Results of the clinical and economic analysis of the state of pharmaceutical provision of patients with dementia in Alzheimer’s disease in Ukraine
Authors: Fedotova M. S. , Panfilova H. L. , Iurchenko G. M. , Palamar А. O. , Tereshchenko L. V. , Kliuiko A. A. , Lebedyn A. M. , Chernukha V. M. 
Published: November 2022

Aim. To conduct the clinical and economic analysis of the state of pharmaceutical provision of patients with dementia in Alzheimer’s disease in Ukraine.

Materials and methods. Both general theoretical (historical, analytical-comparative, systemic, graphical, logical, hypothetical-deductive) and applied (clinical-economic, mathematical-statistical) research methods were used.

Results. It was found that the vast majority of patients belonged to socially unprotected segments of the population. Thus, the proportion of pensioners was 71.0 %, and 40 patients (20.0 %) had disability groups. All patients, without exception, had a burdened anamnesis. On average, patients were treated in specialized medical institutions for 43.8 bed-days. The sum of 548,714.5 UAH (19,072.45 USD) was spent on drug provision for these patients, which amounted to 2,743.57 UAH (95.36 USD) per one patient. For one bed-day, patients used drugs for only 62.64 UAH (2.18 USD). Physicians wrote 2,487 prescriptions (12.4 per a patient) and used 128 drugs under international non-proprietary names or 218 drugs taking into account all their trade names. In the structure of medical prescriptions, there was a significant duplication of drugs represented by international non-proprietary names. According to the first level of the ATC classification system, the highest rates of prescription frequency were for group N – Drugs affecting the nervous system (861 prescriptions or 34.62 %), and according to the second level, there were drugs from group C01 – Cardiac therapy group (375 prescriptions or 15 .08 %). At the same time, the second and third positions by the number of prescriptions were occupied by drugs from groups N05 – Psycholeptics (363 prescriptions or 14.60 %) and N06 – Psychoanaleptics (309 prescriptions or 12.42 %). It was found that physicians prescribed 617 (24.81 %) drugs recommended by the Clinical Protocol for the treatment of cognitive and non-cognitive behavioral disorders in patients with dementia due to Alzheimer’s disease. Of the drugs in group N06D – Anti-dementia drugs, the drugs in group N06DX – Other drugs for the treatment of dementia had the highest prescribing rates (191 physicians), while drugs of group N06DA – Cholinesterase inhibitors were prescribed by physicians only 43 times. The highest prescription rates in the structure of pathogenetic therapy were drugs of group N06DX01 – Memantine (188 prescriptions or 30.47 %). Then, drugs of group N06DA03 – Rivastigmine (34 prescriptions or 5.51 %) and N06DA02 – Donepezil (6 prescriptions or 0.97 %) followed by a significant margin. The drugs of group N06DX01 – Memantine also occupied leading positions in the structure of drug consumption. Thus, the volume of their consumption was equal to 84,420.2 UAH (2,934,314 USD), which accounted for 15.39 % of the total cost of drug provision for patients and 91.76 % of drug consumption in group N06D – Medicines for use in dementia.

Conclusions. A significant financial burden associated with the need to use pathogenetic therapy drugs in patients with dementia in Alzheimer’s disease requires the development and implementation of effective models of resource provision for pharmacotherapy and social support of neuropsychiatric patients in Ukraine.