Pharmacotherapeutic profile of users and expenditure on high-cost drugs in São Leopoldo, Rio Grande do Sul State, Brazil, 2014*

Sopelsa, Mariani; Motter, Fabiane Raquel; Barcellos, Nêmora Tregnago; Leite, Heloísa Marquardt; Paniz, Vera Maria Vieira

doi:10.5123/S1679-49742017000400008

person Mariani Sopelsa

schoolUniversidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo-RS, Brasil

person Fabiane Raquel Motter

schoolUniversidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo-RS, Brasil

person Nêmora Tregnago Barcellos

schoolUniversidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo-RS, Brasil

person Heloísa Marquardt Leite

schoolUniversidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo-RS, Brasil

person Vera Maria Vieira Paniz

schoolUniversidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo-RS, Brasil

Correspondence: Vera Maria Vieira Paniz
- Universidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, Av. Unisinos, No. 950, Cristo Rei, São Leopoldo-RS, Brasil CEP: 93022-000. E-mail:
vpvieira@terra.com.br

Sopelsa M reviewed the literature, developed this project, organized the database, and worked on the analysis and interpretation of data and on writing this manuscript. Motter FR contributed to the database organization and analyses. Barcellos NT and Leite HM contributed to the critical review and writing of this manuscript. Paniz VMV participated in all stages of this project, from the analysis and interpretation of data to its final writing. All authors reviewed and approved the final version of this manuscript and declared to be responsible for all aspects of this study, ensuring its accuracy and integrity.

	Users of Specialized Component drugs, by sex
ICD-10 chapters ^a	Total: 1,528		Females: 866		Males: 662		p-value ^c
	%	95%CI^b	%	95%CI^b	%	95%CI^b
I Certain infectious and parasitic diseases	8.4	7.0;9.8	6.4	4.7;8.0	11.2	8.8;13.6	0.001
II Neoplasms	0.1	0.1;0.3	0.1	0.1;0.3	0.2	0.1;0.5	0.849
III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism	0.9	0.4;1.3	1.4	0.6;2.2	0.2	0.1;0.4	0.009
IV Endocrine, nutritional and metabolic diseases	11.6	10.0;13.2	11.2	9.1;13.3	12.1	9.6;14.6	0.593
V Mental and behavioural disorders	6.6	5.4;7.9	3.8	2.5;5.1	10.3	8.0;12.6	<0.001
VI Diseases of the nervous system	9.2	7.8;10.7	8.9	7.0;10.8	9.7	7.4;11.9	0.603
VII Diseases of the eye and adnexa	0.1	0.1;0.2	0.1	0.1;0.3	0.0	-	0.382
IX Diseases of the circulatory system	0.7	0.2. 1.1	0.8	0.2. 1.4	0.5	0.1;1.0	0.394
X Diseases of the respiratory system	18.7	16.7;20.6	19.5	16.9;22.2	17.5	14.6;20.4	0.322
XI Diseases of the digestive system	6.1	4.9;7.3	6.1	4.5;7.7	6.0	4.2;7.9	0.950
XII Diseases of the skin and subcutaneous tissue	0.8	0.3;1.2	0.6	0.1;1.1	1.1	0.3;1.8	0.292
XIII Diseases of the musculoskeletal system and connective tissue	17.3	15.4;19.2	24.1	21.3;27.0	8.5	6.3;10.6	<0.001
XIV Diseases of the genitourinary system	12.4	10.7;14.0	10.3	8.3;12.3	15.1	12.4;17.8	0.004
XVII Congenital malformations, deformations and chromosomal abnormalities	0.2	0.0;0.4	0.4	0.0;0.7	0.0	-	0.130
XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	1.3	0.7;1.9	1.5	0.7;2.3	1.1	0.3;1.8	0.449
XIX Injury, poisoning and certain other consequences of external causes	0.2	0.0;0.4	0.2	0.1;0.6	0.2	0.1;0.4	0.727
XXI Factors influencing health status and contact with health services	10.5	9.0;12.1	9.4	7.4;11.3	12.1	9.6;14.6	0.085

	Users of Specialized Component drugs, by age group (in years)
ICD-10 chapters^a	0 to 19: 95		20 to 39: 273		40 to 59: 582		60 or more: 578		p-value
	%	95%CI^b	%	95%CI^b	%	95%CI^b	%	95%CI^b
I Certain infectious and parasitic diseases	0.0	-	10.3	6.6;13.9	12.4	9.7;15.1	5.0	3.2;6.8	<0.001 ^c
II Neoplasms	0.0	-	0.0	-	0.2	0.2;0.5	0.2	0.2;0.5	n.a.^d
III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism	3.2	0.4;6.7	1.5	0.0;2.9	0.5	0.1;1.1	0.5	0.1;1.1	0.013 ^e
IV Endocrine, nutritional and metabolic diseases	24.2	15.4;33.0	10.6	6.9;14.3	10.0	7.5;12.4	11.6	9.0;14.2	0.001 ^c
V Mental and behavioural disorders	14.7	7.5;22.0	15.4	11.1;19.7	4.8	3.1;6.6	2.9	1.6;4.3	<0.001 ^e
VI Diseases of the nervous system	14.7	7.5;22.0	11.0	7.3;14.7	4.1	2.5;5.7	12.6	9.9;15.3	<0.001 ^c
VII Diseases of the eye and adnexa	0.0	-	0.0	-	0.2	0.2;0.5	0.0	-	n.a.^d
IX Diseases of the circulatory system	0.0	-	0.4	0.4;1.1	0.7	0.0;1.4	0.9	0.1;1.6	0.250 ^e
X Diseases of the respiratory system	16.8	9.2;24.5	6.2	3.3;9.1	14.8	11.9;17.7	28.7	25.0;32.4	<0.001 ^e
XI Diseases of the digestive system	4.2	0.1;8.3	13.9	9.8;18.1	6.4	4.4;8.3	2.4	1.2;3.7	<0.001 ^e
XII Diseases of the skin and subcutaneous tissue	4.2	0.1;8.3	0.7	0.3;1.8	0.5	0.1;1.1	0.5	0.1;1.1	0.010 ^e
XIII Diseases of the musculoskeletal system and connective tissue	4.2	0.1;8.3	13.2	9.1;17.2	23.9	20.4;27.4	14.9	12.0;17.8	<0.001 ^c
XIV Diseases of the genitourinary system	8.4	2.7;14.1	9.5	6.0;13.0	13.1	10.3;15.8	13.7	10.9;16.5	0.048 ^e
XVII Congenital malformations, deformations and chromosomal abnormalities	3.2	0.4. 6.7	0.0	-	0.0	-	0.0	-	n.a.^d
XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	0.0	-	1.1	1.5;2.3	1.7	0.7;2.8	1.2	0.3;2.1	0.530 ^e
XIX Injury, poisoning and certain other consequences of external causes	1.1	1.0;3.1	0.0	-	0.2	0.2;0.5	0.2	0.2;0.5	0.428 ^e
XXI Factors influencing health status and contact with health services	5.3	0.7;9.8	12.8	8.8;16.8	10.8	8.3;13.4	10.0	7.6;12.5	0.934 ^e

	Users of Specialized Component drugs, by sex
ICD-10^a diagnoses	Total: 1,528		Females: 866		Males: 662		p-value ^c
	%	95%CI^b	%	95%CI^b	%	95%CI^b
Predominantly allergic asthma	17.1	15.2;19.0	18.1	15.6;20.7	15.7	12.9;18.5	0.213
Chronic kidney disease stage 5	11.5	9.9;13.1	9.1	7.2;11.0	14.5	11.8;17.2	0.001
Kidney transplant status	7.6	6.3;8.9	7.2	5.4;8.9	8.2	6.1;10.2	0.466
Chronic viral hepatitis C	6.0	4.8;7.1	4.5	3.1;5.9	7.9	5.8;9.9	0.006
Other seropositive rheumatoid arthritis	5.1	4.0;6.2	7.5	5.7;9.3	2.0	0.9;3.0	<0.001
Paranoid schizophrenia	4.7	3.6;5.7	2.2	1.2;3.2	7.9	5.8;9.9	<0.001
Seronegative rheumatoid arthritis	3.3	2.4;4.2	5.2	3.7;6.7	0.9	0.2;1.6	<0.001
Pure hypercholesterolemia	3.2	2.3;4.1	2.7	1.6;3.7	3.9	2.4;5.4	0.162
Ankylosing spondylitis	2.8	1.9;3.6	2.7	1.6;3.7	2.9	1.6;4.1	0.800
Chronic viral hepatitis B without delta-agent	2.4	1.6;3.2	1.9	0.9;2.7	3.2	1.8;4.5	0.095
Parkinson disease	2.2	1.5;3.0	1.6	0.8;2.5	3.0	1.7;4.3	0.065
Hyperprolactinemia	2.1	1.4;2.8	2.8	1.7;3.9	1.2	0.4;2.0	0.035
Liver transplant status	2.0	1.3;2.7	1.4	0.6;2.2	2.9	1.6;4.1	0.041
Systemic lupus erythematous with organ or system involvement	1.9	1.2;2.6	2.9	1.8;4.0	0.6	0.0;1.2	0.001
Alzheimer disease with late onset	1.7	1.1;2.4	1.6	0.8;2.5	1.8	0.8;2.8	0.769
Other diagnoses ^d	31.7	29.3;34.0	34.0	30.8;37.1	28.8	25.2;32.2	0.029

	Users of Specialized Component drugs, by age group (in years)
ICD-10 ^a diagnoses	0 to 19: 95		20 to 39: 273		40 to 59: 582		60 or more: 578		p-value
	%	95%CI^b	%	95%CI^b	%	95%CI^b	%	95%CI^b
Predominantly allergic asthma	14.7	7.5; 22.0	6.2	3.3;9.1	14.1	11.3;17.0	25.6	22.0;29.2	<0.001 ^c
Chronic kidney disease stage 5	3.2	0.4;6.7	8.4	5.1;11.7	12.4	9.7;15.1	13.3	10.5;16.1	0.002 ^c
Kidney transplant status	4.2	0.1;8.3	11.4	7.6;15.1	8.3	6.0;10.5	5.7	3.8;7.6	0.016 ^d
Chronic viral hepatitis C	0.0	-	7.0	3.9;10.0	8.8	6.5;11.1	3.6	2.1;5.2	<0.001 ^d
Other seropositive rheumatoid arthritis	0.0	-	0.7	0.3;1.8	7.9	5.7;10.1	5.2	3.4;7.0	<0.001 ^d
Paranoid schizophrenia	9.5	3.5;15.5	11.7	7.9;15.6	3.3	1.8;4.7	1.9	0.8;3.0	<0.001 ^c
Seronegative rheumatoid arthritis	0.0	-	2.2	0.4;3.9	5.0	3.2;6.8	2.8	1.4;4.1	0.020 ^d
Pure hypercholesterolemia	0.0	-	0.0	-	1.6	0.5;2.6	6.9	4.8;9.0	<0.001 ^c
Ankylosing spondylitis	0.0	-	4.0	1.7;6.4	4.5	2.8;6.2	0.9	0.1;1.6	<0.001 ^d
Chronic viral hepatitis B without delta-agent	0.0	-	3.3	1.2;5.4	3.4	2.0;4.9	1.4	0.4;2.3	0.038 ^d
Parkinson disease	0.0	-	0.4	0.4;1.1	0.9	0.1;1.6	4.8	3.1;6.6	<0.001 ^c
Hyperprolactinemia	0.0	-	4.8	2.2;7.3	2.8	1.4;4.1	0.5	0.1;1.1	0.013 ^c
Liver transplant status	1.1	1.0;3.1	0.4	0.4;1.1	2.1	0.9;3.2	2.9	1.6;4.3	0.018 ^c
Systemic lupus erythematous with organ or system involvement	1.1	1.0;3.1	2.6	0.7;4.5	2.2	1.0;3.4	1.4	0.4;2.3	0.505 ^c
Alzheimer disease with late onset	0.0	-	0.0	-	0.0	-	4.5	2.8;6.2	n.a.^e
Other diagnoses ^f	70.5	61.2;79.9	42.1	36.2;48.2	28.0	24.3;31.7	24.1	20.6;27.5	<0.001 ^c

Drugs	N	Average monthly expense per person	Total monthly expense
	N	(BRL)	(BRL)
The most prevalent drugs
1 Budesonide+formoterol fumarate 12 / 400 mcg CAP INHA	280	44.33	12,411.77
2 Epoetin alfa 4,000 IU INJ	175	216.70	37,922.34
3 Iron hydroxide saccharate 100 mg INJ	129	15.60	2,012.40
4 Azathioprine 50 mg TAB	100	12.78	1,278.00
5 Tacrolimus 1 mg CAP	91	368.98	33,576.90
6 Ribavirin 250 mg TAB	88	18.09	1,591.52
7 Calcitriol 1 mcg INJ	85	168.96	14,361.48
8 Sodium mycophenolate 360 mg TAB	80	384.20	30,735.90
9 Leflunomide 20 mg TAB	73	138.60	10,117.80
10 Methotrexate 2.5 mg TAB	59	11.61	685.52
Total monthly expense with the ten most prevalent drugs			144.693,63
The most expensive drugs
1 Infliximab 10 mg/ml INJ	14	5,178.81	72,503.28
2 Human immunoglobulin 5 g INJ	3	4,923.96	14,771.88
3 Octreotide Acetate LAR 30 mg/ml INJ	2	4,075.76	8,151.52
4 Octreotide Acetate LAR 20 mg/ml INJ	3	3,019.09	9,057.27
5 Dornase alpha 2.5 mg INHA SOL	8	2,607.90	20,863.20
6 Rituximab 500 mg INJ	10	2,461.81	24,618.10
7 Interferon beta-1b 9,600,000 IU (300 mcg) INJ	2	2,061.90	4,123.80
8 Interferon beta-1a 12,000 IU (44 mcg) INJ	8	1,977.48	15,819.84
9 Interferon beta-1a 6,000 IU (30 mcg) INJ	4	1,856.08	7,424.32
10 Glatiramer acetate 20 mg INJ	7	1,790.00	12,530.00
Total monthly expense with the ten most expensive drugs			189.863,21

[TFN20] a) ICD-10: International Statistical Classification of Diseases and Related Health Problems - 10th Revision.

[TFN21] b) 95%CI: 95% confidence interval.

[TFN22] c) p-value from a chi-squared test for heterogeneity of proportions.