Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Prescribing patterns of cartilage constituents in a national elderly population Rose Galvin, Gráinne Cousins, Nicola Motterlini, Kathleen Bennett and Tom Fahey

Background Arthritis affects approximately 714,000 people in Ireland, accounting for one in three visits to general practitioners Osteoarthritis (OA) is the most common form of arthritis and is the leading cause of disability in the elderly Prevalence of OA is expected to increase in the coming years

Background Treatment options –Pharmacological –Non-pharmacological

Totality of evidence Three systematic reviews with meta-analysis failed to demonstrate that glucosamine and chondroitin (or a combination of the two) had an impact on progression of OA in terms of joint pain, radiological progression of the disease, function and quality of life (Wandel et al 2010, Reichenbach et al 2007, Towheed et al 2005)

Study aim To examine the prescribing patterns of cartilage constituents from in an elderly Irish national population cohort using data from the Health Service Executive Primary Care Reimbursement (HSE-PCRS) General medical services (GMS) Scheme.

Method National cohort study –HSE-PCRS general medical services (GMS) scheme –≥ 70 years from July December 2008 –~97% of this age group nationally avail of the scheme Pharmacy claims database –Prescriptions coded using the World Health Organization Anatomical Therapeutic Chemical (ATC) classification system –No information on diagnosis or disease condition

Statistical analysis Extraction of codes M01AX05 (glucosamine) and hyaluronic acid (M09AX01) Prescribing rates are reported across years, age (70-74 years, ≥75 years) and gender and are presented with 95% confidence intervals Annual costs are calculated as the total expenditure which includes the net ingredient cost of the drug, value added tax and pharmacist dispensing fee

Results Database – January 2002-December 2008 Mean of 329,231 individuals ≥70 years in Ireland are identified per year On average, 58% of the study population are female (n=191,411) and 42% were male (n=137,820)

Rate and cost of glucosamine prescribing Year Rate of prescribing (per 1000 population) (95% CI) Net ingredient cost (€) Total expenditure (€) ( )419,497457, ( )924,4541,028, ( )1,511,4381,697, ( )2,117,6422,380, ( )2,733,6983,105, ( )3,425,9333,915, ( )3,979,1624,624,093

Rate and cost of glucosamine prescribing In 2002, 1.3% of the GMS eligible population received a glucosamine prescription In 2008, over 6% (n=21,287) of the GMS eligible population (n=351,853) received at least one glucosamine prescription Almost 31% of individuals who were prescribed glucosamine between 2002 and 2008 were defined as long term users (>6 months) The net ingredient cost of glucosamine increased from €419,497 in 2002 to almost €4 million in 2008

Prescribing trends of glucosamine

Conclusions The trend in prescribing of glucosamine increased significantly between 2002 and 2008 Evidence based decisions relating to the prescription and consumption of such supplements Cost effectiveness analyses needed to inform policy reimbursement of such products under the GMS scheme