CLINICAL ECONOMIC ANALYSIS OF THE FINANCIAL COSTS FOR THE PHARMACOTHERAPY OF ACUTE TONSILLITIS IN THE CONDITIONS OF THE HOSPITAL

• Main Authors: A. M. Masheiko, O. V. Makarenko, V. V. Mavrutenkov
• Format: Article
• Language: English
• Published: Ukrmedknyha Publishing House 2017-02-01
• Series: Фармацевтичний часопис
• Subjects: гострий тонзиліт; частотний аналіз; АВС-аналіз; VEN-аналіз; лікування в умовах стаціонару.
• Online Access: https://ojs.tdmu.edu.ua/index.php/pharm-chas/article/view/7121

Introduction Acute tonsillitis (J03 for ICD-10) is one of the most common respiratory diseases in children [1]. According to the medical protocol approved by the Ministry of Health ofUkraine, patients with catarrhal form of acute tonsillitis are provided ambulatory care, but patients with follicular and lacunar tonsillitis forms are treated in a hospital [2]. In the latest data of the State Committee of Statistics, 41.1% of the funds in the structure of health care costs are citizens’ private funds [3]. These funds covered 99.6% of the costs for the purchase of pharmaceutical products for outpatient treatment, and 86.7% costs for treatment in a hospital [4]. In addition, it should take note of the low purchasing power of patients, as 36.1% of them are unable to buy the medicines prescribed by a doctor [5]. In view, the high rates of morbidity, constantly growing treatment costs and low purchasing power of patients, the purpose of our research was to investigate the expediency of the financial expenses for pharmacotherapy of acute tonsillitis based on the results of retrospective clinical and economic analysis of hospital medical history forms. Materials and methods The material of our study were doctors’ prescription sheets (form №003-4/o) of 290 patients with acute tonsillitis aged 2–18 years who were hospitalized in healthcare institutions of Dnipropetrovsk region for the period 2013–2015. Overall, we analyzed 1709 medications. Propriety of medical prescriptions was determined by comparing them to the current Ukrainian medical protocol of care for patients with acute tonsillitis [2] and the Ukraine State Drug Formulary [6]. The expediency of the financial costs for pharmacotherapy of acute tonsillitis was assessed by method the integrated frequency/VEN/ABC analysis [7]. Results and discussion The criterions for classifying medicines to category «V» (vital) were their presence in the medical protocol of care for patients with acute tonsillitis [2] and the the Ukraine State Drug Formulary [6]. The category of «N» (non-essential) included medicines that have been absent at any of the above regulatory documents. Results of the integrated frequency/VEN/ABC-analysis showed that the most costly group A included 15.04% (257 of 1709) medicines category V and 11.29% (193 of 1709) medicines category N. It was found that the basic financial funds had been used for ceftriaxone (J01DD04), local antiseptics (R02AA20) and cefuroxime (J01DC02), among which the most costly ceftriaxone had been prescribed for the largest number of patients. Despite the fact that ceftriaxone is recommended by national standard treatment of acute tonsillitis [2], but it is not the drug of choice for the treatment of this nosology. Ceftriaxone is rational to replace by penicillin or cephalosporin first generation, which have the same clinical efficacy against Streptococcus pyogenes and less cost [11]. The frequency of non-essential medicine prescriptions were dominated by the vital medicines. However, the financial costs for vital medicines were slightly greater than for the non-essential medicines, which amounted to 55.66% and 44.34% respectively. Excessive costs for the third-generation cephalosporin pharmacotherapy of acute tonsillitis can be explained by the doctors' intention to protect their patients from clinical failures associated with the penicillin destruction by β-lactamases of tonsils co-pathogenic microorganisms [12]. Conclusions • Basic funds were not spent for essential medicines for the treatment of acute tonsillitis. The most often prescribed costly medicine may have been replaced by cheaper ones with similar clinical efficacy. • Economically more rational begin pharmacotherapy of acute tonsillitis with penicillins. Сephalosporins second- or third generation and inhibitor-protected penicillins, as antibiotics for second-line therapy, should be prescribed only in cases of recurrent tonsillitis [5]. • Local antiseptics, probiotics, corticosteroids and dietary supplements had been widely used by doctors. Removal these pharmaceutical products from doctors’ prescription sheets would reduce the financial expenses for pharmacotherapy of acute tonsillitis without affecting its quality.