Economic burden of irrational use of injectable form of Dexamethasone: a warning to health system

Irrational prescribing of injections is common in Iran. According to the statistics of the National Committee of Rational Use of Drugs (NCRUD), more than 40% of rescriptions have at least one injectable form, while injectable dosage form of dexamethasone is on the top of the list. Considering the side effects of corticosteroids, the objective of this study was to investigate the prescribing pattern of dexamethasone in all physicians'' prescriptions from 2007 to 2011 in Iran. A cross-sectional study was carried out on a collection of prescriptions collected from health insurance companies from 2007 to 2011. The inspection was for prescriptions including injectable form of dexamethasone using special software called Rx Analyst and cost analysis was conducted using NCRUD. Almost 365 million prescriptions were reviewed. Those prescriptions including at least one injectable form were identified. Among prescriptions including injectable form of medicines, more than 21% had at least one injectable dosage form of dexamethasone making it the first prescribed medicine by general practitioners. An overall increasing tendency in prescribing pattern and the cost of injectable dosage form of dexamethasone were evident over the observation period. Prescribing the injectable form of dexamethasone was 12.28% in 2007, 13.11% in 2010 and 12.10% in 2011 by all physicians. All related costs were calculated using governmental prices and finally total costs were adjusted to 2011 fees in USD. Irrational pattern of prescribing injectable form of dexamethasone was extracted from the results of this study. It seems that general practitioners are trying to substitute pain relievers’ drugs by injectable dosage form of dexamethasone. Irrational prescriptions of injectable dexamethasone cause not only further costs but also adverse reactions associated with steroid injections. A robust strategy to promote rational use of medicine is strongly needed to correct the pattern of dexamethasone prescription in Iran.