Study on assessment of prescribing pattern and cost of anti-craving medication in alcohol dependent patients from rural areas

Abstract

OBJECTIVE: Alcohol dependence is one of the major chronic disorder with high mortality and morbidity in the today’s world, with a relapsing and remitting course. The main objective of the present study was to assess the prescribing pattern and cost of anticraving medications in alcohol dependent patients from rural areas. Materials and Methods: A prospective observational study was carried out for 110 patients for a period of six months in an in-patient Psychiatry department of a 950 bedded tertiary care teaching hospital in Bangalore. Patients satisfying inclusion criteria were enrolled after obtaining Informed consent. Patient’s data entered into case report form (CRF). Medication orders were observed for drug utilization Pattern. Patients who have been diagnosed with alcohol dependence syndrome as per ICD 10 diagnostic criteria were included, noted down the prescription components and prescriptions analyzed as per “Clinical practice guidelines for the treatment of alcohol dependence. Result & discussion: A total number of 110 prescription were analyzed during the six month study period from which 108(98.19%) were found to be male diagnosed with ADS. The range of all inpatient was from 20 to 60 years. Of these, 36-55 years of age group was in majority with 80 number of patients.47(42.73%) patients diagnosed with ADS and 63(57.27%) diagnosed with ADS with other complication. 10(9.09%) patients found very severe, 69(62.73%) patients were found with high level severity and 31(28.18%) patients were found medium level severity measured by the AUDIT SCALE. 29(35.45%) patients were found with mild alcohol withdrawal symptoms, 61(55.45%) were found with moderate withdrawal symptoms and 10 (9.09%) were found with sever withdrawal symptoms measured with CIW-Ar Scale. 3(2.73%) patients were low dependence to alcohol, 13(11.82%) patient were medium dependence to alcohol , 94(85.45%) patients were high dependence. 103(93.64%) patients were prescribed with Baclofen ,5 (4.55%) patients were prescribed with Acomprosate, 2(1.82%) patients were prescribe with Naltraxone are Anticraving drugs. A total 10 number of other classes of drug were prescribed along with Anti-craving drug like PPI 14(12.72%), Benzodiazepine 110(100%), Multi-vitamins 110(100%), Anti-psychotic 110(100%), Anti-hypertensive 2(1.82%), Anti-diabetic 1(0.91%), Anti-emetic 9(8.12%), NSAID 5(4.55%), Anti-biotic 4(3.64%), Anticonvulsant 5(4.55%). 1-5 number of drugs prescribe in 69(62.72%) number of prescription , 6-10 number of drugs prescribed in 23(20.90%) number of prescription , >10 number of drugs prescribed in 18(16.32%). Baclofen per prescription 10 tablets cost were found INR 194, acomprosate per prescription 10 tablets cost were found INR 57, naltrexone per prescription 10 tablets cost were found INR 350. Conclusion: among anti-craving drugs prescribed for treating the ADS patients with or without other complications, most of the cases were found to be prescribed with baclofen and majority of patients suffering with only ADS with no other co-morbidity. male patients were more than female patients all the anticraving drugs were prescribing in generic name. More than 4 medication per prescription indicate ADS with other complication required more attention. 100% usage of benzodiazepine, anti-psychotic and multi-vitamins indicates that these medications were required to treat the other complication in ADS patients.
Keywords: Alcohol dependence syndrome, prescribing, anti craving medications, cost analysis.