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Master Thesis

Estimation de la prévalence et descriptions des situations à risque d’interactions médicamenteuses en France à partir des données de l’assurance maladie

Abstract : Some studies report that Drug Drug Interactions (DDIs) are estimated to cause 2 to 5% of hospital admissions in elderly patients and 1% in the general population. However, very little data are available on the drugs concerned and on the severity of the interactions encountered. Our aim was to assess the prevalence of drug delivery with Potential Drug Drug Interaction (PDDI) in France and to know which drug combinations are the most concerned. We conducted a transversal study using a random dataset from the Echantillon Généraliste de Bénéficiaires (EGB) to look at PDDIs prevalence in France between 2010 and 2015. PDDI prevalence was studied directly and using an probabilistic indicator called Dips-Score (DS) which is a relative risk between theoretical and observational co-prescription probabilities. In practice, a drug pair with a DS > 1 is more frequent than expected and a drug pair with a DS < 1 is less frequent. Analysis were based on ATC level 2 (therapeutic main group) and 5 (chemical substance). 6,908,910 drug dispensations were analyzed over the considered time period. Among them, 13,196 implied the concomitant delivery of contraindicated drugs (0.2%), and 95,410 the concomitant delivery of drugs which association is not recommended (1.4%). Median DS of contra-indications and not recommended associations were respectively 0.4 and 0.6. Among the 20 most frequent contra-indicated drug pairs, the pair with the highest prevalence was bisoprolol+flecainide for which 5,036 dispensations were identified. The drug pair associated with the highest DS was citalopram+hydroxyzine (DS: 3.7; 2.9 - 4.6); that associated with the lowest one was clarythromycine+simvastatine (DS: 0.2; 0.2 - 0.3). ATC level 2 analysis found more than 50% of contra-indications between beta blocking agents and cardiac therapy and 10% of contra-indications between diuretics and mineral supplements. The prevalence of some IMPs indicates the need for new prevention actions for the proper use of drugs. In this perspective, the Dips-Score indicator, which we present in this paper, can help to identify the IMPs least considered in practice and to consider specific studies or preventive actions on them.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01640102
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Monday, November 20, 2017 - 4:51:22 PM
Last modification on : Saturday, December 9, 2017 - 1:16:55 AM
Long-term archiving on: : Wednesday, February 21, 2018 - 2:39:04 PM

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Louis Létinier. Estimation de la prévalence et descriptions des situations à risque d’interactions médicamenteuses en France à partir des données de l’assurance maladie . Médecine humaine et pathologie. 2017. ⟨dumas-01640102⟩

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