What is happening with not recommended drugs for dementia in Argentina? Prescription patterns and direct costs analysis

Abstract

Objectives: The only recommended pharmacological treatments for specific dementias are donepezil, galantamine, rivastigmine, and memantine (recommended drugs, RD). However, other drugs without recommendations (not recommended drugs, NRD) are often used to treat patients with cognitive impairment (CI) in Argentina. The INSSJyP is the largest health insurance in Argentina. The objective of this study is to analyze the prescription pattern, cost, and implications of NRD used for the treatment of CI in the INSSJyP. Materials: This is a retrospective, population-based study of the INSSJyP outpatients' prescriptions database for drugs usually prescribed for CI during 2015. These data were compared with the same database in 2009. The number of "prescriptions" always refers to dispensed packages. Results: A total of 3 255 438 packages of drugs usually indicated for CI were prescribed during 2015: 1 912 476 packages of RD (59%) and 1 342 962 packages of NRD (41%).Comparing the results with those obtained in 2009, there is a 148% gross increase in the prescription of both RD and NRD for CI, although the rates/1000 affiliates/year show a lesser rise for NRD (70.1%) compared to RD (103.9 %).The expenditure on CI drugs prescribed during 2015 was 77 million USD. NRD cost represented approximately 20 million USD. Conclusion: Inappropriate drug use increases health costs in developing countries.We found a high number of patients with a probable diagnosis of CI treated with NRD. It is extremely relevant that all the healthcare professionals can update their knowledge and modify behavioral insights about appropriate prescription for specific dementias.

Treatment of Alzheimer’s Disease in the New Era of Monoclonal Antibodies Against Cerebral Amyloid-β: Pharmacological Prescription and Knowledge in Argentina

“…There were no significant differences between SCD and NSCD regarding the use of RT or NRT in MCI or mild dementia. This agrees with the work published by Bustin et al [9] in 2019, where of a total of 3,255,438 prescriptions for patients with cognitive impairment, 59% were RT and 41% were NRT.…”

“…To delineate the pharmacological treatment modalities for patients diagnosed with mild cognitive impairment (MCI) and AD, we employed the classification criteria outlined by Bustin et al [ 9 ] in their study on pharmacological prescriptions. This classification system encompasses three distinct categories: Recommended Treatments (RT), Non-Recommended Treatments (NRT), and off-label treatments.…”

“…NRT were defined as all drugs without indications or endorsement in international literature (such as vitamin supplements, nimodipine, citicoline, among others). In MCI, a predementia syndrome in which individuals demonstrate cognitive impairment without functional consequences, there is not any RT for the different clinical and etiological subtypes of this condition [9]. However, there is some evidence of benefits of donepezil and memantine in MCI [10,11].…”

Data transparency for building a stronger healthcare system: A case study from Argentinean administrative drug utilization data sources

“…La base de datos contiene información individual sobre la dispensa ambulatoria de medicamentos, incluyendo el nombre genérico y la marca comercial, la especialidad medicinal, el precio total y el gasto de bolsillo. Esta base de datos se ha utilizado para estudios sobre psicofármacos y antihipertensivos, entre otros (18,20,21,22) .…”

Effect of a Social Norm Email Feedback Program on the Unnecessary Prescription of Nimodipine in Ambulatory Care of Older Adults

“…Elderly patients are often prescribed inappropriate medications and supplements for mild cognitive impairment and dementia . In Argentina, nonrecommended drugs account for between 41% and 45% of prescriptions for cognitive impairment, the most widely used of which is nimodipine—a drug recommended for use with acute subarachnoid hemorrhage during short hospital stays, not outpatient use for cognitive impairment …”