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BY T

TRNG I HC DC H NI

IU HUY QUN ANH

KHO ST C CU V XU HNG

NHP KHU THUC IU TRI THO NG TI VIT NAM

GIAI ON 2006-2011

KHA LUN TT NGHIP DC S

H NI 2013


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BY T

TRNG I HC DC H NI

IU HUY QUN ANH

KHO ST C CU V XU HNGNHP KHU THUC IU TR

I THO NG TI VIT NAMGIAI ON 2006-2011

KHA LUN TT NGHIP DC S

Ngi hng dn:

1.DS. Nguyn Vnh Nam2. ThS. Chu Quc Thnh

Ni thc hin:

1.

Bmn Qun l v Kinh tdc

Trng i hc Dc H Ni

2.Phng Qun l gi thuc

Cc Qun l Dc - BY t

H NI 2013


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LI CM N

Ti xin c by tlng bit n chn thnh v su sc nht n:

ThS. Chu Quc Thnh Chuyn vin Phng Qun l gi thuc Cc

Qun l Dc BY t, ngi cung cp cho ti cc sliu, hng dn v

gi cho ti vphng php nghin cu.

DS. Nguyn Vnh Nam Bmn Qun l v kinh tDc Trng

i hc Dc H Ni, thy lun tn tnh hng dn, ng vin v cho ti

nhiu kin thc qu bu hon thnh kha lun tt nghip ny.

ThS. Nguyn ThH Bmn Qun l v kinh tDc Trng i

hc Dc H Ni, c cho ti nh ng li khuyn qu bu v gip ti

trong sut thi gian lm kha lun.

Ti cng xin cm n cc thy c gio Trng i hc Dc H Ni,

c bit cc thy c Bmn Qun l v Kinh tDc tn tnh dy dti

trong sut thi gian hc tp ti trng.

Cui cng ti xin gi li cm n su sc n gia nh v bn b khch lng vin ti t c nhng thnh cng ngy hm nay.

H ni, ngy 21 thng 05 nm 2013.

Sinh vin

iu Huy Qun Anh


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MC LC

DANH MC CC CHVIT TT

DANH MC CC BNG

DANH MC CC HNH

T VN .................................................................................................. 1

Chng 1. TNG QUAN............................................................................... 2

1.1. Tng quan vbnh i tho ng ...................................................... 2

1.1.1. nh ngha bnh i tho ng................................................... 2

1.1.2. Phn loi i tho ng............................................................... 2

1.1.3. Tnh hnh i tho ng ti Vit Nam v trn thgii................ 2

1.2. Tng quan vthuc v iu tri tho ng .................................... 3

1.2.1. Cc nhm thuc iu tri tho ng....................................... 3

1.2.2. iu tri tho ng.................................................................. 4

1.3. Tng quan vthtrng thuc nhp khu v thuc iu tritho ....

ng Vit Nam ............................................................................................. 8

1.3.1. Vai tr ca thuc nhp khu.......................................................... 8

1.3.2. Vtr thuc iu tri tho ng trong thtrng thuc nhp ...

khu Vit Nam............................................................................................. 9

1.4. Tng quan vnghin cu nh lng sdng thuc ......................... 10

1.4.1. Nghin cu chi ph....................................................................... 10

1.4.2. Nghin cu da trn slng n vng gi........................... 11

1.4.3. Nghin cu da trn n thuc.................................................... 11

1.4.4. Nghin cu da trn liu trung bnh sdng hng ngy............ 12

1.5. Cc nghin cu tng tti Vit Nam v trn thgii ..................... 12

1.5.1. Cc nghin cu vsdng/ tiu ththuc iu tri tho ng

trn thgii............................................................................................... 13

1.5.2. Cc nghin cu tng tti Vit Nam........................................ 13


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Chng 2. I TNG V PHNG PHP NGHIN CU............. 15

2.1. i tng nghin cu ......................................................................... 15

2.2. Thi gian v a im nghin cu ...................................................... 15

2.3. Thit knghin cu ............................................................................ 15

2.4. Ni dung nghin cu .......................................................................... 15

2.5. Cc ch snghin cu ........................................................................ 15

2.6. Thu thp v lm sch dliu .............................................................. 16

2.7. Xl sliu........................................................................................ 18

2.8. Trnh by v bo co kt qu.............................................................. 18

Chng 3. KT QUNGHIN CU........................................................ 19

3.1. Gi trkim ngch nhp khu v slng sng k cc thuc iu tr

i tho ng nhp khu vo Vit Nam (2006-2011) ............................... 19

3.1.1. Gi trkim ngch nhp khu cc thuc iu tri tho ng .....

nhp khu (2006-2011)............................................................................. 19

3.1.2. Slng sng k cc thuc iu tri tho ng nhp khu(2006-2011)............................................................................................... 19

3.2. C cu v xu hng nhp khu cc nhm thuc iu tri tho.........

ng (2006-2011) ...................................................................................... 20

3.2.1. Kho st da trn gi trkim ngch nhp khu.......................... 20

3.2.2. Kho st da trn slng sng k........................................ 21

3.2.3. Kho st da trn tng sliu DDD........................................... 223.3. C cu v xu hng nhp khu cc hot cht iu tri tho ng ..

(2006 2011) ............................................................................................... 24

3.3.1. Kho st da trn gi trkim ngch nhp khu.......................... 24

3.3.2. Kho st theo slng sng k.............................................. 26

3.3.3. Kho st theo tng sliu DDD.................................................. 28


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3.4. C cu v xu hng nhp khu cc thuc iu tri tho ng theo

quc gia xut x(2006-2011) ...................................................................... 29

3.4.1. Kho st theo kim ngch nhp khu. ........................................... 30

3.4.2. Kho st theo slng sng k.............................................. 32

Chng 4. BN LUN................................................................................. 34

4.1. Bn lun vkt qunghin cu ......................................................... 34

4.1.1. Xu hng chung vnhp khu cc thuc iu tri tho ng ..

...................................................................................................... 34

4.1.2. Xu hng nhp khu cc nhm thuc iu tri tho ng ... 34

4.1.3. Xu hng nhp khu cc hot cht iu tri tho ng....... 35

4.2. Hn chca ti ............................................................................... 38

4.2.1. Hn chvphng php nghin cu........................................... 38

4.2.2. Hn chvdliu nghin cu..................................................... 38

4.2.3. Hn chvbin gii kt qu........................................................ 39

KT LUN V KIN NGH...................................................................... 40

TI LIU THAM KHO

PHLC


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DANH MC CC K HIU, CH VIT TT

ADA : Hip hi i tho ng hoa k

DDD : Liu trung bnh sdng hng ngy

T : i tho ng

EASD : Hip hi nghin cu i tho ng Chu u

Ins : Insulin

IDF : Lin on i tho ng quc t

KNNK : Kim ngch nhp khu

Met : Metformin

NK : Nhp khu

Pio : Pioglitazon

TLS : Thay i li sng

TZD : Thiazolidinedion

SK : Sng k

Sul : Sulfonamid v dn xut ure

WHO : Tchc y tThGii


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DANH MC CC BNG

Bng 1.1. Ttrng thuc trong nc v nhp khu ......................................... 9

Bng 1.2. Gi trv ttrng gi trmt snhm thuc nhp khu ti Vit .......

Nam ................................................................................................ 10

Bng 2.1. Danh mc cc hot cht iu tri tho ng trong nghin cu 17

Bng 3.1. Gi trkim ngch nhp khu v ttrng gi trkim ngch nhp .......

khu thuc iu tri tho ng (2006-2011) ........................... 19

Bng 3.2. Slng sng kcc thuc iu tri tho ng nhp khu ....

(2006-2011).................................................................................... 19

Bng 3.3. Gi trkim ngch nhp khu ca mt sbit dc iu tri tho..

ng c xut xtPhp. ............................................................. 32


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DANH MC CC HNH

Hnh 1.1. Phc iu trT ca Hip hi i tho ng Mv hip hi ..

nghin cu i tho ng Chu u nm 2009 .............................. 8

Hnh 3.1 Gi trv ttrng kim ngch nhp khu cc nhm thuc iu tri.

tho ng...................................................................................... 21

Hnh 3.2 Slng sng kca cc nhm thuc iu tri tho ng ......

(2006-2011).................................................................................... 22

Hnh 3.3. Tng sliu v ttrng tng sliu DDD ca cc nhm thuc ......

iu tri tho ng (2006 2011) ........................................... 23

Hnh 3.4. Gi trkim ngch nhp khu ca cc hot cht iu tri tho........

ng v ttrng (2006-2011) ...................................................... 26

Hnh 3.5. Slng sng kca cc hot cht iu tri tho ng nhp .

khu ................................................................................................ 27

Hnh 3.6. Tng sliu DDD v ttrng tng sliu DDD ca cc hot cht...iu tri tho ng ................................................................... 28

Hnh 3.7. Gi trv ttrng gi trkim ngch nhp khu theo xut xca cc

thuc iu tri tho ng ......................................................... 31

Hnh 3.8. Slng sng ktcc quc gia c thuc iu tri tho.........

ng Vit Nam giai on 2006-2011 ....................................... 33


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1

T VN

Cng vi spht trin vkinh t, cht lng cuc sng c nng cao

khin cho cc bnh mn tnh ni chung v bnh i tho ng ni ring ngy

cng trnn phbin. Theo c tnh ca Tchc y tthgii, vi tc gia

tng slng bnh nhn hin nay, khong 4,4% dn sthgii smc bnh

i tho ng vo nm 2030[23]. Mc d l mt quc gia ang pht trin,

cc thng k dch thc cho thy ti Vit Nam vo nm 2010, c kho ng

3% dn smc bnh ny [24].

Tc pht trin bnh nhanh nh vy l mt thch thc ln vi ngnh

Y tcng nh ngnh Dc Vit Nam.thc hin tt mc tiu cung ng y

c v s lng v cht lng cc thuc iu tr i tho ng, ngnh

Dc khng nhng phi pht trin v quy m v danh mc thuc sn xut

trong nc m cn phi nhp khu thuc.

Mc d vai tr thuc nhp khu trong iu tr i tho ng l rt

quan trng, tuy nhin hin nay, cha c mt kho st no nh gi c cu vxu hng nhp khu thuc iu tri tho ng. Trn c s, chng ti

thc hin ti Kho st c cu v xu hng nhp khu thuc iu tr

i tho ng giai on 2006-2011 vi hai mc tiu:

1. Kho st c cu nhp khu thuc iu tri tho ng vo Vit

Nam giai on 2006-2011.

2. Kho st xu hng nhp khu thuc iu trvo Vit Nam giai on2006-2011.


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2

Chng 1. TNG QUAN

1.1. Tng quan vbnh i tho ng

1.1.1.

nh ngha bnh i tho ng

Theo Tchc y tthgii (WHO): i tho ng (T)l mt bnh

mn tnh gy ra bi sthiu ht tngi hay tuyt i insulin, dn n cc

ri lon chuyn ha hydratcacbon. Bnh c c trngbi tnh trng tng

ng huyt mn tnh v cc ri lon chuyn ha [4].

1.1.2.Phn loi i tho ng

i tho ng typ1: Do bnh tmin dch, cc tbo beta tuyn ty

bph hy bi cht trung gian min dch,s ph hy ny c thnhanh hay

chm. Tin trin nhanh hay gp ngi tr


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3

Theo Lin on Tquc t(International Diabetes Federation IDF)

cng trong nm 2012 c ti 4,8 triu ngi cht v bnh i tho ng,

mt na trong s tui di 60 tui. Thgii chi hn 471 tUSD

cho bnh Tnm 2012[15].

Nm 2002, theo iu tra trn phm vi ton quc la tui 30-64 ca

Bnh vin Ni tit Trung ng, t lmc bnh T chung ca cnc l

2,7%, cc thnh phl 4,4%, vng ng bng ven bin 2,2% v min ni l

2,1% [1]. Ti 2010 theo t chc y t thgii Vit Nam c khong 2,64

triu ngi tng ng 3% dn smc bnh [24].

1.2. Tng quan vthuc v iu tri tho ng

1.2.1.Cc nhm thuc iu tri tho ng

1.2.1.1. Insulin

o Chnh:

L bt buc vi T typ1 v T thai k [2].

S dng cho T typ 2 khi c: nhim trng, vt thng cp, tngng huyt vi tng ceton mu cp nng, c thai, suy gan,suy thn, dng

hay tht bi vi cc thuc ung hng huyt, khi c chnh tm thi ngay

khi ng huyt tng >250-300 mg/dl hay HbA1c>11%, v mt s trng

hp khc [2].

o Phn loi insulin theo thi gian tc dng [2],[4],[12].

- Loi tc dng nhanh nh Lispro, Aspart,Glulisin.- Loi tng i nhanh nh Regular.

- Loi tc dng trung gian nh Lente hay NPH.

- Loi tc dng ko di nh Glargin, Ultralente, Detemir .

- Loi hn hp nh 70%NPH /30%Regular hay 75%NPH /25%Lispro.

Trong :meal-insulin l loi tc dng nhanh v tng i nhanh [12].


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1.2.1.2. Cc thuc iu tri tho ng ng ung

- Nhm thuc kch thch ty bi tit insulin (sulfonamide/xut ure):

glyclazid, glimepirid, glibenclamid, gliburid, glipizid [2].

- Nhm thuc lm tng nhy cm insulin ngoi vi, gim khng

insulin: biguanid, thiazolidinedion [2].

Biaguanid: metformin.

Thiazolidinedione: pioglitazon, rosiglitazon.

- Nhm c ch emzyme alpha glucosidase lm gim hp thu glucose:

acarbose, voglibose, miglitol [2].

- Nhm glinid: kch thch tbo beta tuyn ty tit insulin. Gm cc hot

cht nh: meglitinid, repaglinid.

- Nhm cc thuc tc dng trn hincretin:

Cc thuc ng phn GLP-1 (glucagon-like peptide 1): lm gim

ng huyt sau n. V d: exenatid.

Thuc c ch emzym phn hy GLP-1 l DPP IV (dipeptidylpeptidase IV): lm tng nng v tc dng ca GLP-1 ni sinh.

ng phn amylin: tc dng theo c chlm chm trng ddy,

c chtit glucagon, tng GLP[4].

1.2.2.iu tri tho ng

1.2.2.1. iu trkhng dng thuc

- Chn: vi T typ 1 n calo, vi T typ 2 n t calo (t hn1200Kcal/ngy ), n nhiu ba nhv gin phi u. Khu phn n

cn i (50-60% glucid, 30-35% lipid, 10% protid), m bo vitamin,

khong cht, hn chcc loi ng hp thu nhanh, king ru [4],[2].

- Vn ng thlc l rt quan trng v cn thit, c bit l T typ 2.

Luyn tp ty theo la tui v tnh trng tim mch ca bnh nhn [4].


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- Kim sot ng huyt bng cch nh lng ng huyt thng

xuyn chnh liu thuc cho ph hp [4].

- Gio dc bnh nhn nhng kin thc vT bnh nhn phi hp

tt trong iu tr, bit cch t dng thuc v phng nga c bin

chng [4].

- Khm nh k theo di cc bin chng v c tham vn ca bc s

khi c vn c bit xy ra [4].

1.2.2.2. Cc phc iu tr

a. Cc phc iu trbng insulin

C nhiu phc iu trinsulin khc nhau. i vi T typ 1 thng

sdng cc phc 2- 4 mi/ ngy. i vi T typ 2 ngoi phc nh

T typ 1 c thsdng thm phc 1 mi insulin kt hp vi thuc vin

(insulatard, lantus) [2].

T thai kthng sdng phc 1-4 mi/ ngy ty theo nng

ng huyt bnh nhn. Chsdng loi insulin tng hp (actrapid, mixtard,insulatard) [2].

- Phc 1 mi insulin : phi hp thuc vin iu tr T vi 1 mi

insulin tc dng trung gian hoc hn hp vo trc ba n ti hoc 1

mi insulin tc dng trung gian hoc Glargin (lantus) vo bui ti trc

khi i ng.

- Phc 2 mi insulin: thng s dng 2 mi insulin tc d ng trunggian hoc insulin hn hp tim trc n sng v ti. Chia liu 2/3 trc

ba im tm sng, 1/3 trc ba n ti. Khi vi phc trn tht bi,

chn v chsinh hot tht thng hoc khi cn kim sot cht

chng huyt nh khi c thai hoc khi c cc bin chng nng cn

sdng cc phc khc vi nhiu mi insulin[2].


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- Phc nhiu mi insulin: tim 3 ln trong ngy: 2 mi nhanh v 1 mi

bn chm hoc 2 mi bn ch m hoc insulin nn. Tim 4 ln trong

ngy: 3 mi insulin tc dng nhanh trc 3 ba n v 1 mi insulin nn

loi NPH trc khi nghoc Glargin (lantus) [2].

b. Phc iu trTtyp 2 ca IDF nm2005 v 2012

Trong c 2 phc ny, metformin l u tin s dng u tin cho

kim sot ng huyt, tip n l sulfonamid/dn xut ure. iu ny cho

thy trong giai on nghin cu, khng c s thay i v vai tr ca

metfomin v sulfonamid trong vic kim sot ng huyt.- Phc iu trT ca IDF nm2005 [16]

Bc 1. Thay i li sng.

Bc 2. Sdng metformin, theo di chc nng thn khi sdng.

Bc 3. Sdng sulfonamid/dn xut ure khi metformin khng kim

sot c ng huyt. Insulin tc dng nhanh c ththay thsulfonamid.

Bc 4. Sdng (thiazolidindion + metformin) hoc (thiazolidinedion+ sulfonamid) hoc (thiazolidinedion + mt thuc dng kt hp ca

metformin v sufonamid) khi bc 3 khng t c mc tiu iu tr.

Bc 5. S dng cht c ch alpha glucosidase nh mt thuc thm

vo.

Bc 6. Tng liu, dng thm cc thuc h ng huyt khc, dng

insulin.- Phc iu trT typ 2 ca IDF nm 2012 [14]

Bt u vic iu trbng cch thay i li sng, nu khng t mc

tiu mi bc (thng l HbA1C


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Bc 2. S dng sulfonamid/dn xut ure, c th thay th bng mt

trong cc thuc: metformin, cht c chalphaglucosidase, thiazolidinedion,

DPP-4.

Bc 3. La chn mt trong cc thuc: insulin tc dng ko di, insulin

dng hn hp, c chalpha-glucosidase, DPP-4, thiazolidinedion, c ththay

thbng cht ng vn GLP1.

Bc 4. La chn mt trong cc thuc: mt insulin tc dng ko di v

mt meal-time insulin, insulin nn hoc insulin hn hp.

c. Phc iu trT ca hip hi T Mv hip hi nghin cu T

Chu u

Chin lc iu trT typ 2 theo ng thun ca Hip hi T M

(American Dental Asociation -ADA) v Hip hi nghin cu T chu u

(European Association for the Study of Diabetes - EASD) a ra nm 2009

c trnh by trong hnh 1.1.

Thnh 1.1 pha di ta thy:Trong phc loi 1, l phc c u tin iu trth metformin,

sulfonamid/dn xut ure v insulin l nhng nhm thuc quan trng nht

trong vic kim sot ng huyt.

Phc 1 l cc phc iu trhiu quv kinh tnht. Cc phc

ny c a ra da vo cc kt quthnghim lm sng, v c chng

minh l gip t c HbA1c ch nn c la chn cho hu ht cc bnhnhn.

Phc loi 2 khc vi loi 1 bc thhai v thba. Phc loi 2

ny thng c p dng t phbin hn phc loi 1.


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8

Hnh 1.1. Phc iu trT ca ADA v EASD nm 2009[17]

1.3.

Tng quan v th trng thuc nhp khu v thuc iu tr itho ng ti Vit Nam

1.3.1.Vai tr ca thuc nhp khu

Trong thi gian gn y, nhu cu sdng thuc ca ngi dn ngy

cng tng cao. Tin thuc bnh qun u ngi 2008 (16,45 USD/ ngi) tng

gp hn 2 ln so vi nm 2004 (8,6 USD/ngi) [5]. Trc nhu cu sdng

thuc ca ngi dn ngy cng tng vcslng v cht lng th ngnh

Chn on T: Thayi li sng (TLS) +

Met

TLS+Met+Sul

TLS+ Met+Insulin nn

TLS +Met+ Ins tch

cc

TLS + Met+ PioKhng gy hGluose mu

Gy ph,suy tim, Mtxng

TLS +Met+ ng vnGLP-1

Khng hglucose muGim cn, nn, bun nn

TLS+ Met+

Pio+Sul

TLS +

Met+Ins nn

BC 1 BC 2 BC 3

LOI 2: t c bng chng hn

Ghi ch:

TLS: Thay i lisng,

Met: metformin,

Sul: Sulfonamid/dnxut ure,

Pio: Pioglitazone,Ins: Insulin.

LOI 1: iu trc bn, y bng chng


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9

dc cn khng ngng pht trin vquy m v cht lng. Bn cnh , kh

nng sn xut thuc trong nc cn hn ch(thuc thnh phm chp ng

c 50% nhu cu sdng thuc ca nhn dn, 90% nguyn liu lm thuc

vn phi nhp khu). Do , thuc nhp khu ng vai tr r t quan trng

trong hthng y tnc ta.

So snh ttrng thuc trong nc v thuc nhp khu da trn tng gi

trtin thuc tnm 2006-2010 c thhin bng 1.2. Theo ta thy, t

trng thuc nhp khu l tng ng vi thuc trong nc.

Bng 1.1. Ttrng thuc trong nc v nhp khu [9]

Nm Tng gi trtinthuc

(Triu USD)

Thuc trong nc Thuc nhp khu

Gi tr(Triu USD)

Ttrng%

Gi tr(Triu USD)

Ttrng%

2006 956,353 475,400 49,71 548,200 50,29

2007 1136,350 600,630 52,86 597,082 47,14

2008 1425,660 715,440 50,18 759,752 49,82

2009 1686,140 831,210 49,01 859,763 50,992010 1913,660 919,040 48,03 994,529 51,97

1.3.2.Vtr thuc iu tri tho ng trong thtrng thuc nhp khu

Vit Nam

Ti Vit Nam, thuc iu tr cc bnh nhim khun c t trng kim

ngch nhp khu (KNNK) ln nht (>21% mi nm). ng th2 l cc thuc

iu trcc bnh vng tiu ha v chuyn ha (> 18% mi nm) [5].Thuc iu tr bnh T nm trong nhm cc thuc iu tr bnh

ng tiu ha v chuyn ha (nhm A) v lun c ttrng KNNK ln th3

trong nhm A, ln lt l 16,1%, 13,3%, 17,0% trong 3 nm t2006-2008 so

vi tng KNNK ca nhm A [5].

Gi trv ttrng 1 snhm thuc c KNNK ln vo Vit Nam c

thhin bng 1.2 [5].


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10

Bng 1.2. Gi trv ttrng gi trmt snhm thuc nhp khu ti

Vit Nam [5]

Nhm thuc theom bc 1 phn loi

ATC

Nm 2006 Nm 2007 Nm 2008Gi tr(TriuUSD)

Ttrng

%

Gi tr(TriuUSD)

Ttrng

%

Gi tr(TriuUSD)

Ttrng

%A - ng tiu ha

v chuyn ha.93,5 18,2 138,0 20,0 148,7 18,1

J - Hkhng khun 129,1 25,1 148,7 21,4 206,3 24,8

C - Htim mch 48,5 9,4 60,9 8,8 77,7 9,4

Tng cc nhmthuc 513,7 100,0 690,5 100,0 829,5 100,0

1.4. Tng quan vnghin cu nh lng sdng thuc

Ni dung chnh ca ti l kho st c cu v xu hng nhp khu

thuc iu trT. Trong qu trnh phn tch kt qu, cc chsnghin cu

khc nhau bao gm kim ngch nhp khu (thhin gi trbng tin), tng s

liu trung bnh sdng hng ngy (Defined Daily Dose DDD) (thhin gi

trsdng), tng sng k (thhin mc cnh tranh) sc a vo

phn tch song song vi tng ni dung nghin cu. Cc chsny c rt ra

da trn cc nghin cu nh lng vsdng, tiu ththuc. Do , chng

ti thc hin phn tng quan ny nhm m tcc loi nghin cu v cc ch

stng ng cc nghin cu vsdng/tiu ththuc.

1.4.1.Nghin cu chi ph

Cc nghin cu v chi ph thuc em li thng k ban u v tng

quan gia chi ph sdng thuc so vi tng chi ph y t, c bit trn quy m

quc gia. Trn thc t, khi trin khai cc nghin cu ny, nh nghin cu

thng thc hin so snh gia chi ph sdng thuc vi thu nhp bnh qun

u ngi [13].

Nghin cu vchi ph c mt shn chnh: khng cung cp chnh

xc vslng thuc c bn ra hay slng thuc thc tc ngi dn


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11

s dng, hn na gi thuc khc nhau gia cc quc gia gy ra nhng kh

khn trong vic so snh chi ph tiu ththuc gia cc quc gia. Nghin cu

di hn cng gp kh khn do nhng bin ng vtin tv nhng thay i

trong gi thuc [11],[20].

1.4.2.Nghin cu da trn slng n vng gi

nh gi s tiu th da trn s lng n v ng gi (vin, l,

ng,...) a ra nhng nh gi chnh xc v tiu th thuc hn l nh gi

theo chi ph. Nghin cu ny hay c sdng nh gi s dng thuc

trong cmt giai on hoc so snh gia cc quc gia [11].

Hn ch ca nghin cu ny l ng vi cng mt hot cht theo thi

gian v gia cc quc gia c thc nhiu bit dc vi dng bo ch, nng

, hm lng v quy cch ng gi khc nhau, do gy kh khn cho vic

nh lng tiu th. Tuy nhin, nu lm c cc nghin cu ny scho thy

bin ng vchng loi bit dc ng vi dng mt hot cht, theo thi gian

[11].1.4.3.Nghin cu da trn n thuc

Nghin cu ny c thphn nh mi quan hgia ngi thy thuc v

bnh nhn v sthay i ca mi quan h trong mt giai on thi gian.

Hn chca phng php ny l khng ththc hin c trkhi skho st

bao gm cnhng chn on v nhng vn lin quan khc. Khng may l,

nhng thng tin ny thng rt kh c c v mt vi l do hn n a skho st loi ny c trngi l thng t [11].


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12

1.4.4.Nghin cu da trn liu trung bnh sdng hng ngy

Liu DDD: l liu tng cng trung bnh ca mt thuc dng cho mt

ngy cho mt chnh ngi trng thnh [3].

ngha:DDD l mt n vo lng kthut vsdng thuc, c

ngha theo di, gim st, nh gi vtnh hnh tiu thv sdng hp l

hay khng [3].

DDD c sdng trong cc nghin cu tiu ththuc thng qua tnh

ton v tng s liu DDD. Cc nghin cu ny scho thy thc tv tng

lng thuc tiu thca qun thnghin cu.

Cc nghin cu ny ph hp gim st, nh gi vtnh hnh tiu th

v sdng ca cc thuc iu trbnh mn tnh c liu quy nh gn vi liu

DDD. V dnh: cc thuc iu trT, c bit l cc thuc iu trT

ng ung [11],[20].

Hn chca phng php nghin cu ny:

- Th nht l, nghin cu tiu th thuc s dng cc d liu trn ccthuc c k n hoc bn ra cho bnh nhn. Tuy nhin, khng phi

tt ccc thuc ny u c bnh nhn sdng ht [11].

- Mt sthuc khng thdung liu DDD theo di, nh gi tnh hnh

sdng thuc: dch truyn, vac xin,thuc t, m, thuc ngoi da, cn

quang [3].

1.5.

Cc nghin cu tng tti Vit Nam v trn thgiiTnh ti thi im nghin cu, chng ti cha tm c nghin cu no

trn thgii kho st thc trng nhp khu thuc iu trT cng nh phn

tch vai tr ca thuc iu trT nhp khu. Tuy nhin, c mt snghin

cu vtiu thv sdng thuc iu trT c thc hin. Cthl:


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13

1.5.1.Cc nghin cu v s dng/tiu th thuc iu tri tho ng

trn thgii

Nghin cu v xu hng k n cho bnh nhn i tho ng ca

Marta Baviera v cng s trn hn 9 triu dn Lombardy-Italia thc hin

nm 2008. Nghin cu ly s liu t c s d liu qun l sc khe ca

Lombardy giai on 2000-2008. Kt qunghin cu cho thy:

Trong giai on nghin cu.

- T lbnh nhn c iu trbng biguanid v sulfonamide/dn cht

ure l cao nht (> 50%).

- Tlbnh nhn c iu trbng biguanid tng t53,4% - 66,5%.

- Tlbnh nhn c iu trbng sulfonamid/dn xut ure gim dn

t78,6% xung cn 56,4%

- Tlbnh nhn sdng insulin t c sthay i.

- C sra tng sdng thiazolidinedion t0,8 - 5,7% [10].

Nghin cuvsdng thuc iu trT ti Hungary ca B.Hankov cng strn dliu ths bo him y tquc gia v cng ty t vn MIS

giai on 1998-2002. Kt qunghin cu cho thy:

- Sulfonamid/dn xut ure c dng nhiu nht trong nhng thuc iu

trT ng ung v cao gp gn hai ln so vi biguanid l thuc

iu trT ng ung c dng nhiu thhai [13].

1.5.2.

Cc nghin cu tng tti Vit Nama. Cc nghin cu vsdng thuc iu tri tho ng ti Vit Nam

Nghin cu ca o Mai Hngvsdng thuc iu trT ng

ung ti khoa khm bnh bnh vin Bch Mai thc hin trn 200 bnh n nm

2009 cho tlcc nhm thuc c sdng nh sau

- Tlbnh nhn c iu trbng metformin l cao nht (73%).

- Tlbnh nhn c iu trbng sulfonamide/dn xut ure l 72,2%.


23/65

14

- Tlbnh nhn iu trbng nhm c chalpha glucosidasel 24,3%.

- T l bnh nhn c dng thuc phi hp gia rosiglitazon v

metformin l 7,5%.

- Tlbnh nhn c dng thiazolidinedion l 1,5% [8].

Nghin cu ca Kong Chunny vthc trng sdng thuc T typ 2

ti khoa ni tit v T bnh vin Bach Mai thc hin trn 200 bnh n vo

nm 2008 cho thy:

- Tlbnh nhn c sdng insulin l cao nht (95,5%).

- Tlbnh nhn c sdng biguanid l 34%.

- Tlbnh nhn c sdng sulfonamide/ dn xut ure l 21,5%.

- Tlbnh nhn c sdng c chalpha glucosidase l 20% [6].

b. Cc nghin cu vnhp khu thuc ti Vit Nam

Nghin cu Phn tch c cu thuc thnh phm nhp khu giai on

2006-2010 ca Chu Quc Thnh trn c scc dliu vthuc nhp khu t

Tng cc Hi quan. Nghin cu tp trung kho st vc cu thuc nhp khutheo xut x, theo phn loi ATC, theo c quan gii phu...[5].

Nghin cu Phn tch thc trng nhp khu cc thuc khng khun

trong giai on 2006-2010 ca L ThPhng Hoa cng da trn c sd

liu vthuc nhp khu tTng cc Hi. Nghin cu tp trung kho st quan

vc cu nhp khu thuc khng sinh theo xut x, theo hot cht, theo nhm

thuc v theo hn bo hc quyn [9].


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15

Chng 2. I TNG V PHNG PHP NGHIN CU

2.1. i tng nghin cu

i tng nghin cu ca ti l ton bcc thuc thnh phm iu

trTnhp khu vo Vit Nam trong giai on tnm 2006ti nm 2011.

2.2. Thi gian v a im nghin cu

o Thi gian nghin cu:

Nghin cu c thc hin trong thi gian t1/2/2013 ti 21/5/2013.

o a im nghin cu:

Bmn Qun l v kinh tDc - i hc Dc H Ni

Phng Qun l gi thuc - Cc Qun l Dc - BY t

2.3. Thit knghin cu

Thit knghin cu m t.

2.4. Ni dung nghin cu

o Kho st c cu v xu hng nhp khu cc nhm thuc iu trT giai

on 2006-2011.o Kho st c cu v xu hng nhp khu cc hot cht iu trT giai

on 2006-2011.

o Kho st c cu v xu hng nhp khu cc thuc iu trT theo quc

gia xut xgiai on 2006-2011.

2.5. Cc ch snghin cu

o Gi trKNNK v ttrng gi trKNNK ca cc nhm thuc, hot cht vca cc quc gia xut khu thuc iu trT vo Vit Nam.

o Slng v ttrng slng sng k (SK) ca cc nhm thuc, hot

cht v ca cc quc gia xut khu thuc iu trT vo Vit Nam.

o S lng v t trng tng s liu DDD trong mi nm ca cc nhm

thuc, hot cht v ca cc quc gia xut khu thuc iu tr T vo

Vit Nam.


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- Tng sliu DDD nhp khu ca mt hot cht trong mi nm c

tnh theo cng thc:

Tng sliu DDD =

- Tng s liu DDD nhp khu ca nhm thuc = tng s liu DDD

nhp khu ca cc hot cht trong nhm

2.6. Thu thp v lm sch dliu

D liu nhp khu thuc lu tr ti Tng Cc hi quan Vit Nam t

1/1/2006 ti 31/12/2011 c thu thp v xl theo quy trnh:

Hnh 2.1. S xl sliu

Gii thch quy trnh:

Bc 1: Sng lc dliu vthuc thnh phm

D liu ban u do Tng cc Hi quan Vit Nam cung cp bao gm

tng t nhp hng trong nm ca nhiu nhm hng khc nhau (thuc thnh

D liu thuc nhpkhu ca cc Hi quan

D liu thuc thnhphm

D liu thuc thnhphm hon chnh

D liu ban u v

thuc iu tr T

D liu thuc iu trT hon thin

Sng lc dliu vthuc thnh phm

Bsung mc hot cht

(nu cn)

Gn m ATC, liuDDD v SK cho cc

thuc nghin cu

Sng lc dliu vthuc iu trT


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phm, nguyn liu lm thuc, thuc th y, ha cht st khun,...). Do ,

ph hp vi i tng nghin cu ca ti l thuc thnh phm, chthng

tin v thuc thnh phm (m hng 3004) c chit tch v a vo nghin

cu.

Bc 2: Bsung thng tin vhot cht (nu cn)

Trong dliu ban u ti Tng cc Hi quan, thng tin vhot cht c

thkhng c, hoc khng y . Do , cn bsung thng tin ny do thng

tin hot cht l thit yu cho ni dung phn tch ca nghin cu.

hn chcc sai sc thxy ra, thng tin c tra cu ti hai c s

dliu c lp v cha vo nghin cu khi c snht qun gia hai c s

ny.

Bc 3: Sng lc dliu thuc iu tri tho ng

Sng lc dliu tt ccc thuc m hot cht tng ng c m bc 2 l

A10 theo phn loi ATC/WHO (Cc thuc s dng trong iu tr bnh

T).Danh mc hot cht a vo nghin cu c trnh by bng 2.1.

Bng 2.1.Danh mc cc hot cht iu trT trong nghin cu

Tn hot cht M ATC Tn hot cht M ATCAcarbose A10BF01 Insulin A10A

Benfluorex A10BX06 Metformin A10BA02

Chlorpropamid A10BB02 Pioglitazon A10BG03

Glibenclamid A10BB01 Repaglind A10BX02Glibenclamid v Metformin A10BD02 Rosiglitazon A10BG02

Gliclazid A10BB09 Rosiglitazon v Metformin A10BD03

Gliclazid v Metformin A10BD02 Glimepirid v Metformin A10BD02

Glimepirid A10BB12 Pioglitazon v Metformin A10BD05


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19

Chng 3. KT QUNGHIN CU3.1. Gi trKNNK v slng SK cc thuc iu trT nhp khu

vo Vit Nam (2006-2011)3.1.1.Gi trKNNK cc thuc iu trT nhp khu (2006-2011)

Gi trKNNK v ttrng KNNK thuc iu trT trn tng gi tr

KNNK thuc nhp khu giai on 2006-2011 c thhin bng 3.1.

Bng 3.1. Gi trKNNK v ttrng gi trKNNK thuc iu trT

(2006-2011)

2006 2007 2008 2009 2010 2011KNNK thuc T

(triu USD)15,05 18,41 25,44 27,84 35,43 40,98

Tng KNNK(triu USD)

513,68 690,52 829,52 1051,04 1162,44 1328,21

Ttrng KNNK(%)

2,93 2,67 3,07 2,65 3,05 3,09

Tbng kt qutrn, ta thy:

Gi trKNNK thuc iu trT tng ng k trong thi gian khost. Cth, gi trKNNK tng 2,7 ln: t15,05 triu USD (2006) ln 40,98

triu USD (2011). Trong khi , ttrng gi trKNNK thuc iu trT so

vi tng KNNK thuc nhp khu tng i n inh: t trng cc thuc ny

chim khong t2,7-3,1% tng gi trKNNK ca thuc nhp khu.

3.1.2.Slng SK ccthuc iu trT nhp khu (2006-2011)

Tng s lng s ng k (SK) ca tt c cc thuc iu tr Tnhp khu vo Vit Nam c thhin trong bng 3.2 bn di.

Bng 3.2. Slng SK cc thuc iu trT nhp khu (2006-2011)

2006 2007 2008 2009 2010 2011

Slng SK 126 141 151 155 182 186

Tbng kt qutrn ta thy:


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20

Tng slng SK ca 16 hot cht c nghin cu trong ti tng

dn qua tt c cc nm. Tng mnh nht l tng 27 SK mt nm (2009-

2010). V tng t nht chtng4 SK mt nm (2008-2009 v 2010-2011).

3.2. C cu v xu hng NK cc nhm thuc iu trT (2006-2011)

By nhm thuc iu tr T theo phn loi ATC c a vo

nghin cu bao gm: insulin (A10A), cc biguanid (A10BA), sulfolnamid/

dn cht ure (A10BB), thuc iu tr T ng ung dng kt hp

(A10BD), cc cht c ch alphaglucosidase (A10BF), cc thiazolindinion

(A10BG) v cc thuc hng huyt khc ngoi tr insulin (A10BX). C

cu nhp khu cc nhm thuc ny c kho st da trn ba chs: gi tr/t

trng KNNK, tng sliu/ttrng slng liu DDD v slng SK.

3.2.1.Kho st da trn gi trkim ngch nhp khu

C cu nhp khu cc nhm thuc iu trT theo gi trKNNK v

ttrng gi trKNNK c trnh by trong hnh 3.1. Ttrng gi trKNNK

ca mt nhm thuc trong mt nm c tnh bng tlphn trm gia gitrKNNK ca nhm thuc trong nm trn tng gi trKNNK ca tt ccc

thuc iu trT trong nm.

Thnh 3.1, v sliu chi tit ti phlc 1, phlc 2, ta thy:

Trong giai on 2006-2011, cc nhm thuc c ttrng gi trKNNK

ln nht l: sulfonamid/dn xut ure (37,0-48,4%), biguanid (17,8-24,2%) v

insulin (16,2-27,7%). Trong 3 nhm ny, t trng gi trKNNK ca nhmsulfonamid/dn xut ure c xu hng tng trong giai on 2006-2008 (nm

2008 t ti gn 50% tng gi trKNNK cc thuc iu trT) v gim

trong giai on 2008-2011. Trong khi , hai nhm cn li cho thy xu hng

ngc li: tsau nm 2008, t trng KNNK ca hai nhm thuc ny c xu

hng tng dn.


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i vi cc nhm thuc khc, kt qucho thy: ttrng KNNK tng

nhm cht c chalpha glucosidase v cc thuc T ng ung dng kt

hp. Cc nhm thuc cn li c xu hng gim t trng, c bit l nhm

thiazolidinedion: gim t10.5% (2006) xung cn 2% (2011).

Hnh 3.1 Gi trv ttrng KNNK cc nhm thuc iu trT3.2.2.Kho st da trn slng sng k

C cu nhp khu cc nhm thuc iu trT ti Vit Nam theo s

lng SK c thhin hnh 3.2.

Thnh 3.2, v sliu cthti phlc 3, ta thy:

Trong giai on 2006-2011,cc nhm thuc iu trT c s lng

SK nhiu nht l sulfonamid/dn xut ure (47-76 SK), biguanid (29-43

0

2

4

6

8

10

12

14

16

18

Triu

USD

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Biguanid

Sulfonamid/dnxut ure

Thuc Tng ungdng kt hp

Cht c chalphaglucosidase

Thiazolidindion

Cc cht hng huytkhc tr insulin

Insulin


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SK), insulin (17-34 SK) v thiazolidindion (17-27 SK). Trong bn

nhm, ngoi tr thiazolidindion, cc nhm cn li c xu hng tng dn s

lng SK.

i vi cc nhm thuc khc, kt qucho thy: cc thuc iu trT

ng ung dng kt hp c slng SK tng dn t6 SK (2006) ti 13

SK (2010). Hai nhm cn li (cht c chalpha glucosidase v cc thuc h

ng huyt khc ngoi trinsulin) c rt t SK (khng qu 3 SK/nhm).

Hnh 3.2 Slng SK ca cc nhm thuc iu trT (2006-2011)

3.2.3.Kho st da trn tng sliu DDD

T trng tng s liu DDD ca mt nhm thuc c tnh bng t l

phn trm gia tng sliu DDD ca nhm thuc trn tng sliu DDD ca

tt ccc thuc iu trT. Ngoi trcc thuc iu trT ng ung

0

10

20

30

40

50

60

70

80

Nm

2006

Nm

2007

Nm

2008

Nm

2009

Nm

2010

Nm

2011

Biguanid

Sulfonamid v dn xuture

Thuc T ng ungdng kt hp

Cht c ch alphaglucosidase

Thiazolidindion

Cc cht h ng huytkhc tr insulin

Insulin


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dng kt hp (A10BD), tt ccc nhm thuc cn li c thtnh ton c

theo chsny.

Tng sliu DDD ca cc nhm thuc cn li c tnh ton v c

thhin hnh 3.3.

Hnh 3.3. Tng sliu v ttrng tng sliu DDD ca cc nhm thuc

iu trT (2006 2011)

Thnh 3.3, v sliu chi tit ti phlc 4, phlc 5, ta thy:

Bn nhm thuc c t trng tng s liu DDD ln nht l:

sulfonamid/dn xut ure (57,07-76,06%), biguanid (11,42-31,93%), insulin

(5,27-8,33%) v thiazolidinedion (1,93-4,09%). Tip tc phn tch su hn

bn nhm cht ny:

0

20

40

60

80

100

120

140

160

180

Triu

liu

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Biguanid

Sulfonamid/dnxut ure

Thuc Tng ungdng kt hp

Cht c chalphaglucosidase

Thiazolidindion

Cc cht hng huytkhc tr insulin

Insulin


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- i vi hai nhm sulfonamid/dn cht ure v biguanid:

T 2006-2008: sulfonamid/dn cht ure tng mnh v t trng

(57,07%-76,06%) trong khi biguanid gim mnh vttrng (31,67%-

11,42%).

T 2008-2010: biguanid tng mnh v t trng (11,42%-

19,62%) trong khi sulfonamid/dn cht ure gim mnh v t trng

(76,06%-66,50%)

- i vi hai nhm cn li:

Tnm 2007, ttrng Insulin c xu hng tng lin tc (5,27%-

8,74%) trong khi thiazolidinedion n nh mc 3-4%, chgim xung

di 2% vo nm 2011.

Cc nhm khc (cc cht c chalphaglucosidase v cc cht h

ng huyt khc ngoi trinsulin) c ttrng slng liu DDD rt

nh(< 1,3%).

3.3.

C cu v xu hng nhp khu cc hot cht iu trTDanh mc cc hot cht iu trT nghin cu trnh by trong bng

2.1. C cu nhp khu cc hot cht ny c kho st da trn ba chs: gi

tr/ttrng KNNK, tng sliu/ttrng slng liu DDD v slng SK.

3.3.1.Kho st da trn gi trkim ngch nhp khu

C cu nhp khu cc hot cht iu trT ti Vit Nam theo gi trv

ttrng gi trKNNK c thhin hnh 3.4.Ttrng KNNK ca mt hot cht c tnh bng tlphn trm gia

gi trKNNK ca hot cht so vi tng gi trKNNK ca tt ccc hot

cht. Thnh 3.4, v chi tit sliu phlc 6, phlc 7, ta thy:

Cc hot cht c t trng KNNK ln nht l gliclazid (22,6-34,5%),

metformin (17,8-24,2%), insulin (19,3-24,7%) v glimepirid (8,5-14,9%).


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Tm hiu su hn v xu hng ca hai nhm thuc l gliclazid v

metformin:

- Trong giai on 2006-2007: gliclazid c t trng KNNK tng t

22,6%-34,5% trong khi metformin c ttrng KNNK gim t24,2%-

17,8%.

- Trong giai on 2007-2008: metformin c t trng KNNK tng

(17,8%-18,3%), trong khi gliclazid c t trng KNNK gim (34,5%-

30,9%).

- Trong giai on 2009-2010: metformin c t trng KNNK tng

(18,9%-22,9%) trong khi gliclazid c t trng KNNK gim (33,4%-

28,3%).

Xt vgi trKNNK, trong giai on t2006-2011, cc hot cht c

gi trKNNK tng lin tip l: gliclazid (3,64-11,08 triu USD), insulin (2,43

-10,10 triu USD), metformin tng t(3,64-8,71 triu USD).

Trong cc hot cht cn li:- Benfluorex c ttrng KNNK gim t2,23% (2006) n 0%(2010).

- Rosiglitazon c ttrng KNNK gim t7,26% (2006) n 0%(2011).

- Hot cht dng kt hp gia rosiglitazon v metformin c t trng

KNNK gim t1,69% (2010) xung 0%(2011).

Xu hng nhp khu cc hot cht iu trTtheo KNNK c th

hin trong hnh 3.4 di y.


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Hnh 3.4. KNNK ca cc hot cht iu trT v ttrng (2006-2011)

3.3.2.Kho st theo slng sng k

C cu nhp khu cc hot cht iu trT theo slng SK c

thhin trong hnh 3.5 di y.

0

2

4

6

8

10

12

Tr

iu

USD

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

acarbose

benfluorex

chlorpropamid

glibenclamid

glibenclamid vmetformin

gliclazid

gliclazid vmetformin

glimepirid

insulin

metformin

pioglitazon

repaglind

rosiglitazon

rosiglitazon vmetformin

glimepirid vmetformin

pioglitazon vmetformin


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Hnh 3.5. Slng SK ca cc hot cht iu trT nhp khu

Thnh 3.5 v chi tit sliu phlc 8 ta thy:

Bn hot cht c slng SK nhiu nht l meformin (29-43 SK),

glimepirid (17-46 SK), gliclazid (16-24 SK) v insulin (18-34 SK).

Nhn xt vxu hng bin ng slng SK ca tng hot cht trn nh

sau:

- Trong giai on 2008-2011: metformin c xu hng tng slng (t

30-43 SK), glimepirid c xu hng tng slng SK(29-46 SK).

- Trong giai on 2007-2011: insulin tng gp i slng SK (17-

34 SK), gliclazid c slng SK tng i n nh (22-24 SK).

Vi cc hot cht cn li: rosiglitazon c slng SK gim 8-4 SK

(2006-2010) v khng cn SK no nm 2011. Benfluorex ch c duy nht

mt SK trong bn nm (2006-2009),v khng c SK no nm 2010 v

2011.

0

5

10

15

20

25

30

35

40

45

50

Nm

2006

Nm

2007

Nm

2008

Nm

2009

Nm

2010

Nm

2011

acarbose

benfluorex

chlorpropamid

glibenclamid

glibenclamid v metformin

gliclazid

gliclazid v metformin

glimepirid

insulin

metformin

pioglitazon

repaglind

rosiglitazon

rosiglitazon v metformin

glimepirid v metformin

pioglitazon v metformin


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3.3.3.Kho st theo tng sliu DDD

Ttrng sliu DDD ca cc hot cht c tnh bng tlphn trm

gia slng liu DDD ca mt hot cht so vi tng slng liu DDD ca

tt ccc hot cht c tnh ton (A10BD khng c tnh ton liu DDD).

Ngoi trcc hot cht iu trT dng kt hp (A10BD), slng

liu DDD v ttrng ca cc hot cht iu trT c thhin trong hnh

3.6 di y.

Hnh 3.6. Tng sliu DDD ca cc hot cht iu trT v ttrng

0

10

20

30

40

50

60

70

80

90

Triu

liu

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

50.00% acarbose

benfluorex

chlorpropamid

glibenclamid

glibenclamide vmetformingliclazid

gliclazide vmetforminglimepirid

insulin

metformin

pioglitazon

repaglind

rosiglitazon

rosiglitazon vmetforminglimepirid vmetforminpioglitazon vmetformin


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Thnh 3.6 v chi tit sliu ti phlc 9, phlc 10, ta thy :

Ba hot cht c t trng s liu DDD ln nht l gliclazid (29,05-

45,59%), metformin (11,42- 31,93%), glimepirid (8,04- 29,38%). Xt vxu

hng bin ng ttrng cc hot cht ny thy rng :

- i vi gliclazid: trong giai on 2006-2009 c t trng tng s liu

DDD tng t29,05%-45,59% v gim t45,59%-34,44% trong giai

on t2009-2011.

- i vi glimepirid: hot cht ny c xu hng tng t trng tng s

liu DDD t8,04% (2007) ti 29,38% (2011).

- i vi metformin: hot cht ny c t trng tng s liu DDD gim

mnh t 31,93-11,42% (2007-2008) v tng mnh t 11,42-19,62%

(2008-2010).

- c bit, giai on 2007-2008: t trng tng s liu DDD: gliclazid

tng (37,42-40,54%) v glimepirid tng (8,04-22,25%) trong khi

metformin gim mnh (31,93-11,42%).Trong cc hot cht cn li: glibenclamid c xu hng gim ttrng

sliu DDD t11,93-3,96% trong giai on 2006-2010. Insulin c xu hng

tng ttrng sliu DDD t5,79% (2006) ti 8,33% (2011). Benfluorex v

rosiglitazon u gim dn ttrng tng sliu DDD v0. (benfluorex c t

trng gim v0 nm 2010, rosiglitazon c ttrng gim v0 nm 2011).

3.4.

C cu v xu hng nhp khu cc thuc iu tri tho ngtheo quc gia xut x(2006-2011)

Cc thuc iu trT nhp khu ti Vit Nam c ngun gc t23

quc gia trn ton th gii. Gm c Argentina, Bangladesh, Canada, Trung

Quc, Cyprus, an Mch, Php, c, n , Indonesia, , Hn Quc,

Malaysia, Pakistan, Ba Lan, Singapo, Ty Ban Nha, i Loan, ThNh K,

Anh, M, Israel, c.


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30

C cu nhp khu tcc quc gia ny c kho st da trn ba chs:

gi tr/t trng KNNK, v slng SK. Ngoi ra cc quc gia c t trng

KNNK ln cng c kho st cthhn.

3.4.1.Kho st theo kim ngch nhp khu.

Ttrng KNNK ca mt quc gia c tnh bng tlphn trm gia

gi trKNNK ca quc gia so vi tng gi trKNNK ca tt ccc quc

gia.

Thnh 3.7 v chi tit sliu ti phlc 11, phlc 12, ta thy:

Bn quc gia c t trng KNNK ln nht ln lt l Php (42,1-

48,2%), an mch (8,5-16,3%), n (7,3-13,4%), (6,0-11,7%). Nhn xt

ta thy:

- Giai on 2009-2011: n c xu hng tng dn ttrng KNNK t

7,4-13,4%, tng t6-7,6%, trong khi ttrng KNNK tPhp c xu

hng gim dn 48,1-42,1%.

- Trong giai on 2006 - 2011, Php c ttrng KNNK gim t48,2%-42,1%, tuy nhin gi tr KNNK ca Php li tng mnh 7,25-17,27

triu USD.

- Trong giai on nghin cu ttrng KNNK ca an Mch ln xung

qua tng nm, tuy nhin gi tr KNNK li tng dn 1,56-6,69 triu

USD.

Trong cc quc gia cn li, Ba Lan c t trng KNNK tng dn t3,4%-7,1% giai on (2006-2008) v gim dn t7,1-2,7% giai on (2008-

2011). Hn Quc c t trng KNNK thp nhng l quc gia duy nht c t

trng KNNK tng dn sau 6 nm t1,7%-3,9% (2006-2011).

Kim ngch nhp khu v ttrng KNNK tcc quc gia c thhin

trong hnh 3.7 di y.


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31

Hnh 3.7. Gi trKNNK v ttrng gi trKNNK theo quc gia xut x

Thnh 3.7 trn ta thy:

Php l quc gia c gi trKNNK v tlKNNK cao nht trong tt c

cc quc gia trong c6 nm t2006 n 2011. V vy ta nghin cu khn

vc cu nhp khu mt sbit dc tPhp.

KNNK mt sbit dc tc ttrng ln nht tPhp c trnh by

trong bng 3.3 di y.

0

2

4

6

8

10

12

14

16

18

20

Tr

iu

USD

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0% Argentina

Bangladesh

Canada

Trung Quc

Cyprus

an Mch

Php

c

n

Indonesia

Hn Quc

Malaysia

Pakistan

Ba Lan

Singapo

Ty Ban Nha

a Loan

Th nh k

Anh

M

Israel

c


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32

Bng 3.3.Gi trKNNK ca mt sbit dc iu trT c xut xtPhp.

Tn Bit dc 2006 2007 2008 2009 2010 2011

DiamicronKNNK

(Triu USD)3,04 5,57 6,51 8,15 8,84 9,67

Ttrng % 41,9 63,4 58,2 60,9 57,8 56,0

GlucophageKNNK

(Triu USD)2,85 2,04 3,28 3,54 4,70 5,75

Ttrng % 39,3 23,2 29,3 26,4 30,7 33,3

GlucovanceKNNK

(Triu USD)0,64 0,76 0,95 1,23 1,40 1,85

Ttrng % 8,8 8,6 8,5 9,2 9,2 10,7

KNNK tPhp

KNNK(Triu USD)

7,25 8,79 11,19 13,39 15,29 17,27

Tbng trn ta thy:

Hai bit dc Diamicron v Glucophage chim hn 86% tng KNNK

ca cc bit dc c xut xPhp.

Trong Diamicron vi hot cht gliclazid ttrng chim 41,9- 63,4%

tng KNNK ca cc thuc tPhp v chim ti 20,2-30,3% ttrng KNNKca tt ccc thuc iu tr T nhp khu vo thtrng Vit Nam. ng

th 2 l bit dc Glucophage (hot cht metformin) vi t trng KNNK

23,2-39,3% tng KNNK ca cc thuc c ngun gc tPhp. Cao th3 trong

cc bit dc nhp khu tPhp l Glucovance (kt hp gia glibenclamid v

metformin) vi t trng 8,8 10,7% tng KNNK t Php v ang c xu

hng tng ln (8,8 % nm 2006 ti 10,7% nm 2011).3.4.2.Kho st theo slng sng k

Cc quc gia c SK nhiu nht Vit Nam l n (41-78 SK),

Hn Quc (10- 20 SK), Php (9-14 SK), c (11-13 SK), an Mch (8-

10 SK).Nhn xt thnh 3.8 v chi tit sliu ti phlc 13, ta thy:


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33

- Slng SK tn v Hn Quc ang c xu hng gia tng, n

tng t 53- 78 SK (2008-2011), Hn Quc c slng SK tng

gp i trong 6 nm t10-20 SK (2006-2011).

- Php, c v an Mch c slng SK tng i n nh. Php (9-

14 SK), c (11-13SK), an Mch (8-10SK).

Trong nhm cc quc gia cn li Pakistan l quc gia c SK tng

nhanh t3 SK (2009) ti 13 SK (2011)(gp hn 4 ln).

S lng SK cc thuc iu tr T theo quc gia c th hin

trong hnh 3.8 di y:

Hnh 3.8. Slng SK tcc quc gia c thuc iu trT Vit

Nam giai on 2006-2011

0

10

20

30

40

50

60

70

80

90

Nm 2006 Nm 2007 Nm 2008 Nm 2009 Nm 2010 Nm 2011

Argentina

Bangladesh

Canada

Trung Quc

Cyprus

an Mch

Php

c

n

Indonesia

Hn Quc

Malaysia

Pakistan

Ba Lan

Singapo

Ty Ban Nha

a LoanTh nh k

Anh

M

Israel

c


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34

Chng 4. BN LUN

4.1.

Bn lun vkt qunghin cu

4.1.1.Xu hng chung vnhp khu cc thuc iu tri tho ng

Trong thi gian thc hin kho st (2006-2010), gi trKNNK ca cc

thuc iu trT Vit Nam lin tc tng: t15,05 triu USD (2006) ti

40,98 triu USD (2011) (tng gp 2,7 ln). Xt v t trng KNNK, t trng

KNNK cc thuc iu trT duy tr khong 3%, ph hp vi m hnh

bnh TVit Nam (tlhin mc bnh T ti Vit Nam l 3%) [24].

S lng SK cc thuc iu trT nhp khu vo Vit Nam tng

dn qua cc nm: mc tng mnh nht ghi nhn giai on 2009-2010 (tng

27 SK), trong i vi ring hot cht pioglitazon, mc tng l 11

SK.

4.1.2.Xu hng nhp khu cc nhm thuc iu tri tho ng

Ba nhm thuc iu trT c nhp khu nhiu nht (v t trnggi trKNNK, t trng tng sliu DDD, s lng SK) vo Vit Nam l:

biguanid, sulfonamide/dn xut ure, v insulin. Kho st kcho thy gi tr

KNNK, s lng SK, tng s liu DDD ca cba nhm thuc ny c xu

hng tng ln trong giai on nghin cu. Cba nhm thuc ny u c

khuyn co s dng sm trong cc phc iu tr T ca IDF v ca

ADA/EASD.Nhm thiazolidinedion khng tng nhiu v gi tr KNNK, t trng

KNNK lin tc gim, c bit, vo nm 2011 gim xung mc di 2%. Hai

hot cht ca nhm thuc ny c nhp khu vo th trng Vit Nam l

rosiglitazon v pioglitazon. Trong , hot cht rosiglitazon b Cc Qun

l dc Vit Nam cho ngng nhp khu vo 22/03/2011, v tc dng phgy

nguy c tim mch v au tht ngc [7].


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35

Theo cc phc iu tr ca IDF, ADA/EASD, metformin (thuc

nhm biuanid) l u tin hng u kim sot ng huyt bnh nhn

T typ 2. Tuy nhin, ttrng gi trKNNK v ttrng tng sliu DDD

nhp khu ca nhm thuc biguanid thp hn ca nhm thuc

sulfonamide/dn xut ure, iu ny khc so vi nghin cu ca o Mai

Hng, ca Kong Chunny v ca Marta Baviera [6],[8],[10].

Tlnhp khu sulfonamide/dn xut ure cao hn biguanid ging vi

nghin cu ca B.Hanko v cng s v vic s dng thuc T ti

Hungary. Tuy nhin nghin cu ny c thc hin vo giai on 1998

2002, khc vi giai on nghin cu 2006 2011 trong kha lun [13].

4.1.3.Xu hng nhp khu cc hot cht iu tri tho ng

Cc hot cht c ttrng gi trKNNK, slng SK v ttrng tng

s liu DDD ln nht trong giai on nghin cu l gliclazid, metfomin,

insulin, glimepirid. Cc hot cht ny cng thu c cc nhm hot cht c t

trng gi trKNNK ln nht trong thi gian kho st.Nhn xt vsph hp gia c cu nhp khu v cc thng tin y hc

ca mt shot cht iu trT:

a. Benfluorex:

Benfluorex l thuc iu trT thuc nhm A10BX theo phn loi

ATC/WHO. Ti Vit Nam, hot cht ny chc mt sng k duy nht ca

Mediator (Php).Kho st gi trKNNK ca hot cht ny ta thy:

- Trong giai on t2006 2008, gi trKNNK ca benfluorex tng lin

tc t335.000 USD ti 454 nghn USD.

- Tuy nhin, vo nm 2009, KNNK ca benfluorex gim nhxung cn

413.000 USD. Ti nm 2010, benfluorex khng cn c nhp khu vo Vit

Nam


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36

Tm hiu cc thng tin lin quan ti hot cht ny, chng ti nhn thy

c slin quan gia vic NK ca benfluorex v cc thng tin y hc, cthl:

- Vic gim nhgi trKNNK ca benfluorex lin quan ti quyt nh

thu hi Mediator ca C quan qun l thuc Chu u (European Medicines

Agency) do nghi ngv nguy c gy bnh van tim ca benfluorex trn bnh

nhn T typ 2[19],[21].

- Vic ngng nhp khu benfluorex lin quan n quyt nh s260/Q-

QLD vvic rt sng k i vi bit dc Mediator ti Vit Nam.

b. Rosiglitazon.

Rosiglitazon l mt trong hai hot cht thuc nhm thiazolidinedion

c nhp khu vo Vit Nam (hot cht cn li l Pioglitazon).Nm 2010,

rosiglitazon nhp khu vo Vit Nam vi cc bit dc l Avandia, Rogelin,

Rosiglen, Rapzole. Ngoi ra, Vit Nam cn c Avandamet l bit dc ca

hot cht rosiglitazon kt hp vi metformin.

Kho st gi trKNNK ca hot cht rosiglitazon ta thy:- Trong giai on 2006 2007, gi trKNNK gim 6,3 ln t1,1 triu

USD xung cn 173.000 USD.

- Trong giai on 2009 2010, gi trKNNK gim khong 5,8 ln t

475.000 USD xung cn 82.000 USD. Trong khi , hot cht cng nhm l

pioglitazon li c s gia tng ng k v gi tr KNNK (tng 2,3 ln t

589.000USD n 1,35 triu USD).- Nm 2010, rosiglitazon khng cn c nhp khu vo Vit Nam.

Trong khi t trng KNNK ca pioglitazon li ng th ba trong s cc

hot cht c gi trKNNK cao nht.

Tm hiu cc thng tin lin quan ti hot cht ny, chng ti nhn thy

c slin quan gia vic NK rosiglitazon v cc thng tin y hc, cth:


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38

chng trng, scnh tranh ca cc quc gia sn xut thuc generic c nh

hng nht nh ti cc quc gia sn xut thuc pht minh.

4.2.

Hn chca ti

4.2.1.Hn chvphng php nghin cu

Vphng php nghin cu, ti c mt shn chsau:

Mt trong nhng ch s nghin cu ti la chn l tng s liu

DDD. Vic nghin cu da trn chsny c hn chl DDD l liu c

tnh ton cho ngi trng thnh, do ,khi sdng liu DDD nh gi

tiu th thuc ni chung th thng khng hon ton chnh xc. Tuy nhin,

im ny t nh hng khi nh gi tiu ththuc iu trT do bnh T

thng t gp trnh. Bn cnh , liu thc tsdng li gn ging vi

liu DDD ca cc hot cht.

Dliu vthuc nhp khu khng nh gi c ht tnh hnh sdng

thuc trong thc t, do kt quca nghin cu khng c gi trcho vic

ngoi suy thc trng sdng thuc iu trT ti Vit Nam.Giai on nghin cu cn ngn v khng c dliu vcc thuc NK

nm 2012 v vy c thcha nh gi chnh xc c vxu hng cc thuc

iu trT nhp khu ti Vit Nam.

Khng c dliu vcc thuc sn xut trong nc, do khng thso

snh v nh gi ton din vtiu ththuc iu trT ti Vit Nam.

Do hn ch v phn tch kt qu, cc hot cht trong nhm thucinsulin cha chit tch ring c, do nghin cu cha phn tch c xu

hng v c cu ca cc hot cht insulin nhp khu vo Vit Nam.

4.2.2.Hn chvdliu nghin cu

Dliu nghin cu khng c thng nht gia nhng trng dliu

nhp trong Microsoft Excel, thiu hot cht ca mt sthuc. Cc thiu st v

danh mc hot cht ny cn c bsung v kim tra li.


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39

hn chnhng sai skhi bsung danh mc hot cht, tt ccc d

liu ngoi suy u c kim tra t nht hai ln ti hai c sdliu khc nhau

v cha vo nghin cu khi hai ngun thng tin l nht qun.

4.2.3.Hn chvbin gii kt qu

Do hn chca ngi nghin cu, cc so snh vsph hp gia vic

nhp khu thuc v cc phc iu trchda vo cc phc iu trT

ca nc ngoi m cha so snh vi cc phc trong nc.

Cc thng tin lin quan n cht lng, phn ng c hi hay thay i

hng dn iu trcn cha c cp nht y , do qu trnh bi n lun

cc xu hng nhp khu cn hn ch.


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40

KT LUN V KIN NGH

1. Kt lun

Kt quca ti cho thy:

Gi trKNNK, slng SK v tng sliu DDD ca cc thuc iu

trT vo Vit Nam ngy cng tng. Trong :

Cc nhm thuc iu trT nhp khu c ttrng KNNK, slng

SK v t trng tng s liu DDD cao nht l sulfonamid /dn xut ure,

biguanid v insulin. Cc nhm thuc ny c gi trKNNK v slng SK

c xu hng tng dn trong giai on 2006- 2011. Xu hng ny l ph hp

so vi cc khuyn co viu trT trn thgii

Cc hot cht iu trT nhp khu vo Vit Nam c ttrng gi tr

KNNK, s lng SK, v t trng tng s liu DDD ln nht l gliclazid,

metfomin, glimepirid. Cc hot cht ny u l cc hot cht nm trong nhm

cc thuc c khuyn co sdng sm kim sot ng huyt.

n l quc gia c slng SK thuc iu trT ln nht nhngPhp mi l quc gia c ttrng gi trKNNK vo Vit nam l ln nht. Tuy

nhin, ttrng gi trKNNK ca Php c xu hng gim dn trong khi ca

n c xu hng tng dn.

Cc thng tin y hc v cc quyt nh qun l c tc ng quan trng

ti xu hng nhp khu, thhin qua vic gim ttrng nhp khu do thng

tin vphn ng c hi trng hp ca benfluorex v rosiglitazon.2. Kin nghv xut.

thun tin cho vic qun l v nghin cu cc thuc nhp khu vo

thtrng Vit Nam, xut Tng cc Hi Quan v Cc Qun l kt hp xy

dng chng trnh qun l cc thuc nhp khu vi y thng tin vqun

l xut nhp khu v thng tin vqun l dc.


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nh gi ton din vthuc iu trT ti Vit Nam, chng ti

xut thc hin ti nghin cu vc cu v xu hng cc thuc iu tr

T c sn xut ti trong nc v ti vc cu v xu hng nhp khu

cc thuc insulin ti Vit Nam.

Cc doanh nghip nhp khu thuc iu trT vo Vit Nam nn cp

nht thng xuyn cc thng tin y hc (c bit l cc thng tin vcnh gic

dc), sthay i cc phc iu trT v cc quyt nh lin quan n

qun l thuc c thdon c cc xu hng nhp khu ph hp vi

tnh hnh bnh tt v cc thng tin y hc nh trng hp ca benfluorex v

rosiglitazon.


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TI LIU THAM KHO

TING VIT:

1. BThu H (2009),Nghin cu thc trng bnh i tho ng iu tr

ti bnh vin a khoa tnh Bc Kn, Lun vnthc s, Trng i hc

Y Dc Thi Nguyn.

2. Bnh vin Bch Mai (2012),Hng dn chn on v iu trbnh ni

khoa, Nh xut bn Y hc, H Ni.

3. BY T (2011), Php chDc, Nh xut bn Gio Dc Vit Nam,

H Ni.

4. BY t(2010),Bnh hc, Nh xut bn y hc, H Ni.

5. Chu Quc Thnh (2009), Phn tch c cu thuc thnh phm nhp

khu giai on 2006-2008, Lun vn thc s, i hc Dc H Ni,

H Ni.

6. Chunny Kong (2008), Kho st thc trng sdng thuc iu tri

tho ng typ 2 ti khoa ni tit v i tho ng bnh vin BchMai, Lun vn thc sdc hc, i hc Dc H Ni, H Ni.

7. Cc Qun l Dc Vit Nam - BY t(2011), Quyt nh vng k,

sn xut, lu hnh, sdng thuc cha Rosiglitazone - S3886/QLD-

K.

8. o Mai Hng (2012),Nhn xt vic sdng thuc iu tri tho

ng dng ung ti khoa khm bnh - Bnh vin Bch Mai, Lun vnthc s, i hc Dc H Ni, H Ni.

9. L ThPhng Hoa (2011), Phn tch thc trng nhp khu cc thuc

khng khun trong giai on 2006-2010, Lun vn thc s, i hc

Dc H Ni, H Ni.


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TING ANH:

10. Baviera Marta, Monesi Lara, Marzona Irene, et al. (2011), "Trends in

drug prescriptions to diabetic patients from 2000 to 2008 in Italy's

Lombardy Region: a large population-based study",Diabetes Research

and Clinical Practice, 93(1), pp. 123-130.

11. Dukes Maurice Nelson Graham (1993), Drug utilization studies:

methods and uses, WHO Regional Office for Europe.

12. Goei Monica (2010), Premixed Insulin for Type 2 Diabetes: A Guide

for Adults, DIANE Publishing, pp. 6,7,8,12.

13. Hank Balzs, Tukarcs va, Kumli Pter, et al. (2005), "Antidiabetic

drug utilization in Hungary", Pharmacy World and Science, 27(3), pp.

263-265.

14. International Diabetes Federation (2012), Global Guideline for Type 2

Diabetes, pp. 55-57.

15. International Diabetes Federation (2012), IDF Diabetes Atlas 5thEdition 2012 Update.

16. International Diabetes Federation (2005), Global Guideline for Type 2

Diabetes, pp. 35-38.

17. Nathan DM, Buse JB, Davidson MB (2009), "European Association for

Study of Diabetes. Medical management of hyperglycemia in type 2

diabetes: a consensus algorithm for the initiation and adjustment oftherapy: a consensus statement of the American Diabetes Association

and the European Association for the Study of Diabetes", Diabetes

Care, 32(1), pp. 193-203.

18. Nissen Steven E, Wolski Kathy (2007), "Effect of rosiglitazone on the

risk of myocardial infarction and death from cardiovascular causes",

New England Journal of Medicine, 356(24), pp. 2457-2471.


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19. Weill Alain, Pata Michel, Tuppin Philippe, et al. (2010), "Benfluorex

and valvular heart disease: a cohort study of a million people with

diabetes mellitus", Pharmacoepidemiology and drug safety, 19(12), pp.

1256-1262.

20. World Health Organization (2003), Introduction to drug utilization

research, World Health Organization, pp. 38-44.

WEBSITES:

21..http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events

/news/2010/01/news_detail_000977.jsp&mid=WC0b01ac058004d5c1.

Truy cp ngy 20/5/2013.

22. http://www.fda.gov/Drugs/DrugSafety/ucm241411.htm.Truy cp ngy

20/5/2013.

23. http://www.who.int/features/factfiles/diabetes/en/index.html. Truy cp

ngy 20/5/2013.

24. http://www.who.int/nmh/countries/vnm_en.pdf. Truy cp ngy20/5/2013.
http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2010/01/news_detail_000977.jsp&mid=WC0b01ac058004d5c1http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2010/01/news_detail_000977.jsp&mid=WC0b01ac058004d5c1http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2010/01/news_detail_000977.jsp&mid=WC0b01ac058004d5c1http://www.fda.gov/Drugs/DrugSafety/ucm241411.htmhttp://www.who.int/features/factfiles/diabetes/en/index.htmlhttp://www.who.int/nmh/countries/vnm_en.pdfhttp://www.who.int/nmh/countries/vnm_en.pdfhttp://www.who.int/features/factfiles/diabetes/en/index.htmlhttp://www.fda.gov/Drugs/DrugSafety/ucm241411.htmhttp://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2010/01/news_detail_000977.jsp&mid=WC0b01ac058004d5c1http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2010/01/news_detail_000977.jsp&mid=WC0b01ac058004d5c1http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2010/01/news_detail_000977.jsp&mid=WC0b01ac058004d5c1


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PHLC

Phlc 1. Ttrng gi trKNNK cc nhm thuc iu trT (2006-2011)

Phlc 2. Gi trKNNK cc nhm thuc iu trT (2006-2011)

Phlc 3. Slng SK cc nhm thuc iu trT NK(2006-2011)

Phlc 4. Ttrng tng sliu DDD cc nhm thuc T NK(2006-2011)

Phlc 5. Tng slng liu DDD cc thuc iu trT NK(2006- 2011)

Phlc 6. Ttrng gi trKNNK cc thuc iu trT(2006-2011)

Phlc 7.Gi trKNNK ca cc hot cht iu trT (2006-2011)

Phlc 8. Slng SK ca hot cht iu trT NK(2006-2011)

Phlc 9. Ttrng tng sliu DDD ca cc hot cht iu trT NK giai

on (2006-2011)

Ph lc 10. Tng s liu DDD ca cc hot cht iu tr T NK (2006-

2011)

Phlc 11. Ttrng gi trKNNK thuc iu trT ca cc quc gia xut

xgiai on (2006-2011)

Phlc 12. Gi trKNNK thuc iu trT ca cc quc gia xut xgiai

on (2006-2011)

Ph lc 13. S lng SK cc thuc iu trT tcc quc gia xut x

giai on (2006 - 2011)


55/65

Phlc 1. Ttrng gi trKNNK cc nhm thuc iu trT

(2006-2011)

n v: %

Nhm thucNm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Biguanid 24,2 17,8 18,3 18,9 22,9 21,2

Sulfonamidv dn xut ure

37,0 46,1 48,4 45,2 40,9 40,7

Thuc T ngung dng kt hp

5,6 6,3 5,3 7,2 8,5 7,5

Cht c ch alphaglucosidase

4,1 3,3 3,3 3,5 3,8 3,9

Thiazolidindion 10,5 4,9 5,9 3,8 4,0 2,0

Cc cht h nghuyt khc tr insulin

2,5 2,5 1,9 1,7 0,2 0,1

Insulin 16,2 19,3 16,9 19,6 19,5 24,7

Tng 100,0 100,0 100,0 100,0 100,0 100,0

Phlc 2. Gi trKNNK cc nhm thuc iu trT (2006-2011)n v: Nghn USD

Tn nhm thucNm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Biguanid 3.640 3.270 4.658 5.272 8.127 8.706


5.564 8.488 12.302 12.593 14.496 16.663

Thuc T ng

ung dng kt hp 843 1.151 1.342 2.006 3.023 3.078Cht c chalpha glucosidase

613 603 847 984 1.361 1.584

Thiazolidindion 1.583 898 1.508 1.063 1.433 816


373 454 486 459 69 30

Insulin 2.432 3.544 4.297 5.462 6.921 10.104

Tng 15.048 18.408 25.441 27.839 35.429 40.981


56/65

Phlc 3. Slng SK cc nhm thuc iu trT nhp khu giai

on 2006-2011

Nhm thuc

S lng SK

Nm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Biguanid 29 31 30 38 39 43


47 55 62 59 66 76

Thuc T ngung dngkt hp

6 7 7 15 19 13

Cht c ch alphaglucosidase 2 2 2 2 3 2

Thiazolidindion 22 27 27 17 26 17


2 2 2 3 2 1

Insulin 18 17 21 21 27 34

Tng 126 141 151 155 182 186


57/65

Phlc 4. Ttrng tng sliu DDD cc nhm thuc T nhp khu

(2006-2011)

n v: %

Nhm thucNm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Biguanid 31,67 31,93 11,42 16,01 19,62 16,59


57,07 58,20 76,06 71,83 66,50 72,29

Cht c chalpha glucosidase

0,72 0,52 0,59 0,78 0,98 0,84

Thiazolidindione 3,46 2,95 3,28 2,85 4,09 1,93Cc cht h ng huytkhc tr insulin

1,29 1,15 0,99 0,93 0,06 0,02

Insulin 5,79 5,27 7,66 7,59 8,74 8,33

Tng 100,00 100,00 100,00 100,00 100,00 100,00

Phu lc 5. Tng slng liu DDD cc thuc iu trT nhp khu

(2006-2011)n v: Nghn liu DDD

Nhm thucNm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Biguanid 34.555 48.607 21.269 25.935 34.057 38.373


62.273 88.607 141.714 116.338 115.436 167.187

Cht c chalpha glucosidase 784 787 1.106 1.259 1.702 1.941

Thiazolidindion 3.780 4.487 6.105 4.619 7.106 4.469

Cc cht h nghuyt khc trinsulin

1.412 1.743 1.845 1.513 109 45

Insulin 6.321 8.018 14.278 12.290 15.175 19.266

Tng 109.126 152.250 186.317 161.953 173.587 231.281


58/65


59/65

Phlc 7. Gi trKNNK ca cc hot cht iu trT

(2006-2011)

n v: Nghn USD

Tn hot chtNm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Acarbose 613 603 847 984 1.361 1.584

Benfluorex 335 416 454 413

Chlorpropamid 96 88 71 87 52 47

Glibenclamid 386 478 566 339 272 574

Glibenclamid,metformin 695 834 1.207 1.545 1.635 2.308

Gliclazid 3.406 6.356 7.867 9.309 10.035 11.083

Gliclazid,metformin

16 15 32 83 304 452

Glimepirid 1.676 1.566 3.798 2.858 4.136 4.958

Insulin 2.432 3.544 4.297 5.462 6.921 10.104

Metformin 3.640 3.271 4.658 5.272 8.127 8.706

Pioglitazon 490 725 928 589 1.352 816Repaglind 38 38 32 47 69 30

Rosiglitazon 1.093 173 580 475 82

Rosiglitazon,metformin

132 302 103 318 600

Glimepirid,metformin

59 179 114

Pioglitazon,

metformin

305 205

Tng 15.048 18.408 25.441 27.839 35.429 40.981


60/65

Phlc 8. Slng SK ca hot cht iu trT nhp khu

(2006-2011)

Tn hot chtS lng SK

Nm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Acarbose 2 2 2 2 3 2

Benfluorex 1 1 1 1 0 0

Chlorpropamid 2 2 2 2 1 1

Glibenclamid 12 8 9 6 8 7

Glibenclamid,

metformin 4 3 5 7 6 7Gliclazid 16 24 22 22 24 22

Gliclazid,metformin

1 1 1 3 2 2

Glimepirid 17 21 29 29 33 46

Insulin 18 17 21 21 27 34

Metformin 29 31 30 38 39 43

Pioglitazon 14 19 21 11 22 17

Repaglind 1 1 1 2 2 1Rosiglitazon 8 8 6 6 4 0

Rosiglitazon,metformin

1 3 1 4 6 0

Glimepirid,metformin

1 3 1

Pioglitazon,metformin

2 3

Tng 126 141 151 155 182 186


61/65

Phlc 9. Ttrng tng sliu DDD ca cc hot cht iu trT

nhp khu (2006-2011)

n v: %

Tn hot chtNm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Acarbose 0,72 0,52 0,59 0,78 0,98 0,84

Benfluorex 1,25 1,12 0,97 0,89 0,00 0,00

Chlorpropamid 2,88 1,67 3,82 1,87 1,02 0,64

Glibenclamid 11,93 11,07 9,46 5,35 3,96 7,82

Gliclazid 29,05 37,42 40,54 45,59 40,02 34,44Glimepirid 13,20 8,04 22,25 19,02 21,51 29,38

Insulin 5,79 5,27 7,66 7,59 8,74 8,33

Metformin 31,67 31,93 11,42 16,01 19,62 16,59

Pioglitazon 2,37 2,45 2,60 1,67 3,74 1,93

Repaglind 0,04 0,03 0,02 0,05 0,06 0,02

Rosiglitazon 1,10 0,50 0,67 1,18 0,35 0,00

Tng 100,00 100,00 100,00 100,00 100,00 100,00


62/65

Phlc 10. Tng sliu DDD ca cc hot cht iu trT nhp khu

giai on 2006-2011

n v: nghn liu DDD

Tn hot chtNm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Acarbose 784 787 1.106 1.259 1.702 1.941

Benfluorex 1.367 1.698 1.800 1.440 0 0

Chlorpropamid 3.146 2.540 7.117 3.031 1.767 1.489

Glibenclamid 13.016 16.859 17.624 8.670 6.868 18.094

Gliclazid 31.703 56.973 75.525 73.840 69.461 79.648

Glimepirid 14.408 12.235 41.448 30.797 37.341 67.957

Insulin 6.321 8.018 14.278 12.290 15.175 19.266

Metformin 34.555 48.607 21.269 25.935 34.057 38.373

Pioglitazon 2.581 3.723 4.850 2.709 6.500 4.469

Repaglind 45 45 45 73 110 45

Rosiglitazon 1.199 764 1.254 1.910 606 0

Tng 109.126 152.249 186.317 161.953 173.587 231.281


63/65

Phlc 11. Ttrng gi trKNNK thuc iu trT ca cc quc gia

xut x(2006-2011)

n v: %

Tn qucgia

Nm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Argentina 0,1 0,0 0,1 0,1 0,1 0,0

Bangladesh 0,0 0,0 0,0 0,3 0,4 0,3

Canada 1,6 1,7 1,1 0,4 0,7 0,4

Trung Quc 0,0 0,0 1,0 0,0 0,0 0,1

Cyprus 0,7 2,0 1,0 0,5 0,7 0,3an Mch 10,4 14,2 8,5 12,2 10,0 16,3

Php 48,2 47,8 44,0 48,1 43,1 42,1

c 7,8 6,5 6,6 7,0 6,5 9,0

n 7,3 9,7 8,2 7,4 12,2 13,4

Indonesia 0,8 0,4 1,1 1,1 0,4 0,3

8,5 6,5 11,7 6,0 7,1 7,6

Hn Quc 1,7 2,3 2,4 3,2 3,5 3,9

Malaysia 0,4 0,5 0,3 0,5 0,0 0,2

Pakistan 1,6 0,4 1,2 1,1 2,5 0,9

Ba Lan 3,4 4,5 7,1 6,6 4,9 2,7

Singapo 0,0 0,0 0,0 0,1 0,1 0,0

Ty BanNha

1,6 1,7 3,3 1,9 1,4 0,0

a Loan 0,0 0,7 1,5 1,3 1,1 0,9

Th nh k 0,0 0,2 0,1 0,6 0,4 0,5Anh 0,0 0,0 0,0 0,5 0,1 0,0

M 6,0 1,0 0,8 1,3 1,1 0,8

Israel 0,0 0,0 0,0 0,0 3,7 0,0

c 0,0 0,0 0,0 0,0 0,0 0,4

Tng 100,0 100,0 100,0 100,0 100,0 100,0


64/65

Phlc 12. Gi trKNNK thuc iu trT ca cc quc gia xut x

(2006-2011)

n v: Nghn USD

Tn qucgia

Nm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Argentina 8 9 18 20 30 20

Bangladesh 71 136 129

Canada 235 314 287 100 254 161

Trung Quc 260 34

Cyprus 107 370 263 141 257 125an Mch 1.560 2.613 2.150 3.386 3.554 6.690

Php 7.254 8.790 11.188 13.388 15.285 17.273

c 1.175 1.202 1.674 1.954 2.318 3.677

n 1.093 1.779 2.090 2.061 4.320 5.477

Indonesia 120 67 284 299 139 112

1.279 1.192 2.974 1.661 2.515 3.124

Hn Quc 259 426 607 898 1.227 1.591

Malaysia 63 95 81 140 10 63Pakistan 235 81 309 295 896 352

Ba Lan 515 827 1.800 1.825 1.733 1.089

Singapo 35 22 11

Ty BanNha

248 306 827 535 484

a Loan 126 372 364 395 357

Th nh k 36 33 168 138 198

Anh 10 139 23M 896 176 214 360 397 320

Israel 1.294

c 179

Tng 15.048 18.408 25.441 27.839 35.429 40.981


65/65

Phlc 13. Slng SK cc thuc iu trT tcc quc gia xut x

Tn qucgia

S lng SK

Nm2006

Nm2007

Nm2008

Nm2009

Nm2010

Nm2011

Argentina 1 1 2 1 1 1

Bangladesh 4 7 5

Canada 6 6 6 3 3 3

Trung Quc 1

Cyprus 3 3 4 3 2 5

an Mch 9 8 8 8 10 9

Php 14 12 9 10 13 10c 12 11 12 11 11 13

n 41 56 53 55 77 78

Indonesia 4 2 6 5 7 4

3 4 3 3 3 2

Hn Quc 10 13 16 17 16 20

Malaysia 4 4 2 3 1 2

Pakistan 7 4 7 3 9 13

Ba Lan 5 8 10 10 5 9

Singapo 1 1 1

Ty BanNha

3 3 4 2 2

a Loan 2 3 4 4 3

Th nh k 1 1 1 1 1

Anh 2 5 4

M 4 3 3 6 4

Israel 1 4

c 2

Tng 126 141 151 155 182 186

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