Skin diseases significantly contribute to the overall disease burden in society, affecting individuals across all age groups, from neonates to the elderly. Due to their chronic nature, these conditions exert a substantial impact on the quality of life and financial well-being of the affected individuals and their families. The challenge is exacerbated by the improper and irrational use of medications. A recent study published in the Cureus Journal of Medical Science sheds light on the significant use and economic analysis of immunosuppressant drugs in patients with skin disorders.
Dr. Shaku et al. conducted a comparative analysis of the drug utilization pattern, as well as the prescribed daily dose/defined daily dose (PDD/DDD) defined by the World Health Organization (WHO), and the cost-effectiveness ratio of various immunosuppressants. This observational and analytical study took place in the outpatient department of skin and venereal diseases at a tertiary care hospital in eastern India (Bihar) over six months (October 2022 – April 2023). The study included patients aged between 18 and 60 years, and a total of 612 prescriptions were collected during this period. Among these, 117 prescriptions included immunosuppressants. The study adhered to the WHO recommendation of including at least 600 encounters in a cross-sectional survey to assess current prescribing practices.
Shakur and colleagues reported that immunosuppressants were prescribed in 117 (19.12%) of the total 612 prescriptions. Deflazacort was the most frequently prescribed systemic immunosuppressant (27.18% of cases) for irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD), followed by prednisolone and betamethasone. Tacrolimus emerged as the most commonly used topical immunosuppressant (15.90% of patients) for irritant contact dermatitis and vitiligo, followed by clobetasol and mometasone. Betamethasone, prednisolone, clobetasol, and mometasone demonstrated better cost-effectiveness. The PDD/DDD ratio for all immunosuppressants was less than one, except for prednisolone, which had a PDD/DDD ratio of 3.52. A similar prescription survey conducted by Pathak et al. reported the significance of periodic evaluation of prescription patterns to monitor and improve the quality of prescriptions in other departments of the hospital.
The conclusions drawn from the current study indicate that the cost-effectiveness of steroids offers the benefit of enhancing patient adherence to pharmacotherapy. In addition, it is crucial to acknowledge that excessive prescribing may result in long-term adverse effects associated with steroids. Therefore, future pharmacovigilance research endeavors should integrate pharmacoeconomic analysis to elucidate the interplay between these two dimensions.
References
- Shakur AA, Ranjan RK, Sinha R, Hameed S, Mohan L, Shakur AA, et al. A Study of Drug Utilization Pattern and Pharmacoeconomic Analysis of Immunosuppressant Drugs in Patients with Skin Disorders in a Tertiary Care Hospital in Bihar. Cureus [Internet]. 2023 Nov 8 [cited 2023 Nov 9];15(11).
- Pathak AK, Kumar S, Kumar M, Mohan L, Dikshit H. Study of Drug Utilization Pattern for Skin Diseases in Dermatology OPD of an Indian Tertiary Care Hospital – A Prescription Survey. J Clin Diagn Res. 2016 Feb;10(2): FC01–5.