European Commission - Public Health: healthindicators.org

Medicine use, selected group

Definition of indicator

(1) Percent of population who have used medication (defined medicine groups) prescribed by a physician during the past 2 weeks.

(2) Amount of medicine use, per day per 1000 population, for defined medicine groups.

Calculation (numerator, denominator)

(1) Percent of population who have used medication (defined medicine groups) prescribed by a physician during the past 2 weeks, measured by the EHIS-instrument derived from EHISquestions MD.1-2:

MD.: during the past two weeks, have you used any medicines (including dietary supplements such as herbal medicines or vitamins) that were prescribed or recommended fo you by a doctor – (for women, please also state: include also contraceptive pills or other hormones)?

(yes / no)

MD.2: Were they medicines for…? (15 medicine groups, i.e. for Asthma / Chronic bronchitis, chronic pulmonary disease, emphysema / High blood pressure / Lowering the blood cholesterol level / Other cardiovascular disease, such as stroke and heart attack / pain in the joints (arthrosis, arthritis) / Pain in the neck or back / Migraine / Other pain / Diabetes / Allergic symptoms (eczema, rhinitis, hay fever) / Stomach troubles / Cancer (chemotherapy) / Depression / Tension or anxiety)

(2) OECD / EURO-MED-STAT -project: Utilization of medicines (sales statistics) of major Anatomic Therapeutic Chemical Classification (ATC) groups, in Daily Defined Doses (DDDs) per day, per 1000 population. DDD is defined as the assumed average maintenance dose per day for a drug used on its main indication in adults. The MINDFUL project specifically recommends to include antipsychotics (ATC class NO5A), anxiolytics (NO5B), hypnotics (NO5C) and antidepressants (NO6A). Each group separately. Calculation is based on the volume of sales to pharmacies and hospitals by wholesalers.

Precise ATC medicine groups to be included is to be decided later.

Additional underlying concepts

(2) The ATC system divides drugs into different groups according to the organ system on which they act and/or therapeutical, pharmacological and chemical characteristics. (created by the WHO Collaborating Centre for Drug Statistics Methodology).

The sale and actual use of drugs are not always the same figure.

Relevant dimensions (subgroups)

Country (also region), calendar year, sex, age group.

Preferred data sources

(1) National HIS, EHIS

(2) National medicine sales register linked to diagnosis.

Rationale

Indicates aspects of accessibility, up-to-date quality of care, and costs. Large differences between countries may point to under-use as well as over-use. However, a benchmark value cannot be given because several different factors can influence the use of a medicine.

Data availability, quality and periodicity

(1) EHIS implemented 2007-2009. EHIS can be the primary data source, as long as patientbased register data (2) as DDD by ATC are not available in most countries. When these registers become available in a comparable manner, these are the first choice. Before both are implemented, data are available from national HIS for most of EU-27.

- National HIS: recall period varies, EHIS has 2 weeks.

- Eurostat and WHO: no data available.

(2) OECD: data available only by DDD of ATC groups for 10-15 of the EU27 countries. EURO-MED-STAT has outlined methodology very accurately, but has no regular data collection and no proposal on ATC groups to be used.

- MINDFUL: data available for half of EU-27

References

- EHIS standard questionnaire (version of 11/2006)

- The main principles for the classification of medicinal substances according to the ATC is presented in the publication “Guidelines for ATC classification and DDD assignment” ( WHO Collaborating Centre for Drug Statistics Methodology, Oslo). The publication “ATC Index with DDDs” lists all assigned ATC codes and DDD values. Both these publications are updated annually. ATC Index can be browsed at WHO Collaborating Centre for Drug Statistics Methodology site.

- MINDFUL

- Statistics on Medicines in Europe -project, EURO-MED-STAT

Work to do

• Decide which calculation method (data source) to follow. OECD ? suggestion: only for routine statistics (does not apply for this definition) -> EHIS preferred
• Decide which ATC medicine groups to use; suggestion: a limited (<20) number of medicine groups, including the 4 from WPMH; try to get close to the EHIS categories which are not precisely on ATC-basis but related
• Check recent PHP reports for recommendations on groups and data sources.