# Pharmaceutical Utilization Review: A Five-Year Time Trend Analysis of the Pharmaceutical Market in Iran

## TL;DR

This study analyzed changes in pharmaceutical use in Iran from 2018 to 2023, showing how insurance coverage and policies like the Daruyar Plan affected drug utilization.

## Contribution

The study provides a comprehensive five-year trend analysis of pharmaceutical utilization in Iran using national data and insurance coverage patterns.

## Key findings

- Drug classes C, J, L, N, and P showed significant increases in overall utilization.
- Insurance-covered utilization increased notably in drug classes L, R, and S.
- The Daruyar Plan and currency exchange rate changes were linked to increased insurance-covered drug use.

## Abstract

The primary objective of this study was to compare the total and insurance-covered utilization of pharmaceuticals in Iran from March 2018 to March 2023. The findings of this study can offer valuable insights to healthcare professionals, researchers, and policymakers to make informed decisions.

A retrospective cross-sectional study in Iran examined drug utilization patterns (specific databases, e.g., Iranian Health Insurance Organization and Social Security Organization) using Joinpoint regression. The study calculated the Defined Daily Doses per 1000 inhabitants per day (DID) for each medicine based on the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system. All medicines with valid ATC/DDD assignments available during 2018 - 2023 were included to ensure comprehensive national coverage rather than a selected sample. Joinpoint regression was employed for trend analysis, focusing on annual and monthly percent changes in pharmaceutical utilization. Statistical analysis was conducted using MS Excel and Joinpoint software, with significance set at P-value < 0.05.

The study assessed 1185 ATC codes, out of which 751 were found eligible for analysis. Among these, 728 were covered by two major Iranian insurance organizations. The study found that the share of insurance utilization of these pharmaceuticals ranged from 27 to 48 percent. The trend utilization showed significant increases in overall utilization in classes C, J, L, N, and P. The utilization trends under insurance coverage revealed that classes L, R, and S showed a significant increase. After the implementation of the Daruyar Plan and the removal of the preferred currency exchange rate for all classes, there has been an increase in utilization under insurance coverage.

This study reveals notable patterns and discrepancies in utilization levels within different drug classes, as well as the impact of insurance coverage and the Daruyar Plan on medication utilization.