engleski

Do regular changes in DDDs discredit the ATC/DDD methodology in drug utilization research?

A widely accepted method in drug utilization research is the ATC/DDD methodology. It is suitable for international comparisons and analyses of long-term trends in drug use. However, ATCs and DDDs may change and the main reasons are changes in the recommended or prescribed daily doses or changes in the main indication. In order to follow the level of consumption of a certain drug over time, it is therefore important to use the same DDD value and it should be clearly stated what edition of the ATC/DDD Index was used. As various editions of ATC/DDD Index are not always available to individual researchers and professionals, it might be difficult to get a quick orientation on the dynamics of drug use within a setting unless changes in certain DDDs have been strictly pointed out. The aim of this study was to assess whether alterations in DDDs discredit the method and to what extent, by monitoring total drug use for 5 years at the University Hospital Rijeka. The data on drug use 2001-2005 were obtained from hospital pharmacy records. The volume of drugs used was presented as number of DDD/100 bed days. For each year, corresponding ATC/DDD Index was used. In parallel, utilization of drugs, for which DDD changed in this period, was expressed as the number of physical units (mg, IU, etc)/ 100 bed days. Alterations in DDDs were obtained from the official web site (www.whocc.no). There were 132 alterations made in the period from 1982-2005 and 19 from 2001-2005. Among drugs used at the hospital there were 6 for which the DDD changed in 5 years. There was a twofold increase in the use of repaglinid (A10BX02) between 2003 and 2004 expressed as number of mg/100 bed days, and almost threefold increase expressed as number of DDD/100 bed days. Expressed in mg /100 bed days there was a 39% increase in the use of folic acid (B03BB01) in 2003 compared to 2002 and only 4% when expressing the use in DDDs/100 bed days. The actual use of erythropoietin (B03XA01) decreased in 2002, expressed as TU/100 bed days, but when expressing the use in DDD/100 bed-days, an increase of 77% was observed. Expressed in mg/100 bed days there was only a slight decrease in use of parenteral amoxicilin/clavulanic acid (J01CR02) between 2004 and 2005, but expressed as DDD/100 bed days the use decreased threefold. There was an increase of 14% in utilization of fentanil TTS (N02AB03) expressed in mg/100 bed days and the value in DDD/100 bed days decreased by 43% . Expressed in mg/100 bed days the use of budenosid nasal spray (R01AD05) was equal in 2002 and 2004, but expressed in DDD/100 bed days, the use appeared to increase by 50%. Although the changes in DDDs did affect the picture of drug use in our hospital, there were only 6 drugs involved, and it may not be considered important provided that future changes are kept to a minimum. Similar study investigating the impact of DDD changes on the outpatient drug use should also be performed.

ATC/DDD; changes; methodology

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