[e-drug] Drugs to avoid to improve quality use of medicines:

e-drug
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E-DRUG: Drugs to avoid to improve quality use of medicines:
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Drugs to avoid to improve quality use of medicines: how is Australia faring?
Agnes Vitry and Barbara Mintzes

Journal of Pharmaceutical Policy and Practice
Volume 14, Article number: 60 (2021)
Full text available:
https://joppp.biomedcentral.com/track/pdf/10.1186/s40545-021-00346-3.pdf

Abstract
Background
Each year, the French independent bulletin Prescrire publishes a list
of medicines, 'Drugs to avoid', that should not be used in clinical
practice as their risk-to-benefit ratio is unfavourable. This study
assessed the market approval, reimbursement and use of these medicines in
Australia.
   
Methods
The approval status of the medicines included in 2019 Prescrire 'Drugs
to avoid' list was assessed by searching the Australian Register of
Therapeutic Goods website. Funding status was assessed on the
Pharmaceutical Benefits Scheme (PBS) website, the Australian public insurance system. Use levels were determined by examining governmental
reports on prescribing rates including the Australian Statistics on
Medicines (ASM) reports, drug use reports released by the Drug Utilisation
Sub Committee (DUSC) and PBS statistics.

Results
Of the 93 medicines included in the Prescrire 2019 'Drugs to avoid'list included, 57 (61%) were approved in Australia in 2019 including 9(16%) that were sold as over-the-counter medicines, 35 (38%) were listed on the PBS, 22 (24%) were registered but not listed on the PBS. Although most of these medicines were used infrequently, 16 (46%) had substantial use despite serious safety concerns. Dipeptidyl peptidase-4 (DPP-4) inhibitors were used by 22% of patients receiving a treatment for diabetes in 2016. More than 50,000 patients received an anti-dementia medicine in 2014, a 19% increase since 2009. Denosumab became the 8th medicine, in terms of total sales, funded by the Australian Government in 2017-2018.
   
Conclusions
Prescrire's assessments provide a reliable external benchmark to assess the current use of medicines in Australia. Sixteen 'drugs to avoid',judged to be more harmful than beneficial based on systematic, independent evidence reviews, are in substantial use in Australia. These results raise serious concerns about the awareness of Australian clinicians of medicine safety and efficacy. Medicines safety has become an Australian National Health Priority. Regulatory and reimbursement agencies should review the marketing and funding status of medicines which have not been shown to provide an efficacy and safety at least similar to alternative therapeutic options.

Agnes Vitry
University of South Australia
agnes.vitry@unisa.edu.au
and
Barbara Mintzes
University of Sydney
Barbara.MIntzes@sydney.edu.au

2

E-DRUG: Drugs to avoid to improve quality use of medicines:
--------------------------------------------------------------------------

Drugs to avoid to improve quality use of medicines: how is Australia faring?
Agnes Vitry and Barbara Mintzes

Journal of Pharmaceutical Policy and Practice
Volume 14, Article number: 60 (2021)
Full text available:
https://joppp.biomedcentral.com/track/pdf/10.1186/s40545-021-00346-3.pdf

Abstract
Background
Each year, the French independent bulletin Prescrire publishes a list
of medicines, 'Drugs to avoid', that should not be used in clinical
practice as their risk-to-benefit ratio is unfavourable. This study
assessed the market approval, reimbursement and use of these medicines in
Australia.

Methods
The approval status of the medicines included in 2019 Prescrire 'Drugs
to avoid' list was assessed by searching the Australian Register of
Therapeutic Goods website. Funding status was assessed on the
Pharmaceutical Benefits Scheme (PBS) website, the Australian public
insurance system. Use levels were determined by examining governmental
reports on prescribing rates including the Australian Statistics on
Medicines (ASM) reports, drug use reports released by the Drug Utilisation
Sub Committee (DUSC) and PBS statistics.

Results
Of the 93 medicines included in the Prescrire 2019 'Drugs to avoid' list
included, 57 (61%) were approved in Australia in 2019 including 9(16%) that
were sold as over-the-counter medicines, 35 (38%) were listed on the PBS,
22 (24%) were registered but not listed on the PBS. Although most of these
medicines were used infrequently, 16 (46%) had substantial use despite
serious safety concerns. Dipeptidyl peptidase-4 (DPP-4) inhibitors were
used by 22% of patients receiving a treatment for diabetes in 2016. More
than 50,000 patients received an anti-dementia medicine in 2014, a 19%
increase since 2009. Denosumab became the 8th medicine, in terms of total
sales, funded by the Australian Government in 2017-2018.

Conclusions
Prescrire's assessments provide a reliable external benchmark to assess the
current use of medicines in Australia. Sixteen 'drugs to avoid',judged to
be more harmful than beneficial based on systematic, independent evidence
reviews, are in substantial use in Australia. These results raise serious
concerns about the awareness of Australian clinicians of medicine safety
and efficacy. Medicines safety has become an Australian National Health
Priority. Regulatory and reimbursement agencies should review the marketing
and funding status of medicines which have not been shown to provide an
efficacy and safety at least similar to alternative therapeutic options.

Agnes Vitry
University of South Australia
agnes.vitry@unisa.edu.au
and
Barbara Mintzes
University of Sydney
Barbara.MIntzes@sydney.edu.au

3

Médicaments à éviter pour améliorer la qualité de l'utilisation des médicaments : comment se porte l'Australie ?

Agnès Vitry et Barbara Mintzes

Journal des politiques et pratiques pharmaceutiques
Volume 14, Numéro d'article : 60 (2021)
Texte intégral disponible :
https://joppp.biomedcentral.com/track/pdf/10.1186/s40545-021-00346-3.pdf

Résumé

Contexte

Chaque année, le bulletin indépendant français Prescrire publie une liste de médicaments, « Médicaments à éviter », qui ne doivent pas être utilisés en pratique clinique car leur rapport bénéfice/risque est défavorable. Cette étude a évalué l'autorisation de mise sur le marché, le remboursement et l'utilisation de ces médicaments en Australie.

Méthodes

L’obtention d’une autorisation de mise sur le marché des médicaments inclus dans la liste Prescrire 2019 « Médicaments à éviter » a été vérifiée en effectuant une recherche sur le site Internet du registre australien des produits thérapeutiques. Le statut de financement a été évalué sur le site Web du Pharmaceutical Benefits Scheme (PBS), le système d'assurance public australien. Les niveaux d'utilisation ont été déterminés en examinant les rapports gouvernementaux sur les taux de prescription, y compris les rapports Australian Statistics on Medicines (ASM), les rapports sur l'utilisation des médicaments publiés par le Drug Utilisation Sub Committee (DUSC) et les statistiques PBS.

Résultats

Sur les 93 médicaments inclus dans la liste Prescrire 2019 des « Médicaments à éviter », 57 (61 %) avaient reçu une autorisation de mise sur le marché en Australie dont 9 (16 %) vendus en vente libre, 35 (38 % ) figuraient sur le PBS, 22 (24 %) étaient enregistrés mais ne figuraient pas sur le PBS. Bien que la plupart de ces médicaments aient été utilisés peu fréquemment, 16 (46 %) étaient largement utilisés malgré de sérieux problèmes de sécurité. Les inhibiteurs de la dipeptidyl peptidase-4 (DPP-4) ont été utilisés par 22 % des patients recevant un traitement contre le diabète en 2016. Plus de 50 000 patients ont reçu un médicament anti-démence en 2014, soit une augmentation de 19 % depuis 2009. Le dénosumab est devenu le 8e médicament, en termes de ventes totales, financé par le gouvernement australien en 2017-2018.

Conclusion

Les évaluations de Prescrire constituent une référence externe fiable pour évaluer l'utilisation actuelle des médicaments en Australie. Seize « médicaments à éviter », jugés plus nocifs que bénéfiques sur la base d'évaluations systématiques et indépendantes des données, sont largement utilisés en Australie. Ces résultats soulèvent de sérieuses inquiétudes quant à la sensibilisation des cliniciens australiens à l'innocuité et à l'efficacité des médicaments. La sécurité des médicaments est devenue une priorité de sante nationale en Australie. Les agences de réglementation et de remboursement devraient réviser l’autorisation de mise sur le marché et le financement des médicaments qui n'ont pas démontré une efficacité et une sécurité d'emploi au moins similaires aux options thérapeutiques alternatives.

Agnès Vitry
University of South Australia
agnes.vitry@unisa.edu.au

et

Barbara Mintzes
The University of Sydney
Barbara.MIntzes@sydney.edu.au