ABC/VEN-analysis of baseline therapy for chronic heart failure: the position of physicians and patients

Introduction. Pharmacoeconomic studies of chronic heart failure (CHF) treat- ment remain relevant in primary care. Objective – ABC/VEN-, analysis of the three-component therapy of CCN from the perspective of physicians’ prescribing and its use by patients. Material and methods. Two groups of CHF patients were analyzed. The first group consisted of 71 patients selected from 745 outpatient records. The second group consisted of 31 CHF patients, obtained from 1,284 online questionnaires. They studied the use of angiotensin converting enzyme in- hibitors (iACE), angiotensin II receptor antagonists (APA II), beta blockers (BB), aldosterone antagonists (AA) and fixed combinations (FC) contain- ing antihypertensive drugs. ABC, VEN, and frequency analysis and the “cost minimization” method were used. The daily cost of treatment with the drug was estimated, taking into account its price in the “EAPTEK” and the target/maximum dose prescribed in the clinical recommendations (CR). Results. Physicians and patients used 4 groups of three-component therapy (iACE/APA II; BB and AA) as well as FC in the treatment of CHF. Three-com- ponent therapy was prescribed by physicians in single cases; patients took it more often. In physicians and patients, the choice of drugs from different groups of three-component therapy for CHF from the position of VEN analysis corresponded to class A, such was not the case in classes B and C. Physicians prescribed 9 drugs from the group of ACE inhibitors to half of the patients; one third of them took 6 items. Their use did not always take into account dosing frequency and cost, contributing to 2.5 times more spending per patient per day than the use of ramipril. Physicians prescribed 5 items from the ARA II group to every fifth patient; a third of them were taking 2 drugs. Both did not always take into account the CR and the cost of the drugs. The latter resulted in 1.5 times higher costs per patient per day than the use of Lorista®. Doctors and patients used the same BB only in 60.0% of cases. The choice of drugs from this group was rationalised in only half of the cases, resulting in one- third more costs compared to cheap Bisoprolol. Physicians prescribed AA to only one in ten patients; they took them in almost one in two cases. Both preferred Verospirone to Spironolactone, which was 0.2 roubles/day cheaper. Physicians and patients used FC equally rarely. Out of 9 drugs prescribed by doctors, patients took two. Many of them contained drugs not specified in the CR for treatment of CHF. The cost of treatment of one patient with them ex- ceeded the justified use of Valsartan+hydrochlorthiazide more than 1.5 times. Conclusion. Physicians in the outpatient clinic and patients at home rarely use three-component therapy of CHF. From the position of ABC- and VEN-analy- sis, the most optimal was class A in category V, which represents drugs from all groups (iAPP/APA II; BB, AA and FC) used in the treatment of CHF. Howev- er, both do not always focus on CR and drug cost when selecting them. The latter contributes to a greater financial cost compared to the proposed option. The situation can be improved through online interaction between doctors, patients, pharmacies and pharmaceutical companies.