Evaluation of the state of pharmaceutical supply of patients with dementia with Alzheimer disease in Ukraine in accordance with international recommendations

Abstract

The aim: to assess the state of pharmaceutical provision of patients with dementia in Alzheimer's disease in Ukraine in accordance with international recommendations.

Materials and methods. In our studies, we used data from international guidelines, clinical protocols that regulate the organization of medical and pharmaceutical care for these patients in the USA, Australia, Japan, Germany, Great Britain, Finland, India, Kazakhstan, and Ukraine. The actual state of pharmaceutical provision of these patients in Ukraine was studied using a depersonalized database of medical prescriptions, which operates based on a number of specialized healthcare institutions. In addition, data from the Morion information search system were used. We used general theoretical (historical, formal, graphic, hypothetical-deductive, etc.) and applied (clinical-economic, organizational-economic, mathematical-statistical, etc.) research methods.

Results. It has been established that a consolidated opinion has been formed in the world scientific community regarding the possibility of effective use in the pathogenetic treatment of patients with dementia in Alzheimer's disease of drugs from the groups N06DA Acetylcholinesterase inhibitors and N06DX-Other drugs for use in case of dementia. Thus, the pharmaceutical component of international recommendations, clinical protocols for the treatment of patients with dementia in Alzheimer's disease contains four drugs used in pathogenetic therapy. These are N06DA02 Donepezil, N06DA03 Rivastigmine, N06DA04 Galantamine and N06DX01 Memantine. It has been reported that all the above drugs are included in the domestic clinical protocol for the treatment of patients with dementia in Alzheimer's disease, the State Drug Formulary (with the exception of N06DA03 Rivastigmine), and the State Drug Registry. At the same time, all of them were absent from the National List of Essential Drugs, which has an important socio-economic and medical-pharmaceutical significance in the health care system. It was found that patients (200 people) received 2487 prescriptions (100.0 %), among which 9.41 % (234 prescriptions) were drugs used in pathogenetic treatment. There is a highly disproportionate nature of the distribution of prescriptions and consumption by international generic names of drugs. Thus, drugs N06DX01 Memantine accounted for 80.41 % (188 prescriptions) of all prescriptions in the group N06D Drugs for use in dementia, and the consumption rate was UAH 84420.20, which accounted for 91.48 % of the amount of expenses directed to patients with carrying out pathogenetic treatment. Significant dominance of drugs N06DX01 Memantine in the structure of prescriptions and consumption indicates the presence of severe, advanced forms of dementia in patients. This fact once again emphasizes the need for early detection and treatment of cognitive impairment, primarily for the rational use of limited health care resources. We have found that there are no prescriptions for N06D A04 Galantamine preparations, which are recommended by the relevant international recommendations in different countries of the world, as well as by the domestic clinical protocol for the pathogenetic treatment of mild and moderate forms of Alzheimer's disease. At the same time, N06DA05 Ipidacrine preparations were used in the treatment of domestic patients, which are not presented in the pharmaceutical component of international recommendations and protocols governing the pathogenetic treatment of the above-mentioned groups of neuropsychiatric patients.

Conclusions. The peculiarities of the formation of the pharmaceutical component in the organization of the treatment process of patients with dementia in Alzheimer's disease in Ukraine, established by us, allow further research on the development of rational ways of resource provision of neuropsychiatric patients