Zartab Saman, Abbassian Hadi, Nassiri Koopaei Nasrin, Hajimolaali Mohammad
Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Science, Tehran, Iran.
Department of Food and Drug, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Iran J Pharm Res. 2019 Spring;18(2):1117-1125. doi: 10.22037/ijpr.2019.1100695.
Dyslipidemia is responsible for great mortality and morbidity each year. Little data are available on the availability and affordability of Dyslipidemia medications in low and middle incomes countries. In a retrospective time-series study, we examined the utilization pattern and affordability of lipid-lowering medications in Iran as a lower middle-income country. We initially calculated the defined daily dose for 1000 inhabitants (DID) in different years and compared the results with OECD member countries in the same year. We also used 90% Drug Utilization method to rank and compare lipid lowering drugs with the WHO Essential Medicines List (EML). We measured the affordability by the minimum daily wage for one-month course of treatment. The use of lipid-lowering medications increased from 6.31 to 45.98 DID between 2005 and 2016. The utilization share of the subgroup of statins was above 80% of total utilization. Compared to OECD countries, Iran utilized 40% of the average utilization in 2015. In 2015, Atorvastatin was on 90% of DU medications. At the beginning of the study, only Lovastatin and Nicotinic acid were affordable in 2005, but at the end of the study, all lipid-lowering medications were affordable. The utilization of lipid-lowering medications, despite being affordable, was low. One of its possible reasons is the lack of proper management of patients with Dyslipidemia and low adherence of patients. Another possible cause is the high percentage of undiagnosed patients in the community. Therefore, comprehensive planning and policy-making should be taken to increase utilization and eliminate the related obstacles.
血脂异常每年导致大量的死亡和发病。关于低收入和中等收入国家血脂异常药物的可获得性和可负担性的数据很少。在一项回顾性时间序列研究中，我们调查了伊朗这个中低收入国家降脂药物的使用模式和可负担性。我们首先计算了不同年份每1000名居民的限定日剂量（DID），并将结果与同年的经合组织成员国进行比较。我们还使用90%药物利用方法对降脂药物与世界卫生组织基本药物清单（EML）进行排名和比较。我们通过一个月疗程治疗的最低日工资来衡量可负担性。2005年至2016年期间，降脂药物的使用从6.31 DID增加到45.98 DID。他汀类药物亚组的使用份额占总使用量的80%以上。与经合组织国家相比，伊朗在2015年的使用量为平均使用量的40%。2015年，阿托伐他汀在90%的药物利用药物中使用。在研究开始时，2005年只有洛伐他汀和烟酸是可负担得起的，但在研究结束时，所有降脂药物都是可负担得起的。尽管降脂药物可负担得起，但使用量较低。其可能的原因之一是血脂异常患者缺乏适当的管理以及患者依从性低。另一个可能的原因是社区中未确诊患者的比例很高。因此，应采取全面的规划和政策制定来提高使用率并消除相关障碍。
