College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Clin Drug Investig. 2018 Jul;38(7):565-572. doi: 10.1007/s40261-018-0648-y.
Drug utilization research on benzodiazepines remains important for measuring trends in consumption within and across borders over time for the sake of monitoring prescribing patterns and identifying potential population safety concerns. The defined daily dose (DDD) system by the World Health Organization (WHO) remains the internationally accepted standard for measuring drug consumption; however, beyond consumption, DDD-based results are difficult to interpret when individual agents are compared with one another or are pooled into a total class-based estimate. The diazepam milligram equivalent (DME) system provides approximate conversions between benzodiazepines and Z-drugs (i.e. zopiclone, zolpidem, zaleplon) based on their pharmacologic potency. Despite this, conversion of total dispensed benzodiazepine quantities into DME values retains diazepam milligrams as the total unit of measurement, which is also impractical for population-level interpretation. In this paper, we propose the use of an integrated DME-DDD metric to obviate the limitations encountered when the component metrics are used in isolation. Through a case example, we demonstrate significant change in results between the DDD and DME-DDD method. Unlike the DDD method, the integrated DME-DDD metric offers estimation of population pharmacologic exposure, and enables superior interpretation of drug utilization results, especially for drug class summary reporting.
苯二氮䓬类药物的药物利用研究对于衡量随时间推移在国内外的消费趋势仍然很重要，目的是监测处方模式并识别潜在的人群安全问题。世界卫生组织（WHO）的限定日剂量（DDD）系统仍然是衡量药物消费的国际公认标准；然而，除了消费之外，当个别药物相互比较或汇总为总类估计时，基于 DDD 的结果难以解释。地西泮毫克当量（DME）系统根据药物的药理效力，提供了苯二氮䓬类药物和 Z 类药物（即佐匹克隆、唑吡坦、扎来普隆）之间的近似转换。尽管如此，将总配给的苯二氮䓬类药物数量转换为 DME 值仍然保留了地西泮毫克作为总测量单位，这对于人群水平的解释也是不切实际的。在本文中，我们提出使用整合的 DME-DDD 指标来避免在单独使用组成指标时遇到的限制。通过一个案例示例，我们展示了 DDD 和 DME-DDD 方法之间结果的显著变化。与 DDD 方法不同，整合的 DME-DDD 指标提供了人群药理暴露的估计，并能够更好地解释药物利用结果，特别是对于药物类别汇总报告。
