Pharmacoeconomic aspects of patients treated by hemodialysis.

Hemodialysis as a therapeutic procedure in patients being in the end-stage of renal failure has been used since the sixties of the 20th century. Generally speaking, the conservative drug therapy in patients treated by hemodialysis is complex, and economically it consummes as great proportion of financial expenses. The aim of the study was to perform an economic analysis of 101 patients, both sexes (37 females and 64 males, aged from 22 to 81 years) treated by hemodialysis, in respect of drug treatment costs. The total average cost of treatment medication represented 161,589 SKK/patient/year. Eighty one percent of total expenses were linked with the consumption on antianemic drugs (102,298.40 SKK/patient/year). The second most expensive drug group (9% of the total cost) were medications used in coincidence with hemodialysis complications (14,981 SKK/patient/year). Diuretic--furosemid was the most frequently used drug out of the category of antihypertensive medications (68% of patients), followed by beta-blockers (preparation Concor), calcium channel blockers (preparations Norvasc and Plendil) and angiotensin converting enzyme tritace inhibitors (ACEI, preparations Trirace, Enap, Prestarium), respectively. Only 27% of patients were treated by hypolipidemic drugs mostly by the preparations of Gevilon and Innogen. In the majority of patients (93%) preparations for the correction of calcium and phosphorus metabolisms such as Vitacalcin and Rocaltrol were administered, the latter being most expensive. Antianemic drugs have been used in all patients. In this category of preparations, those composing acid folate and erythropoetin were used most frequently. Alkaline supplementation of NaHCO, (bicarbonate) was used in 88% of patients. In order to prevent the development of thrombosis and other vascular complications, the drugs with antiaggregative effects were used (Ibustrin, Curantyl, Anopyrin). To prevent the manifestation of gastrointestinal adverse reactions, the administration of H2-antagonists have been preferred (Famosan, Quamtel). The group of "Other drugs" was represented by vitamins and drugs with anti-uratic effects (ascorbic acid--preparation Celaskon, tocopherol--preparation E-vitamin and Milurit). When summed together, the costs of therapy in patients treated by hemodialysis are three times higher compared with those in the pre-dialysis phase. In addition to the latter hemodialysis is associated with a large number of medical, psychic and social complications. In the presented pilot study the authors analysed the financial expenses coinciding with drug costs (direct loads) which are significant, but represent only a part of the pharmacoeconomic complexity. In the future it is necessary to perform a more complex pharmacoeconomic analysis in order to evaluate also other factors, such as the costs of hospitalization, dialysate solutions, technologys, salaries of the staff, etc. (Tab. 6, Ref. 37.).