@article{3124423,
    title = "Drug utilization patterns and costs of erythropoiesis-stimulating agents in an outpatient setting in Greece",
    author = "Papachristos, A. and Kani, C. and Litsa, P. and Valsami, G. and Souliotis, K. and Saridi, M. and Markantonis, S.",
    journal = "Consultant Pharmacist",
    year = "2016",
    volume = "31",
    number = "5",
    pages = "271-281",
    publisher = "American Society of Consultant Pharmacists",
    issn = "0888-5109",
    doi = "10.4140/TCP.n.2016.271",
    keywords = "antianemic agent;  antianemic agent;  biosimilar agent;  erythropoietin, adolescent;  adult;  aged;  Article;  child;  clinical trial;  demography;  drug cost;  drug dose regimen;  drug utilization;  female;  funding;  Greece;  human;  infant;  major clinical study;  male;  medical record review;  newborn;  outpatient;  outpatient department;  pharmacy;  prescription;  register;  social insurance;  treatment indication;  ambulatory care;  anemia;  clinical practice;  dose response;  drug cost;  economics;  middle aged;  off label drug use;  preschool child;  quality of life;  retrospective study;  statistics and numerical data;  very elderly;  young adult, Adolescent;  Adult;  Aged;  Aged, 80 and over;  Ambulatory Care;  Anemia;  Biosimilar Pharmaceuticals;  Child;  Child, Preschool;  Dose-Response Relationship, Drug;  Drug Costs;  Erythropoietin;  Female;  Greece;  Hematinics;  Humans;  Male;  Middle Aged;  Off-Label Use;  Practice Patterns, Physicians';  Quality of Life;  Registries;  Retrospective Studies;  Young Adult",
    abstract = "Anemia in the elderly is often related to a higher prevalence of chronic diseases such as chronic kidney failure, arthritis, and malignancy. Erythropoiesis-stimulating agents (ESAs) have been used for years to effectively treat anemia and when used appropriately can substantially improve the health status and quality of life of older adults. Following the 2008 recession in Greece, the government introduced ESA price control restrictions, but no prescribing restrictions, in an effort to reduce drug expenditure. Objective: ESA prescribing patterns and treatment costs were analyzed to determine inappropriate or appropriate use of these agents and related health care resources in Greece. Method: A retrospective register-based drug utilization study was carried out using data from prescriptions dispensed at the public pharmacy of the largest social insurance fund (IKAETAM), for patients receiving ESAs over a six-month period. For each patient, demographic data, ESA dosage regimen, treatment indication and cost, prescriber specialty, and prescription origin were recorded. Results: A total of 14,387 prescriptions from 6,074 patients (median age 74 years) were reviewed. A substantial number of patients (13.5%) were treated for off-label indications, for which the average cost per patient per indication was higher. ESA dosage/frequency of administration varied but was in accordance with recommendations. The percentage of patients who received innovator and biosimilar erythropoietin (EPO) was 88% and 12%, respectively. Conclusion: For the optimization of ESA utilization and the reduction of treatment costs, strict ESA prescription monitoring, development of registries, and criteria for off-label indications and biosimilar use in naive patients under the umbrella of risksharing agreements should be proposed. © 2016 American Society of Consultant Pharmacists, Inc. All rights reserved."
}