ORGANIC NITRATE CHOICE IN ANTIANGINAL THERAPY OF STABLE ANGINA PECTORIS

Aim. To assess the use of isosorbide-5-mononitrate in clinical practice and evaluate its benefits in antianginal therapy of stable angina pectoris, based on pharmaco-economic analysis data. Material and methods. The authors analysed 902 medical histories of in-patients treated in a cardiology department in 2004-2006. The reports on pharmaceutical support of federal and regional cardiovascular therapy programs, as well as the three-year data on organic nitrate (ON) sales, were also analysed. For standardization purposes, the results were presented as defined daily dose (DDD), in accordance with the Anatomical Therapeutic Chemical (ATC) Classification. A prospective survey of 259 patients was performed, in order to assess their quality of life (QoL) with a psychometric visual analogous scale. In addition, the cost-effectiveness and cost-utility analyses were performed. Results. Overall, the use of ON was relatively low; mean in-hospital levels were 4,57±0,13 DDD/100 bed-days, while out-patient levels were almost 1,5 times lower (3,12±0,19 DDD/1000 patients per year). There was a positive tendency towards the increased use of ON with improved pharmacokinetic profile, such as standard and prolonged-action isosorbide-5-mononitrates (ISMN). The use of ISMN was also associated with a more pronounced QoL improvement. The pharmaco-economic analysis demonstrated the economic benefits of ISMN use in clinical practice. The use of standard isosorbide dinitrate forms for stable angina treatment is not justified both clinically and economically.

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