Patterns of glucose lowering drugs utilization in Portugal and in the Netherlands. Trends over time.
OBJECTIVE
To compare the temporal trends in the consumption patterns of glucose lowering drugs (GLD) between Portugal and the Netherlands from 2004 to 2013 and to examine possible reasons behind the cross-national variation found.


METHODS
All GLD (ATC pharmacological subgroup A10B) were selected for analysis. Consumption data were obtained for the 10-year period. Portuguese and Dutch drug estimates were obtained from nationwide databases.


RESULTS
The consumption of GLD increased in Portugal from 52.9 defined daily dose per 1000 inhabitants per day (DHD) in 2004 to 70.0 DHD in 2013 and in the Netherlands from 44.9 DHD in 2004 to 50.7 DHD in 2013. In Portugal, the use of fixed-dose combinations, especially with dipeptidyl peptidase-4 inhibitors (DPP-4) increased remarkably and in 2013 represented almost a quarter of total GLD consumption. In the Netherlands, the use of combinations was residual.


CONCLUSIONS
The consumption of GLD rose over the 10-year period in both countries. However, Portuguese overall consumption and costs of GLD were higher. The differentially rapid uptake of DPP-4 inhibitors in Portugal was the main driver of the cost difference.
Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Lisboa, Portugal; Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal. Electronic address: carla.torre@anf.pt.
Carla
C
Torre
Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Lisboa, Portugal.
José
J
Guerreiro
Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal; Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal.
Sofia
S
de Oliveira Martins
Faculty of Medical Sciences, New University of Lisbon, Lisboa, Portugal; Portuguese Diabetes Association (APDP), Lisboa, Portugal.
João Filipe
JF
Raposo
Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal; Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal.
Ana Paula
AP
Martins
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Hubert
H
Leufkens
D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D062313:Databases, Pharmaceutical; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D016527:Drug Costs / Q000639:trends; D017723:Drug Utilization Review; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D009426:Netherlands / Q000453:epidemiology; D011174:Portugal / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents
Diabetes mellitus, type 2; Hypoglycaemic drugs; Physician prescribing pattern; Portugal; Small-area variation analysis; The Netherlands; Trends