Prescription Patterns

Fernán Caballero FonsecaCaracas, Venezuela

December 2011

Prescriptions patterns and outcomes

• Asthma prevalence• Epidemiology of asthma control• Worldwide patterns of prescriptions• Changes in prescription patterns in

Latin-America and outcomes• Conclusions

Worldwide asthma prevalence

Perú 13.0Costa Rica 11.9Brasil 11.4USA 10.9Inglaterra 15.3

Colombia 7.4Argentina 5.5Chile 5.1México 3.3

Global Burden of Asthma, 2004

10.1

5.1-7.5

0-2.5

No standardised data available

2.5-5.0

7.6-10.0

Global prevalence of asthma (world health survey)

To et al. Submitted, 2011

< 50%

50-80 %

81-95 %

> 95 %

Access to essentials drugs for asthma treatment

Global Burden of Asthma, 2004

Citi 6 – 7 y/o 13 – 14 y/o

Asthma Rhinitis Dermatitis Asthma RhinitisDermatiti

s

VERACRUZ 13.3

MERIDA 12.6 36.5 8.3 13 40.8 3.4

CD VICTORIA 8.5 21.0 2.1 14.4 34.9 4.8

DF NORTE 6.8 42.1 9.9 29.4

DF SURESTE 3.6 46.6 3.8 29.6

DF CENTRO 8.9 56.6 9.9 35.1

TIJUANA 8.0 24.5 0.7 8.6 28.1 2.0

MONTERREY 5.8 7.1 3.1 7.2 4.8 1.6

Prevalence of asthma, rhinitis and dermatitis in children

in different cities in México

ISAAC, 2003

ISAAC fase III Venezuela

Wheezing prevalence in 6 and 14 y/o 6-7 y/o 13-14 y/o

32 %3530

Wheezing in the last 12 months (persistent asthma)

18

Intermitent asthma 14

Night awakenings 13

Speech impairment (severity) 8

Exercise induce wheezing 20

Dry nocturnal cought not associated with colds.

37

International Study for Asthma and Allergies in Children. Aldrey O et al. RSVAAI 2004

Vital Signs: Asthma prevalence, disease

characteristics, and self-management education

United States, 2001-2009

CDC Morbiditiy and Mortality Weekly Reports (MMWR) 2011, 60 (17); 547-552

Prevalence of current asthma* among children and adults,† by selected characteristics

Characteristic

Total (N = 38,815) Children (n = 11,129) Adults (n = 27,686)

No. in sample

(%§) (95% CI)§No. in

sample(%§) (95% CI)§

No. in sample

(%§) (95% CI)§

Total 38,815 (8.2) (7.8--8.6) 11,129 (9.6) (8.9--10.4) 27,686 (7.7) (7.3--8.1)

Poverty threshold**

Poor 6,898 (11.6) (10.6--12.7) 2,307 (13.5 ) (11.6--15.5) 4,591 (10.6)(9.5--11.7)

Near poor 8,293 (8.5) (7.8--9.4) 2,595 (9.5 ) (7.9--11.3) 5,698 (8.1) (7.3--9.1)

Not poor 23,624 (7.3) (6.9--7.8) 6,227 (8.3) (7.5--9.1) 17,397 (7.0) (6.6--7.6)

Abbreviation: CI = confidence interval.*Includes persons who answered "yes" to the questions: "Have you ever been told by a doctor or other health professional that [you/your child] had asthma?" and "Do [you/your child] still have asthma?" † Children aged <18 years; adults aged ≥18 years.§ Weighted estimates.** Poor = household income below the federal poverty level (FPL), near poor = 100% to <200% of the FPL, and nonpoor = ≥200% of the FPL.

National Health Interview Survey, United States, 2009

 Children

4 - 11 years

Adolescents 12 - 17

years

% Of NWCA 30.5 % 24.4 %

Allergic Rhinitis 54 - 55 % 54 -55 %

Eczema 18.6 % 10.1 %

Oral Corticosteroid Use 38.3 % 26.9 %

Emergency Use 37.1 % 24.1 %

Hospitalitations 6.0 % 1.9 %

A national survey to assess asthma control in the US pediatric population

R.H. Standford et al.American Thoracic Society (ATS). ATS,Toronto, Canada May 16-21, 2008

Background: The 2007 NHLBI Asthma Guidelines Propose asthma control as a goal of therapy.

Objetive: To measure the level of not well controlled asthma (NWCA) in children aged 4-11 and 12-17 yrs and associated demographics and comorbidities (159.872 US households)

CharacteristicTotal (N = 2,421) Children (n = 806) Adults (n = 1,615)

No. (%§) (95% CI)§ No. (%§) (95% CI)§ No. (%§) (95% CI)§

Prescription asthma medicine useQuick-relief inhaler during

preceding 3 mos2,421 (64.4) (62.1--66.7) 806 (59.4) (54.9--63.7) 1,615 (66.6) (63.8--69.2)

Long-term control medicine (oral or inhaler) at the time

of survey2,421 (33.5) (31.1--35.9) 806 (31.3) (27.5--35.3) 1,615 (34.4) (31.6--37.4)

Disease characteristics and self-management education

status among children and adults* with current asthma†

Abbreviation: CI = confidence interval; ED/UC = emergency department/urgent care.* Children aged <18 years; adults aged ≥18 years. † Includes persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that [you/your child] had asthma?" and "Do [you/your child] still have asthma?" § Weighted estimates.¶ Related questions were asked among persons who had an asthma attack during the previous 12 months.

National Health Interview Survey, United States, 2008

J ALLERGY CLIN IMMUNOL AUGUST 2011

Base: all respondents (n=3,415)

SABA use (inhalations/day in the last week)

Patients (%)

Nu

mb

er

of

inh

ala

tion

s/d

ay

26%

38%

21%

11%

Partridge MR, BMC Pulmonary Medicine 2006

Despite ICS or ICS/LABA therapy, 74% of patients used rescue therapy each day

Patterns of asthma controler prescribing for pediatric asthma

patients in UK primary care

M. Thomas et al.BMC Pulmonary Medicine 2010

Persistent underuse of asthma medication in a large health plan

Savwicki R et all. ATS 2009

Patients hospitalized due to asthma

Rodrigo et al. J Bras Pneumologia 2009

Asthma drugs sales in Mexico

Antiasthmatic drug sales in Argentina, 1990-1999

Neffen H. ACI International, 1999:11(5)171-175

Asthma mortality vs. inhaled steroids sales Argentina, 80s-90s

Mortality Rate Rho Spearman 5-34

0.72 0.38 - 0.84 (p = 0.003)

3.38 2.58 - 0.81 (p = 0.005)

Global

Pediatric prescriptions for asthma in Venezuela

QTR~12/2000

QTR~03/2001

QTR~06/2001

QTR~09/2001

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Pediatric prescriptions for asthma in Venezuela

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Pediatric prescriptions for asthma in Venezuela

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SERETIDE GSK FORADIL/MIFLONIDE NVR SYMBICORT AZN SPIRIVA B_I FORADIL NVR VANNAIR AZN MIFLONIDE NVR FORACORT PG4 FORMOTEC PG4 SYMBICORT + VANNAIR

Seretide is the market leader with negative perforamance over thepast years in Venezuela

IMS – PMV Diciembre 2009

Foradil/Miflonide and Symbicort + Vannair show a positive trend Spiriva after three year of growth lost market share in 2009

Asthma drugs sales in Venezuela

Upon closer look on the respiratory market in Venezuela

IMS – PMV Diciembre 2009

Comb (LABAs+ICS) represent 37% of usage, while LABAs have 18% and LAMAs 12%

Pediatric prescriptions for asthma in

Caracas, Venezuela

Leon. M, Ortega. E, Sanchez-Aguilar. M, Sanchez-Borges M, Caballero-Fonseca F, Cedraro S. Interasma 2009

N=121: 2-12 years 73 (63.6%) uncontrolled 33 (27.33%) p. controlled 11 (9.1%) controlled

Pediatric prescriptions for asthma in

Caracas, Venezuela

Inhaled corticosteroids Bronchodilator + Inhaled

corticosteroids

Leon. M, Ortega. E, Sanchez-Aguilar. M, Sanchez-Borges M, Caballero-Fonseca F, Cedraro S. Interasma 2009

Salvador

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ati

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Reduction in hospitalizations due to asthma in Brazil

Souza-Machado et al. ERJ 2009

Recife

Hosp

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on r

ate

s/10.0

00 inhabit

ants

● Asthma prevalence in developing countries may

be higher than in the developed world

o Lack of access to proper care and medication

o Poor compliance

● There is an urgent need for the implementation

of better strategies for asthma control among

the underserved populations

Mario Sánchez-Borges, MD, Arnaldo Capriles-Hulett, MD, and Fernan Caballero-Fonseca, MD. Journal of WAO 2011

Asthma care in resource-poor settings

Conclusions

● The prevalence of asthma is variable world wide

● We need to improve adherence to guidelines both in Latin America and in more developed countries

● We are in urgent need of more “friendly” guidelines

● We need to disseminate guidelines to improve morbidity from asthma

● Change in prescription patterns has a positive impact in asthma morbidity