Nilotinib and Imatinib Utilization in Iran over 14 years

Background: Tyrosine Kinase Inhibitors (TKIs) are drugs of choice for Chronic Myeloid Leukemia (CML) treatment. CML healthcare costs greatly exceed of other haematological malignancies treatment mostly due to TKIs. There are several generic and brand preparations of imatinib and nilotinib, the only available TKIs, in Iran with different prices and varied insurance coverage. We have studied TKIs utilization and also investigate the effect of different insurance coverage on TKIs utilization in Iran. Methods: This was drug utilization study about Imatinib and Nilotinib over 14 years. It was conducted in two phases; data extraction from pharmaceutical wholesale data (2003-2017) for utilization trend assessment and registered data of prescriptions from Sizdah-Aban Pharmacy (2011-2014) for utilization trend and insurance coverage assessment such as; prescriptions frequency, number of TKIs, insurance companies and their cost coverage in each prescription. Results: Imatinib consumption increased significantly from 2003 to 2013. This trend stopped afterward. Nilotinib consumption had ascending trend. The trend line of years 2014 to 2017 was steeper and statistically significant (β=0.0014, p-value=0.02). The amount of nilotinib cost coverage by insurance companies increased significantly from 2011 to 2014 (p-value=0.04). The coverage of imatinib costs by insurance companies changed slightly during the study period that was not statistically significant. Frequency of prescriptions with full cost coverage doubled for nilotinib, while did not change remarkably for imatinib, from 2011 to 2014. Mean (SD) of imatinib and nilotinib counts per prescription was significantly higher in prescriptions for which 100% of the cost was covered. Conclusion: We found increasing trend in nilotinib utilization and observed some effects from nilotinib cost coverage by insurance on its consumption. This study made a clear picture for policy makers to monitor imatinib and nilotinib use appropriateness and design the proper cost-effective studies to make evidence-based decisions.