Post on 11-Jan-2016
description
Prescription Patterns
Fernán Caballero FonsecaCaracas, Venezuela
December 2011
Prescriptions patterns and outcomes
• Asthma prevalence• Epidemiology of asthma control• Worldwide patterns of prescriptions• Changes in prescription patterns in
Latin-America and outcomes• Conclusions
Worldwide asthma prevalence
Perú 13.0Costa Rica 11.9Brasil 11.4USA 10.9Inglaterra 15.3
Colombia 7.4Argentina 5.5Chile 5.1México 3.3
Global Burden of Asthma, 2004
10.1
5.1-7.5
0-2.5
No standardised data available
2.5-5.0
7.6-10.0
Global prevalence of asthma (world health survey)
To et al. Submitted, 2011
< 50%
50-80 %
81-95 %
> 95 %
Access to essentials drugs for asthma treatment
Global Burden of Asthma, 2004
Citi 6 – 7 y/o 13 – 14 y/o
Asthma Rhinitis Dermatitis Asthma RhinitisDermatiti
s
VERACRUZ 13.3
MERIDA 12.6 36.5 8.3 13 40.8 3.4
CD VICTORIA 8.5 21.0 2.1 14.4 34.9 4.8
DF NORTE 6.8 42.1 9.9 29.4
DF SURESTE 3.6 46.6 3.8 29.6
DF CENTRO 8.9 56.6 9.9 35.1
TIJUANA 8.0 24.5 0.7 8.6 28.1 2.0
MONTERREY 5.8 7.1 3.1 7.2 4.8 1.6
Prevalence of asthma, rhinitis and dermatitis in children
in different cities in México
ISAAC, 2003
ISAAC fase III Venezuela
Wheezing prevalence in 6 and 14 y/o 6-7 y/o 13-14 y/o
32 %3530
Wheezing in the last 12 months (persistent asthma)
18
Intermitent asthma 14
Night awakenings 13
Speech impairment (severity) 8
Exercise induce wheezing 20
Dry nocturnal cought not associated with colds.
37
International Study for Asthma and Allergies in Children. Aldrey O et al. RSVAAI 2004
Vital Signs: Asthma prevalence, disease
characteristics, and self-management education
United States, 2001-2009
CDC Morbiditiy and Mortality Weekly Reports (MMWR) 2011, 60 (17); 547-552
Prevalence of current asthma* among children and adults,† by selected characteristics
Characteristic
Total (N = 38,815) Children (n = 11,129) Adults (n = 27,686)
No. in sample
(%§) (95% CI)§No. in
sample(%§) (95% CI)§
No. in sample
(%§) (95% CI)§
Total 38,815 (8.2) (7.8--8.6) 11,129 (9.6) (8.9--10.4) 27,686 (7.7) (7.3--8.1)
Poverty threshold**
Poor 6,898 (11.6) (10.6--12.7) 2,307 (13.5 ) (11.6--15.5) 4,591 (10.6)(9.5--11.7)
Near poor 8,293 (8.5) (7.8--9.4) 2,595 (9.5 ) (7.9--11.3) 5,698 (8.1) (7.3--9.1)
Not poor 23,624 (7.3) (6.9--7.8) 6,227 (8.3) (7.5--9.1) 17,397 (7.0) (6.6--7.6)
Abbreviation: CI = confidence interval.*Includes persons who answered "yes" to the questions: "Have you ever been told by a doctor or other health professional that [you/your child] had asthma?" and "Do [you/your child] still have asthma?" † Children aged <18 years; adults aged ≥18 years.§ Weighted estimates.** Poor = household income below the federal poverty level (FPL), near poor = 100% to <200% of the FPL, and nonpoor = ≥200% of the FPL.
National Health Interview Survey, United States, 2009
Children
4 - 11 years
Adolescents 12 - 17
years
% Of NWCA 30.5 % 24.4 %
Allergic Rhinitis 54 - 55 % 54 -55 %
Eczema 18.6 % 10.1 %
Oral Corticosteroid Use 38.3 % 26.9 %
Emergency Use 37.1 % 24.1 %
Hospitalitations 6.0 % 1.9 %
A national survey to assess asthma control in the US pediatric population
R.H. Standford et al.American Thoracic Society (ATS). ATS,Toronto, Canada May 16-21, 2008
Background: The 2007 NHLBI Asthma Guidelines Propose asthma control as a goal of therapy.
Objetive: To measure the level of not well controlled asthma (NWCA) in children aged 4-11 and 12-17 yrs and associated demographics and comorbidities (159.872 US households)
CharacteristicTotal (N = 2,421) Children (n = 806) Adults (n = 1,615)
No. (%§) (95% CI)§ No. (%§) (95% CI)§ No. (%§) (95% CI)§
Prescription asthma medicine useQuick-relief inhaler during
preceding 3 mos2,421 (64.4) (62.1--66.7) 806 (59.4) (54.9--63.7) 1,615 (66.6) (63.8--69.2)
Long-term control medicine (oral or inhaler) at the time
of survey2,421 (33.5) (31.1--35.9) 806 (31.3) (27.5--35.3) 1,615 (34.4) (31.6--37.4)
Disease characteristics and self-management education
status among children and adults* with current asthma†
Abbreviation: CI = confidence interval; ED/UC = emergency department/urgent care.* Children aged <18 years; adults aged ≥18 years. † Includes persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that [you/your child] had asthma?" and "Do [you/your child] still have asthma?" § Weighted estimates.¶ Related questions were asked among persons who had an asthma attack during the previous 12 months.
National Health Interview Survey, United States, 2008
J ALLERGY CLIN IMMUNOL AUGUST 2011
Base: all respondents (n=3,415)
SABA use (inhalations/day in the last week)
Patients (%)
Nu
mb
er
of
inh
ala
tion
s/d
ay
26%
38%
21%
11%
Partridge MR, BMC Pulmonary Medicine 2006
Despite ICS or ICS/LABA therapy, 74% of patients used rescue therapy each day
Patterns of asthma controler prescribing for pediatric asthma
patients in UK primary care
M. Thomas et al.BMC Pulmonary Medicine 2010
Persistent underuse of asthma medication in a large health plan
Savwicki R et all. ATS 2009
Patients hospitalized due to asthma
Rodrigo et al. J Bras Pneumologia 2009
Asthma drugs sales in Mexico
Antiasthmatic drug sales in Argentina, 1990-1999
Neffen H. ACI International, 1999:11(5)171-175
Asthma mortality vs. inhaled steroids sales Argentina, 80s-90s
Mortality Rate Rho Spearman 5-34
0.72 0.38 - 0.84 (p = 0.003)
3.38 2.58 - 0.81 (p = 0.005)
Global
Pediatric prescriptions for asthma in Venezuela
QTR~12/2000
QTR~03/2001
QTR~06/2001
QTR~09/2001
K
LA
S
V
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IN
FLIX
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P
ULM
ICO
RT
S
ER
ETID
E
0
100
200
300
400
500
600
700
800
900
Pediatric prescriptions for asthma in Venezuela
Num
ber
of
pre
scri
pti
ons
INTE 2006
E sist
émic
o
B 2 o
ral
B 2 A
C+E
B 2 in
h
Expe
ctor
ante
s
E in
h
AntiL
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
Pediatric prescriptions for asthma in Venezuela
INTE 2006
0,0
2,0
4,0
6,0
8,0
10,0
12,0
Sh
are
en
Dó
lare
s
SERETIDE GSK FORADIL/MIFLONIDE NVR SYMBICORT AZN SPIRIVA B_I FORADIL NVR VANNAIR AZN MIFLONIDE NVR FORACORT PG4 FORMOTEC PG4 SYMBICORT + VANNAIR
Seretide is the market leader with negative perforamance over thepast years in Venezuela
IMS – PMV Diciembre 2009
Foradil/Miflonide and Symbicort + Vannair show a positive trend Spiriva after three year of growth lost market share in 2009
Asthma drugs sales in Venezuela
Upon closer look on the respiratory market in Venezuela
IMS – PMV Diciembre 2009
Comb (LABAs+ICS) represent 37% of usage, while LABAs have 18% and LAMAs 12%
Pediatric prescriptions for asthma in
Caracas, Venezuela
Leon. M, Ortega. E, Sanchez-Aguilar. M, Sanchez-Borges M, Caballero-Fonseca F, Cedraro S. Interasma 2009
N=121: 2-12 years 73 (63.6%) uncontrolled 33 (27.33%) p. controlled 11 (9.1%) controlled
Pediatric prescriptions for asthma in
Caracas, Venezuela
Inhaled corticosteroids Bronchodilator + Inhaled
corticosteroids
Leon. M, Ortega. E, Sanchez-Aguilar. M, Sanchez-Borges M, Caballero-Fonseca F, Cedraro S. Interasma 2009
Salvador
Hosp
italiz
ati
on r
ate
s/10.0
00 inhabit
ants
Reduction in hospitalizations due to asthma in Brazil
Souza-Machado et al. ERJ 2009
Recife
Hosp
italiz
ati
on r
ate
s/10.0
00 inhabit
ants
● Asthma prevalence in developing countries may
be higher than in the developed world
o Lack of access to proper care and medication
o Poor compliance
● There is an urgent need for the implementation
of better strategies for asthma control among
the underserved populations
Mario Sánchez-Borges, MD, Arnaldo Capriles-Hulett, MD, and Fernan Caballero-Fonseca, MD. Journal of WAO 2011
Asthma care in resource-poor settings
Conclusions
● The prevalence of asthma is variable world wide
● We need to improve adherence to guidelines both in Latin America and in more developed countries
● We are in urgent need of more “friendly” guidelines
● We need to disseminate guidelines to improve morbidity from asthma
● Change in prescription patterns has a positive impact in asthma morbidity