About; Content; Publications and Glossary
Purpose of the Toolkit
Studies to monitor drug utilization can assist governments and organizations to ensure rational use of medicines in their countries. Such studies help to identify medicine-related risks and problems including unmet need, economic waste, potential misuse, and sub-optimal drug selection. These studies can raise important research questions and identify areas for targeted intervention to reduce irrational drug use and the associated consequences.
Most middle/low-income countries and many high-income countries do not have comprehensive data on drug utilization at a national level.
The Toolkit is a comprehensive online resource for anyone interested in undertaking drug utilization studies.
Toolkit content:
- The ATC/DDD methodology : Background and history of the ATC/DDD methodology, and responsible organizations
- ATC (Anatomical Therapeutic Chemical) classification : Structure and classification principles, challenges and changes in the classification
- DDD (Defined Daily Dose) : Definition, principles of DDD assignments, DDDs for single products, combinations, children, changes in DDDs, and the concept of the prescribed daily dose (PDD)
- DDD indicators : Common indicators for presenting drug utilization in DDDs
- Applications of the ATC/DDD methodology : Uses and misuses of the ATC/DDD methodology
- ATC/DDD for drug safety assessment : Use of ATC and DDD in the WHO Programme for International Drug Monitoring
- Sources of Drug Utilization data : Types of drug use, information available, and sources of data on drug utilization
- Start using ATC/DDD: First steps required to start using the ATC/DDD system in drug utilization monitoring and research, implementation of ATC/DDD system and how to request or change an ATC code and/or DDD
- How to set up a Drug Utilization study
- Training in the ATC/DDD methodology: More about the ATC/DDD methodology directly from the experts: Training courses organized by WHO Collaborating Centre for Drug Statistics Methodology
Publications
Links
Population-based drug utilization data using the ATC/DDD system with a search interface allowing for presentation and download of tables with drug utilization data:
- Norwegian prescription database
- Danish Register of Medicinal Product Statistics
- Swedish Prescribed drug register
- Sales of medicines in the Nordic countries (NOMESCO database 1998-2012)
- Antimicrobial consumption in European countries (ESAC-Net)
- General information on databases in Europe with drug consumption statistics can be found in a report from the PROTECT project: DRUG CONSUMPTION DATABASES IN EUROPE Countries summary
- Australian Statistics on Medicines
- Malaysian Statistics on Medicines
Literature references
Historical aspects of Drug Utilization Research
- Engel A, Siderius P. The consumption of drugs. Report on a study, 1966-1967. WHO Regional Office for Europe, Copenhagen 1968 (EURO 3101).
- Dukes MNG, ed. Drug Utilization Studies: Methods and Uses. Copenhagen, WHO Regional Office for Europe, 1993 WHO Regional Publications European series No45.
- Bergman U. The history of the drug utilization research group in Europe. Pharmacoepidemiol Drug Saf 2006, Feb;15(2):95-8.
Methodological aspects of Drug Utilization Research using ATC and /or DDD methodology
- Merlo J, Wessling A, Melander A. Comparison of dose standard units for drug utilisation studies. Eur J Clin Pharmacol 1996;50(1-2):27-30.
- Bergman U1, Popa C, Tomson Y, Wettermark B, Einarson TR, Aberg H, Sjöqvist F. Drug utilization 90%--a simple method for assessing the quality of drug prescribing. Eur J Clin Pharmacol. 1998 Apr;54(2):113-8.
- Ronning M et al. Different versions of the anatomical therapeutic chemical classification system and the defined daily dose - are drug utilization data comparable? European Journal of Clinical Pharmacology, 2000, 56:723-727.
- Cosentino M, Leoni O, Banfi F, Lecchini S, Frigo G. An approach for the estimation of drug prescribing using the defined daily dose methodology and drug dispensation data. Theoretical considerations and practical applications. Eur J Clin Pharmacol 2000, Sep;56(6-7):513-7.
- Mantel-Teeuwisse AK, Klungel OH, Verschuren WM, Porsius A, de Boer A. Comparison of different methods to estimate prevalence of drug use by using pharmacy records. J Clin Epidemiol 2001, Nov;54(11):1181-6.
- Ronning M, Blix HS, Strom H, Skovlund E, Anderson M, Vander Stichele R. Problems in collecting comparable national drug use data in Europe: the example of antibacterials. Eur J Clin Pharmacol 2003;58:843-849.
- Vander Stichele RH, Elseviers MM, Ferech M, Blot S, Goossens H; ESAC Project Group. European surveillance of antimicrobial consumption (ESAC): data collection performance and methodological approach. Br J Clin Pharmacol. 2004 Oct;58(4):419-28.
- Hallas J. Drug utilization statistics for individual-level pharmacy dispensing data. Pharmacoepidemiol Drug Saf 2005, Jul;14(7):455-63.
- Hallas J, Støvring H. Templates for analysis of individual-level prescription data. Basic Clin Pharmacol Toxicol 2006, Mar;98(3):260-5.
Prescribing in primary care
- Stolk P1, Van Wijk BL, Leufkens HG, Heerdink ER. Between-country variation in the utilization of antihypertensive agents: Guidelines and clinical practice. J Hum Hypertens. 2006 Dec;20(12):917-22.
- Henrik Støvring, Morten Andersen, Henning Beck-Nielsen, Anders Green and Werner Vach. Counting drugs to understand the disease: The case of measuring the diabetes epidemic. Population Health Metrics 2007, 5:2.
- Tina Ken Schramm et al. Diabetes Patients requiring glucose-lowering therapy and nondiabetics with a prior MI carry the same cardiovascular risk. Circulation, 2008; 117: 1945-1954.
- Yingfen Hsia, Antje C. Neubert, Fariz Rani, Russell M. Viner, Peter C. Hindmarsh andIan C. K. Wong. An increase in the prevalence of type 1 and 2 diabetes in children and adolescents: results from prescription data from a UK general practice database. British Journal of Clinical Pharmacology, 2009, Volume 67, Issue 2, pages 242–249.
- Wirtz VJ1, Dreser A, Gonzales R.Trends in antibiotic utilization in eight Latin American countries, 1997-2007. Rev Panam Salud Publica. 2010 Mar;27(3):219-25.
- Ingrid Schubert, Peter Ihle, Rainer Sabatowski. Increase in opiate prescription in Germany between 2000 and 2010, a study based on insurance data. Dtsch Arztebl Int. 2013 Jan; 110(4): 45–51.
- Hanne Strøm et al. No increase in new users of blood glucose-lowering drugs in Norway 2006-2011: a nationwide prescription database study. BMC Public Health 2014, 14:520.
Drug Utilization in hospitals
- Vander Stichele RH, Elseviers MM, Ferech M, Blot S, Goossens H; European Survaillance of Antibiotic Comsuption (ESAC) Project Group. Hospital consumption of antibiotics in 15 European countries: results of the ESAC Retrospective Data Collection (1997-2002). J Antimicrob Chemother. 2006 Jul;58(1):159-67.
- De With K, Steib-Bauert M, Straach P, Kern WV. Is there significant regional variation in hospital antibiotic consumption in Germany? Infection, 2006 Oct; 34(5):274-7.
- Kuster SP, Ruef C, Ledergerber B, Hintermann A, Deplazes C, Neuber L, Weber R. Quantitative antibiotic use in hospitals: comparison of measurements, literature review, and recommendations for a standard of reporting. Infection, 2008 Dec; 36(6):549-59.
- Megha Sharma, Bo Eriksson, Gaetano Marrone, Suryaprakash Dhaneria, Cecilia Stålsby Lundborg. Antibiotic prescribing in two private sector hospitals; one teaching and one non-teaching: A cross-sectional study in Ujjain, India. BMC Infect. Dis. 2012; 12: 155.
Drug interaction database using the ATC system
- Böttiger Y, Laine K, Andersson ML, Korhonen T, Molin B, Ovesjö ML, et al. SFINX-a drug-drug interaction database designed for clinical decision support systems. Eur J Clin Pharmacol 2009, Jun;65(6):627-33.
Glossary
- ADR
Adverse Drug Reactions
- ATC
Anatomical Therapeutic Chemical
- ATC Levels
The ATC system is divided into 5 different levels:
1st level: 14 anatomical groups
2nd level: Pharmacological or therapeutic subgroup<>< 3rd="" and="" 4th="" level:="" chemical,="" pharmacological="" or="" therapeutic="">
5th level: Chemical substance - BAN
British Approved Name
- Combination products
Products containing two or more active ingredients
- DDD
Defined Daily Dose. The assumed average maintenance dose per day for a drug used for its main indication in adults
- DUR
Drug Utilization Research
- DURG
Drug Utilization Research Group
- EphMRA
European Pharmaceutical Market Research Association
- ICSRs
Individual Case Safety Reports
- INN
International Nonproprietary Names. The preferred substance name in the ATC-system
- Maintenance dose
Long-term therapeutic dose. The dose preferred when establishing the DDD
- NIPH
Norwegian Institute of Public Health
- PDD
Prescribed Daily Dose. The average dose prescribed according to a representative sample of prescriptions
- Plain products
Preparations containing one active component
- PRR
Proportional Reporting Ratio
- USAN WHO-DD
United States Adopted Name. WHO Drug Dictionary