2. ECONOMIC ASSESSMENT OF IMPLEMENTATION TREATMENT GUIDELINES OF HYPERTENSION IN OUT-PATIENT PRACTICE Kulmagambetov IR Karaganda State Medical Academy, Kazakhstan

3. Population: 16,763,795 (July 2003 est.) Area: total: 2,717,300 sq km water: 47,500 sq km land: 2,669,800 sq km

4. Karaganda State Medical Academy was founded in 1950. Students – 3500 Faculties - General medicine, Pediatrics, Dental Medicine, Medico-biological work, Hygiene and Epidemiology, Pharmacy, Traditional Medicine

5. Introduction: One of the problems in cardiology is evaluating the economic efficiency of the treatment of hypertension Setting: At the сenter for primary health care and 2 general practice outpatient centers in Karaganda

6. Objectives:  To assess the efficiency of hypertension treatment  To assess the cost of hypertension drug therapy  To assess the quality of life of hypertension patients in the outpatient setting before and after implementation of hypertension treatment guidelines

7.  Retrospective analysis of 61 outpatients records with an established diagnosis of hypertension in outpatient practice for 2001 – 2002  Statistical analysis carried out by calculation of a standard set of the parameters used in descriptive statistics Methods:

8.  The cost-effectiveness analysis  The patient quality of life was assessed by score range, with higher scores indicating better health status  The economic analysis of cost of treatment after implementation of guidelines The assessment of expenses for therapy was calculated at the rate of daily average dozes of antihypertensive medicines in USD Methods:

9.  Before implementation of treatment guidelines the percentage of cases achieving a target level of arterial pressure was 14 %; after the intervention was 71.4%  Before implementation of treatment guidelines the percentage of ineffective antihypertensive therapies was 72%; after the intervention the percentage of ineffective therapy decreased to 28.6 %, effective therapies increased by 57.4%  Before implementation of treatment guidelines the percentage of developing complications was 14% of hypertension patients; after the intervention was 0% Results:

10. The efficiency of hypertension treatment before and after implementation of treatment guidelines

11.  The expenses for treatment of 61 patient with hypertension before the implementation of treatment guidelines were USD 4,728; after the intervention were USD 1,882, representing a reduction of USD 2,846 (60%)  The expenses for treatment per patient with hypertension before the implementation of treatment guidelines were USD 77.5; after the intervention were USD 30.85  The assessment of patient quality of life showed an average improvement of 4.3 ± 0.9 for 82.9% of patients; quality of life did not change for 17.1% of patients Results:

12. Expenses for treatment of hypertension patients

13. Conclusions and recommendations:  Implementation of the treatment guidelines has increased efficiency in the management of hypertension and improved patient quality of life  The rational choices of effective pharmacotherapy following the implementation improved the of economy of treatment

14. Key lessons from our experience Our experience has shown:  the necessity to develop educational program for physicians in collaboration with International Organizations  the necessity to develop the training courses for health workers in Kazakhstan and Central Asia Region for appropriately implementation the evidence-based guidelines to improve prescribing practice  the necessity to develop the network that would allowed to involve active participation of experts from different settings and external experts to discuss and review of treatment guidelines and adopt into the local clinical practice

15. Implications of implementation of treatment guidelines The intervention:  allowed to identify the lack of knowledges of physicians  has shown the necessity to change the approaches to improve prescribing practice and promote rational use of medicines  has shown physicians adherence to treatment guidelines and improved prescribing practice  has shown the necessity to implementation the principles to problem-based pharmacotherapy teaching in medical curriculum  stimulates to the further activity to develop and research rational drug use in cooperation with Ministry of Health

16. The specific studies for a future research To carry out the multicountries research in Central Asia Region:  to investigate of medicine use in different settings  to investigate the current situation of implementation treatment guidelines in these countries  to assess economic effects after implementation of treatment guidelines of priority diseases All results should be used for support countries in implementing and monitoring a national strategy to promote rational use of drugs