Use of the Health
Insurance Company Database for Investigation of the Exposure to Hypolipidaemics
Vlček J.1, Kočová M.1, Kučera Z.1, Macek K.2, Vitásek Z.3, Ulmanová D.3
1Katedra sociální a klinické farmacie UK, Farmaceutická fakulta, Hradec Králové, vedoucí doc. RNDr. Jiří Vlček, CSc. 2I. interní klinika FN, Hradec Králové, přednosta doc. MUDr.Miloslav Pleskot, CSc. 3Zaměstnanecká pojišťovna Škoda, Mladá Boleslav, ředitelka ing. Darina Ulmanová |
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Summary:
Objective: The objective of the investigation was to analyze theoretical exposures to hypolipidaemics
in patients treated chronically with these drugs, using the database of the health insurance
company.
Investigated group: From the database (with information on age, sex of the insured person, the
number of packeges and the type of hypolipidemic and year of issue of the prescription) of
subjects insured at the Employees Health Insurance Škoda Mladá Boleslav comprisingsom e 100
000 insured subjects in 1994 - 2000. Patients with long-term (more than one year) hypolipidaemic
treatment were selected in years from 1995 to 1999. The group increased every year. In 1995 it
comprised 668 cases in 1999 2396 subjects.
Method: The consumption of hypolipidaemics was expressed in defined daily doses (DDD). The
authors investigated the ratio of chronically treated patients and the proportion of the following
groups of patients according to their annual consumption in 1995 - 1999:group of of drug "vacation"
(0 DDD) and the group with a low (<121.7 DDD ), medium (< 243.3 & > 121.7 DDD) and optimal
(> 243.3 DDD) consumption of hypolipidaemics and their relationship to sex and age. For statistical
ealuation software SPSS 10.1 was used.
Results: In the course of the investigation among the insured subjects the statin consumption
increased 76times and the consumption of fibrates 5times. The ratio of consumption of resin
derivatives and of nicotinic acid was negligible. The size of the group of subjects treated with
hypolipidaemics for longer than one year increased from 0.8 % in 1995 to 2.2 % of the database.
The average age increased from 55 to 59 years. The ratio of seniors (> 65 years) increased in the
course of the investigation and reached 33 % in 1999 of all members of the investigated group. The mean annual consumption of hypolipidaemics increased significantly as compared with 1995 and
the interannual increase as compared with the previous year was statistically significant in 1997
and 1999. In 1999 it was 237 DDD/per consumer. A lower consumption was recorded in women
and in seniors. Drug"vaca tions" were recorded in 6 % of the insured subjects of the group and the
frequency did not change significantly in the course of the investigation and no relationship with
age and sex was found. A low exposure according to DDD was found in 20 %, medium exposure in
about 40 % and optimal exposure in only one third of the subjects of the investigated group.
Conclusion: The authors developed a method which makes it possible, when individual data of the
health insurance company are available, to investigate the theoretical exposure to hypolipidaemics
in insured subjects treated on a long-term basis with these drugs. The authors provided
evidence that analysis of the database of the health insurance company can provide certain
signals for further pharmacoepidemiological research and for application in a defined medical
discipline. Some of the insured subjects are exposed to smaller doses than theoretically assumed.
It is necessary to extend the investigation so that the results will better reflect the population of
patients and prescribingphys icians. Complete evaluation of cases with a low exposure from the
aspect ofmorbidity and drugcomp liance will be also essential.
Key words:
Hypolipdaemics - Consumption of medicaments - Drugdata base - Health insurance
company
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