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Abstract：
Aims The cost-effective therapy of immunosuppressant drugs in dermatological conditions will not only lead to adherence to rational prescribing but will also increase patient compliance with fewer dropouts due to cost factor. Thus, this study was done to determine and compare the drug utilization pattern, prescribed daily dose/defined daily dose (PDD/DDD) defined by WHO, and the cost-effectiveness ratio of different immunosuppressants. Methods and material Prescriptions for patients with skin disorders prescribed with any one systematic or topical immunosuppressant were collected. The utilization of drugs in different skin disorders was expressed as frequency and percentage. PDD was compared with DDD as per the WHOCC-Anatomical Therapeutic Chemical (ATC)/DDD index. The pharmacoeconomic analysis was done using a cost-effectiveness ratio. Statistical analysis Descriptive statistics were used to calculate percentages, frequency, and 95% CI. The cost-effectiveness ratio in terms of SFDs (symptom-free days) was defined as the total cost of the initial antibiotic during the study period divided by the number of SFDs (cost/ SFD) and was expressed as mean±standard deviation, and the Kruskal-Wallis test was used to determine statistical significance of difference. Results Immunosuppressants were prescribed in 117 (19.12%) prescriptions out of a total of 612 prescriptions. Deflazacort was the most utilized systemic immunosuppressant prescribed in 27.18% of cases and was commonly prescribed for irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) followed by prednisolone and betamethasone. Tacrolimus was the most utilized topical immunosuppressant prescribed in 15.90% of patients and was commonly used for ICD and vitiligo followed by clobetasol and mometasone. Betamethasone, prednisolone, clobetasol, and mometasone had better cost-effectiveness. PDD/DDD of all immunosuppressants was less than one except prednisolone, which had a PDD/DDD ratio of 3.52. Conclusions The cost-effectiveness of steroids has the advantage of providing better patients\' adherence to pharmacotherapy, but over-prescribing could also lead to long-term adverse effects of steroids. Pharmacovigilance research should also incorporate pharmacoeconomic analysis to determine the relation between these two aspects.
摘要：
目的在皮肤病的情况下，免疫抑制剂药物的成本有效的治疗不仅会导致坚持合理的处方，而且还会增加患者的依从性，减少因成本因素而辍学。因此，这项研究是为了确定和比较药物利用模式，规定的日剂量/定义的日剂量（PDD/DDD）由世界卫生组织定义，以及不同免疫抑制剂的成本-效果比。方法和材料收集使用任何一种系统或局部免疫抑制剂的皮肤病患者的处方。药物在不同皮肤病中的使用以频率和百分比表示。根据WHOCC-解剖治疗化学(ATC)/DDD指数将PDD与DDD进行比较。使用成本-效果比进行药物经济学分析。统计分析描述性统计用于计算百分比，频率,95%CI。以SFDs（无症状天数）表示的成本-效果比定义为研究期间初始抗生素的总成本除以SFDs的数量（成本/SFD），并表示为平均值±标准偏差。使用Kruskal-Wallis检验确定差异的统计学意义。结果在612份处方中，117份(19.12%)处方中使用了免疫抑制剂。Deflazacort是27.18％的病例中使用最多的全身性免疫抑制剂，通常用于刺激性接触性皮炎（ICD）和过敏性接触性皮炎（ACD），其次是泼尼松龙和倍他米松。他克莫司是15.90％的患者中使用最多的局部免疫抑制剂，通常用于ICD和白癜风，其次是氯倍他索和莫米松。倍他米松,泼尼松龙,氯倍他索,和莫米松具有更好的成本效益。除泼尼松龙外，所有免疫抑制剂的PDD/DDD均小于1，PDD/DDD比为3.52。结论类固醇的成本-效果具有为患者提供更好的药物治疗依从性的优势,但过度处方也可能导致类固醇的长期不良反应。药物警戒研究还应纳入药物经济学分析，以确定这两个方面之间的关系。
