ANTICANCER DRUG UTILIZATION FOR THE TREATMENT OF BREAST CANCER AT REGIONAL CANCER CENTERS IN THAILAND

Abstract

All stakeholders realized that cost of medications, new innovative medicines, reimbursement policy, clinical practice guideline or other factors may cause the overuse of budget, deviation from the guideline and finally leading to low quality of treatment. To explore the situation of anticancer drug, this research was aimed to describe the pattern of use, examine the appropriated use and elaborate factors affected pattern and appropriate use of anticancer drugs in healthcare provider perspective. Retrospective study was conducted by collecting anticancer drugs prescriptions from out-patients department at seven regional cancer centers of Thailand between January to June 2010. There were 7,520 analyzed prescriptions by three groups (3,485 of Chemotherapy, 3,930 of Hormone therapy and 105 of Targeted therapy) for describing pattern of use and three anticancer drugs (Docetaxel, Letrozole and Trastuzumab) were selected to examine the appropriate use. Chi-square, Man-Whitney U test, 2-Independent Sample test and Logistic regression were used to analyze. The results showed pattern of prescribing original drug and non-National list of Essential Drug (NLED) were most frequently in hormone therapy drug as 26.50% and 9.35% respectively. Chemotherapy prescriptions showed the highest average percentage of concomitant drugs prescribing (92.60%). Due to National Health Service Office (NHSO) cancer guideline, the percentage of prescriptions that complied with the guideline in each group was 92.60%, 94.35% and 100.00% in chemotherapy, hormone therapy and targeted therapy respectively. To compare average cost of chemotherapy regimen found that only cost CMF (Cyclophosphamide, Methotrexate and Fluorouracil) regimen was under reimbursed cost. More than 90% of hormone and targeted therapy prescription did not found drug interaction and the sequential of administration lead to prevent drug interaction in chemotherapy. Drug use evaluation (DUE) by clinical evaluation show 49.72%, 80.76% and 100.00% appropriate in Docetaxel, Letrozole and Trastuzumab respectively even DUE forms were not all completed. The factor affected patterns of prescribing were non-NLED policy, original drug policy, medication safety standard policy and health benefit scheme. The factor affected appropriated use of Docetaxel were medication safety standard policy, health benefit scheme, physician specialist and age. The factor affected appropriated use of Letrozole were physician specialist and age. The logistic regression equation of all factors were analyzed for predicting the pattern and appropriate use.