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Prescription Patterns

Prescription Patterns. Fernán Caballero Fonseca Caracas, 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.

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Prescription Patterns

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  1. Prescription Patterns Fernán Caballero Fonseca Caracas, Venezuela December 2011

  2. Prescriptions patterns and outcomes • Asthma prevalence • Epidemiology of asthma control • Worldwide patterns of prescriptions • Changes in prescription patterns in Latin-America and outcomes • Conclusions

  3. No standardised data available 0-2.5 2.5-5.0 10.1 7.6-10.0 5.1-7.5 Worldwide asthma prevalence Colombia 7.4 Argentina 5.5 Chile 5.1 México 3.3 Perú 13.0 Costa Rica 11.9 Brasil 11.4 USA 10.9 Inglaterra 15.3 Global Burden of Asthma, 2004

  4. Global prevalence of asthma (world health survey) To et al. Submitted, 2011

  5. Access to essentials drugs for asthma treatment < 50% 50-80 % 81-95 % > 95 % Global Burden of Asthma, 2004

  6. Prevalence of asthma, rhinitis and dermatitis in children in different cities in México ISAAC, 2003

  7. ISAAC fase III Venezuela International Study for Asthma and Allergies in Children. Aldrey O et al. RSVAAI 2004

  8. 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

  9. Prevalence of current asthma* among children and adults,† by selected characteristics 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

  10. A national survey to assess asthma control in the US pediatric population 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) R.H. Standford et al.American Thoracic Society (ATS). ATS,Toronto, Canada May 16-21, 2008

  11. 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

  12. J ALLERGY CLIN IMMUNOL AUGUST 2011

  13. SABA use (inhalations/day in the last week) 26% 38% 21% Number of inhalations/day 11% Base: all respondents (n=3,415) Patients (%) Despite ICS or ICS/LABA therapy, 74% of patients used rescue therapy each day Partridge MR, BMC Pulmonary Medicine 2006

  14. Patterns of asthma controler prescribing for pediatric asthma patients in UK primary care M. Thomas et al.BMC Pulmonary Medicine 2010

  15. Persistent underuse of asthma medication in a large health plan Savwicki R et all. ATS 2009

  16. Patients hospitalized due to asthma Rodrigo et al. J Bras Pneumologia 2009

  17. Asthma drugs sales in Mexico

  18. Antiasthmatic drug sales in Argentina, 1990-1999 Neffen H. ACI International, 1999:11(5)171-175

  19. Asthma mortality vs. inhaled steroids sales Argentina, 80s-90s Mortality Rate Rho Spearman 5-34 0.72 0.38 - 0.84 (p = 0.003) Global 3.38 2.58 - 0.81 (p = 0.005)

  20. QTR~12/2000 QTR~03/2001 QTR~06/2001 QTR~09/2001 KLAS VENTIDE NUELIN COSOLVE TEOBID BRODILIN BRIXILON BECLO VENTIDE SINGULAIR ZADITEN FLIXOTIDE KETOTISIN SERETIDE PULMICORT Pediatric prescriptions for asthma in Venezuela 900 800 700 600 500 400 300 200 100 0

  21. 180000 160000 140000 120000 100000 80000 60000 40000 20000 0 Pediatric prescriptions for asthma in Venezuela Number of prescriptions AntiL B2 inh B2 oral E inh B2 AC+E E sistémico Expectorantes INTE 2006

  22. Pediatric prescriptions for asthma in Venezuela INTE 2006

  23. Asthma drugs sales in Venezuela Seretide is the market leader with negative perforamance over thepast years in Venezuela Foradil/Miflonide and Symbicort + Vannair show a positive trend Spiriva after three year of growth lost market share in 2009 IMS – PMV Diciembre 2009

  24. Upon closer look on the respiratory market in Venezuela Comb (LABAs+ICS) represent 37% of usage, while LABAs have 18% and LAMAs 12% IMS – PMV Diciembre 2009

  25. Pediatric prescriptions for asthma in Caracas, Venezuela N=121: 2-12 years 73 (63.6%) uncontrolled 33 (27.33%) p. controlled 11 (9.1%) controlled Leon. M, Ortega. E, Sanchez-Aguilar. M, Sanchez-Borges M, Caballero-Fonseca F, Cedraro S. Interasma 2009

  26. Pediatric prescriptions for asthma in Caracas, Venezuela Bronchodilator + Inhaled corticosteroids Inhaled corticosteroids Leon. M, Ortega. E, Sanchez-Aguilar. M, Sanchez-Borges M, Caballero-Fonseca F, Cedraro S. Interasma 2009

  27. Reduction in hospitalizations due to asthma in Brazil Hospitalization rates/10.000 inhabitants Hospitalization rates/10.000 inhabitants Salvador Recife Souza-Machado et al. ERJ 2009

  28. Asthma care in resource-poor settings • Asthma prevalence in developing countries may be higher than in the developed world • Lack of access to proper care and medication • 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

  29. 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

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