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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(07): 444-451
DOI: 10.1590/0004-282X20180064
ARTICLE

Trends and disparities in the use of cholinesterase inhibitors to treat Alzheimer’s disease dispensed by the Brazilian public health system – 2008 to 2014: a nation-wide analysis

Tendência e desigualdade no uso de anticolinesterásicos para tratamento de doença de Alzheimer dispensados pelo sistema de saúde público do Brasil – 2008 e 2014: uma análise nacional
Flávia Silva de Moraes
1   Unversidade Federal de Juiz de Fora, Faculdade de Medicina, Juiz de Fora MG, Brasil.
,
Mariana Lima Cerqueira de Souza
1   Unversidade Federal de Juiz de Fora, Faculdade de Medicina, Juiz de Fora MG, Brasil.
,
Giancarlo Lucchetti
1   Unversidade Federal de Juiz de Fora, Faculdade de Medicina, Juiz de Fora MG, Brasil.
,
Alessandra Lamas Granero Lucchetti
1   Unversidade Federal de Juiz de Fora, Faculdade de Medicina, Juiz de Fora MG, Brasil.
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ABSTRACT

In light of the high cost of dementia treatment, there is legislation authorizing free distribution of cholinesterase inhibitors to those suffering from Alzheimer’s disease in Brazil. However, the existence of this free distribution does not guarantee adequate distribution.

Objectives The present study aimed to investigate the trends of prescriptions and the coverage of Alzheimer’s disease treatment using cholinesterase inhibitors from public pharmacies dispensing high-cost drugs in Brazil.

Methods This was a retrospective study that collected data from the Brazilian public Unified Health System. All cholinesterase inhibitors distributed at no cost to Brazilians during the year 2014, as well as the estimated number and percentages of patients who used these medications, were evaluated and compared to data from the year 2008.

Results Our estimates indicated that 9.7% of the population having dementia syndromes used cholinesterase inhibitors, as well as 16.1% of those with Alzheimer’s disease in Brazil. A clear disparity was noted between the use and distribution of cholinesterase inhibitors, depending on the region in which they were found. Over time, an increase in the distribution of cholinesterase inhibitors has been noted. In 2008, that use was 12.0% whereas, in 2014, it was 16.1%, an increase of 34% in six years.

Conclusion It was estimated that 16.1% of patients with Alzheimer’s disease in Brazil use cholinesterase inhibitors. These values have increased and, in spite of not being satisfactory, they indicate a potential for improvement. However, there is still a significant disparity among the regions.

RESUMO

Devido ao custo alto de tratamento, existe uma legislação autorizando a distribuição sem custo de anticolinesterásicos para pacientes com doença de Alzheimer no Brasil. Entretanto, a existência dessa distribuição gratuita nem sempre garante uma distribuição adequada.

Objetivos O presente estudo objetiva investigar a distribuição e desigualdades no uso de anticolinesterásicos (AChE) dispensados pelo Sistema de Saúde Público do Brasil.

Métodos Estudo retrospectivo que coletou dados do Sistema Único de Saúde brasileiro. Foram avaliados todos os anticolinesterásicos distribuídos sem custo no Brasil durante o ano de 2014, assim como o número estimado e a porcentagem de pacientes que usavam essa medicação. Esses dados foram comparados com o ano de 2008.

Resultados Estima-se que 9,7% da população que possui síndromes demenciais usa anticolinesterásicos, assim como 16,1% dos pacientes com doença de Alzheimer. Uma clara desigualdade entre o uso e a distribuição dos anticolinesterásicos foi encontrada, variando de acordo com a região. Houve um aumento na distribuição de anticolinesterásicos ao longo do tempo. Em 2008, o uso era de 12% e, em 2014, foi de 16,1%, resultando em um aumento de 34% em 6 anos.

Conclusão Estima-se que 16,1% dos pacientes com doença de Alzheimer no Brasil usam anticolinesterásicos. Esses valores tiveram um aumento e, embora ainda não sejam satisfatórios, eles indicam um potencial de melhora. Entretanto, ainda foi evidenciada uma significante desigualdade entre as regiões.

cholinesterase inhibitors - public health - dementia - Alzheimer’s disease
Inibidores da colinesterase - saúde pública - demência - Doença de Alzheimer


Publication History

Received: 08 December 2017

Accepted: 10 April 2018

Article published online:
25 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Mendes ACG, Sa DA, Miranda GM, Lyra TM, Tavares RA. [The public healthcare system in the context of Brazil’s demographic transition: current and future demands]. Cad Saúde Pública. 2012 May;28(5):955-64. Portuguese. https://doi.org/10.1590/S0102-311X2012000500014
  • 2 Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013 Jan;9(1):63-75.e2. https://doi.org/10.1016/j.jalz.2012.11.007
  • 3 Suemoto CK, Ferretti-Rebustini RE, Rodriguez RD, Leite RE, Soterio L, Brucki SM et al. Neuropathological diagnoses and clinical correlates in older adults in Brazil: A cross-sectional study. PLoS Med. 2017 Mar;14(3):e1002267. https://doi.org/10.1371/journal.pmed.1002267
  • 4 Terry AV Jr, Buccafusco JJ. The cholinergic hypothesis of age and Alzheimer’s disease-related cognitive deficits: recent challenges and their implications for novel drug development. J Pharmacol Exp Ther. 2003 Sep;306(3):821-7. https://doi.org/10.1124/jpet.102.041616
  • 5 Ihl R, Bunevicius R, Frölich L, Winblad B, Schneider LS, Dubois B et al. World Federation of Societies of Biological Psychiatry guidelines for the pharmacological treatment of dementias in primary care. Int J Psychiatry Clin Pract. 2015 Mar;19(1):2-7. https://doi.org/10.3109/13651501.2014.961931
  • 6 Wimo A, Jönsson L, Bond J, Prince M, Winblad B; Alzheimer Disease International. The worldwide economic impact of dementia 2010. Alzheimers Dement. 2013 Jan;9(1):1-11.e3. https://doi.org/10.1016/j.jalz.2012.11.006
  • 7 Picon PD, Beltrame A, Banta D. National guidelines for high-cost drugs in Brazil: achievements and constraints of an innovative national evidence-based public health policy. Int J Technol Assess Health Care. 2013 Apr;29(2):198-206. https://doi.org/10.1017/S0266462313000056
  • 8 Costa RD, Osorio-de-Castro CG, Silva RM, Maia AA, Ramos MC, Caetano R. [The acquisition of medication to treat Alzheimer’s disease in Brazil: an analysis of federal purchases, 2008-2013]. Cien Saúde Colet. 2015 Dec;20(12):3827-38. Portuguese. https://doi.org/10.1590/1413-812320152012.11542015
  • 9 Almeida-Brasil CC, Costa JO, Aguiar VC, Moreira DP, Moraes EN, Acurcio FA et al. [Access to medicines for Alzheimer’s disease provided by the Brazilian Unified National Health System in Minas Gerais State, Brazil]. Cad Saúde Pública. 2016 Aug;32(7):e00060615. Portuguese. https://doi.org/10.1590/0102-311X00060615
  • 10 Moraes EN, Cintra MT. Belém D, Moraes FL. Evaluation of the Brazilian public Alzheimer’s disease treatment program in 2008. Geriatr Gerontol Aging. 2013;7(1):14-9.
  • 11 Pariente A, Helmer C, Merliere Y, Moore N, Fourrier-Réglat A, Dartigues JF. Prevalence of cholinesterase inhibitors in subjects with dementia in Europe. Pharmacoepidemiol Drug Saf. 2008 Jul;17(7):655-60. https://doi.org/10.1002/pds.1613
  • 12 Hoffmann F, Bussche H, Glaeske G, Kaduszkiewicz H. Eight-year prescription trends of memantine and cholinesterase inhibitors among persons 65 years and older in Germany. Int Clin Psychopharmacol. 2010 Jan;25(1):29-36. https://doi.org/10.1097/YIC.0b013e3283339496
  • 13 Franchi C, Lucca U, Tettamanti M, Riva E, Fortino I, Bortolotti A et al. Cholinesterase inhibitor use in Alzheimer’s disease: the EPIFARM-Elderly Project. Pharmacoepidemiol Drug Saf. 2011 May;20(5):497-505. https://doi.org/10.1002/pds.2124
  • 14 François M, Sicsic J, Elbaz A, Fleury NP. Trends in drug prescription rates for dementia: an observational population-based study in France, 2006-2014. Drugs Aging. 2017 Sep;34(9):711-21. https://doi.org/10.1007/s40266-017-0481-7
  • 15 Dybicz SB, Keohane DJ, Erwin WG, McRae T, Shah SN. Patterns of cholinesterase-inhibitor use in the nursing home setting: a retrospective analysis. Am J Geriatr Pharmacother. 2006 Jun;4(2):154-60. https://doi.org/10.1016/j.amjopharm.2006.06.002
  • 16 Di Santo SG, Prinelli F, Adorni F, Caltagirone C, Musicco M. A meta-analysis of the efficacy of donepezil, rivastigmine, galantamine, and memantine in relation to severity of Alzheimer’s disease. J Alzheimers Dis. 2013;35(2):349-61. https://doi.org/10.3233/JAD-122140
  • 17 Tan CC, Yu JT, Wang HF, Tan MS, Meng XF, Wang C et al. Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis. 2014;41(2):615-31. https://doi.org/10.3233/JAD-132690.
  • 18 Picon PD, Camozzato AL, Lapporte EA, Picon RV, Moser Filho H, Cerveira MO et al. Increasing rational use of cholinesterase inhibitors for Alzheimer’s disease in Brazil: public health strategy combining guideline with peer-review of prescriptions. Int J Technol Assess Health Care. 2010 Apr;26(2):205-10. https://doi.org/10.1017/S0266462310000097
  • 19 Forlenza OV. Ginkgo biloba and memory: myth or reality? Rev Psiquiatr Clin. 2003;30(6):218-220. https://doi.org/10.1590/S0101-60832003000600004
  • 20 DeKosky ST, Williamson JD, Fitzpatrick AL, Kronmal RA, Ives DG, Saxton JA et al. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008 Nov;300(19):2253-62. https://doi.org/10.1001/jama.2008.683
  • 21 Vellas B, Coley N, Ousset PJ, Berrut G, Dartigues JF, Dubois B et al. Long-term use of standardised Ginkgo biloba extract for the prevention of Alzheimer’s disease (GuidAge): a randomised placebo-controlled trial. Lancet Neurol. 2012 Oct;11(10):851-9. https://doi.org/10.1016/S1474-4422(12)70206-5
  • 22 Herrmann N, Black SE, Li A, Lanctçt KL. Discontinuing cholinesterase inhibitors: results of a survey of Canadian dementia experts. Int Psychogeriatr. 2011 May;23(4):539-45. https://doi.org/10.1017/S1041610210001535
  • 23 Deardorff WJ, Feen E, Grossberg GT. The Use of Cholinesterase Inhibitors Across All Stages of Alzheimer’s Disease. Drugs Aging. 2015 Jul;32(7):537-47. https://doi.org/10.1007/s40266-015-0273-x
  • 24 Bradford A, Kunik ME, Schulz P, Williams SP, Singh H. Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord. 2009 Oct-Dec;23(4):306-14. https://doi.org/10.1097/WAD.0b013e3181a6bebc
  • 25 Cummings JL. Use of cholinesterase inhibitors in clinical practice: evidence-based recommendations. Am J Geriatr Psychiatry. 2003 Mar-Apr;11(2):131-145. https://doi.org/10.1097/00019442-200303000-00004
  • 26 Gutierrez BA, Silva HS, Guimarães C, Campino AC. [Economic impact of Alzheimer’s disease in Brazil: is it possible to improve care and minimize costs?]. Cien Saúde Colet. 2014 Nov;19(11):4479-86. Portuguese. https://doi.org/10.1590/1413-812320141911.03562013
  • 27 Zilkens RR, Duke J, Horner B, Semmens JB, Bruce DG. Australian population trends and disparities in cholinesterase inhibitor use, 2003 to 2010. Alzheimers Dement. 2014 May;10(3):310-8. https://doi.org/10.1016/j.jalz.2013.04.001
  • 28 Cooper C, Lodwick R, Walters K, Raine R, Manthorpe J, Iliffe S et al. Observational cohort study: deprivation and access to anti-dementia drugs in the UK. Age Ageing. 2016 Jan;45(1):148-54. https://doi.org/10.1093/ageing/afv154
  • 29 Scheffer M, coordinator. Demografia médica no Brasil 2015. São Paulo: Faculdade de Medidina da USP; 2015 [cited 2018 Mar 8]. Available from http://www.usp.br/agen/wp-content/uploads/DemografiaMedica30nov2015.pdf