비용효과성을 고려한 의약품 처방의 질 향상 : Proton-Pump Inhibitor 외래처방분석을 중심으로
Does Cost-Effective Prescribing Matter? : Implications of Proton-Pump Inhibitor Prescribing in Ambulatory Service
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과학적 근거와 비용효과성에 기반한 합리적 의약품 사용은 처방의 질 향상과 재정절감을 가져다준다. PPI제제는 성분간 효능과 안전성이 유사하다는 점을 토대로 비용효과성을 고려한 외래처방행태를 국민건강정보DB를 활용하여 분석하였다. 분석 결과, 요양기관 종별과 연도별로 선호성분이 상이하여 약물선택의 명확하고 일관된 기준을 엿보기 어려웠으나, 주로 100개 이상 제품이 등재된 Esomeprazole(1,016원/DDD, 31.6%)과 Rabeprazole(1,047원/DDD, 23.2%)이 높은 비중을 보였다. 또, 최근 등재된 Tegoprazan(1,296원/DDD, 16.5%) 처방은 급증한 반면 가장 비용효과적인 Dexlansoprazole(527원/DDD)의 비중(2.7%)은 미미하였다. DU90%를 통해 다빈도 처방성분이 나머지 대비 1.3배 비싸게 나타나 고가약 중심 처방이 만연함을 재확인하였다. 처방의 질 향상 및 합리적 의약품 사용을 조장하기 위해 외래 처방가이드라인 등의 도입이 조속히 요구된다.
Abstract
Rational use of medicines(RUM), based on scientific evidence and cost-effectiveness, will improve the quality of prescribing and create financial savings. Based on the fact that the efficacy and safety profiles of Proton-Pump Inhibitors are equivalent, patterns of cost-effective prescribing for ambulatory services were analyzed using the National Health Information Database provided by the National Health Insurance Service. The results found no consistent principles for drug selection among physicians since the most preferred agents varied from year to year and by type of the medical institutions. However, Esomeprazole(1,016 KRW/DDD, 31.6%) and Rabeprazole(1,047KRW/DDD, 23.2%), with more than 100 products listed, showed a high proportion. The share of the recently listed expensive Tegoprazan(1,296KRW/DDD, 16.5%) was rapidly increasing, while that of the most cost-effective Dexlansoprazole(527 KRW/DDD) was mediocre(2.7%). The DU90% showed that the ingredients that account for 90% of volume prescribed were found to be 1.3 times more expensive than the rest, confirming the prevalence of prescribing centred on high-priced drugs. To improve the quality of prescribing and promote RUM in Korea, Interventions such as prescribing guidelines based on cost-effectiveness should be promptly introduced.
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