만성 B형간염 진단 환자의 항바이러스제 처방양상

Prescribing Patterns of Antivirals for Chronic Hepatitis B

  • 투고 : 2011.11.10
  • 심사 : 2012.02.20
  • 발행 : 2012.03.31

초록

This study was aimed to examine the prescribing patterns of antivirals in outpatients with chronic hepatitis B (CHB), using National Health Insurance adjudicated claims data (total 1,426,065 claims) dated March 19, 2008 submitted from nationwide healthcare providers to Health Insurance Review and Assessment Service. From the data, there were 2,965 claims with CHB diagnosis (ICD-10 code B18.0 and B18.1), and 44.2% (1,311 claims) of the CHB related claims included antivirals such as lamivudine, clevudine, adefovir and entecavir. Lamivudine, adefovir, clevudine and entecavir shared 54.9%, 19.9%, 13.2% and 11.9%, respectively, among antiviral prescriptions. Adefovir and entecavir 1mg presumed as the 2nd line therapy for HBV resistant cases were shared 23.3% of overall antiviral prescriptions. There were statistically significant difference in prescription patterns according to age and institution type: Lamivudine usage was higher in younger (< 20 years old) and older age group (> 70 years old) than the others (p = 0.016), and adefovir and entecavir, which were relatively newer antivirals, had higher prescription rates in higher level of institutions such as tertiary hospitals than the others (p < 0.001). This study would be of help to make an appropriate drug therapy plan for patients with CHB.

키워드

참고문헌

  1. 김도영, 신준범. 만성 B형 간염 치료의 최신지견. 제10회 연세대학교 의과대학 내과 연수강좌. 2009년.
  2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of chronic hepatitis B. J Hepatol. 2009; 50(2): 227-42. https://doi.org/10.1016/j.jhep.2008.10.001
  3. 최연호, 서정기, 윤정환 등. 학동기전 정상아동에서의 B형 간염 항원 및 항체 보유율에 관한 연구. 대한소아과학회지 2005; 39(9): 1254-9.
  4. 보건복지부한국보건사회연구원. 국민건강영양조사 제3기 (2005) 총괄보고서. 2006년.
  5. 한철주. 만성 B형간염의 자연경과와 예후. 소화기연관학회 춘계학술대회. 2005년.
  6. WHO(World Health Organization) ICD-10(the Tenth Edition of the International Classification of Diseases). http:// www.who.int/classifications/apps/icd/icd10online(2009.3.5).
  7. 국민건강보험공단. 건강보험DB 질병통계. http://211.34.86.121:8092/nsieu/view/tree.do?task=branchView&hOrg= 350&id=350_35001_6*MT_OTITLE(2009.3.7)
  8. 정영호, 고숙자. 5대 사망질병의 사회.경제적 비용 추계: 2001년. 보건복지포럼 2003; 79: 55-65.
  9. 양봉민, 백승운, 한오석 등. B형 간염 바이러스 관련 질환의 사회적 비용 추계. 보건경제연구 2000; 6(2): 117-42.
  10. 전계식. 한국에 있어서 성과 연령으로 본 질병동향. 자연과학연구소논문지 1999; 4(1): 1-6.
  11. 이관식. 만성 B형간염의 치료. 대한의사협회지 2009; 52(8): 831-7.
  12. Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2007; 45: 507-39. https://doi.org/10.1002/hep.21513
  13. World Health Organization(WHO). ATC(Anatomical Therapeutic Classification) Code. http://www.whocc.no/ atc_ddd_index/(2009.3.7)
  14. Lee YS, Suh DJ, Lim YS, et al. Increased risk of adefovir resistance in patients with lamivudine-resistant chronic hepatitis B after 48 weeks of adefovir dipivoxil monotherapy. Hepatology 2006; 43(6): 1385-91. https://doi.org/10.1002/hep.21189