IMPACT OF INTRODUCTION OF STATINS TO THE PRIVATE AND STATE SECTORS IN SRI LANKA ON UTILISATION, COST

1
IMPACT OF INTRODUCTION OF STATINS TO THE PRIVATE
AND STATE SECTORS IN SRI LANKA ON UTILISATION,
COST AND PRESCRIPTION PATTERN

• Galappatthy P
• Cooray BPR
• Galappatthy GKS
• Fernandopulle BMR
• Department of Pharmacology Faculty of Medicine
  University of Colombo and Cardiology Unit
  National Hospital of Sri Lanka

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Background

• Ischaemic heart disease is the leading cause of
  death in Sri Lanka with 18 deaths per 100,000
  population
• (Annual Health Bulletin, Ministry of Health
  -2002)
• HMG CoA reductase inhibitors (Statins) improve
  survival in IHD
• They were introduced only recently to SL
• High cost of statins is a limiting factor for
  statin use even in developed countries
• WHO recommends selection of statins at national
  level based on local availability and costs as
  all statins have comparable and efficacy and
  safety.
• (WHO Drug information proposed INN list
  2002162)

3
Study aims

• To find out the current utilisation of statins in
  Sri Lanka and sales pattern since their
  introduction
• To find the costs per daily defined doses(DDD) of
  different brands of statins available in the
  market
• To find the prescription pattern, indications for
  use, age and sex distribution and side effects of
  statins in patients attending a Cardiology clinic
• To make recommendations on the choice of statins
  for Sri Lanka based on local data

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Methods- 1

• Utilisation was calculated in number of DDD per
  thousand inhabitants per day according to the
  Guidelines for ATC Classification and DDD
  assignment (World Health Organisation 2000)
• Information on costs and supply of statins to
  state and private sector was obtained from State
  Pharmaceuticals Corporation (SPC) from 1996 -2003
  and from private sector importers from 2000-2003

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Methods- 2

• Prescription pattern, indications for use,
  patient characteristics and side effects were
  obtained from 180 consecutive patients taking
  statins, attending the Cardiology clinic in
  National Hospital of Sri Lanka in 2002
• Three investigators visited the Cardiology
  clinics on two days of the week to gather above
  data and all those who complained of any side
  effects were evaluated by a specialist for
  diagnosis and causality assessment

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Results - 1

• Only 3 statins were available in Sri Lanka

Table 1 Available statins in Sri Lanka
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Results -2
Table 2- DDD and total consumption in 2003

• Supply to government hospitals
• In 2002 - Atorvastatin - 2 kg
• In 2003 - lovastatin - 0.8 kg

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Results -3

• Total consumption in DDD 13.82million
• Population in Sri Lanka19.5 million
• Utilisation number of DDD per 1000
  inhabitants per day
• 1.94 DDD per 1000 inhabitants per day
• Utilisation in a developed country (Finland)
• 54.6 DDD per 1000 inhabitants per day

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Results - 4

• Figure 1 - Sales in Kg of statins by SPC from
  1996-2003

Sales in kg
10
Results -5
Figure 2 - Cost of DDD of several brands of
different statins available in the market
SLR 0.01USD
ltLovastatingt
ltsimvastatingt
ltatorvastatingt
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Results - 6

• Figure - 3 Cost of DDD in USD of innovator brand
  IB, most sold generic MSG and lowest cost
  generic LCG

USD
12
Results - 7

• Figure 4- Cost of DDD in SLR of lowest cost
  generic products over the last 3 years

SLR
13
Results -8

• Figure 5 - Cost in SLR of DDD of innovator
  brands over last 3 years

SLR
14
Results -9

• Figure 6- Prescription pattern of statins

Percentage
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Results -10

• Age range of patients - 38-79 years
• males -64 females -36
• indication - secondary prevention in 90
• Side effects -
• muscle pain or cramps - 14.4
• most resolved spontaneously, CPK normal
• gastro intestinal manifestations - abdominal
  pain(2.7), flatulence (5.1), nausea(1.67) -
  short lasting and resolved
• no serious adverse reactions noted
• Side effects noted were similar for all 3 drugs

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Conclusions -1

• Utilisation of statins increased from 1996 but it
  still remains very low
• Only a small fraction of total consumption is
  provided by the state
• A wide gap exists in costs of innovator and
  generic brands
• with introduction of different statins and brands
  costs of generics have come down but that of
  innovator has gone up

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Conclusions -2

• Atorvastatin has the lowest cost per DDD
• Most commonly prescribed statin and the most
  commonly consumed statin is still lovastatin
• Use of atorvastatin would be more cost effective
  than other 2 statins in view of its lower DDD and
  availability of low cost generic products

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Recommendations

• Statins should be made available in adequate
  quantities to government hospitals considering
  the high mortality due to IHD in Sri Lanka and
  availability of low cost generic products
• National needs based on mortality and morbidity
  data, cost per DDD of drugs in same class,
  efficacy, safety and availability should be
  considered when procuring drugs
• Based on our data, supply of atorvastatin can be
  recommended to government hospitals in Sri Lanka
  as it has the lowest cost per DDD with comparable
  safety and efficacy to other statins.

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Thank you