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Kalinić D, Škrbić R, Vulić D, Stojaković N, Stoisavljević-Šatara S, Stojiljković MP, Marković-Peković V, Golić Jelić A, Pilipović-Broćeta N, Wong ND, Godman B. Trends in Antihypertensive Medicine Utilization in the Republic of Srpska, Bosnia and Herzegovina: An Eleven-Year Follow-Up. Front Pharmacol 2022; 13:889047. [PMID: 35784727 PMCID: PMC9240340 DOI: 10.3389/fphar.2022.889047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/30/2022] [Indexed: 01/13/2023] Open
Abstract
Background: In last 2 decades, there have been substantial changes in the utilization patterns of antihypertensive medicines following new clinical trials and the introduction of new treatment guidelines. The aim of this study was to analyze utilization and prescribing patterns regarding antihypertensive medicines in the Republic of Srpska, Bosnia and Herzegovina during an 11-years follow-up according to national and European treatment guidelines. Methods: In this retrospective, observational study, medicine utilization data were analyzed between 2009–2019 period using the ATC/DDD methodology and expressed as the number of DDD/1,000 inhabitants/day (DID/TID). The medicine utilization 90% (DU90%) method was used for determine the quality of prescribing. Results: During the observed period, the use of antihypertensive medicines increased more than 3-times (125.97 DDD/TID in 2009 vs 414.95 DDD/TID in 2019), corresponding to a rise in the prevalence of hypertensive patients from 91.7/1,000 to 186.3/1,000 in the same period. This was mainly driven by increased use of angiotensin converting enzyme inhibitors with 241.69%, beta blockers with 146.87%, calcium channel blockers with 251.55%, and diuretics with 178.95%. Angiotensin receptor blockers were the fastest growing group of antihypertensive medicines in this period and their utilization increased nearly 40 times. Conclusions: The overall antihypertensive medicines utilization was largely influenced by national and ESH/ESC guidelines and strongly corresponded to the positive medicine list of the national health insurance fund. Antihypertensive medicines utilization is comparable with medicine utilization trends in other countries.
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Affiliation(s)
- Dragan Kalinić
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- *Correspondence: Dragan Kalinić,
| | - Ranko Škrbić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Duško Vulić
- Centre for Specializations and Continuous Medical Education, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Nataša Stojaković
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Svjetlana Stoisavljević-Šatara
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Miloš P. Stojiljković
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Vanda Marković-Peković
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Ana Golić Jelić
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Nataša Pilipović-Broćeta
- Family Medicine Teaching Center, Primary Health Care of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, United States
| | - Brian Godman
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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2
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Godman B, Wladysiuk M, McTaggart S, Kurdi A, Allocati E, Jakovljevic M, Kalemeera F, Hoxha I, Nachtnebel A, Sauermann R, Hinteregger M, Marković-Peković V, Tubic B, Petrova G, Tachkov K, Slabý J, Nejezchlebova R, Krulichová IS, Laius O, Selke G, Langner I, Harsanyi A, Inotai A, Jakupi A, Henkuzens S, Garuolienė K, Gulbinovič J, Bonanno PV, Rutkowski J, Ingeberg S, Melien Ø, Mardare I, Fürst J, MacBride-Stewart S, Holmes C, Pontes C, Zara C, Pedrola MT, Hoffmann M, Kourafalos V, Pisana A, Banzi R, Campbell S, Wettermark B. Utilisation Trend of Long-Acting Insulin Analogues including Biosimilars across Europe: Findings and Implications. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9996193. [PMID: 34676266 PMCID: PMC8526244 DOI: 10.1155/2021/9996193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes mellitus rates and associated costs continue to rise across Europe enhancing health authority focus on its management. The risk of complications is enhanced by poor glycaemic control, with long-acting insulin analogues developed to reduce hypoglycaemia and improve patient convenience. There are concerns though with their considerably higher costs, but moderated by reductions in complications and associated costs. Biosimilars can help further reduce costs. However, to date, price reductions for biosimilar insulin glargine appear limited. In addition, the originator company has switched promotional efforts to more concentrated patented formulations to reduce the impact of biosimilars. There are also concerns with different devices between the manufacturers. As a result, there is a need to assess current utilisation rates for insulins, especially long-acting insulin analogues and biosimilars, and the rationale for patterns seen, among multiple European countries to provide future direction. Methodology. Health authority databases are examined to assess utilisation and expenditure patterns for insulins, including biosimilar insulin glargine. Explanations for patterns seen were provided by senior-level personnel. RESULTS Typically increasing use of long-acting insulin analogues across Europe including both Western and Central and Eastern European countries reflects perceived patient benefits despite higher prices. However, activities by the originator company to switch patients to more concentrated insulin glargine coupled with lowering prices towards biosimilars have limited biosimilar uptake, with biosimilars not currently launched in a minority of European countries. A number of activities were identified to address this. Enhancing the attractiveness of the biosimilar insulin market is essential to encourage other biosimilar manufacturers to enter the market as more long-acting insulin analogues lose their patents to benefit all key stakeholder groups. CONCLUSIONS There are concerns with the availability and use of insulin glargine biosimilars among European countries despite lower costs. This can be addressed.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Magdalene Wladysiuk
- Chair of Epidemiology and Preventive Medicine, Medical College, Jagiellonian University, Krakow, Poland
- HTA Consulting, Starowiślna Str. 17/3, 31-038 Krakow, Poland
| | - Stuart McTaggart
- Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche ‘Mario Negri' IRCCS, Milan, Italy
| | - Mihajlo Jakovljevic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Institute of Comparative Economic Studies, Faculty of Economics, Hosei University Tokyo, Tokyo, Japan
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Anna Nachtnebel
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Robert Sauermann
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Manfred Hinteregger
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Vanda Marković-Peković
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Tubic
- Faculty of Medicine, Department of Medicinal Chemistry, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Agency for Medicinal Product and Medical Devices of Bosnia and Herzegovina, 78000 Banja Luka, Bosnia and Herzegovina
| | - Guenka Petrova
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Juraj Slabý
- State Institute for Drug Control, Prague, Czech Republic
| | | | - Iva Selke Krulichová
- Department of Medical Biophysics, Faculty of Medicine in Hradec Králové, Charles University, Simkova 870, 500 03 Hradec Králové, Czech Republic
| | - Ott Laius
- State Agency of Medicines, Nooruse 1, 50411 Tartu, Estonia
| | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, 10178 Berlin, Germany
| | - Irene Langner
- Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, 10178 Berlin, Germany
| | - András Harsanyi
- Department of Health Policy and Health Economics, Eotvos Lorand University, Budapest, Hungary
| | - András Inotai
- Syreon Research Institute and Semmelweis University, Center of Health Technology Assessment, Budapest, Hungary
| | - Arianit Jakupi
- Faculty of Pharmacy, UBT Higher Education Institute, Pristina, Kosovo
| | | | - Kristina Garuolienė
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Health Services Management, University of Malta, Valletta, Malta
| | - Jakub Rutkowski
- HTA Consulting, Starowiślna Str. 17/3, 31-038 Krakow, Poland
| | - Skule Ingeberg
- Medicines Committee, Oslo University Hospitals, Oslo, Norway
| | - Øyvind Melien
- Medicines Committee, Oslo University Hospitals, Oslo, Norway
| | - Ileana Mardare
- Faculty of Medicine, Public Health and Management Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, 050463 Bucharest, Romania
| | - Jurij Fürst
- Health Insurance Institute, Miklosiceva 24, SI-1507 Ljubljana, Slovenia
| | | | | | - Caridad Pontes
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Corinne Zara
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | - Marta Turu Pedrola
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | | | - Vasileios Kourafalos
- National Organization for the Provision of Healthcare Services (EOPYY), Athens, Greece
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rita Banzi
- Istituto di Ricerche Farmacologiche ‘Mario Negri' IRCCS, Milan, Italy
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Bjorn Wettermark
- Department of Pharmacy, Disciplinary Domain of Medicine and Pharmacy, Uppsala University, Uppsala, Sweden
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3
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Godman B, Fadare J, Kwon HY, Dias CZ, Kurdi A, Dias Godói IP, Kibuule D, Hoxha I, Opanga S, Saleem Z, Bochenek T, Marković-Peković V, Mardare I, Kalungia AC, Campbell S, Allocati E, Pisana A, Martin AP, Meyer JC. Evidence-based public policy making for medicines across countries: findings and implications for the future. J Comp Eff Res 2021; 10:1019-1052. [PMID: 34241546 DOI: 10.2217/cer-2020-0273] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Global expenditure on medicines is rising up to 6% per year driven by increasing prevalence of non-communicable diseases (NCDs) and new premium priced medicines for cancer, orphan diseases and other complex areas. This is difficult to sustain without reforms. Methods: Extensive narrative review of published papers and contextualizing the findings to provide future guidance. Results: New models are being introduced to improve the managed entry of new medicines including managed entry agreements, fair pricing approaches and monitoring prescribing against agreed guidance. Multiple measures have also successfully been introduced to improve the prescribing of established medicines. This includes encouraging greater prescribing of generics and biosimilars versus originators and patented medicines in a class to conserve resources without compromising care. In addition, reducing inappropriate antibiotic utilization. Typically, multiple measures are the most effective. Conclusion: Multiple measures will be needed to attain and retain universal healthcare.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Joseph Fadare
- Department of Pharmacology & Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, Korea
| | - Carolina Zampirolli Dias
- Graduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Isabella Piassi Dias Godói
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
- Researcher of the Group (CNPq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Dan Kibuule
- Department of Pharmacy Practice & Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Sylvia Opanga
- Department of Pharmaceutics & Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Zikria Saleem
- Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Tomasz Bochenek
- Department of Nutrition & Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Vanda Marković-Peković
- Department of Social Pharmacy, University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina
| | - Ileana Mardare
- "Carol Davila" University of Medicine & Pharmacy, Bucharest, Romania
| | | | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche 'Mario Negri' IRCCS, Milan, Italy
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Antony P Martin
- Faculty of Health & Life Sciences, The University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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4
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Mwita JC, Ogunleye OO, Olalekan A, Kalungia AC, Kurdi A, Saleem Z, Sneddon J, Godman B. Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications. Int J Gen Med 2021; 14:515-530. [PMID: 33633461 PMCID: PMC7901404 DOI: 10.2147/ijgm.s253216] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a concern with the growing use of antimicrobials across countries increasing antimicrobial resistance (AMR) rates. A key area within hospitals is their use for the prevention of surgical site infections (SSI) with concerns with timing of the first dose, which can appreciably impact on effectiveness, as well as duration with extended prophylaxis common among low- and middle-income countries (LMICs). This is a concern as extended duration increases utilization rates and AMR as well as adverse events. Consequently, there is a need to document issues of timing and duration of surgical antibiotic prophylaxis (SAP) among LMICs together with potential ways forward to address current concerns. METHODS Narrative review of timings and duration of SAP among LMICs combined with publications documenting successful approaches to improve SAP to provide future direction to all key stakeholder groups. RESULTS There were documented concerns with the timing of the first dose of antibiotics, with appropriate timing as low as 6.7% in Egypt, although as high as 81.9% in Turkey. There was also an extensive duration of SAP, ranging from long duration times in all patients in a study in Nigeria with a mean of 8.7 days and 97% of patients in Egypt to 42.9% of patients in Pakistan and 35% in Turkey. Successful interventions to improve SAP typically involved multiple approaches including education of all key stakeholder groups, monitoring of usage against agreed guidelines,as well as quality targets. Multiple approaches typically improved timing and duration as well as reduced costs. For instance, in one study appropriateness increased from 30.1% to 91.4%, prolonged duration reduced to 5.7% of patients, and mean costs of antibiotics decreased 11-fold. CONCLUSION There are considerable concerns with the timing and duration of SAP among LMICs. Multiple interventions among LMICs can address this providing future directions.
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Affiliation(s)
- Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
- Centre for Genomics of Non-Diseases and Personalized Healthcare (CGNPH), University of Lagos, Lagos, Nigeria
| | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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5
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Ellegård LM. Effects of pay-for-performance on prescription of hypertension drugs among public and private primary care providers in Sweden. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2020; 20:215-228. [PMID: 31960248 PMCID: PMC7426314 DOI: 10.1007/s10754-020-09278-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
This study exploits policy reforms in Swedish primary care to examine the effect of pay-for-performance (P4P) on compliance with hypertension drug guidelines among public and private health care providers. Using provider-level outcome data for 2005-2013 from the Swedish Prescription Register, providers in regions using P4P were compared to providers in other regions in a difference-in-differences analysis. The results indicate that P4P improved guideline compliance regarding prescription of angiotensin converting enzyme inhibitors and angiotensin receptor blockers. The effect was mainly driven by private providers, suggesting that policy makers should take ownership into account when designing incentives for health care providers.
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Affiliation(s)
- Lina Maria Ellegård
- Department of Economics, Lund University, P.O. Box 7082, 220 07, Lund, Sweden.
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6
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Godman B, Kurdi A, McCabe H, Johnson CF, Barbui C, MacBride-Stewart S, Hurding S, Leporowski A, Bennie M, Morton A. Ongoing initiatives within the Scottish National Health Service to affect the prescribing of selective serotonin reuptake inhibitors and their influence. J Comp Eff Res 2019; 8:535-547. [DOI: 10.2217/cer-2018-0132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aim: Increasing use of selective serotonin-reuptake inhibitors (SSRIs) in Scotland, coupled with safety concerns with some SSRIs, and the increasing availability of generic SSRIs, have resulted in multiple initiatives to improve the quality and efficiency of their prescribing in Scotland. Our aim is to assess their influence to provide future direction. Materials & methods: The prescription costs analysis database was used to document utilization and expenditure on SSRIs between 2001 and 2017 alongside documenting the initiatives. Results: Multiple interventions over the years increased international nonproprietary name prescribing up to 99.9% lowering overall costs. This, coupled with initiatives to limit escitalopram prescribing due to concerns with its value, resulted in a 73.7% reduction in SSRI expenditure between 2001 and 2017 despite a 2.34-fold increase in utilization. Safety warnings resulted in a significant reduction in the prescribing of paroxetine, citalopram and escitalopram alongside a significant increase in sertraline Conclusion: Multiple initiatives have increased the quality and efficiency of SSRI prescribing in Scotland providing direction to others.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy & Biomedicial Sciences, University of Strathclyde, Glasgow, UK
- Division of Clinical Pharmacology, Karolinska, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Pharmacy & Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedicial Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Holly McCabe
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Chris F Johnson
- Prescribing Support Unit, National Health Service Greater Glasgow & Clyde (NHS GGC), Glasgow, UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research & Training in Mental Health & Service Evaluation, Department of Neuroscience, Biomedicine & Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Sean MacBride-Stewart
- Prescribing Support Unit, National Health Service Greater Glasgow & Clyde (NHS GGC), Glasgow, UK
| | - Simon Hurding
- Therapeutics Branch, Scottish Government, Edinburgh, UK
| | - Axel Leporowski
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Institute of Pharmacy & Biomedicial Sciences, University of Strathclyde, Glasgow, UK
| | - Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK
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7
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McDowell R, Bennett K, Moriarty F, Clarke S, Barry M, Fahey T. An evaluation of prescribing trends and patterns of claims within the Preferred Drugs Initiative in Ireland (2011 -2016): an interrupted time-series study. BMJ Open 2018; 8:e019315. [PMID: 29678966 PMCID: PMC5914712 DOI: 10.1136/bmjopen-2017-019315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the impact of the Preferred Drugs Initiative (PDI), an Irish health policy aimed at enhancing evidence-based cost-effective prescribing, on prescribing trends and the cost of prescription medicines across seven medication classes. DESIGN Retrospective repeated cross-sectional study spanning the years 2011-2016. SETTING Health Service Executive Primary Care Reimbursement Service pharmacy claims data for General Medical Services (GMS) patients, approximately 40% of the Irish population. PARTICIPANTS Adults aged ≥18 years between 2011 and 2016 are eligible for the GMS scheme. PRIMARY AND SECONDARY OUTCOMES The percentage of PDI medications within each drug class per calendar quarter. Linear regression was used to model prescribing of the preferred drug within each medication group and to assess the impact of PDI guidelines and other relevant changes in prescribing practice. Savings in drug expenditure were estimated. RESULTS Between 2011 and 2016, around a quarter (23.59%) of all medications were for single-agent drugs licensed in the seven drug classes. There was a small increase in the percentage of PDI drugs, increasing from 4.64% of all medications in 2011 to 4.76% in 2016 (P<0.001). The percentage of preferred drugs within each drug class was significantly higher immediately following publication of the guidelines for all classes except urology, with the largest increases noted for lansoprazole (1.21%, 95% CI: 0.84% to 1.57%, P<0.001) and venlafaxine (0.71%, 95% CI: 0.15% to 1.27%, P=0.02). Trends in prescribing of the preferred drugs between PDI guidelines and the end of 2016 varied between drug classes. Total cost savings between 2013 and 2016 were estimated to be €2.7 million. CONCLUSION There has been a small increase in prescribing of PDI drugs in response to prescribing guidelines, with inconsistent changes observed across therapeutic classes. These findings are relevant where health services are seeking to develop more active prescribing interventions aimed at changing prescribing practice.
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Affiliation(s)
- Ronald McDowell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Moriarty
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - Sarah Clarke
- Health Service Executive Medicines Management Programme, Trinity Centre for Health Sciences, St James’s Hospital, Dublin, Ireland
| | - Michael Barry
- National Centre for Pharmacoeconomics, Trinity Centre for Health Sciences, St. James’s Hospital, Dublin, Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
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Trietsch J, van Steenkiste B, Grol R, Winkens B, Ulenkate H, Metsemakers J, van der Weijden T. Effect of audit and feedback with peer review on general practitioners' prescribing and test ordering performance: a cluster-randomized controlled trial. BMC FAMILY PRACTICE 2017; 18:53. [PMID: 28407754 PMCID: PMC5390393 DOI: 10.1186/s12875-017-0605-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 02/28/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Much research worldwide is focussed on cost containment and better adherence to guidelines in healthcare. The research focussing on professional behaviour is often performed in a well-controlled research setting. In this study a large-scale implementation of a peer review strategy was tested on both test ordering and prescribing behaviour in primary care in the normal quality improvement setting. METHODS We planned a cluster-RCT in existing local quality improvement collaboratives (LQICs) in primary care. The study ran from January 2008 to January 2011. LQICs were randomly assigned to one of two trial arms, with each arm receiving the same intervention of audit and feedback combined with peer review. Both arms were offered five different clinical topics and acted as blind controls for the other arm. The differences in test ordering rates and prescribing rates between both arms were analysed in an intention-to-treat pre-post analysis and a per-protocol analysis. RESULTS Twenty-one LQIC groups, including 197 GPs working in 88 practices, entered the trial. The intention-to-treat analysis did not show a difference in the changes in test ordering or prescribing performance between intervention and control groups. The per-protocol analysis showed positive results for half of the clinical topics. The increase in total tests ordered was 3% in the intervention arm and 15% in the control arm. For prescribing the increase in prescriptions was 20% in the intervention arm and 66% in the control group. It was observed that the groups with the highest baseline test ordering and prescription volumes showed the largest improvements. CONCLUSIONS Our study shows that the results from earlier work could not be confirmed by our attempt to implement the strategy in the field. We did not see a decrease in the volumes of tests ordered or of the drugs prescribed but were able to show a lesser increase instead. Implementing the peer review with audit and feedback proved to be not feasible in primary care in the Netherlands. TRIAL REGISTRATION This trial was registered at the Dutch trial register under number ISRCTN40008171 on August 7th 2007.
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Affiliation(s)
- J Trietsch
- School for Public Health and Primary Care (CAPHRI), Department of Family Medicine, Maastricht University, PO Box 616, , 6200 MD, Maastricht, The Netherlands.
| | - B van Steenkiste
- School for Public Health and Primary Care (CAPHRI), Department of Family Medicine, Maastricht University, PO Box 616, , 6200 MD, Maastricht, The Netherlands
| | - R Grol
- IQ Healthcare, Radboud University Nijmegen, PO Box 9101 (144), , 6500HB, Nijmegen, The Netherlands
| | - B Winkens
- School for Public Health and Primary Care (CAPHRI), Department of Methodology and Statistics, Maastricht University, PO Box 616, , 6200 MD, Maastricht, The Netherlands
| | - H Ulenkate
- Department of Clinical Chemistry, ZorgSaam Hospital, Wielingenlaan 2, 4535 PA, Terneuzen, The Netherlands
| | - J Metsemakers
- School for Public Health and Primary Care (CAPHRI), Department of Family Medicine, Maastricht University, PO Box 616, , 6200 MD, Maastricht, The Netherlands
| | - T van der Weijden
- School for Public Health and Primary Care (CAPHRI), Department of Family Medicine, Maastricht University, PO Box 616, , 6200 MD, Maastricht, The Netherlands
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Ah YM, Lee JY, Choi YJ, Kong J, Kim B, Choi KH, Han N, Yu YM, Oh JM, Shin WG, Lee HY. Influence of initial angiotensin receptor blockers on treatment persistence in uncomplicated hypertension: A nation-wide population-based study. Clin Exp Hypertens 2016; 38:325-30. [PMID: 27028796 DOI: 10.3109/10641963.2015.1116548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We identified 55 504 uncomplicated, treatment-naïve hypertensive patients who started angiotensin II receptor blockers (ARBs) in 2012 from national claims data. The proportion of patients remaining on any hypertension treatment at 12 months and the adherence rate were similar between the losartan cohort (66.82% and 68.25%) and the nonlosartan ARB cohort (67.48% and 69.01%). After adjusting for confounding factors, there was no difference in persistence (aHR 0.98, 95% confidence interval (CI) 0.95-1.01) on hypertension treatment between losartan and nonlosartan ARB cohort. Post hoc analysis showed that patients initially prescribed eprosartan, irbesartan (both, aHR 1.33), and telmisartan (aHR 1.11) were more likely to discontinue the initial drug, whereas valsartan initiators (aHR 0.96) were less likely compared with losartan initiators.
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Affiliation(s)
- Young-Mi Ah
- a College of Pharmacy, Institute of Pharmaceutical Science and Technology , Hanyang University , Gyeonggi-do , Republic of Korea
| | - Ju-Yeun Lee
- a College of Pharmacy, Institute of Pharmaceutical Science and Technology , Hanyang University , Gyeonggi-do , Republic of Korea
| | - Yun-Jung Choi
- a College of Pharmacy, Institute of Pharmaceutical Science and Technology , Hanyang University , Gyeonggi-do , Republic of Korea
| | - Jisun Kong
- b College of Pharmacy & Research Institute of Pharmaceutical Sciences , Seoul National University , Seoul , Republic of Korea
| | - Baegeum Kim
- a College of Pharmacy, Institute of Pharmaceutical Science and Technology , Hanyang University , Gyeonggi-do , Republic of Korea
| | - Kyung Hee Choi
- c College of Pharmacy , Sunchon National University , Suncheon , Jeollanam-do , Republic of Korea
| | - Nayoung Han
- b College of Pharmacy & Research Institute of Pharmaceutical Sciences , Seoul National University , Seoul , Republic of Korea
| | - Yun Mi Yu
- b College of Pharmacy & Research Institute of Pharmaceutical Sciences , Seoul National University , Seoul , Republic of Korea
| | - Jung Mi Oh
- b College of Pharmacy & Research Institute of Pharmaceutical Sciences , Seoul National University , Seoul , Republic of Korea
| | - Wan Gyoon Shin
- b College of Pharmacy & Research Institute of Pharmaceutical Sciences , Seoul National University , Seoul , Republic of Korea
| | - Hae-Young Lee
- d Department of Internal Medicine , Seoul National University Hospital , Seoul , Republic of Korea
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10
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Zeng W, Zhen J, Feng M, Campbell SM, Finlayson AE, Godman B. Analysis of the influence of recent reforms in China: cardiovascular and cerebrovascular medicines as a case history to provide future direction. J Comp Eff Res 2015; 3:371-86. [PMID: 25275234 DOI: 10.2217/cer.14.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pharmaceutical expenditure has grown by 16% per annum in China, enhanced by incentives for physicians and hospitals. Hospital pharmacies dispense 80% of medicines in China, accounting for 46% of total hospital expenditure. Principal measures to moderate drug expenditure growth include pricing initiatives as limited demand-side measures. OBJECTIVE Assess current utilization and expenditure including traditional Chinese medicines (TCMs) between 2006 and 2012. METHODS Uncontrolled retrospective study of medicines to treat cardiovascular and cerebrovascular diseases in one of the largest hospitals in southwest China. RESULTS Utilization increased 3.3-fold for cerebrovascular medicines, greatest for TCMs, with expenditure increasing 4.85-fold. Low prices for generics were seen, similar to Europe. However, there was variable utilization of generics at 29-31% of total product volumes in recent years. There continued to be irrationality in prescribing with high use of TCMs, and the utilization of different medicines dropping significantly once they achieved low prices. CONCLUSION Prices still have an appreciable impact on utilization in China. Potential measures similar to those implemented among western European countries could improve prescribing rationality and conserve resources.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, Chongqing, China
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11
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Yoo KB, Lee SG, Park S, Kim TH, Ahn J, Cho MH, Park EC. Effects of drug price reduction and prescribing restrictions on expenditures and utilisation of antihypertensive drugs in Korea. BMJ Open 2015; 5:e006940. [PMID: 26179644 PMCID: PMC4513484 DOI: 10.1136/bmjopen-2014-006940] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To evaluate the quantitative effects of the drug price reduction on pharmaceutical expenditures and the new guidelines to restrict prescribing on drug utilisation for antihypertensive drugs. DESIGN We used an interrupted time series design with the National patient sample data of Health Insurance Review and Assessment Service in South Korea. METHODS 54,295 participants who were with primary hypertension from the National patient sample data of Health Insurance Review and Assessment Service were included. The study period was from March 2011 to December 2013. The dependent variables were antihypertensive drug costs, antihypertensive drug cost per prescribing day, daily drug utilisation, average number of drugs per month, percentage of original drugs per prescription, drug overutilisation and prohibited combinations. Segmented regression analysis was used. RESULTS The drug price reduction reduced expenditure (US$-1.51, -10.2%), and the new guidelines reduced expenditures even more (US$-2.13; -16.2%). These policies saved US$4.22 (28%) of antihypertensive drug costs per patient in December 2013 compared to March 2012. Drug price reduction policy was introduced in April 2012. We established the policy effect by comparing it before (March 2012) with after(21 months later-December 2012). The effects of the guidelines decreased expenditures, daily drug utilisation and the average number of drugs per month more than did the drug price reduction. CONCLUSIONS Both policies saved money. The guidelines were more effective over time and had fewer side effects such as increasing daily drug utilisation and number of drugs than the effects of drug price reduction.
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Affiliation(s)
- Ki-Bong Yoo
- Department of Healthcare Management, Eulji University, Sungnam, South Korea
| | - Sang Gyu Lee
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
- Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Sohee Park
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
- Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Tae Hyun Kim
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
- Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Jeonghoon Ahn
- National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Mee-Hyun Cho
- Health Insurance Review and Assessment Service, Seoul, South Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, South Korea
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12
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Poluzzi E, Veronese G, Piccinni C, Raschi E, Koci A, Pagano P, Godman B, Marchesini G, Boriani G, De Ponti F. Switching among Equivalents in Chronic Cardiovascular Therapies: 'Real World' Data from Italy. Basic Clin Pharmacol Toxicol 2015; 118:63-9. [PMID: 26150075 DOI: 10.1111/bcpt.12442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/29/2015] [Indexed: 11/29/2022]
Abstract
Since August 2012, Italian general practitioners are required to prescribe the generic name of medicines, except for refill of chronic therapy. We evaluated the extent of switching among equivalents in chronic cardiovascular therapies, the influence of the 2012 regulatory intervention and of patient-related or drug-related factors. Prescriptions of off-patent anti-arrhythmics, oral antidiabetics and ACE inhibitors dispensed from August 2011 to August 2013 within the Bologna Local Health Authority (870,000 inhabitants) was collected. The rate of actual switching among equivalents was evaluated monthly. The effect of the regulatory intervention was estimated by interrupted-time-series analysis. Adjusted odds ratios (aORs) of switching were calculated for the following: age, gender, number of different equivalents available for each drug and change in dispensing pharmacy between subsequent refills. The average monthly rates of switches were 9.6%, 16.3% and 16.3% for anti-arrhythmics, antidiabetics and ACE inhibitors, respectively. Values significantly increased soon after the regulatory intervention for ACE inhibitors (+1.81%, p < 0.01), anti-arrhythmics (+1.46%, p = 0.01) and antidiabetics (+1.09%, p = 0.01), and no significant decreasing trends were observed in the following 12 months. For all drug classes, odd of switching was higher in case of change in dispensing pharmacy (up to aOR = 4.31, 95 CI = 4.26-4.35 for ACE inhibitors) and availability of ≥5 different equivalents (up to aOR = 7.82, 95 CI = 7.39-8.28 for antidiabetics). Switching was lower for age ≥65 for antidiabetics and ACE inhibitors (aOR = 0.92, 95 CI = 0.90-0.93; 0.87, 0.86-0.88, respectively). The Italian regulatory intervention generated an immediate increase, not sustained in time, in switching among equivalents of cardiovascular therapies. Young age, high number of available equivalents and changes in dispensing pharmacy between subsequent refills were associated with switching.
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Affiliation(s)
- Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giacomo Veronese
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo Piccinni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ariola Koci
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paola Pagano
- Drug Policy Department, Local Health Authority of Bologna, Bologna, Italy
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Boriani
- Department of Clinical and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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13
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Kwon HY, Yang B, Godman B. Key Components of Increased Drug Expenditure in South Korea: Implications for the Future. Value Health Reg Issues 2015; 6:14-21. [PMID: 29698186 DOI: 10.1016/j.vhri.2015.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/04/2014] [Accepted: 01/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The cost of pharmaceuticals has increased rapidly in Korea in recent years. Expenditure is likely to grow further with the policy of expanding National Health Insurance coverage for the following four disease areas: cerebrovascular and cardiovascular disease, rare diseases, and cancer. Consequently, there is a need to analyze the different components leading to this increased expenditure as a basis for suggesting future reforms in Korea. OBJECTIVE To quantify the impact of new and established drugs on the growth of total drug spending in South Korea in recent years, specially focusing on the differentiated components of drug spending. These include treatment expansion and drug-mix effects (switching from cheaper drugs to expensive ones and vice versa). METHODS A model was proposed and used to assess the impact of both new and existing drugs on changes in price, quantity, and drug mix over the 5-year period in Korea from 2006 to 2010. The database used was the National Health Insurance claims data, which covers about 97% of the total population of Korea. RESULTS Overall drug spending increased 1.43-fold from 2006 to 2010. Drug-mix effect (εt = 1.32) was the main factor contributing to increased drug spending, followed by increased drug utilization (Qt = 1.26). For existing drugs, treatment expansion (QI) and drug-mix effect (εI) were measured at 1.28 and 1.24, respectively, while those of new drugs were 1.02 (QN) and 1.03 (εN). Therefore, existing drugs have a much greater effect on drug spending than do new drugs. According to the Anatomical Therapeutic Classification, drug spending rose most significantly for the "sensory organs" class of drugs (Et = 1.78) followed by the "various" class (Et = 1.68). For existing drugs in the sensory organs class (S), drug-mix effect (εI) was measured at 0.96. This implies that expensive drugs among existing drugs were replaced by cheaper ones. However, the quantity prescribed (QI) substantially increased by 1.88-fold. New drugs within this class that were more expensive than existing ones were also prescribed (εN = 1.09), further increasing drug expenditure in Korea. CONCLUSIONS We found contrasting results from previous studies. The drug-mix effect and existing drugs made the largest contribution to drug spending growth rather than new drugs. Policies targeting drug mix, such as promoting cost-effective prescription and rational use of drugs, including the use of cheaper cost generics without compromising care, should be primarily considered to help contain future drug expenditure.
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Affiliation(s)
- Hye-Young Kwon
- Institute of Health and Environment, Seoul National University, Seoul, South Korea; Harvard School of Public Health, Boston, MA, USA
| | - Bongmin Yang
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; Liverpool Health Economics Centre, Liverpool University, Liverpool, UK
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14
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Zeng W, Gustafsson LL, Bennie M, Finlayson AE, Godman B. Review of ongoing initiatives to improve prescribing efficiency in China; angiotensin receptor blockers as a case history. Expert Rev Pharmacoecon Outcomes Res 2014; 15:157-69. [PMID: 25348709 DOI: 10.1586/14737167.2015.963557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Pharmaceutical expenditure is rising by 16% per annum in China and is now 46% of total expenditure. Initiatives to moderate growth include drug pricing regulations and encouraging international non-proprietary name prescribing. However, there is no monitoring of physician prescribing quality and perverse incentives. OBJECTIVES Assess changes in angiotensin receptor blocker (ARB) utilization and expenditure as more generics become available; compare findings to Europe. METHODOLOGY Observational retrospective study of ARB utilization and expenditure between 2006 and 2012 in the largest hospital in Chongqing district. RESULTS Variable and low use of generics versus originators with a maximum of 31% among single ARBs. Similar for fixed dose combinations. Prices typically reduced over time, greatest for generic telmisartan (-54%), mirroring price reductions in some European countries. However, no preferential increase in prescribing of lower cost generics. Accumulated savings of 33 million CNY for this large provider if they adopted European practices. CONCLUSION Considerable opportunities to improve prescribing efficiency in China.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, No.66 Xuefu Road, Nan'an District, Chongqing 400074, China
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15
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Moon JC, Godman B, Petzold M, Alvarez-Madrazo S, Bennett K, Bishop I, Bucsics A, Hesse U, Martin A, Simoens S, Zara C, Malmström RE. Different initiatives across Europe to enhance losartan utilization post generics: impact and implications. Front Pharmacol 2014; 5:219. [PMID: 25339902 PMCID: PMC4189327 DOI: 10.3389/fphar.2014.00219] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 09/09/2014] [Indexed: 12/13/2022] Open
Abstract
Introduction: There is an urgent need for health authorities across Europe to fully realize potential savings from increased use of generics to sustain their healthcare systems. A variety of strategies were used across Europe following the availability of generic losartan, the first angiotensin receptor blocker (ARB) to be approved and marketed, to enhance its prescribing vs. single-sourced drugs in the class. Demand-side strategies ranged from 100% co-payment for single-sourced ARBs in Denmark to no specific measures. We hypothesized this heterogeneity of approaches would provide opportunities to explore prescribing in a class following patent expiry. Objective: Contrast the impact of the different approaches among European countries and regions to the availability of generic losartan to provide future guidance. Methodology: Retrospective segmented regression analyses applying linear random coefficient models with country specific intercepts and slopes were used to assess the impact of the various initiatives across Europe following the availability of generic losartan. Utilization measured in defined daily doses (DDDs). Price reductions for generic losartan were also measured. Results: Utilization of losartan was over 90% of all ARBs in Denmark by the study end. Multiple measures in Sweden and one English primary care group also appreciably enhanced losartan utilization. Losartan utilization actually fell in some countries with no specific demand-side measures. Considerable differences were seen in the prices of generic losartan. Conclusion: Delisting single-sourced ARBs produced the greatest increase in losartan utilization. Overall, multiple demand-side measures are needed to change physician prescribing habits to fully realize savings from generics. There is no apparent “spill over” effect from one class to another to influence future prescribing patterns even if these are closely related.
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Affiliation(s)
- James C Moon
- Heart Hospital Imaging Centre, The Heart Hospital, University College Hospital London, UK
| | - Brian Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden ; Medicine Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK ; National Institute for Science and Technology on Innovation on Neglected Diseases, Centre for Technological Development in Health, Oswaldo Cruz Foundation (Fiocruz) Rio de Janeiro, Brazil
| | - Max Petzold
- Occupational and Environmental Medicine, Centre for Applied Biostatistics, University of Gothenburg Gothenburg, Sweden
| | - Samantha Alvarez-Madrazo
- Medicine Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James Hospital Dublin, Ireland
| | - Iain Bishop
- Public Health and Intelligence Business Unit, NHS National Services Scotland Edinburgh, UK
| | - Anna Bucsics
- Department of Finance, Faculty of Business, Economics and Statistics, University of Vienna Vienna, Austria ; Hauptverband der Österreichischen Sozialversicherungsträger Vienna, Austria
| | - Ulrik Hesse
- National Institute for Health Data and Disease Control Copenhagen, Denmark
| | - Andrew Martin
- NHS Greater Manchester Commissioning Support Unit Salford, Manchester, UK
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences Leuven, Belgium
| | - Corinne Zara
- Barcelona Health Region, Catalan Health Service Barcelona, Spain
| | - Rickard E Malmström
- Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna Stockholm, Sweden
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16
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Martin A, Godman B, Miranda J, Tilstone J, Saleem N, Olsson E, Acosta A, Restrepo L, Bennie M. Measures to improve angiotensin receptor blocker prescribing efficiency in the UK: findings and implications. J Comp Eff Res 2014; 3:41-51. [PMID: 24345256 DOI: 10.2217/cer.13.83] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Generic losartan provides an opportunity to enhance angiotensin receptor blocker (ARB) prescribing efficiency, with all ARBs essentially being similar. Initially, there was limited activity in NHS Bury (UK). This changed in March 2011 with therapeutic switching and other measures encouraging the prescribing of losartan following generics to enhance its utilization versus patented ARBs. AIM This study aims to assess the impact of multiple measures on losartan utilization, its price and total ARB expenditure. METHODS An interrupted time series analysis was performed. Utilization was measured as prescription items dispensed, typically 28 days. RESULTS No immediate change in losartan utilization was observed following generics. This changed after the multiple initiatives with losartan accounting for 65% of all single ARB items dispensed by the study end. ARB expenditure was 59% below prestudy levels by the study end, which was helped by a 92% reduction in expenditure per item for losartan. Annual net savings from the program were estimated at just under GB£290,000, which is over eight-times the cost of implementation. CONCLUSION Multiple measures can enhance prescribing efficiency. Health authorities cannot rely on a 'spillover' effect from other classes in order to affect changes in physician prescribing habits.
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Affiliation(s)
- Andrew Martin
- NHS Greater Manchester Commissioning Support Unit, Salford, Manchester, UK
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17
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Godman B, Wettermark B, van Woerkom M, Fraeyman J, Alvarez-Madrazo S, Berg C, Bishop I, Bucsics A, Campbell S, Finlayson AE, Fürst J, Garuoliene K, Herholz H, Kalaba M, Laius O, Piessnegger J, Sermet C, Schwabe U, Vlahović-Palčevski VV, Markovic-Pekovic V, Vončina L, Malinowska K, Zara C, Gustafsson LL. Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: findings and future implications. Front Pharmacol 2014; 5:106. [PMID: 24987370 PMCID: PMC4060455 DOI: 10.3389/fphar.2014.00106] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/22/2014] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The appreciable growth in pharmaceutical expenditure has resulted in multiple initiatives across Europe to lower generic prices and enhance their utilization. However, considerable variation in their use and prices. OBJECTIVE Assess the influence of multiple supply and demand-side initiatives across Europe for established medicines to enhance prescribing efficiency before a decision to prescribe a particular medicine. Subsequently utilize the findings to suggest potential future initiatives that countries could consider. METHOD An analysis of different methodologies involving cross national and single country retrospective observational studies on reimbursed use and expenditure of PPIs, statins, and renin-angiotensin inhibitor drugs among European countries. RESULTS Nature and intensity of the various initiatives appreciably influenced prescribing behavior and expenditure, e.g., multiple measures resulted in reimbursed expenditure for PPIs in Scotland in 2010 56% below 2001 levels despite a 3-fold increase in utilization and in the Netherlands, PPI expenditure fell by 58% in 2010 vs. 2000 despite a 3-fold increase in utilization. A similar picture was seen with prescribing restrictions, i.e., (i) more aggressive follow-up of prescribing restrictions for patented statins and ARBs resulted in a greater reduction in the utilization of patented statins in Austria vs. Norway and lower utilization of patented ARBs vs. generic ACEIs in Croatia than Austria. However, limited impact of restrictions on esomeprazole in Norway with the first prescription or recommendation in hospital where restrictions do not apply. Similar findings when generic losartan became available in Western Europe. CONCLUSIONS Multiple demand-side measures are needed to influence prescribing patterns. When combined with supply-side measures, activities can realize appreciable savings. Health authorities cannot rely on a "spill over" effect between classes to affect changes in prescribing.
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Affiliation(s)
- Brian Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden ; Medicines Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK ; Liverpool Health Economics Centre, University of Liverpool Management School Liverpool, UK
| | - Bjorn Wettermark
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden ; Centre for Pharmacoepidemiology, Karolinska Institute, Karolinska University Hospital Solna, Stockholm, Sweden ; Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council Stockholm, Sweden
| | | | - Jessica Fraeyman
- Epidemiology and Social Medicine, Research Group Medical Sociology and Health Policy, University of Antwerp Antwerp, Belgium
| | - Samantha Alvarez-Madrazo
- Medicines Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK
| | - Christian Berg
- Division of Epidemiology, Department of Pharmacoepidemiology, Norwegian Institute of Public Health Oslo, Norway
| | - Iain Bishop
- Public Health and Intelligence Business Unit, National Services NHS Scotland Edinburgh, UK
| | - Anna Bucsics
- Department of Finance, Faculty of Business, Economics and Statistics, University of Vienna Vienna, Austria ; Department of Reimbursement, Hauptverband der Österreichischen Sozialversicherungsträger Vienna, Austria
| | - Stephen Campbell
- Centre for Primary Care, Institute of Population Health, University of Manchester Manchester, UK
| | | | - Jurij Fürst
- Health Insurance Institute Ljubljana, Slovenia
| | - Kristina Garuoliene
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, University of Vilnius Vilnius, Lithuania ; Medicines Reimbursement Department, National Health Insurance Fund Vilnius, Lithuania
| | - Harald Herholz
- Kasemarzliche Vereinigung Hessen Frankfurt am Main, Germany
| | - Marija Kalaba
- Department of Medicines and Pharmacoeconomics, Republic Fund for Health Insurance Belgrade, Serbia
| | - Ott Laius
- State Agency of Medicines Tartu, Estonia
| | - Jutta Piessnegger
- Department of Reimbursement, Hauptverband der Österreichischen Sozialversicherungsträger Vienna, Austria
| | | | - Ulrich Schwabe
- Institute of Pharmacology, University of Heidelberg Heidelberg, Germany
| | | | - Vanda Markovic-Pekovic
- Faculty of Medicine, University of Banja Luka Banja Luka, Republic Srpska, Bosnia and Herzegovina ; Ministry of Health and Social Welfare Banja Luka, Republic Srpska, Bosnia and Herzegovina
| | - Luka Vončina
- Ministry of Health Republic of Croatia, Zagreb, Croatia
| | - Kamila Malinowska
- Department of Epidemiology and Health Promotion, Public Health School Warsaw, Poland ; Drug Management Department, National Health Fund Warsaw, Poland
| | - Corinne Zara
- Barcelona Health Region, Catalan Health Service Barcelona, Spain
| | - Lars L Gustafsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden
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Godman B, Petzold M, Bennett K, Bennie M, Bucsics A, Finlayson AE, Martin A, Persson M, Piessnegger J, Raschi E, Simoens S, Zara C, Barbui C. Can authorities appreciably enhance the prescribing of oral generic risperidone to conserve resources? Findings from across Europe and their implications. BMC Med 2014; 12:98. [PMID: 24927744 PMCID: PMC4073810 DOI: 10.1186/1741-7015-12-98] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/23/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Generic atypical antipsychotic drugs offer health authorities opportunities for considerable savings. However, schizophrenia and bipolar disorders are complex diseases that require tailored treatments. Consequently, generally there have been limited demand-side measures by health authorities to encourage the preferential prescribing of generics. This is unlike the situation with hypertension, hypercholaesterolaemia or acid-related stomach disorders.The objectives of this study were to compare the effect of the limited demand-side measures in Western European countries and regions on the subsequent prescribing of risperidone following generics; to utilise the findings to provide future guidance to health authorities; and where possible, to investigate the utilisation of generic versus originator risperidone and the prices for generic risperidone. METHODS Principally, this was a segmented regression analysis of retrospective time-series data of the effect of the various initiatives in Belgium, Ireland, Scotland and Sweden following the introduction of generic risperidone. The study included patients prescribed at least one atypical antipsychotic drug up to 20 months before and up to 20 months after generic risperidone. In addition, retrospective observational studies were carried out in Austria and Spain (Catalonia) from 2005 to 2011 as well as one English primary care organisation (Bury Primary Care Trust (PCT)). RESULTS There was a consistent steady reduction in risperidone as a percentage of total selected atypical antipsychotic utilisation following generics. A similar pattern was seen in Austria and Spain, with stable utilisation in one English PCT. However, there was considerable variation in the utilisation of generic risperidone, ranging from 98% of total risperidone in Scotland to only 14% in Ireland. Similarly, the price of generic risperidone varied considerably. In Scotland, generic risperidone was only 16% of pre-patent loss prices versus 72% in Ireland. CONCLUSION Consistent findings of no increased prescribing of risperidone post generics with limited specific demand-side measures suggests no 'spillover' effect from one class to another encouraging the preferential prescribing of generic atypical antipsychotic drugs. This is exacerbated by the complexity of the disease area and differences in the side-effects between treatments. There appeared to be no clinical issues with generic risperidone, and prices inversely reflected measures to enhance their utilisation.
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Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
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Hesse U, Godman B, Petzold M, Martin A, Malmström RE. Impact of delisting ARBs, apart from losartan, on ARB utilisation patterns in Denmark: implications for other countries. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:677-685. [PMID: 24105097 DOI: 10.1007/s40258-013-0059-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Renin-angiotensin inhibitor drugs have been a target for health authority initiatives across Europe with the potential for substantial savings once generic angiotensin-converting enzyme inhibitors (ACEIs) became available without compromising care. Recently, losartan was the first angiotensin receptor blocker (ARB) to lose its patent. In Denmark, the authorities removed all other ARBs from the reimbursement list, apart from losartan, as they were all seen as essentially similar for the management of hypertension or congestive heart failure at appropriate doses, but more expensive. Similarly, all other ARB fixed-dose combinations (FDCs), apart from losartan, were removed from the reimbursement list. OBJECTIVE The aims of the study were to (i) assess the impact of these reimbursement changes on the subsequent utilisation of losartan and other ARBs alone or as FDCs; (ii) assess changes in the prices of losartan and other ARBs post-generic losartan to calculate potential savings; and (iii) compare the impact of the policies in Denmark with other European countries to provide guidance. METHODOLOGY This was a retrospective segmented regression analysis of an interrupted time-series design comparing utilisation patterns before and after the changes in ARB reimbursement status. Utilisation was measured in defined daily doses (DDDs). Changes in total expenditure and expenditure/DDD were also assessed over time. RESULTS Losartan utilisation grew from 31 to 33 % of total single ARB utilisation before generic losartan, to 93 % by October 2011. There was a corresponding decrease in the utilisation of all other ARBs. Both changes were significant (p < 0.001). Total expenditure on single ARBs in 2011 was 77 % below 2009 levels despite a 16 % increase in utilisation. Estimated savings were 290.5 million Danish Kroner (DKK). A similar trend was seen for losartan FDCs, which was also significant (p < 0.001). DISCUSSION Losartan utilisation grew appreciable following the changes. The change was much greater than seen in countries that had eased prescribing restrictions for losartan but not the other ARBs. Active therapeutic switching programmes plus education and financial incentives also significantly enhanced losartan utilisation following generics in two countries and regions; however, the increase in losartan utilisation was less than that seen in Denmark.
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Affiliation(s)
- Ulrik Hesse
- National Institute for Health Data and Disease Control, Copenhagen, Denmark
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Godman B, De Bruyn K, Miranda J, Raschi E, Bennie M, Barbui C, Simoens S. Generic atypical antipsychotic drugs in Belgium: their influence and implications. J Comp Eff Res 2013; 2:551-61. [DOI: 10.2217/cer.13.75] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction: Generic atypical antipsychotic drugs should be a focus of attention given their expenditure. However, there is a recognized need to tailor treatments. There were no specific measures in Belgium to enhance the prescribing of oral risperidone following generics in January 2008. Prescribing restrictions have remained for long-acting risperidone injections throughout. Objective: Assess changes in risperidone utilization before and after oral generics were reimbursed, as well as the utilization and expenditure of the various risperidone preparations. Method: Principally a retrospective observational study and interrupted time series design. Results: As expected, no increased utilization of oral risperidone after generics. Both originator and generic oral risperidone prescribed, with the originator reducing its price. Generic risperidone was 59% below prepatent loss prices by September 2012. Conclusion: Authorities cannot rely on a ‘spill over’ of learning from other disease areas to affect changes in physician prescribing habits. Specific measures are needed to encourage generic risperidone where appropriate. However, their influence will be limited by the complexity of the disease area.
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Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
- National Institute of Science & Technology on Innovation on Neglected Diseases, Centre for Technological Development in Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Kristien De Bruyn
- Statistics Department, Association of Belgian Pharmacists, Archimedesstraat 11, B-1000 Brussels, Belgium
| | - Jamilette Miranda
- Department of Development, Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden
| | - Emanuel Raschi
- Department of Medical & Surgical Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Marion Bennie
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Public Health & Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, EH12 9EB, UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health & Service Evaluation, Department of Public Health & Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Steven Simoens
- KU Leuven, Department of Pharmaceutical & Pharmacological Sciences, KU Leuven, Herestraat 49, O & N 2 Bus 521, 3000 Leuven, Belgium
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Godman B, Persson M, Miranda J, Skiöld P, Wettermark B, Barbui C, Gustafsson LL. Changes in the utilization of venlafaxine after the introduction of generics in Sweden. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:383-393. [PMID: 23754677 DOI: 10.1007/s40258-013-0037-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND There has been an appreciable increase in the prescribing efficiency of proton pump inhibitors, statins, and renin-angiotensin inhibitor drugs in Sweden in recent years. This has been achieved through multiple reforms encouraging the prescription of generics at low prices versus patented drugs in the same class. Generic venlafaxine also presents an opportunity to save costs given the prevalence of depression. However, depression is more complex to treat, with physicians reluctant to change prescriptions if patients are responding to a particular antidepressant. OBJECTIVES We assessed (a) changes in the utilization pattern of venlafaxine versus other newer antidepressants before and after the availability of generic venlafaxine and before and after the initiation of prescription restrictions for duloxetine limiting its prescription to refractory patients, (b) utilization of generic versus original venlafaxine after its availability, and (c) price reductions for generic venlafaxine and the subsequent influence on total expenditure on newer antidepressants over time. METHODOLOGY We performed interrupted time series analysis of changes in monthly reimbursed prescriptions using defined daily doses (DDDs) of patients dispensed at least one newer antidepressant from January 2007 to August 2011. DDDs was defined as the average maintenance dose of a drug when used in its major indication in adults. This included 19 months after the availability of generic venlafaxine and before initiation of prescription restrictions for duloxetine to 13 months after prescription restrictions. Total expenditure and expenditure/DDD for venlafaxine were measured over time. RESULTS No appreciable change in the utilization pattern for venlafaxine was observed after generic availability when no appreciable demand-side activities by the regions (counties) were implemented to encourage its use. The utilization of venlafaxine significantly increased after prescription restrictions for duloxetine. Generic venlafaxine was dispensed once available, reaching 99.6 % of total venlafaxine (DDD basis) by August 2011. There was an appreciable fall in expenditure for newer antidepressants in Sweden after generic venlafaxine despite increased utilization, helped by a 90 % reduction in expenditure/DDD for venlafaxine by the end of the study versus prepatent loss prices. CONCLUSION Multiple demand-side measures are needed to change physician prescribing habits. Authorities should not rely on a spillover effect between drug classes to effect change. Limited influence of prescription restrictions on the subsequent utilization of duloxetine reflects the complexity of this disease area. This is exacerbated by heterogeneous indications for duloxetine.
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Affiliation(s)
- Brian Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden.
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Godman B, Persson M, Miranda J, Barbui C, Bennie M, Finlayson AE, Raschi E, Wettermark B. Can authorities take advantage of the availability of generic atypical antipsychotic drugs? Findings from Sweden and potential implications. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine; Division of Clinical Pharmacology; Karolinska Institute; Karolinska University Hospital Huddinge; Stockholm Sweden
- Liverpool Health Economics Centre; University of Liverpool; Liverpool UK
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
| | - Marie Persson
- Unit of Medicine Support; Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
| | - Jamilette Miranda
- Department of Healthcare Development; Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation; Department of Public Health and Community Medicine, Section of Psychiatry; University of Verona; Verona Italy
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
- Information Services Division; NHS National Services Scotland; Edinburgh UK
| | - Alexander E Finlayson
- King's Centre for Global Health; Global Health Offices; Weston Education Centre; London UK
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences; Pharmacology Unit; Alma Mater Studiorum - University of Bologna; Bologna Italy
| | - Bjorn Wettermark
- Department of Laboratory Medicine; Division of Clinical Pharmacology; Karolinska Institute; Karolinska University Hospital Huddinge; Stockholm Sweden
- Department of Healthcare Development; Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
- Centre for Pharmacoepidemilogy; Karolinska Institute; Karolinska University Hospital Solna; Stockholm Sweden
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