Vertigo Management – Mapping prevalence and treatment. Understanding once a day preparation usage and place in therapy.

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RESEARCH OBJECTIVE

Primary objective:
To determine the prevalence and treatment choice most effective in Vertigo management. Also, to develop an understanding of once a day preparation usage and place in therapy.

Secondary Objectives:
·         To map the prevalence of vertigo at various specialities (Neurology, Cardiology, E.N.T, Medicine)
·         To analyse the cause/s of vertigo under these specialties
·         To understand the molecule management by doctors to counter Vertigo
·         To understand usage of Betahistine in Vertigo management
·         To develop understanding regarding dosage, frequency & duration of Betahistine usage for Vertigo treatment
·         To map the effective position of Betahistine OD in therapy in comparison with other treatment choices

RESEARCH METHODOLOGY

1. SECONDARY RESEARCH:
Secondary data was collected before designing the questionnaire relevant to the project to have brief insights about the research work.
Information was collected through various sources which include medical journals, Textbooks and websites. Market study was done through ORG-IMS and C-MARC.

Following information was collected:-
1.      Pathophysiology of Vertigo.
2.      Management of Vertigo medically.
3.      Market share and prescription pattern of various brands from ORG IMS and CMARC.

- After a proper understanding, a questionnaire was designed.

2. PRIMARY RESEARCH:

S.No.

PARAMETER

DESCRIPTION

 

Research type

Qualitative and Quantitative Research

 

Data collection

Primary

 

Tool of data collection

 

A market Research Questionnaire with open-ended as well as close-ended questions was used for data collection.

 

Type of Questionnaire

Semi-structured

 

Mode of data collection

One-to-one interview

 

Interview technique

In depth interview was conducted by using probing method for each question.

 

Sample selection

Area and speciality wise

 

Sample size

165

 

Target respondents

Neurologists (40),

Consultant physicians (60),

E.N.T (35),

Cardiologists (20),

Diabetologists (10)

 

Sampling Technique

Convenience sampling based on geography

 

Analysis of Data

Was performed in Microsoft Excel and Coding method was used for the purpose of data entry

Primary Data: Field work done in different areas of Mumbai (zone wise)

Zone

Areas

Western

Mahim, Santacruz, Andheri, Jogeshwari, Goregaon, Kandivali, Borivali, Khar, Malad, Ville Parle, Bhyander

Central

Bandra, Dadar, Ghatkopar, Chembur, Byculla, Parel

South

Churchgate, Marine Lines, Grant road

LIMITATIONS:
·         The interviewer bias was a major limitation in the research. There could have been difference between the information generated and the information wanted due to the way in which the respondent must have interpreted the question.
·         The research was carried out in parts of Mumbai and its surrounding areas. The primary data collected may not be a representative of other geographical areas.
·         Sample size of 165 may not reflect the same results in actual size.
·         Some subjects were less cooperative and showed unfriendly attitude.

NEUROLOGISTS

NEUROLOGISTS  (SAMPLE SIZE = 40)
·             The incidence of 10-15% patients was found to be a majority amongst 52.5% Neurologists, who have administered anti-vertigo medications.
·               The % of female patients who seek anti-vertigo medications were found to be on the higher side amongst Neurologists.
·             Out of all the Neurologists sampled, 62.5% felt that a 40:60 (Male:Female) ratio is most observed in their practice.
·               70% Neurologists reported that 40-50 years was the prevalent category of the patients.
·               It was revealed through the study that 72.5% of the Neurologists, observed patients with Primary Vertigo.
·               Diabetes Mellitus is the most common secondary to pre-existing ailment amongst 44% Neurologists, followed by Spondylosis (40%).
·               BPPV is the most common cause of Vertigo, followed by Vestibular Neuronitis and Spondylosis amongst the sampled Neurologists.
·             Pharmacological and Manoeuvres is the most preferred line of treatment amongst 70.58% Neurologists for effective Vertigo management.
·             Betahistine is the most preferred drug of choice for treating vertigo amongst 86.96% Neurologists.
·             42.5% of the Neurologists prefer to treat with 8mg TID dose of Betahistine for patients with vertigo.
·               1-2 weeks is the most preferred duration of therapy with Betahistine amongst 75% Neurologists.
·               90% of the Neurologists were found to titrate the dosage in Vertigo treatment.
·               With the usual approach being tapering down the dosage in patients where symptoms are relieved and do not recur, and then putting it off. But in some recurrent cases of vertigo the dosage is increased.
·             95% of the Neurologists were found to be aware of Betahistine once a day preparation. Only 5% Neurologists were still unaware of Betahistine O.D formulation.
·               55% of the sampled Neurologists, were found to use Betahistine O.D formulation.
·               Amongst all Neurologists those who use Betahistine once a day preparation, 77.27% mostly prescribe 24mg C.R, while 22.73% use 48mg C.R formulation.
·               The duration for which 24mg C.R is prescribed the most is 1 week by 50% Neurologists, followed by 2 weeks amongst 22.73% Neurologists.
·               67.5% of the Neurologists prefer to use O.D formulation as a start up dose, while the rest (32.5%) preferred to use it as a maintenance dose only.
·               82.5% of the Neurologists do not use O.D formulation particularly specific to any indication
·               Amongst the Neurologists sampled, 90% do not use two Anti-Vertigo molecules together.
·               40% of the Neurologists have not tried this combination, but 37.5% said it to be a potent and viable combination. They were further aided by 12.5% of doctors who felt it maybe a fruitful combination.

1)      In your practice what is the incidence of patients who need anti-vertigo medication?

Total Respondents = 40

Category

Responses

Percentage of responses

5-10%

8

20

10-15%

21

52.5

15-25%

8

20

More than 25%

3

7.5

Table 1: Responses for incidence of patients requiring Anti-Vertigo Medication per week

Interpretation:
·             The incidence of 10-15% patients was found to be a majority amongst 52.5% Neurologists, who have administered anti-vertigo medications.
·             The incidence of 5-10% & 15-25% patients were also reported amongst 20% Neurologists.
·             Only 7.5% of the Neurologists reported of more than 25% patients requiring anti-vertigo medication.

2)      May I know the approximate bifurcation of patients gender wise (in %)?

Total Respondents = 40

% of Patients

Approx Ratio

Responses

% of Responses

Male

40

25

62.5

Female

60

 

Male

50

6

15

Female

50

       

Male

30

9

22.5

Female

70

       

Male

20

0

0

Female

80

Table 2: Responses for gender bifurcation of patients requiring Anti-Vertigo Medication per week

Interpretation:
·         The % of female patients who seek anti-vertigo medications were found to be on the higher side amongst Neurologists.
·         62.5% of the Neurologists felt that a 40:60 (Male:Female) ratio is most observed in their practice.
·         30:70 (Male:Female) ratio was observed amongst 22.5% Neurologists.
·         15% Neurologists observed an equal ratio of 50:50 (Male:Female) in their practice.

3)      Is it more predominant in any particular age group?

Total Respondents = 40

Age of Patients

Responses

% of Responses

Below 20 years

0

0

20-40 years

7

17.5

40-50 years

28

70

Above 50 years

5

12.5

Table 3: Responses for prevalent age group of patients requiring Anti-Vertigo Medication per week

Interpretation:
·         70% Neurologists reported that 40-50 years was the prevalent category of the patients.
·         17.5% Neurologists found 20-40 years category to be more prevalent in their practice.
·         Patients above 50 years age was reported with 12.5% Neurologists, while there were no patients reported below 20 years.

4)      Of these patients reported, do you get most patients as primary vertigo/dizziness patients or it is secondary to some pre-existing ailment?

Total Respondents = 40

Type

Responses

% of Responses

Primary

29

72.5

Secondary

11

27.5

Table 4: Responses for category of patient having secondary to pre-existing ailment

Interpretation:
·         It was revealed through the study that 72.5% of the Neurologists, observed patients with Primary Vertigo.
·         Only 27.5% of Neurologists observed Vertigo patients with Secondary to pre-existing ailment.

5)      If it is secondary to pre-existing ailment, what is the most common pre-existing disease/disorder you see?

Total Respondents = 11 multiple responses (out of 40 Neurologists)

Disorder

Responses

% of Responses

Diabetes Mellitus

11

            44

Hypertension & Cardiac problems

2

8

ENT problems

2

8

Spondylosis

10

40

Table 5: Responses for patents having most common secondary to pre-existing ailment

Interpretation:

·         Diabetes Mellitus is the most common secondary to pre-existing ailment amongst 44% Neurologists, followed by Spondylosis (40%).
·         Hypertension & Cardiac problems along with ENT problems were also reported in 8% Neurologists respectively.

6)      What are the most common causes of Vertigo that you see in your practice?

Total Respondents = 40

Cause

Frequency of Ranks

Rank 1

Rank 2

Rank 3

Rank 4

Rank 5

Rank 6

 

BPPV

39

1

 

 

 

 

 

Vestibular Neuronitis

1

19

10

2

 

 

 

Spondylosis

 

17

10

2

1

 

 

Labyrinthitis

 

1

6

3

 

 

 

Meniere’s Disease

 

 

1

1

3

 

 

Vertebral Ischemia

 

 

2

 

 

 

 

Migraine

 

 

 

3

 

 

Table 6: Table depicting the most common cause of Vertigo as ranked

Interpretation:
·         BPPV is the most common cause of Vertigo, followed by Vestibular Neuronitis and Spondylosis amongst the sampled Neurologists.
·         Labyrinthitis, Meniere’s Disease and Vertebral Ischemia were the other causes reported by the Neurologists (in decreasing order of occurrence).
·         Migraine is the least significant cause of Vertigo.

7)      What is the usual line of treatment?

Total Respondents = 40 (multiple responses)

Line of Treatment

Responses

% of Responses

Lifestyle modification

0

0

Pharmacological

13

25.49

Manoeuvres only

2

3.92

Pharmacological and Manoeuvres

36

70.58

Table 7: Responses for usual line of treatment in Vertigo management

Interpretation:
·         Pharmacological and Manoeuvres is the most preferred line of treatment amongst 70.58% Neurologists for effective Vertigo management.
·         25.49% Neurologists also resort to Pharmacological therapy for treating Vertigo.

8)      In pharmacological treatment what is your drug of choice?

Total Respondents = 40 (multiple responses)

Molecule

Responses

% of Responses

Betahistine

40

86.96

Cinnarizine

0

0

Dimenhydrinate

3

6.52

Combination

2

4.35

Any other

1

2.17

Table 8: Responses for molecule management in Vertigo management pharmacologically

Interpretation:
·         Betahistine is the most preferred drug of choice for treating vertigo amongst 86.96% Neurologists.
·         6.52% Neurologists prescribed Dimenhydrinate and 4.35% Neurologists prefer to use a combination of drugs (Betahistine with Dimenhydrinate / Cinnarizine) for treating Vertigo.

9)      May I know your usual treatment approach?

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