Economic burden of irrational use of injectable form of Dexamethasone: a warning to health system

  • Fatemeh Soleymani Food and Drug Laboratory Research Center, Food and Drug Organization. MOH & ME Iran, Tehran, Iran AND Pharmaceutical Policy Research Center, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran AND National Committee on Rational Drug Use, Food and Drug Organization, Ministry of Health and Medical Education, Tehran, Iran.
  • Malikeh Haerizadeh National Committee on Rational Drug Use, Food and Drug Organization, Ministry of Health and Medical Education, Tehran, Iran.
  • Amir Farshchi Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Dexamethasone, Drug use pattern, Irrational use of drugs, Cost.

Abstract

Background: Irrational prescribing of injections is common in Iran. According to the statistics of the National Committee of Rational Use of Drugs (NCRUD), more than 40% ofprescriptions have at least one injectable form, while injectable dosage form of dexamethasone is on the top of the list. Considering the side effects of corticosteroids, theobjective of this study was to investigate the prescribing pattern of dexamethasone in all physicians' prescriptions from 2007 to 2011 in Iran. Method: A cross-sectionalstudy was carried out on a collection of prescriptions collected from health insurance companies from 2007 to 2011. The inspection was for prescriptions including injectableform of dexamethasone using special software called Rx Analyst and cost analysis was conducted using NCRUD. Results: Almost 365 million prescriptions were reviewed.Those prescriptions including at least one injectable form were identified. Among prescriptions including injectable form of medicines, more than 21% had at least oneinjectable dosage form of dexamethasone making it the first prescribed medicine by general practitioners. An overall increasing tendency in prescribing pattern and the costof injectable dosage form of dexamethasone were evident over the observation period. Prescribing the injectable form of dexamethasone was 12.28% in 2007, 13.11% in2010 and 12.10% in 2011 by all physicians. All related costs were calculated using governmental prices and finally total costs were adjusted to 2011 fees in USD. Conclusion:Irrational pattern of prescribing injectable form of dexamethasone was extracted from the results of this study. It seems that general practitioners are trying to substitutepain relievers’ drugs by injectable dosage form of dexamethasone. Irrational prescriptions of injectable dexamethasone cause not only further costs but also adversereactions associated with steroid injections. A robust strategy to promote rational use of medicine is strongly needed to correct the pattern of dexamethasone prescriptionin Iran.

References

(1) World Health Organization (WHO). Injection safety [online], 2006.

Available from: http://www.who.int/injectionsafety.htm.

(2) World Health Organization (WHO). How to develop and

implement a national drug policy. 2nd ed. 2001.

(3) Iranian Ministry of Health- Department of Pharmaceutical Affairs.

Annual Reports 1996-2003, 2004.

(4) Iranian National Formulary. The medicine hygiene, therapy and

instruction, drug and food assistant, 2010.

(5) Mansoor F. Case definition of traumatic injection neuropathy. .

Pakistan J Med Res. 2004;43(3):1-9.

(6) Central Bank of Iran. 2014. Available from: www.cbi.ir/

exrates/rates_fa.aspx.

(7) Furukawa H. Challenge for preventing medication errors learn

from errors: What is the most effective label display to prevent

medication error for injectable drug? HCI Applications and

Services. 2007;4553:437 - 42.

(8) Iranian Ministry of Health- Food and Drug Organization. Available

from: http://fdo.behdasht.gov.ir/

(9) Soleymani F, Valadkhani M, Dinarvand R. Challenges and

achievement of promoting rational use of drug in Iran. Iran J

Public Health. 2009;38:166-8.

(10) Karimi A, Haerizadeh M, Soleymani F, Haerizadeh M, Taheri F.

Evaluation of medicine prescription pattern using World Health

Organization prescribing indicators in Iran: A cross-sectional

study. Journal of research in pharmacy practice 2014;3(2):39

(11) Iranian Ministry of Health- Food and Drug Organization. Drug

prescription indexes 2008-2009,2010.

(12) Iranian Ministry of Health- Food and Drug Organization. Drug

prescription indexes, 2006-2007.2008.

(13) Abdollahiasl A, Kebriaeezadeh A, Nikfar S, Farshchi A, Ghiasi G,

Abdollahi M. Patterns of antibiotic consumption in Iran during

-2009. International Journal of Antimicrobial Agents.

;37(5):489-90.

Published
2015-10-11
How to Cite
1.
Soleymani F, Haerizadeh M, Farshchi A. Economic burden of irrational use of injectable form of Dexamethasone: a warning to health system. JPPM. 1(3/4):56-8.
Section
Articles