Trends and disparities in the use of cholinesterase inhibitors to treat Alzheimer’s disease dispensed by the Brazilian public health system – 2008 to 2014: a nation-wide analysis

Abstract

In light of the high cost of dementia treatment, there is legislation authorizing free distribution of cholinesterase inhibitors to those suffering from Alzheimer’s disease in Brazil. However, the existence of this free distribution does not guarantee adequate distribution. Objectives The present study aimed to investigate the trends of prescriptions and the coverage of Alzheimer’s disease treatment using cholinesterase inhibitors from public pharmacies dispensing high-cost drugs in Brazil. Methods This was a retrospective study that collected data from the Brazilian public Unified Health System. All cholinesterase inhibitors distributed at no cost to Brazilians during the year 2014, as well as the estimated number and percentages of patients who used these medications, were evaluated and compared to data from the year 2008. Results Our estimates indicated that 9.7% of the population having dementia syndromes used cholinesterase inhibitors, as well as 16.1% of those with Alzheimer’s disease in Brazil. A clear disparity was noted between the use and distribution of cholinesterase inhibitors, depending on the region in which they were found. Over time, an increase in the distribution of cholinesterase inhibitors has been noted. In 2008, that use was 12.0% whereas, in 2014, it was 16.1%, an increase of 34% in six years. Conclusion It was estimated that 16.1% of patients with Alzheimer’s disease in Brazil use cholinesterase inhibitors. These values have increased and, in spite of not being satisfactory, they indicate a potential for improvement. However, there is still a significant disparity among the regions.

Adverse Drug Reactions of Acetylcholinesterase Inhibitors in Older People Living with Dementia: A Comprehensive Literature Review

“…20,21 AChEIs were the first pharmacological treatment approved by the US Food and Drug Administration (FDA) for AD and have been reported to be used in 10-20% of dementia patients. [22][23][24][25] The aging population usually have multiple other chronic diseases as well as behavioral and psychological symptoms of dementia (BPSD), 12,22,[26][27][28][29][30][31][32][33][34][35] resulting in the concurrent use of five or more medications or polypharmacy. 26 The exposure of 82-98% of people with dementia to polypharmacy was reported in previous studies.…”

Ethnoracial disparity among patients with dementia during COVID-19 pandemic

“…As consequence, they are more likely to require emergency services, which may be associated with the shorter duration of hospitalization and higher mortality rate. Moreover, the estimated proportion of patients with dementia treated with anticholinesterase drugs in 2014 was lower in the Northeast (5.8%) and the North (2.6%) region than the national average (16.1%) 29 . However, no data about the distribution of this critical pharmacological treatment by ethnoracial groups are available, raising the question about the coverage of governmental programs to distribute this medication among diverse ethnoracial groups.…”

Who are the people with Alzheimer's disease in Brazil? Findings from the Brazilian Longitudinal Study of Aging

“…REV BRAS EPIDEMIOL 2021; 24: E210018 However, the lack of national perspective on social, economic, and clinical factors among people with AD in Brazil lead to disparities in access, coverage, and treatment 12 . For example, a recent systematic review showed that, from seven studies that identified the prevalence of clinically-assessed dementia among older adults in Brazil, six were conducted in the Southeast (states of São Paulo and Minas Gerais) and one in the Northeast (state of Bahia) regions 13 .…”