Thrombolytic drug use in Nova Scotia, Canada: An application of the World Health Organization's Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) methodology

The utilization of thrombolytic medications for acute myocardial infarction (AMI) events in acute care hospitals in the province of Nova Scotia (NS), Canada was studied to determine the effect of health regions and hospital size on the level and type of thrombolytic use. Data from a provincial drugpurchasing database were combined with hospital information to construct regional, hospital size and temporal patterns in thrombolytic use per AMI event. The World Health Organisation's ATC/DDD methodology, a technique used to allow comparison of different types and dosages of medications, was used to construct drug utilization trends of streptokinase and alteplase between 1998 and 2001. Estimated rates of overall thrombolytic use per AMI event showed that thrombolytic use statistically differed in some study years and regions. Alteplase and streptokinase utilization also differed by hospital size, with larger hospitals using these medications at 69% of the level of smaller hospital thrombolytic drug utilization (p<0.05). Larger facilities were also more likely to use different types of thrombolytic medications than smaller hospitals (p<0.005). This investigation has demonstrated that the ATC/DDD approach combined with routinely collected hospital drug purchasing and administrative information is a simple, descriptive tool that can aid drug utilization evaluations and allocation decisions.