| Summary: | Asthma is a chronic disease of the airways and affects many people regardless of their age,
gender, race and socioeconomic status. Since asthma is recognised as one of the major
causes of morbidity and mortality in people and especially in South Africa, the prescribing
patterns, prevalence and medication cost of asthma in South Africa are saliently important and
need to be investigated.
A non-experimental, quantitative retrospective drug utilisation review was conducted on
medicine claims data of a pharmaceutical benefit management company in a section of the
private health care sector of South Africa. The study period was divided into four annual
time periods (1 January 2008 to 31 December 2008, 1 January 2009 to 31 December 2009,
1 January 2010 to 31 December 2010 and 1 January 2011 to 31 December 2011). The
prescribing patterns and cost of asthma medication were investigated and stratified according
to province, age and gender. Patients were included if the prescriptions which were
provided by the health care practitioners matched the Chronic Disease List (CDL) of South
Africa and the International Classification of Disease (ICD-10) coding for asthma and chronic
obstructive pulmonary disease (COPD). Data analysis was conducted by means of the SAS
9.3® computer package. Asthma patients were divided according to different age groups
(there were five different age groups for this study), gender and geographical areas of South
Africa.
The study indicated a steady increase in the prevalence of asthma patients from 0.82% (n =
7949) in 2008 to 1.18% (n = 15 423) in 2009 and reached a minimum of 0.79% (n = 8554) in
2011. Analysis of the prevalence regarding geographical areas in South Africa suggested
that Gauteng had the highest number [n = 17 696, (0.85%)] of asthma patients throughout
the study period, followed by KwaZulu Natal [n = 8 628, 1.16%)] and the Western Cape [(n = 8513, 0.97%) (p < 0.05)]. The prevalence of asthma in female patients [0.89% (n = 26
588)] was higher than in their male counterparts [0.79% (n = 19 244)] (p > 0.05). The results
showed that asthma was not as common chronic disease in children. The total number of
asthma patients younger than 7 years represented 0.64% (n = 2 909). It was found that
patients over 65 years of age showed the highest prevalence of the five age groups [1.94%
(n = 13 403) (p < 0.05)].
The average number of asthma prescriptions per patient per year was 8.28 (95% CI, 8.16-
8.40) and 5.15 (95% CI, 5.06-5.23) in 2008 and 2011, respectively. The number of asthma
items per prescription varied from 1.55 (95% CI, 1.55-1.56) in 2008 to 1.40 (95% CI, 1.39-
1.40) in 2011.
Medication from the MIMS® pharmacological group (anti-asthmatics and bronchodilators)
was used to identify asthma medication. The top three asthma medication with the highest
prevalence in the study period were the anti-inflammatory inhaler of fluticasone (n = 39 721)
followed by the single item combination product of budesonide/ formoterol (n = 25 121) and
salbutamol (n = 24 296). The influence of COPD on asthma treatment and the costimplication
thereof were investigated. Medication from the MIMS® pharmacological group
(anti-asthmatics and bronchodilators) was used to identify COPD medication. This study
also showed that COPD had an influence in the economic burden of the South African
asthma population.
The cost of medication is responsible for the single largest direct cost involved in the
economic burden of asthma. This study showed that asthma represented 0.88% of the
direct medication cost in the study (excluding hospitalisation and indirect cost). The average
cost per prescription and average cost per asthma item both increased throughout the study
period.
The prescribing patterns for the different medication used in the treatment of asthma were
investigated and recommendations for further research in this field of study were made. === MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014
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