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Variations in Drug Utilisation in the EU: Causes and Consequences as illustrated by antibiotics Arne Melander, MD,PhD

Variations in Drug Utilisation in the EU: Causes and Consequences as illustrated by antibiotics Arne Melander, MD,PhD Head The NEPI Foundation ( the Swedish N etwork of Pharmaco EPI demiology) Professor of pharmacoepidemiology Lund University.

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Variations in Drug Utilisation in the EU: Causes and Consequences as illustrated by antibiotics Arne Melander, MD,PhD

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  1. Variations in Drug Utilisation in the EU: Causes and Consequences as illustrated by antibiotics Arne Melander, MD,PhD Head The NEPI Foundation (the Swedish Network of PharmacoEPIdemiology) Professor of pharmacoepidemiology Lund University

  2. It is well established that drug utilisation varies considerably between both countries, counties and municipalities. However, the causes and consequencies of this variation remain uncertain.

  3. Amongthe 15 EU member states, only Denmark Finland and Sweden have publicly accessible, complete, national registers on pharmaceutical drug utilisation

  4. NEPI

  5. NEPI

  6. NEPI

  7. Causes of these variations • could be differences in • (known)prevalence of • diabetes mellitus • number of patients • treated with antidiabetic drugs • average dosage

  8. The relation between these variations and differences in metabolic control is unknown

  9. European Association for the Study of Diabetes (EASD) is currently forming a study group on health care delivery health economy pharmacoepidemiology

  10. Studies both in Sweden and elsewhere indicate that the degree of bacterial resistance depends upon the degree of antibiotics exposure both in individuals and in the population.

  11. Studies in both Denmark and Sweden indicate that education and information about appropriate use of antibiotics promotes more restricted use of antibiotics.

  12. Variation of antibiotics utilisation in the 15 member states of the EU Data from IMS Health (13 countries), from The Danish Medical Agency and from The National Corporation of Swedish Pharmacies

  13. To some extent, this variation may be due to differences in morbidity and insocioeconomic factors

  14. However, it may also have less rational causes, such as different attitudes among prescribers as well as among patients, and different systems of drug delivery and payment.

  15. Cars O, Molstad S, Melander A. Lancet 2001;357:1851-2 NEPI

  16. NEPI

  17. IMS-Health, 1997. Molstad S. Scand J Inf Dis.Accepted NEPI

  18. EARSS; % Penicillin Non-Susceptiple Pneumococci NEPI

  19. Bronswaer S et al. Emerg Inf D, accepted NEPI

  20. NEPI

  21. The Alexander Project 1998: S. pneumoniae, Ery-R Eire12.7% Netherlands 2.4% Poland6.2% UK17% Czech Rep1% Belgium 34% Slovakia8.3% Switzerland 18.8% Germany 4.2% Greece 18.1% Portugal 9.3% France 47.3% Italy42% Austria11.4% NEPI

  22. To some extent, the causes of these variations may be due to differences in morbidity and insocioeconomic factors.

  23. However, the most common reason for prescribing an antibiotic is Upper Respiratory Infections. These are less, not more, common in Southern Europe than in Northern Europe.

  24. Therefore, it seems more likely that the observed differences have more irrational causes such as different attitudes among prescribers and patients, different systems of drug delivery and payment.

  25. NEPI

  26. Antibiotic utilisation and carriage of PNSP in children 0-6 years old, in 33 municipalities in Scania county, 1998. NEPI

  27. Accordingly, the extent of antibiotics prescribing seems to be a major determinant of microbial resistance to antibiotics. Prescriber attitudes, in turn, seem to be a major determinant of the extent of antibiotics prescribing. NEPI

  28. Influence of socioeconomic factors: Comparison between the municipalities in Copenhagen County (Københavns amt) in Eastern Denmark and in Scania County (Skåne län) in Southern Sweden

  29. NEPI

  30. NEPI

  31. NEPI

  32. CONCLUSION Drug utilisation in the EU is far from rational. NEPI

  33. To promote more rational drug utilisation in the EU, a first step should be establishingcomplete national registers on all pharmaceutical drug sales in each member state. NEPI

  34. These registers should be constructed so as to allow linkage with medical records on an individual basis. NEPI

  35. In addition, much more non-commercial education and information is necessary. This should be evidence-based and focussed on genuine long-term benefits and risks for the patient. NEPI

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