Remarkable variations in the use of medicines for peptic ulcer and gastro-esophageal reflux disease between Serbia and the Nordic countries

B Stanimirov1, K Stankov0,2, N Pavlovic1, M Paut Kusturica1, M Stojancevic1, A Sabo1, M Mikov1. 1University of Novi Sad, Medical faculty, Department of Pharmacology, Clinical pharmacology and toxicology, Serbia, 2University of Novi Sad, Medical faculty, Clinical Centre of Vojvodina, Serbia

Introduction and aim: Medicines for peptic ulcer and gastro-esophageal reflux disease (ATC subgroup A02B) are among the most commonly prescribed class of drugs. The aim of this study was to analyze the pattern of consumption of histamine H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) in Serbia in correlation with the Nordic countries (Denmark, Norway, Sweden and Finland).

Methods: Data on consumption of medicines during the four-year period (2007-2010) have been provided from the databases of the national regulatory agencies. The results were expressed as the number of defined daily doses per 1000 inhabitants per day (DID). A qualitative analysis was carried out according to the drug utilization 90% (DU90%) approach.

Results: During the study period, the overall consumption of medicines for peptic ulcer and gastro-esophageal reflux disease in Serbia decreased by 7.8% (from 24.888 DID in 2007 to 22.93 DID in 2010) in opposite to Scandinavian countries where consumption of these medicines continuously increased in all countries up to 56% in Denmark (from 38 DID in 2007 to 51.7 DID in 2010). Utilization of H2RAs in Serbia decreased by 18.9% (from 20.3 DID in 2007 to 16.46 DID in 2010) between 2007 and 2010. However, in 2010, H2RAs accounted for 71.78% of medicines used within A02B subgroup in Serbia, while in Scandinavian countries the share of H2RAs was in the range of 2,2% (1.08 DID in Sweden) up to 12.76% (5.75 DID in Norway). Over the study period, the rise in consumption of PPIs in Serbia by 34.3% (from 4.8 DID in 2007 to 6.45 DID in 2010) was noted. Despite this increase, utilization of PPIs in Serbia was from 6 to 7.6 times lower than in the Scandinavian countries (from 38.84 DID in Norway to 49.1 DID in Denmark) in 2010. The bulk of prescription (DU90%) in 2010 was made up of 3 (out of 7) medicines in Serbia, 2, 4 and 5 (out of 14) medicines in Sweden, Denmark and Finland respectively, and 5 (out of 10) medicines in Norway. Most frequently used medicine from A02B subgroup in Serbia was ranitidine (55.9%), in Sweden and Denmark omeprazole (80.3% and 30.3% respectively), in Norway esomeprazole (34.1%) and in Finland pantoprazole (28.5%).

Conclusion: The overall utilization of medicines for peptic ulcer and gastro-esophageal reflux disease was notably lower in Serbia than in Scandinavian countries. Besides the quantity, the pattern of use showed remarkable differences. These findings suggest that implementation of guidelines in Serbia is needed in order to achieve harmonization in prescribing practice. Acknowledgement: This work is supported by Ministry of Education and Science, Republic of Serbia, project No. 41012.