THE EVALUATION OF RATIONAL USE OF SOME DRUGS IN ALBANIA

Objective: The irrational use of medicines is a major problem worldwide. The irrational antibiotics are one of the causes of mortality and morbidityaround the world and the increasing of antimicrobial resistance too. The objective is to study the consumption of some reimbursement drugs, thestudy of consumption of main antibiotics in a few pharmacies in Tirana, Albania and at the same time, to study the knowledge of the random antibioticuse of patients in Tirana.Methods: Part I. There are five pharmacies randomly selected in Tirana, which are part this study. They accepted us to have access to a considerablenumber (2910) of reimbursement prescriptions, consumed in a total of 5 months. The medical prescriptions were analyzed for: (1) The average totalnumber of drugs prescribed; (2) The percentage of drug prescribed with the right generic name; (3) The percentage of antibiotics prescribed; (4) Thepercentage of injectable pharmaceutical forms prescribed; (5) The average cost of every reimbursement prescription. Part II. There are taken intoconsideration ten pharmacies located in the city of Tirana. The consumption and the knowledge of the patients about antibiotics were analyzed. Thedata are collected for a single month (May 2014). We took into consideration the entries of antibiotics and antimicrobials subtracting the presentstock of these drugs.Results: As we see from the results in there are 91.6% of reimbursement prescription prescribed in accordance with low Albanian Drug Regulation.The average number of drugs prescription is about 2 which means we have not overprescribed of drugs in reimbursement ones. The average ofthe percentage of injectable forms is 3.18, which is not very high too. Azithromycin has the highest consume, followed by amoxicillin, and thechloramphenicol has the lowest one. A high number of patients interviewed (in total 148 or 59.2%) are answered that they take antibiotics only witha medical prescription, and there were not a significant difference between female and males.Conclusions: The findings of this study suggest that the drugs given in reimbursement prescription are generally in accordance with diagnosis andrational prescription. Further investigation is needed to analyze non-reimbursement prescription which do not have the some monitoring systemwhich means that may have more problems that reimbursement ones. The authorities must have under control the enforcement of regulation low fordrug purchasing process. On the other hand, we should sensibilize all the age groups to avoid self-medication especially with antibiotics which causethe resistance problems. The doctors should be careful not to prescribe the drugs by trade name respecting the proper protocols.Keywords: Rational use, Reimbursement drugs, Antibioti

COST-EFFECTIVENESS OF BETA BLOCKERS AND THE SURVIVAL OF THE PATIENTS WITH HEART FAILURE IN THE CARDIOLOGY CENTER IN TIRANA

Objective: To evaluate the survival of the patients with heart failure in the Cardiology Center in Tirana, to evaluate the cost effectiveness of carvedilol versus metoprolol.Methods: 239 patients (pts) suffering chronic heart failure of different aetiologies, on traditional treatment for heart failure (angiotensin-converting enzyme inhibitors, diuretics, digoxin), with ejection fraction<50%, in NYHA class II-IV, were randomised to carvedilol 6.25-25 mg/day, or metoprolol 50-100 mg/day, or nebivolol 5 mg/day or treated only with the traditional treatment for they have contraindications regarding the use of β–blockers, followed for a two-year period.Results: There were included 239 patients of mild, moderate and severe heart failure, NYHA II-IV, with the fraction of ejection<50 hospitalized in the University clinic of cardiology of Tirana, followed for a two-year period; 83 patients (34.7%) were treated with Carvedilol; 70 patients (29.2%) were treated with metoprolol, 21 patients were treated with nebivolol (8.7%), and 65 patients (27.1%) were treated only with the traditional therapy (TTh).Conclusion: The use of carvedilol along with the traditional therapy of heart failure assures a higher survival rate and a lower hospitalization rate but an increase of cost of treatment of 216 €a year compared to metoprolol in addition with traditional therapy.Â

Cost-Effectiveness of Thrombolytic Therapy, Compared with Anticoagulants Therapy in the Treatment of Acute Myocardial Infarction in Albania

AIM: The study aim is to evaluate the cost-effectiveness of thrombolytic treatment in acute MI comparing with anticoagulants therapy and between each other thrombolytic (SK, r-Pa).MATERIAL AND METHODS: We used a prospective registry of all patients admitted for acute myocardial infarction in intensive care units in Tirana. The average drugs cost was calculated for the hospitalization period in Albanian money (ALL). Survival and life quality were estimated by phone contact 1 year after acute MI.RESULTS: Anticoagulant group cost is 23865.3 ALL (170.5€), SK group cost is 54148.63 ALL (386.7€), r-Pa group has a cost of 92184.90 ALL (658.5€). In the group treated with SK the hospital survival is 100%, while in the control group 88.8%. Reteplase group has a lower period of stay in hospital than SK group 13.04 days vs. 17.97 days, mean age in group treated with r-Pa is 64.29 ± 10.03 approximate with anticoagulant group mean age 64.17 ± 11.08; differ significantly with SK group mean age 56.75 ± 10.04. Survival after 1 year was 96.4% for r-Pa and 96.9% SK.CONCLUSIONS: SK and r-Pa are successful thrombolytics with high effectiveness. It is gained a higher survival with the thrombolytic treatments. Reteplase is well tolerated in older patients than SK, is easier to apply than Streptokinase, but has higher cost

THE COST-EFFECTIVENESS OF IBANDRONATE AND ALENDRONATE FOR THE TREATMENT OF OSTEOPOROSIS IN A SPECIALIZED CLINIC IN TIRANA

Objective: Biphosphonates are well known drugs for their efficacy in reducing fracture incidence, increasing bone density and improving bone micro architecture. The aim of this study is to evaluate the effectiveness of ibandronate and alendronate used in the treatment of osteoporosis in post-menopausal women over the age of 50 y at a specialized clinic in Tirana and to calculate the annual cost of osteoporosis treatment and perform a cost-effectiveness analysis.Methods: Study design: Retrospective study The patients included were all female, in menopause or post-menopause with T-score-1 to-6, treated with alendronate or ibandronate. The effectiveness of the treatment was calculated as the average percentage of change in bone mineral density (av. % of change in BMD) between 2011 and 2010 (baseline). The annual cost of the osteoporosis treatment according to the protocols and the cost of the DXA (dual x-ray absorptiometry) scan were calculated and the comparison of cost-effectiveness was performed.Results: Patients with osteoporosis treated with ibandronate (n=24) had a statistically significant higher average change from baseline compared to patients treated with alendronate (n=46) (Mann Whitney U = 66.0, p<0.01). The annual cost of treatment with ibandronate was 1.3 times higher than that of alendronate.The cost/efficacy ratio was 13.434 units for ibandronate and 31.677 units for alendronate type A1.Conclusion: Ibandronate is more effective and cost-effective than alendronate in the treatment of osteoporosis.Â