Transcript Poster presentation

ECONOMIC ASSESSMENT OF
IMPLEMENTATION
TREATMENT GUIDELINES OF
HYPERTENSION IN
OUT-PATIENT PRACTICE
Kulmagambetov IR
Karaganda State Medical
Academy, Kazakhstan
Population: 16,763,795 (July 2003 est.)
Area: total: 2,717,300 sq km
water: 47,500 sq km
land: 2,669,800 sq km
Karaganda State Medical Academy was founded in 1950.
Students – 3500
Faculties - General medicine, Pediatrics, Dental Medicine, Medico-biological
work, Hygiene and Epidemiology, Pharmacy, Traditional Medicine
Introduction:
One of the problems in cardiology is evaluating the economic
efficiency of the treatment of hypertension
Setting:
At the сenter for primary health care
and 2 general practice outpatient centers in Karaganda
Objectives:
 To assess the efficiency of hypertension treatment
 To assess the cost of hypertension drug therapy
 To assess the quality of life of hypertension patients
in the outpatient setting before and after
implementation of hypertension treatment guidelines
Methods:
 Retrospective analysis of 61 outpatients records
with an established diagnosis of hypertension in
outpatient practice for 2001 – 2002
 Statistical analysis carried out by calculation of a
standard set of the parameters used in descriptive
statistics
Methods:
 The cost-effectiveness analysis
 The patient quality of life was assessed by score range, with
higher scores indicating better health status
 The
economic
analysis
of
cost
of
treatment
after
implementation of guidelines
The assessment of expenses for therapy was calculated at
the rate of daily average dozes of antihypertensive
medicines in USD
Results:
 Before implementation of treatment guidelines the
percentage of cases achieving a target level of arterial
pressure was 14 %; after the intervention was 71.4%
 Before implementation of treatment guidelines the
percentage of ineffective antihypertensive therapies was
72%; after the intervention the percentage of ineffective
therapy decreased to 28.6 %, effective therapies increased
by 57.4%
 Before implementation of treatment guidelines the
percentage of
developing complications was 14% of
hypertension patients; after the intervention was 0%
The efficiency of hypertension treatment
before and after implementation of treatment
guidelines
80,0%
71,40%
Before
implementation
of treatment
guidelines
72%
70,0%
60,0%
50,0%
40,0%
30,0%
20,0%
After the
intervention
28,60%
14%
14%
10,0%
developing
complications
ineffective
antihypertensive
therapies
cases achieving
a target level of
arterial pressure
0,0%
0%
Results:
 The expenses for treatment of 61 patient with hypertension
before the implementation of treatment guidelines were
USD 4,728; after the intervention were USD 1,882,
representing a reduction of USD 2,846 (60%)
 The expenses for treatment per patient with hypertension
before the implementation of treatment guidelines were
USD 77.5; after the intervention were USD 30.85
 The assessment of patient quality of life showed an
average improvement of 4.3 ± 0.9 for 82.9% of patients;
quality of life did not change for
17.1% of patients
Expenses for treatment of
hypertension patients
$5 000,00
70
4728
60
$4 000,00
50
$3 000,00
$2 000,00
40
expenses for
treatment after the
intervention
30
1882
20
$1 000,00
10
77,5
30,85
$0,00
0
61patients
expenses for
treatment befor
implementation
1 patient
% representing a
reduction
Conclusions and recommendations:
 Implementation of the treatment guidelines has increased
efficiency in the management of hypertension and improved
patient quality of life
 The rational choices of effective pharmacotherapy following
the implementation improved the of economy of treatment
Key lessons from our experience
Our experience has shown:

the necessity to develop educational program for physicians in
collaboration with International Organizations

the necessity to develop the training courses for health workers in
Kazakhstan and Central Asia Region for appropriately
implementation the evidence-based guidelines to improve
prescribing practice

the necessity to develop the network that would allowed to involve
active participation of experts from different settings and external
experts to discuss and review of treatment guidelines and adopt
into the local clinical practice
Implications of implementation of
treatment guidelines
The intervention:
 allowed to identify the lack of knowledges of physicians
 has shown the necessity to change the approaches to
improve prescribing practice and promote rational use of
medicines
 has shown physicians adherence to treatment guidelines
and improved prescribing practice
 has shown the necessity to implementation the principles to
problem-based pharmacotherapy teaching in medical
curriculum
 stimulates to the further activity to develop and research
rational drug use in cooperation with Ministry of Health
The specific studies for a future
research
To carry out the multicountries research in Central Asia
Region:
 to investigate of medicine use in different settings
 to investigate the current situation of implementation
treatment guidelines in these countries
 to assess economic effects after implementation of
treatment guidelines of priority diseases
All results should be used for support countries in
implementing and monitoring a national strategy to promote
rational use of drugs