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Introduction to
Drug Utilization Research
World Health Organization
WHO International Working Group for Drug Statistics Methodology
WHO Collaborating Centre for Drug Statistics Methodology
WHO Collaborating Centre for Drug Utilization Research and Clinical
Pharmacological Services
WHO Library Cataloguing-in-Publication Data
Introduction to drug utilization research / WHO International Working Group for Drug
Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology,
WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacological
Services.
1. Drug utilization 2. Research 3. Manuals I.WHO International Working Group for
Drug Statistics Methodology II.WHO Collaborating Centre for Drug
Statistics Methodology III.WHO Collaborating Centre for Drug Utilization Research
and Clinical Pharmacological Services
ISBN 92 4 156234 X
(NLM classification: WB 330)
2
© World Health Organization 2003
All rights reserved. Publications of the World Health Organization can be obtained
from Marketing and Dissemination, World Health Organization, 20 Avenue Appia,
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to Publications, at the above address (fax: +41 22 791 4806; email:
permissions@who.int).
The designations employed and the presentation of the material in this publication do not
imply the expression of any opinion whatsoever on the part of the World Health
Organization concerning the legal status of any country, territory, city or area or of its
authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on
maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply
that they are endorsed or recommended by the World Health Organization in preference to
others of a similar nature that are not mentioned. Errors and omissions excepted, the names
of proprietary products are distinguished by initial capital letters.
The World Health Organization does not warrant that the information contained in this
publication is complete and correct and shall not be liable for any damages incurred as a
result of its use.
Printed in Oslo, Norway, 2003
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Contents
Preface: Drug utilization research - the early work
...........................................................................6
Chapter 1: What is drug utilization research and why is it needed?
...............................................8
1.1 Definition and domains............................................................................................................8
1.2 Why drug utilization research? ................................................................................................9
1.2.1 Description of drug use patterns ....................................................................................9
1.2.2 Early signals of irrational use of drugs .......................................................................10
1.2.3 Interventions to improve drug use - follow-up ............................................................10
1.2.4 Quality control of drug use...........................................................................................10
1.3 Drug utilization studies and drug policy decisions................................................................11
1.4 General reading ......................................................................................................................12
Chapter 2: Types of drug use information
........................................................................................13
2.1 Drug-based information .........................................................................................................13
2.1.1 Level of drug use aggregation .....................................................................................13
2.1.2 Indication .....................................................................................................................13
2.1.3 Prescribed daily doses .................................................................................................14
2.2 Problem or encounter-based information ..............................................................................15
2.3 Patient information.................................................................................................................16
2.4 Prescriber information ...........................................................................................................16
2.5 Types of drug utilization study ..............................................................................................17
2.6 Drug costs ..............................................................................................................................17
2.7 General reading ......................................................................................................................18
2.8 Exercises ................................................................................................................................19
Chapter 3: Sources of data on drug utilization
................................................................................20
3.1 Large databases ......................................................................................................................20
3.2 Data from drug regulatory agencies ......................................................................................20
3.3 Supplier (distribution) data ....................................................................................................20
3.4 Practice setting data ...............................................................................................................21
3.4.1 Prescribing data ............................................................................................................21
3.4.2 Dispensing data ............................................................................................................22
3.4.3 Aggregate data .............................................................................................................22
3.4.4 Over-the-counter and pharmacist-prescribed drugs ....................................................22
3.4.5 Telephone and Internet prescribing .............................................................................22
3.5 Community setting data .........................................................................................................23
3.6 Drug use evaluation ...............................................................................................................23
3.7 General reading ......................................................................................................................24
3.8 Exercises ................................................................................................................................24
Chapter 4: Economic aspects of drug use (pharmacoeconomy)
....................................................26
4.1 Introduction ............................................................................................................................26
4.2 Cost-minimization analysis....................................................................................................26
4.3 Cost-effectiveness analysis ....................................................................................................26
4.4 Cost-utility analysis ...............................................................................................................27
4.5 Cost-benefit analysis ..............................................................................................................27
4.6 General reading ......................................................................................................................28
4.7 Exercises ................................................................................................................................28
Chapter 5: Drug classification systems..............................................................................................33
5.1 Different classification systems .............................................................................................33
5.2 The ATC classification system...............................................................................................33
5.3 Ambivalence towards an international classification system ................................................35
5.4 Implementation of the ATC/DDD methodology ...................................................................36
5.5 General reading ......................................................................................................................36
5.6 Exercises ................................................................................................................................37
Chapter 6: Drug utilization metrics and their applications
............................................................38
6.1 The concept of the defined daily dose (DDD).......................................................................38
6.2 Prescribed daily dose and consumed daily dose....................................................................39
6.3 Other units for presentation of volume..................................................................................39
6.4 Cost ......................................................................................................................................39
6.5 General reading .....................................................................................................................40
6.6 Exercises ...............................................................................................................................41
Chapter 7: Solutions to the exercises
.................................................................................................74
Acknowledgements...............................................................................................................................84

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