ECONOMIC ASSESSMENT OFIMPLEMENTATION TREATMENT GUIDELINES OF HYPERTENSION IN OUT-PATIENT PRACTICE 

Kulmagambetov IRKaraganda 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 – 3500Faculties - 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

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

Methods:

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%

Results:

14%

71,40% 72%

28,60%

14%

0%0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

cas

es a

chie

ving

a ta

rget

leve

l of

arte

rial p

ress

ure

in

effe

ctiv

ean

tihyp

erte

nsiv

eth

erap

ies

deve

lopi

ngco

mpl

icat

ions

Beforeimplementationof treatmentguidelines

After theintervention

The efficiency of hypertension treatment before and after implementation of treatment

guidelines

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

Results:

4728

77,5

1882

30,85$0,00

$1 000,00

$2 000,00

$3 000,00

$4 000,00

$5 000,00

61patients 1 patient

0

10

20

30

40

50

60

70

expenses fortreatment beforimplementation

expenses fortreatment after theintervention

% representing areduction

Expenses for treatment of hypertension patients

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