Utilization Trends of Endocrine Therapies for Breast Cancer in Albania During 2004-2014

Abstract

Aim: To evaluate the patterns of use of the out-of-hospital endocrine therapies for breast cancer in Albania during the period 2004-2014. Methods: The study was retrospective and we analyzed the prescription and consumption of these drug classes in the primary health care in Albania during 2004-2014. All data were collected from Health Insurance Institute (HII)(1) and analysed reflecting the ambulatory and outpatient use for the period 2004-2014. The data about the consumption of drugs were expressed as a number of Defined Daily Dose (DDDs) /1000 inhabitants/day. Utilization was measured in DDD/1000 inhabitants/day and was also compared with breast cancer morbidity/1000 inhabitants, to understand the covering of the population from the reimbursement scheme. For all the period under study 2004-2014, there were collected and analysed the data of import and domestic production of drugs, which altogether represent the real consumption of drugs in the country. These data were subsequently included in a comparative analysis with the utilization data according to the HII. Results: The drug with the highest values of consumption is Letrozole 0.05-0.37 DDD/1000 inhabitants/day2004-2014). Anastrazole was introduced to the scheme in 2008. Its consumption in2014 was 0.26 DDD/1000 inhabitants/day. The consumtion of Tamoxifen is reduced through these years with values 0.32-0.17 DDD/1000 inhabitants/day respectively 2004-2014. Breast cancer morbidity data indicate that there does exist a correlation statistically significant between this disease and the trend of consumption of endocrine therapies drugs (p = 0,0009) Conclusions: It is evident that a non-small part of the patients remain untreated under the scheme. There is noted a shift in use of endocrine therapy from tamoxifen to aromatase inhibitors. This trend is consistent with major international clinical guidelines that recomend preferential use of aromatase inhibitors in post-menopausal women.