The financial burden of polypharmacy in type 2 diabetic patients at Mankweng Hospital, Limpopo

Abstract

Introduction: Polypharmacy is highly prevalent within the population of patients with diabetes mellitus (DM), with patients being prescribed with four or more medications with mainly preventative medications for cardiovascular complications. The increase in the prevalence of polypharmacy has a major impact on the drug expenditures. Meanwhile, the management of DM is expensive, and the cost affects individuals, families, society, health care providers, and national productivity. The largest component of financial cost is accounted for by medicines. Furthermore, with DM being the second cause of mortality rates in South Africa there is a need for cost of illness studies in order to develop intervention programs to ameliorate or prevent this lifestyle disease Objectives: To identify the medications the patient was taking that were considered as polypharmacy in the management of type 2 diabetes mellitus (T2DM), to calculate and analyse the costs of the medications and to quantify the financial burden of polypharmacy in T2DM patients. Method: This research was a quantitative study, providing the numeric description of the economic cost of polypharmacy. The financial burden of polypharmacy was retrospectively measured using descriptive statistics. The study was conducted using T2DM patient files (n=115) from the outpatient section of the pharmacy as well as from the records department whereby all DM patients’ files were retrieved by aid of a DM register from outpatient department (OPD). The data sheet enabled recording of information that was divided into three sections namely the demographic information, the diagnosis profile, as well as the medications. The cost of drugs was retrieved from the pharmacy purchase invoices for the years 2016 and 2017 as well as Department of Health medicines registry for the retail prices. Data was analysed using statistical Package for Social Sciences (SPSS) version 25 for descriptive analysis and Microsoft Excel TM was used for calculation and quantification of the financial burden. The independent t test was used in Microsoft ExcelTM for statistical significance of differences. Results: The distribution of the population by gender revealed that 68% of females were on polypharmacy as compared to 32% of males. The results also showed that majority of participants accounting 71% of the population were falling within the age

xi group of 51-70 years, meanwhile the least number of participants accounting 1% of the population were between the age group of 30-40 years. The total cost of the treatment regimen for the two years of the study period was found to be R179303.50 in hospital (Mean=R35860.80, SD=R58945.15, n=115) and the possible cost of polypharmacy was found to be R1517379.00 in retail (Mean=R303475.76, SD=480115.84, n=115). The difference was statistically significant t (16) = 2.11, p=0.04 (1 tail) at 95% confidence interval. This means that the average cost per patient per year is R1558.18 and R129.93 per month in hospitals but R6597.30 per year and R549.78 per month in retail for the management of T2 DM patients who are on polypharmacy. These numbers are 4 times higher than patients who are on monotherapy. Conclusion: Polypharmacy imposes a high financial burden on the management of T2DM for the government and for patients in cases where medications like insulin which is the most costly component of five out of nine detected regimens are unavailable in hospitals and they therefore have to buy at retail pharmacies. The appreciation and understanding of these costs in real terms by health professionals and decision makers, can add value to processes of budget allocations to pharmaceutical services. Recommendations: Doctors and pharmacists should work together to optimize the quality of care for patients with T2DM but also consider the cost aspect when prescribing and dispensing treatment regimen for a patient. The patient’s prescriptions must be thoroughly reviewed and rationalised according to recent progress of the patient. Non-pharmacological management of T2DM is the mainstay of therapy and prevention so pharmacist and doctors needs to emphasize more on those rather than dispensing a lot of medications to patients that can manage to control their condition with no medications prescribed. Lastly, preventative programs for T2DM needs to be prioritized.