Kamyari Naser, Soltanian Ali Reza, Mahjub Hossein, Moghimbeigi Abbas, Shahali Zahra
Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Med J Islam Repub Iran. 2021 Dec 27;35:175. doi: 10.47176/mjiri.35.175. eCollection 2021.
To date, comprehensive data on drug utilization in Iranian people are lacking. The purpose of this study was to graphically describe drug prescription, polypharmacy, and pharmaceutical spending in > 3 million Iranian elderly people. In this multilevel cross-sectional study, using administrative claims data provided by the Iran Health Insurance Organization (IHIO), we assessed drug claims and drug costs in 2018 in >3 million individuals living in Iran and who have been insured with health insurance (Bimeh Salamat). In particular, we analyzed the prevalence of polypharmacy and pharmaceutical spending use according to the annual Report of Iranian Health Insurance Organization. Multilevel ordinal logistic and multilevel beta regression models were used to analyze the data. Significance level was set as P ≤ .05 and CI at 95%. Nationally, the mean number of drug prescriptions per patient was 1.46 (SD, 0.81). The mean number of prescribed drugs per patient was 4.32 (SD, = 3.04). The drug cost for each elderly patient was $6.86 (interquartile range (IQR), 12.26), with $4.96 and $1.76 for the insurance and the insured shares, respectively. For elderly women, the odds of polypharmacy (excessive and nonexcessive vs no polypharmacy) were 1.164 (95% CI, 1.142 to 1.186) times that of elderly men. In addition, in the spring season, the odds of polypharmacy were 1.274 (95% CI, 1.241 to 1.309) times that of the winter. Similarly, polypharmacy was strongly higher among patients who had noncommunicable diseases (OR, 2.174; 95% CI, 2.069 to 2.275 (P < 0.001)). The high prevalence of hyper prescription in Iran elderly people may indicate a need for interventions aiming at deprescribing drugs with an unfavorable benefit-risk profile. The best practice guidelines should be developed for improved medical practice in the prescription of medications for such a vulnerable population.
迄今为止，伊朗人群药物使用的全面数据尚缺。本研究旨在以图表形式描述300多万伊朗老年人的药物处方、多重用药情况及药品支出。在这项多层次横断面研究中，我们利用伊朗健康保险组织（IHIO）提供的行政索赔数据，评估了2018年伊朗300多万参加健康保险（Bimeh Salamat）人群的药品索赔和药品费用。特别是，我们根据伊朗健康保险组织的年度报告分析了多重用药的患病率和药品支出情况。采用多层次有序逻辑回归模型和多层次β回归模型对数据进行分析。显著性水平设定为P≤0.05，置信区间为95%。在全国范围内，每位患者的药物处方平均数为1.46（标准差，0.81）。每位患者的处方药平均数为4.32（标准差=3.04）。每位老年患者的药品费用为6.86美元（四分位间距（IQR），12.26），其中保险支付和参保人自付分别为4.96美元和1.76美元。老年女性多重用药（过度和非过度与无多重用药）的几率是老年男性的1.164倍（95%置信区间，1.142至1.186）。此外，在春季，多重用药的几率是冬季的1.274倍（95%置信区间，1.241至1.309）。同样，患有非传染性疾病的患者多重用药情况明显更严重（比值比，2.174；95%置信区间，2.069至2.275（P<0.001））。伊朗老年人高处方率可能表明需要采取干预措施，减少开具效益风险比不佳的药物。应为改善这类弱势群体的药物处方医疗实践制定最佳实践指南。
