculated. Various World Health Organization prescribing indicators were evaluated. Cost of drugs was calculated from Indian Drug Review (2010).Results:A total of 397 cases were evaluated with a mean age of 44.62 years (95% confidence interval [CI]: 42.56-46.69). Average duration of CCU stay was 4.15 days (95% CI: 3.79-4.51). The average number of drugs prescribed per patient was 13.54 (95% CI: 13.05-14.04). Total drug utilization in terms of DDD/100 bed-days was 226.27. Metronidazole, cefotaxime, atropine, adrenaline, dopamine, dobutamine, deriphyllin, ranitidine, metoclopramide and furosemide were prescribed in more than 30% cases. Number of antimicrobials prescribed per patient was 2.50 (95% CI: 2.37-2.66). Cefotaxime + metronidazole (26.70%) were the most common empirical regimen used. Average cost of treatment per patient was Rs 3225.70 (95% CI: 2749.8-3701.6). Higher economic burden was noted among expired patients and admitted due to medical + surgical indication (P < 0.05).Conclusion:Poly-pharmacy and use of antimicrobials without culture report is a common problem in CCU.

Prescription drug costs and the generic dispensing ratio.

The generic dispensing ratio (GDR)-the number of generic fills divided by the total number of prescriptions-is a standard performance metric on which pharmacy benefit designs and their managers are routinely evaluated. Higher GDRs are considered important because they consistently produce lower prescription drug costs. To (a) quantify the relationship between GDR and gross pharmacy expenditures and (b) distinguish pharmacy cost savings realized from brand-to-generic conversion from those due to brand drug utilization decreases. This study was a longitudinal, retrospective analysis of paid pharmacy claims and insurance eligibility information for 548 employers covering nearly 14 million members. Data were from the period January 1, 2007, through December 31, 2009, aggregated quarterly. In a linear fixed effects model controlling for plan membership demographics and time trends, percentage changes in gross pharmacy expenditures per member per quarter (PMPQ) were associated with changes in GDR. A second model estimated the association of GDR with gross pharmacy cost, holding total drug utilization constant. All claims counts were adjusted to 30-day equivalents, and expenditures were log--transformed. Mean generic claims PMPQ increased by 18.4% during the study period, from 2.01 in 2007 Q1 to 2.38 in 2009 Q4. Conversely, brand claims PMPQ decreased by 21.0%, from 1.76 in 2007 Q1 to 1.39 in 2009 Q4. As a result, mean GDR per plan increased by 9.8 percentage points or a relative change of 18.2%, from 53.9% in 2007 Q1 to 63.7% in 2009 Q4. Over the 3 years, average gross pharmacy costs PMPQ increased by 14.0% from $242 to $276. The relationship between GDR and gross pharmacy expenditures, estimated in the linear fixed effects multivariate models, varied depending upon whether or not total utilization was controlled. In the first model, which did not control for total utilization, each percentage point increase in GDR was associated with a 2.5% reduction in gross pharmacy expenditure. Holding total utilization constant, the reduction in gross pharmacy expenditure for each percentage point increase in GDR was 1.3%. Prescription drug cost savings are realized with increases in GDR. During 2007-2009, each 1 percentage point increase in GDR was associated with a drop of 2.5% in gross pharmacy expenditures. Slightly more than one-half of the savings was derived from the lower drug prices enjoyed with brand-to-generic conversions. The remaining savings, however, were attributed to reduced brand drug utilization. Pharmacy benefit managers and plan sponsors should exercise care to ensure that increases in GDR do not represent reductions in appropriate medication use.

Regional variation and adherence to guidelines for drug treatment of asthma

To describe the utilization of antiasthmatic drugs in Sweden and to explore regional variations in drug utilization and adherence to guidelines for rational drug prescribing of antiasthmatics and their rationale. Data on antiasthmatic drugs dispensed between July 2005 and December 2008 to all Swedish citizens aged between 18 and 44 years were obtained from the Swedish National Prescribed Drug Register. The period prevalence was determined by analyzing the number of users/1000 inhabitants, and the incidence by analyzing the number of new users after an 18-month drug-free wash-out period. Three drug-related indicators were used to assess the adherence to guidelines. All measures were analyzed by gender and region. A total of 161,000 patients were dispensed antiasthmatics in 2007, corresponding to a prevalence of 4 and 6% among men and women, respectively; the incidence rates were 2 and 3%, respectively. The total drug utilization and adherence to guidelines varied between regions. The total drug expenditures of antiastmatics were 258 million SEK (28 million euro), with fixed dose combinations accounting for 46% of the expenditure. No relation was found between models for allocating prescribing budgets or clear Drug and Therapeutics Committee recommendations and adherence to guidelines. There are large regional variations in the utilization of antiasthmatics between Swedish regions, with substantial room for improvement in the adherence to guidelines. New methods of influencing physician behavior may be needed in the future to enhance adherence.

Outpatient utilization of drugs acting on nervous system: a study from the Republic of Srpska, Bosnia &amp; Herzegovina

The aim of this study was to analyse the utilization patterns of drugs acting on the nervous system in the Republic of Srpska, Bosnia & Herzegovina between 2002 and 2008. This was a retrospective study aimed at analysing outpatient utilization of drugs reimbursed by the Health Insurance Fund, with a focus on the utilization of drugs acting on the nervous system. Anatomical therapeutic chemical/defined daily dose methodology was used to monitor drug utilization, and the drug utilization 90% (DU90%) method was used to assess drug prescribing. The most highly used drug subgroups were psycholeptics and antiepileptics followed by the psychoanaleptics. Anxyolitics comprised the most prescribed pharmacological subgroup over the whole study period, but a decrease was observed in 2007 and 2008. Following updating of the list with selective serotonin re-uptake inhibitor drugs, particularly sertraline, antidepressant use increased fivefold in 2008 compared to 2006. Tramadol was the predominant opioid analgesics in terms of utilization, while the use of oral morphine was low. Diazepam was the most highly prescribed drug, followed by phenobarbital and carbamazepine. The list update with the new generation drugs was immediately reflected in the DU90% profile. The observed tendency toward increased total drug utilization observed in our study is comparable to worldwide trends. Implementation of new clinical guidelines for nervous diseases and updating of the list of reimbursable drugs with the addition of new ones contributed to the observed improvement in prescribing patterns in primary healthcare during the study period. The DU90% is shown to be a simple rough method for assessing prescribing quality. More stratified analyses should be performed on a routine basis to ensure a rational use of medicines and a cost-efficient use of limited healthcare resources.

Economic burden of psoriasis compared to the general population and stratified by disease severity

Objective:To evaluate health care utilization and costs for patients with psoriasis vs. the general population and by psoriasis severity.Research design and methods:Claims data were analyzed for adult patients with ≥1 diagnosis of psoriasis and continuous enrollment during the year of 2003 (case sample). A control sample was matched 2:1 on baseline demographic characteristics to the case sample. Case samples were further stratified by psoriasis severity based on treatment patterns. Outcomes were compared descriptively and by a multivariate two-part model to evaluate differences between the case vs. control groups and by psoriasis severity.Main outcome measures:Outcomes included health care resource utilization and health care costs.Results:A total of 56,528 patients with psoriasis met the inclusion criteria. Patients with psoriasis had significantly greater total health care resource utilization, total medical resource utilization, and total drug utilization vs. the control sample (p < 0.0001). Compared with control patients, patients with psoriasis had significantly greater total health care costs ($5529 vs. $3509), including greater medical costs ($3925 vs. $2687) and drug costs ($1604 vs. $822; all p < 0.0001). Patients with moderate to severe psoriasis (n = 5248) had greater total health care costs vs. patients with mild psoriasis (n = 51,280) ($10,593 vs. $5011), including greater medical costs ($5854 vs. $3728) and drug costs ($4738 vs. $1283; all p < 0.0001). Multivariate analyses confirmed the increased utilization and costs in all comparisons.Limitations:The study limitations included limited generalizability of the findings beyond the study population, classification of disease severity based on treatment instead of clinical measures, and exclusion of out-of-pocket costs and indirect costs in the study.Conclusions:Patients with psoriasis incur greater health care resource utilization and costs compared with the general population. Psoriasis severity is positively associated with increased health care resource utilization and costs.

Patient‐controlled epidural analgesia in labor does not always improve maternal satisfaction

We investigated whether patient-controlled epidural analgesia in labor with bupivacaine and fentanyl provides more satisfaction to mothers than intermittent bolus epidural analgesia or patient-controlled epidural analgesia with plain bupivacaine. Ninety mothers with term, uncomplicated pregnancies were randomized to receive intermittent bolus epidural analgesia (bupivacaine + fentanyl), patient-controlled epidural analgesia (bupivacaine + fentanyl), or patient-controlled epidural analgesia (bupivacaine). Pain during labor was evaluated with a visual analog scale. Obstetric and neonatal outcomes were recorded. After delivery, the mothers were given a questionnaire covering the following themes: experience of labor pain, feeling of control, fears and expectations associated with pregnancy/with delivery/with becoming a mother, as well as pain, physical condition and emotions after delivery. To elaborate on these answers, 30 mothers were further randomized to a semistructured interview, in which the same topics were discussed. The main outcome measure was maternal satisfaction. The intermittent bolus epidural analgesia group felt they could influence labor most (p = 0.03), and in the interview they expressed most satisfaction. In this group, the total drug utilization was smallest (bupivacaine: p <0.0001 comparing all groups, fentanyl: p = 0.03 comparing the two fentanyl-receiving groups). No differences in pain occurred. Vomiting (p = 0.04) and pruritus (p <0.0001) were more common or more severe in the groups receiving fentanyl. We found no advantages for patient-controlled epidural analgesia over intermittent bolus epidural analgesia in terms of maternal satisfaction.

Prevalence of drug utilization in the adult population of Catalonia, Spain

OBJECTIVES To describe the prevalence of drug utilization according to sociodemographic factors and self-perceived health in the adult population. METHODS Cross-sectional health survey of the CRONICAT/MONICA-Catalonia study carried out in 1994-96 in a random sample of the general population aged 25-64 years. A total of 3,421 participants (72% response rate) were interviewed about drug consumption in the previous two weeks with an open questionnaire. The participants were also asked about other health habits. Drugs were subsequently classified according to the ATC classification (1993 version). RESULTS A higher proportion of women (38%) than men (26%) self-perceived poor health status (p < 0.001). Age-adjusted total drug utilization was 57% in men (95%CI: 55-59) and 76% in women (95%CI: 74-78). Excluding contraceptives, regular drug utilization was 35% in men (95%CI: 33-37) and 48% in women (95%CI: 46-51). Twenty-nine percent of men and 48% of women (p < 0.001) took more than one drug. Neither educational level nor marital status influenced drug utilization. Among men, drug consumption was higher in retired individuals and pensioners (68%; 95%CI: 62-74) than in active workers (54%; 95%CI: 52-57). The most frequently used drugs were those for the nervous system (35% men and 51% women; p < 0.001), alimentary tract (15%) and the cardiovascular system (9% and 13%; p < 0.001). Most drugs (40%) were prescribed by specialists and one quarter was self-prescribed. CONCLUSIONS The prevalence of total drug utilization in the adult population of Catalonia is high, specially among women, who self-perceived worse health status. Policies of rationalization of drug expenditures should take the epidemiological pattern into account.

Prescription duration after drug copay changes in older people: methodological aspects.

Impact assessment of drug benefits policies is a growing field of research that is increasingly relevant to health care planning for older people. Some cost-containment policies are thought to increase noncompliance. This paper examines mechanisms that can produce spurious reductions in drug utilization measures after drug policy changes when relying on pharmacy dispensing data. Reference pricing, a copayment for expensive medications above a fixed limit, for angiotensin-converting enzyme(ACE) inhibitors in older British Columbia residents, is used as a case example. Time series of 36 months of individual claims data. Longitudinal data analysis, adjusting for autoregressive data. Pharmacare, the drug benefits program covering all patients aged 65 and older in the province of British Columbia, Canada. All noninstitutionalized Pharmacare beneficiaries aged 65 and older who used ACE inhibitors between 1995 and 1997 (N = 119,074). The introduction of reference drug pricing for ACE inhibitors for patients aged 65 and older. Timing and quantity of drug use from a claims database. We observed a transitional sharp decline of 110% t a standard error of 30% (P = .02) in the overall utilization rate of all ACE inhibitors after the policy implementation; five months later, utilization rates had increased, but remained under the predicted prepolicy trend. Coinciding with the sharp decrease, we observed a reduction in prescription duration by 31% in patients switching to no-cost drugs. This reduction may be attributed to increased monitoring for intolerance or treatment failure in switchers, which in turn led to a spurious reduction in total drug utilization. We ruled out the extension of medication use over the prescribed duration through reduced daily doses (prescription stretching) by a quantity-adjusted analysis of prescription duration. The analysis of prescription duration after drug policy interventions may provide alternative explanations to apparent short-term reductions in drug utilization and adds important insights to time trend analyses of drug utilization data in the evaluation of drug benefit policy changes.

Prevalencia del consumo de medicamentos en la población adulta de Cataluña

To describe the prevalence of drug utilization according to sociodemographic factors and self-perceived health in the adult population. Cross-sectional health survey of the CRONICAT/MONICA-Catalonia study carried out in 1994-96 in a random sample of the general population aged 25-64 years. A total of 3,421 participants (72% response rate) were interviewed about drug consumption in the previous two weeks with an open questionnaire. The participants were also asked about other health habits. Drugs were subsequently classified according to the ATC classification (1993 version). A higher proportion of women (38%) than men (26%) self-perceived poor health status (p < 0.001). Age-adjusted total drug utilization was 57% in men (95%CI: 55-59) and 76% in women (95%CI: 74-78). Excluding contraceptives, regular drug utilization was 35% in men (95%CI: 33-37) and 48% in women (95%CI: 46-51). Twenty-nine percent of men and 48% of women (p < 0.001) took more than one drug. Neither educational level nor marital status influenced drug utilization. Among men, drug consumption was higher in retired individuals and pensioners (68%; 95%CI: 62-74) than in active workers (54%; 95%CI: 52-57). The most frequently used drugs were those for the nervous system (35% men and 51% women; p < 0.001), alimentary tract (15%) and the cardiovascular system (9% and 13%; p < 0.001). Most drugs (40%) were prescribed by specialists and one quarter was self-prescribed. The prevalence of total drug utilization in the adult population of Catalonia is high, specially among women, who self-perceived worse health status. Policies of rationalization of drug expenditures should take the epidemiological pattern into account.