Publication:

Prescribing patterns in systemic hypertension and pharmaco-economics (cost effectiveness and cost minimisation analyses) of the commonly prescribed antihypertensives in a district hospital in Enugu State, Southeast Nigeria

Background Prescribing patterns in systemic hypertension vary from place to place. Studies have shown that cost could be one of the factors responsible for non-adherence to treatment among hypertensive patients. Nigerian pharmacoeconomics studies have not provided a general guide on cost-effective prescribing for hypertensive patients in the country. The aim of the study was to examine the prescribing patterns, do cost effectiveness and cost minimisation analyses of the commonly prescribed antihypertensives, and determine if cost is a major reason many of the hypertensive patients of the District Hospital are usually lost to follow up.

Methods 5267 adult (≥18 years) non-antenatal patients’ cards of 2016 were reviewed for hypertension. Examination of the prescriptions, cost-effectiveness and cost-minimisation analyses of the commonly prescribed antihypertensives were done.

Results 12.6% of the patients were hypertensive. 73% of these hypertensive patients were treated pharmacologically. 40.8% adhered to treatment. 73% of the adherent ones responded to treatment. Amlodipine was the most expensive prescribed antihypertensive (N22). Amiloride-hydrochlorothiazide with the largest cost effectiveness ratio (CER) (9) was the most cost effective of all the combinations. Lisinopril- hydrochlorothiazide (N17) was preferable to the triple combination of lisinopril-amlodipine-hydrochlorothiazide (N39), and amlodipine-hydrochlorothiazide (N32) in cost minimisation.

Conclusions Cost of drugs probably had played a significant role in non-adherence to treatment among hypertensive patients in the District Hospital in 2016, since moduretic with the largest CER (9) and nifedipine with the greatest BP reduction when combined with hydrochlorothiazide (56/22 mm Hg) were rarely prescribed.