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

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 26 (4) • Oct-Dec 2017 • https://doi.org/10.5123/S1679-49742017000400008 copy

Pharmacotherapeutic profile of users and expenditure on high-cost drugs in São Leopoldo, Rio Grande do Sul State, Brazil, 2014^* * Manuscript based on Mariani Sopelsa’s Master’s thesis, entitled ‘Profile of users of the Specialized Program for Pharmaceutical Assistance drugs in the municipality of São Leopoldo, RS’, presented to the Post Graduate Program in Public Health of the Vale do Rio dos Sinos University (UNISINOS), São Leopoldo-RS, in 2015.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE:

to describe the pharmacotherapeutic profile of users of the Specialized Program for Pharmaceutical Assistance, and to measure the expenditure on the most prevalent and the most expensive medications.

METHODS:

descriptive study conducted in São Leopoldo-RS, Brazil, with secondary data regarding information about requests accepted in 2014, through administrative proceedings; delivery notes of the State Health Department/RS were used to assess the costs.

RESULTS:

1,528 users were included in the study, mostly women (56.7%), and the average age was 52 years (standard deviation=17.9); the most frequent diagnoses were allergic asthma (17.1%), chronic kidney disease (11.5%) and rheumatoid arthritis (8.4%); the most prevalent drug was budesonide+formoterol fumarate (18.3%); among the most prevalent drugs, the highest total monthly expense was with epoetin alfa (BRL37,922.34) and among the most expensive drugs, infliximab (BRL72,503.28).

CONCLUSION:

the data show the importance of the Specialized Program for Pharmaceutical Assistance in the high-cost treatment of highly prevalent.

Keywords:
Drug Utilization; Drug Costs; Chronic Disease; Pharmaceutical Services; Epidemiology, Descriptive

	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

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[1] 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