Inequality in Prescribing Anti-dementia Medications in Iran: Evidence From Social Security Insurance Claim Data
-
Farshad Sharifi
,
Alireza Khajavi
,
Mehdi Varmaghani
,
Parinaz Mehdipour
,
Elham Heidari
,
Hossein Fakhrzadeh
,
Farshad Farzadfar
,
Kamyar Khoshnevisan
,
Bagher Larijani
Abstract
Background: The prescribed doses of medications used for chronic diseases can be a good index for assessing inequality in healthcare services employment in communities. This study aimed to evaluate inequality in the prescribed dose of anti-dementia medications from 2012 to 2015 in the claim data, in Iran.Methods: This study used the data on the prescribed dose of anti-dementia medications registered by the Social Security Organization (SSO) of Iran. The data on wealth index and educational attainment were extracted from Household, Income, and Expenditure Surveys (HIES) and merged into the claim data. Univariate and multivariable ordinal logistic regression models were applied to evaluate the factors associated with the prescribed dose of antidementia medications. DASP Stata package was used to calculate Gini and concentration indices.Results: In multivariable models, prescription year, age, and educational attainment were related to the prescribed dose of anti-dementia medications. From 2012 to 2015, Gini indices of the prescribed dose of donepezil and rivastigmine were decreased. Gini indices in wealthier subjects were smaller than that in poorer individuals. Furthermore, with increasing the subjects’ age up to the age of 80 years, Gini indices were decreased. Concentration indices were positive about rivastigmine, donepezil and memantine.Conclusion: Different levels of inequality in the prescribed doses of donepezil and rivastigmine were observed among various wealth and education quintiles. Inequality in the prescribed doses of both mentioned medications was reduced from 2012 to 2015 among individuals under the SSO coverage in Iran.
[1] Wang Y, Wang J, Maitland E, Zhao Y, Nicholas S, Lu M. Growing old before growing rich: Inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces, China. BMC Health Serv Res. 2012; 12:302. [DOI:10.1186/1472-6963-12-302] [PMID] [PMCID]
[2] Sharifi F, Fakhrzadeh H, Varmaghani M, Arzaghi SM, Alizadeh Khoei M, Farzadfar F, et al. Prevalence of dementia and associated factors among older adults in Iran: National Elderly Health Survey (NEHS). Arch Iran Med. 2016; 19(12):838-44. [PMID]
[3] van der Flier WM, Scheltens P. Epidemiology and risk factors of dementia. J Neurol Neurosurg Psychiatry. 2005; 76(Suppl 5):v2-7. [DOI:10.1136/jnnp.2005.082867] [PMID] [PMCID]
[4] Cooper C, Lodwick R, Walters K, Raine R, Manthorpe J, Iliffe S, et al. Observational cohort study: Deprivation and access to anti-dementia drugs in the UK. Age Ageing. 2016; 45(1):148-54. [DOI:10.1093/ageing/afv154] [PMID] [PMCID]
[5] Artazcoz L, Rueda S. Social inequalities in health among the elderly: A challenge for public health research. J Epidemiol Community Health. 2007; 61(6):466-7. [DOI:10.1136/jech.2006.058081] [PMID] [PMCID]
[6] Qaseem A, Snow V, Cross Jr JT, Forciea MA, Hopkins Jr R, Shekelle P, et al. Current pharmacologic treatment of dementia: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2008; 148(5):370-8. [DOI:10.7326/0003-4819-148-5-200803040-00008]
[PMID]
[7] Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag. 2008; 4(1):269-86. [DOI:10.2147/TCRM.S1458] [PMID] [PMCID]
[8] Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: Basic principles and practical applications. Br J Clin Pharmacol. 2004; 57(1):6-14. [DOI:10.1046/j.1365-2125.2003.02007.x] [PMID] [PMCID]
[9] Duthie AC, Banerjee S. Use of antidementia medications in Scotland: Views of old age psychiatrists. GeroPsych (Bern). 2011; 24(1):53-7. [DOI:10.1024/1662-9647/a000028]
[10] Yao Q, Liu C, Ferrier JA, Liu Z, Sun J. Urban-rural inequality regarding drug prescriptions in primary care facilities - a pre-post comparison of the National Essential Medicines Scheme of China. Int J Equity Health. 2015; 14:58. [DOI:10.1186/s12939-015-0186-7] [PMID] [PMCID]
[11] Pinilla A, Cano N, Granados C, Paez-Canro C, Eslava-Schmalbach J. Inequalities in prescription of hydrochlorothiazide for diabetic hypertensive patients in Colombia. Rev Salud Publica (Bogota). 2011; 13(1):27-40. [PMID]
[12] Steinman MA, Sands LP, Covinsky KE. Self-restriction of medications due to cost in seniors without prescription coverage. J Gen Intern Med. 2001; 16(12):793-9. [DOI:10.1046/j.1525- 1497.2001.10412.x] [PMID] [PMCID]
[13] van Doorslaer E, Masseria C, Koolman X, OECD Health Equity Research Group. Inequalities in access to medical care by income in developed countries. CMAJ. 2006; 174(2):177-83. [DOI:10.1503/cmaj.050584] [PMID] [PMCID]
[14] Morgan S, Kennedy J. Prescription drug accessibility and affordability in the United States and abroad. Issue Brief (Commonwealth Fund). 2010; 89:1-12. [PMID]
[15] Eaddy MT, Cook CL, O’Day K, Burch SP, Cantrell CR. How patient cost-sharing trends affect adherence and outcomes: A literature review. P T. 2012; 37(1):45-55. [PMID] [PMCID]
[16] World Health Organization (WHO). Islamic Republic of Iran: Medicine prices, availability, affordability and price components [internet]. 2010. [Updated 2010]. Available from: https://apps.who.int/
iris/handle/10665/116636
[17] Office of Economic and Social Statistics. [Satatistical Yearbook of Social Security Insurance in 2014 (Persian)] [Internet]. 2015. [Updated 2015]. Available from: https://bimeh.mcls.gov.ir/icm_content/media/image/2016/10/107003_orig.pdf
[18] Social Security Insurence. [Social Security Organization Pharmacopoeia 2015 (Persian)] [Internet]. 2015 [Updated 2015]. Available from: https://darman.tamin.ir/Forms/Public/Druglist. aspx?pagename=hdpDrugList
[19] Araar A, Duclos JY. User manual DASP: Distributive Analysis Stata Package [Internet]. 2013 [Updated 2013]. Available from: http://dasp.ecn.ulaval.ca/modules/DASP_V2.1/DASP_MANUAL_V2.1.pdf
[20] O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data. A guide to techniques and their implementation. Washington DC: The World Bank; 2008. [DOI:10.1596/978-0-8213-6933-3]
[21] Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer disease in the US population: Prevalence estimates using the 2000 census. Arch Neurol. 2003; 60(8):1119-22. [DOI:10.1001/archneur.60.8.1119] [PMID]
[22] Alzheimer’s Association. 2015 Alzheimer’s disease facts and figures. Alzheimers Dement. 2015; 11(3):332-84. [DOI:10.1016/j.jalz.2015.02.003] [PMID]
[23] Bastani P, Dinarvand R, SamadBeik M, Pourmohammadi K. Pharmaceutical strategic purchasing requirements in Iran: Price interventions and the related effective factors. J Res Pharm Pract. 2016; 5(1):35-42. [DOI:10.4103/2279-042X.176553] [PMID] [PMCID]
[24] Hosseinpoor AR, Naghavi M, Alavian SM, Jamshidi HR, Vega J, Speybroeck N. Determinants of seeking needed outpatient care in Iran: Results from a national health services utilization survey. Arch Iran Med. 2007; 10(4):439-45. [PMID]
[2] Sharifi F, Fakhrzadeh H, Varmaghani M, Arzaghi SM, Alizadeh Khoei M, Farzadfar F, et al. Prevalence of dementia and associated factors among older adults in Iran: National Elderly Health Survey (NEHS). Arch Iran Med. 2016; 19(12):838-44. [PMID]
[3] van der Flier WM, Scheltens P. Epidemiology and risk factors of dementia. J Neurol Neurosurg Psychiatry. 2005; 76(Suppl 5):v2-7. [DOI:10.1136/jnnp.2005.082867] [PMID] [PMCID]
[4] Cooper C, Lodwick R, Walters K, Raine R, Manthorpe J, Iliffe S, et al. Observational cohort study: Deprivation and access to anti-dementia drugs in the UK. Age Ageing. 2016; 45(1):148-54. [DOI:10.1093/ageing/afv154] [PMID] [PMCID]
[5] Artazcoz L, Rueda S. Social inequalities in health among the elderly: A challenge for public health research. J Epidemiol Community Health. 2007; 61(6):466-7. [DOI:10.1136/jech.2006.058081] [PMID] [PMCID]
[6] Qaseem A, Snow V, Cross Jr JT, Forciea MA, Hopkins Jr R, Shekelle P, et al. Current pharmacologic treatment of dementia: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2008; 148(5):370-8. [DOI:10.7326/0003-4819-148-5-200803040-00008]
[PMID]
[7] Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag. 2008; 4(1):269-86. [DOI:10.2147/TCRM.S1458] [PMID] [PMCID]
[8] Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: Basic principles and practical applications. Br J Clin Pharmacol. 2004; 57(1):6-14. [DOI:10.1046/j.1365-2125.2003.02007.x] [PMID] [PMCID]
[9] Duthie AC, Banerjee S. Use of antidementia medications in Scotland: Views of old age psychiatrists. GeroPsych (Bern). 2011; 24(1):53-7. [DOI:10.1024/1662-9647/a000028]
[10] Yao Q, Liu C, Ferrier JA, Liu Z, Sun J. Urban-rural inequality regarding drug prescriptions in primary care facilities - a pre-post comparison of the National Essential Medicines Scheme of China. Int J Equity Health. 2015; 14:58. [DOI:10.1186/s12939-015-0186-7] [PMID] [PMCID]
[11] Pinilla A, Cano N, Granados C, Paez-Canro C, Eslava-Schmalbach J. Inequalities in prescription of hydrochlorothiazide for diabetic hypertensive patients in Colombia. Rev Salud Publica (Bogota). 2011; 13(1):27-40. [PMID]
[12] Steinman MA, Sands LP, Covinsky KE. Self-restriction of medications due to cost in seniors without prescription coverage. J Gen Intern Med. 2001; 16(12):793-9. [DOI:10.1046/j.1525- 1497.2001.10412.x] [PMID] [PMCID]
[13] van Doorslaer E, Masseria C, Koolman X, OECD Health Equity Research Group. Inequalities in access to medical care by income in developed countries. CMAJ. 2006; 174(2):177-83. [DOI:10.1503/cmaj.050584] [PMID] [PMCID]
[14] Morgan S, Kennedy J. Prescription drug accessibility and affordability in the United States and abroad. Issue Brief (Commonwealth Fund). 2010; 89:1-12. [PMID]
[15] Eaddy MT, Cook CL, O’Day K, Burch SP, Cantrell CR. How patient cost-sharing trends affect adherence and outcomes: A literature review. P T. 2012; 37(1):45-55. [PMID] [PMCID]
[16] World Health Organization (WHO). Islamic Republic of Iran: Medicine prices, availability, affordability and price components [internet]. 2010. [Updated 2010]. Available from: https://apps.who.int/
iris/handle/10665/116636
[17] Office of Economic and Social Statistics. [Satatistical Yearbook of Social Security Insurance in 2014 (Persian)] [Internet]. 2015. [Updated 2015]. Available from: https://bimeh.mcls.gov.ir/icm_content/media/image/2016/10/107003_orig.pdf
[18] Social Security Insurence. [Social Security Organization Pharmacopoeia 2015 (Persian)] [Internet]. 2015 [Updated 2015]. Available from: https://darman.tamin.ir/Forms/Public/Druglist. aspx?pagename=hdpDrugList
[19] Araar A, Duclos JY. User manual DASP: Distributive Analysis Stata Package [Internet]. 2013 [Updated 2013]. Available from: http://dasp.ecn.ulaval.ca/modules/DASP_V2.1/DASP_MANUAL_V2.1.pdf
[20] O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data. A guide to techniques and their implementation. Washington DC: The World Bank; 2008. [DOI:10.1596/978-0-8213-6933-3]
[21] Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer disease in the US population: Prevalence estimates using the 2000 census. Arch Neurol. 2003; 60(8):1119-22. [DOI:10.1001/archneur.60.8.1119] [PMID]
[22] Alzheimer’s Association. 2015 Alzheimer’s disease facts and figures. Alzheimers Dement. 2015; 11(3):332-84. [DOI:10.1016/j.jalz.2015.02.003] [PMID]
[23] Bastani P, Dinarvand R, SamadBeik M, Pourmohammadi K. Pharmaceutical strategic purchasing requirements in Iran: Price interventions and the related effective factors. J Res Pharm Pract. 2016; 5(1):35-42. [DOI:10.4103/2279-042X.176553] [PMID] [PMCID]
[24] Hosseinpoor AR, Naghavi M, Alavian SM, Jamshidi HR, Vega J, Speybroeck N. Determinants of seeking needed outpatient care in Iran: Results from a national health services utilization survey. Arch Iran Med. 2007; 10(4):439-45. [PMID]
| Files | ||
| Issue | Vol 7 No 1/2 (2021) | |
| Section | Original Article(s) | |
| Keywords | ||
| Healthcare Socioeconomic factors Dementia Disparities Iran | ||
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How to Cite
1.
Sharifi F, Khajavi A, Varmaghani M, Mehdipour P, Heidari E, Fakhrzadeh H, Farzadfar F, Khoshnevisan K, Larijani B. Inequality in Prescribing Anti-dementia Medications in Iran: Evidence From Social Security Insurance Claim Data. JPPM. 2021;7(1/2):44-52.
