The Dilemma of Irrational Antibiotic and Corticosteroid Prescription in Iran: How Much It Can Affect the Medicine Expenditures?
,
Abstract
In recent years the high cost of medicines and the lack of it were one of the major problems in developing countries that despite numerous efforts to solve the root causes of this problem, the issue remains, unfortunately. Therefore, this study aimed to assess the impact of antibiotics and corticosteroids prescription on the medicines expenditures. This was descriptive-analytical study that conducted to assess the function of medical expenditures through prescription letters and analysis the factors affecting medicine expenditures. We used the data of 91,994,667 selected prescription letters that were collected by the Ministry of the Health and Medical Education (MOHME) throughout the country in the year 2011 which was analyzed through a logarithmic regression model and OLS estimator. The average number of prescription items in each prescription letter were varied from 2.7 to 3.6, and the average price of each letter was varied from 30223 to 69986 Rials. Between 39 to 61 percent of prescription letters containing antibiotic items and between 15 and 35% of them contain corticosteroids. Also, the impact of antibiotic and corticosteroid prescriptions on the average expenditure of prescription letters were -1.4 and 0.032 respectively. Excessive and irrational prescribing had the greatest impact on medicine expenditures. On the other hand, the expenditure of prescription letters had the negative elasticity to antibiotics prescription and relatively inelastic for corticosteroids. So, raising the price of medications to reduce the use of them could not play a successful role in a control policy.
Pharmaceutical products. WHO. (Accessed March 2017, 29, at http://www.who.int/topics/pharmaceutical_products/en
Dumoulin JE, Kaddar MI: Guide to drug financingmechanisms. (Accessed March 2017, 29, at http://apps.who.int/medicinedocs/en/d/Jh2928e.)/
Pharmaceutical Sector Inquiry Preliminary Reports.Accessed March 2017, 18, http://ec.europa.eu/competition/sectors/pharmaceuticals/inquiry/fact_sheet_1.pdf.)
World bank pharmaceuticals, Govindaraj R, Michel R.Reichand and Jillian C. Cohen, September 2000.(Accessed March 2017,18,https://scholar.google.com/citations?view_op=view_citation&hl=en&user=V6sGrijakqYC&citation_for_view=V6sGrijakqYC:Zph67rFs4hoC.)
EbadifardAzar F, Rezapoor A, Rahbar A, Shokouh H,Morteza S. Estimation of the Function of MedicineDemand in Islamic Republic of Iran. J Mil Med2013;15:163-8 .
Khaksari M, Ahmadi Kohanali J, Sepehri G, Shafei K,Sadeghi S. Analysis of the Prescription of Physicians inRafsanjan, 1993-1998. J Rafsanjan Univ Med Sci HealthServ 2002;1:1-7 .
cheraghali AM, Impacts of international sanctions onIranian pharmaceutical market. DARU Journal ofPharmaceutical Sciences 2013, 21:64.
Mohammadi D. US-led economic sanctions strangleIran's drug supply. Lancet 2013;381:279.
ISPOR Mongolia Chapter. Estimating economic lossresulted from irrational use of medicine. (Accessed March2017, 18, athttp://www.ispor.org/regional_chapters/Mongolia/documents/Estimating-economic-loss%20-from irrational-useof-medicines.pdf.)
WHO. The Pursuit of Responsible Use of Medicines:Sharing and Learning from Country Experiences 2012.(Accessed March 2017, 18, athttp://www.who.int/medicines/publications/responsible_use/en.)/
Liss RH, Batchelor FR. Economic evaluations ofantibiotic use and resistance—a perspective: report ofTask Force 6. Rev Infect Dis 1987;9:S297-312.
World Health Organization. Control of antibiotic-esistantbacteria: memorandum from a WHO meeting, WHOScientific Working Group on Antimicrobial Resistance.Am J Hosp Phar 1984;41:1329-37.
Kunin CM. Resistance to antimicrobial drugs—aworldwide calamity. Ann Intern Med 1993;118:557-61.
Loeffler JM, Garbino J, Lew D, Harbarth S, Rohner P.Antibiotic consumption, bacterial resistance and theircorrelation in a Swiss university hospital and its adultintensive care units. Scand J Infect Dis 2003;35:843-50.
Abolhalaj M, Bastani P, Ramezanian M, Tamizkar N.Production and consumption financial Process of drugsin Iranian healthcare market. Dev Count Stud 2013;3:187-91 .
Mosleh A, Darbooy S, Khoshnevis Ansari S, Mohammadi M. Drug prescription based on WHO indicators: Tehranuniversity of medical sciences facilities with pharmacy.Tehran Univ Med J 2008;65:12-5 .
Hashemi Sh, Nasrollah A, Rajabi M. Irrational ntibioticprescribing: a local issue or global concern? EXCLI J2013;12:384-95.
Andayesh Y, Keshavarz K, Zahiri M, Mirian I, BeheshtiA, Imani A, et al. The Effects of Drug SubsidiesExclusion on Price Index of Sectors and Household`sExpenditures; Using Structural Path Analysis. J HealthAdm 2011;13:45-56.
Aminlo H. Fifty-six percent of public health expendituresare financed by people. (Accessed March 2017, 18, atwww.salamatnews.com/ViewNews.aspx?ID=50617.)/
Dinarvand R, Nikzad A. Status of prescription and drugusage in Tehran in 1998. Hakim 2000;1:1-7 .
Sadeghian GH, Safaeian L, Mahdanian AR, Salami S,Kebriaee-Zadeha J. Prescribing Quality in MedicalSpecialists in Isfahan, Iran. Iran J Pharm Res2013;12:235-41.
Goldman DP, Joyce GF, Lawless G, Crown WH, WilleyV. Benefit design and specialty drug use. Health Aff2006;25:1319-31
How to investigate drug use in health facilities. WorldHealth Organization: Jeneva: 1993.
Raveh D, Levy Y, Rudensky B, Yinnon, AM.Longitudinal surveillance of antibiotic use in the hospital.Q J Med 2001;94:141-51.
Beringer PM, Wong-Beringer A, Rho JP. Economicaspects of antibacterial adverse effects.Pharmacoeconomics 1998;13:35-49.
Meymand M, Sepehri G, Farokhi N, Beygim M, MotevaliZadeh H. Pattern of drug use among residents of Bam
during the first 6 months after the 2003 earthquake.Hakim Res J 2008;10:27-33 .
Kozyrskyj AL, Dahl ME, Chateau DG, Mazowita GB,Klassen TP, Law BJ. Evidence-based prescribing ofantibiotics for children: role of socioeconomic status andphysician characteristics. CMAJ 2004;171:139-45.
Stefanou A, Marshall N, Holdan W, Siddiqui A. Arandomized study comparing corticosteroid injection tocorticosteroid iontophoresis for lateral epicondylitis. JHand Surg Am 2012;37:104-9 .
Ravangard R, Jafari A, Motlagh SN. Drug DemandFunction for Iranian Urban Households Based onHouseholds' Budget. Health Scope 2014;3:18494 .
Choi K-H, Park S-M, Lee J-H, Kwon S. Factors Affectingthe Prescribing Patterns of Antibiotics and Injections.2012 The Korean Academy of Medical Sciences. J Korean Med Sci 2012;27:120-7 .
Cholle D, Liu S. Income Elasticity of the Demand for Health Insurance and Health Care Services: A Critical Review of the Literature Final Report. Washington:Mathematical Research Inc, 2006:33-60.
Shea Dennis G, Terza Joseph V, Stuart Bruce C,Briesacher Becky. Estimating the Effects of Prescription Drug Coverage for Medicare Beneficiaries. Health Serv Res 2007;42:933-49 .
Cadieux GTR, Dauphinee D, Libman M: Predictors of inappropriate antibiotic prescribing among primary carephysicians. CMAJ 2007;177:877-83.
Meskarpour-Amiri M, Dopeykar N, Mehdizadeh P,Ayoubian A, Motaghed Z. A Study on the Factors Affecting the Prescription of Injection Medicines in Iran:A Policy Making Approach. Glob J Health Sci.2015;7(3):291–297.
Arjmand B, Goodarzi P, Mohamadi-Jahani F, Falahzadeh K, Larijani B. Personalized Regenerative Medicine. Acta
Med Iran. 2017 Mar;55(3):144-149.
| Files | ||
| Issue | Vol 55, No 10 (2017) | |
| Section | Original Article(s) | |
| Keywords | ||
| Prescription Antibiotic Corticosteroid Medical expenditure Health policy | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
