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Driving forces behind increasing cardiovascular drug utilization: a dynamic pharmacoepidemiological model.

Abstract：

AIMS:To investigate the driving forces behind increasing utilization of cardiovascular drugs. METHODS:Using register data, all Danish residents as of 1 January 1996 were followed until 2006. Cohort members were censored at death or emigration. Cardiovascular drug utilization on the individual level was traced, applying registered out-of-hospital dispensing. The impact of population ageing on cardiovascular drug utilization was investigated using standardized intensities and prevalences. Based on a three-state (untreated, treated and dead) semi-Markov model, we explored to what extent increasing treatment prevalence was driven by changing incidence, discontinuation and mortality. Expected treatment prevalences were modelled, applying stratum-specific cohort prevalence in 1996 along with incidence, discontinuation and drug user mortality either throughout 1996-2004 or at fixed 1996 levels. RESULTS:Treatment prevalence (ages > or =20 years) with cardiovascular drugs increased by 39% during 1996-2005 from 192.4 to 256.9 per 1000 inhabitants (95% confidence interval 256.5, 257.3). Treatment intensity grew by 109% from 272 to 569 defined daily doses 1000(-1) day(-1). Population 'middle-ageing' accounted for 11.5 and 20.3%, respectively. Increasing treatment incidence was the main driver of the rising treatment prevalence in most drug categories. Declining discontinuation drove some of the growth, declining drug user mortality less. Even with fixed incidence in the model, treatment prevalence continued to increase. CONCLUSIONS:Age-related increases in treatment intensity and prevalence, rather than population ageing, drove the increasing treatment intensity with cardiovascular drugs. Increasing treatment prevalence in subgroups was primarily caused by increasing incidence. Due to pharmacoepidemiological disequilibrium, treatment prevalence will continue to grow even with unchanged incidence.

journal_name

Br J Clin Pharmacol

journal_title

British journal of clinical pharmacology

authors

Kildemoes HW,Støvring H,Andersen M

doi

10.1111/j.1365-2125.2008.03282.x

subject

Has Abstract

pub_date

2008-12-01 00:00:00

pages

885-95

issue

eissn

0306-5251

issn

1365-2125

pii

BCP3282

journal_volume

pub_type

杂志文章,多中心研究

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Driving forces behind increasing cardiovascular drug utilization: a dynamic pharmacoepidemiological model.