DRUG UTILIZATION AND ECONOMIC IMPACT OF ANTICOAGULANTS IN UNSTABLE ANGINA/ NON- ST ELEVATION MYOCARDIAL INFARCTION IN KARACHI

摘要

Objective: The present study was designed to evaluate drug utilization and the economic impact of anticoagulants for the treatment of unstable angina (UA)on-ST elevation myocardial infarction (NSTEMI) in Karachi. Methods: A prospective study of prescriptions was conducted in private and public tertiary care hospitals (University of medical education and research) situated in Karachi. The purpose of prescriptions review was to examine the utilization and cost analysis of anticoagulants (enoxaparin, dalteparin and fondaparinux) in hospitalized patients of UA/ NSTEMI during treatment course of 2-8 days. Information of prescribed drugs was obtained from the medical records whereas patient demographics and socioeconomic status were reported through patients/relatives interviews. Data of 487 UA/NSTEMI patients admitted were analyzed during the study period of 2013-2014. Results: Data of 487 UA/NSTEMI hospitalizations demonstrated the increased number of prescriptions for enoxaparin, it was found to be widely used anticoagulant in the public and private organizations in Karachi. Enoxaparin attributed by 70% of drug utilization comparative to 24.8% fondaparinux and 5.1 % dalteparin. Though, economic contribution was in favor of fondaparinux by reducing total drug cost of $ 21 with enoxaparin and $ 32 in contrast of dalteparin on the basis of once daily dose in the conservative management of unstable anginaon-ST elevated myocardial infarction. Conclusion: In patients with unstable angina (UA)on-ST elevation myocardial infarction (NSTEMI), enoxaparin was found to be most widely prescribed low molecular weight heparin (LMWH) among other available alternatives. However, economic assessment considered fondaparinux as cost saving therapeutic agent for initial conservative management of 2-8 days, added financial benefits over current therapies in the treatment of UA/NSTEMI. Keywords: Drug utilization, Economics, Anticoagulants, Unstable angina/NSTEMI.