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Fadare JO, Oshikoya KA, Ogunleye OO, Desalu OO, Ferrario A, Enwere OO, Adeoti A, Sunmonu TA, Massele A, Baker A, Godman B. Drug promotional activities in Nigeria: impact on the prescribing patterns and practices of medical practitioners and the implications. Hosp Pract (1995) 2018; 46:77-87. [PMID: 29426263 DOI: 10.1080/21548331.2018.1437319] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Pharmaceutical companies spend significant amount of resources on promotion influencing the prescribing behavior of physicians. Drug promotion can negatively impact on rational prescribing, which may adversely affect the quality of patient care. However, little is known about these activities in Nigeria as the most populous country in Africa. We therefore aimed to explore the nature of encounters between Nigerian physicians and pharmaceutical sales representatives (PSRs), and how these encounters influence prescribing habits. METHODS Cross-sectional questionnaire-based study conducted among practicing physicians working in tertiary hospitals in four regions of Nigeria. RESULTS 176 questionnaires were completed. 154 respondents (87.5%) had medicines promoted to them in the previous three months, with most encounters taking place in outpatients' clinics (60.2%), clinical meetings (46%) and new medicine launches (17.6%). Information about potential adverse effects and drug interactions was provided in 41.5%, and 27.3% of cases, respectively. Food, in the form of lunch or dinner, was the most common form of incentive (70.5%) given to physicians during promotional activities. 61% of physicians felt motivated to prescribe the drug promoted to them, with the quality of information provided being the driving factor. Most physicians (64.8%) would agree to some form of regulation of the relationship between medical doctors and the pharmaceutical industry. CONCLUSION Interaction between PSRs and physicians is a regular occurrence in Nigeria, influencing prescribing practices. Meals and cheap gifts were the most common items offered to physicians during their encounters with PSRs. The need for some form of regulation by professional organizations and the government was expressed by most respondents to address current concerns.
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Affiliation(s)
- Joseph O Fadare
- a Department of Pharmacology and Therapeutics , Ekiti State University , Ado-Ekiti , Nigeria
| | - Kazeem A Oshikoya
- b Department of Pharmacology , Therapeutics and Toxicology, Lagos State University College of Medicine , Lagos , Nigeria
| | - Olayinka O Ogunleye
- b Department of Pharmacology , Therapeutics and Toxicology, Lagos State University College of Medicine , Lagos , Nigeria
| | - Olufemi O Desalu
- c Department of Medicine , University of Ilorin , Ilorin , Nigeria
| | - Alessandra Ferrario
- d Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - Okezie O Enwere
- e Department of Medicine , Imo State University , Orlu , Nigeria
| | - Adekunle Adeoti
- f Department of Medicine , Ekiti State University , Ado-Ekiti , Nigeria
| | | | - Amos Massele
- h Department of Clinical Pharmacology, Faculty of Medicine , University of Botswana , Gaborone , Botswana
| | - Amanj Baker
- i Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Brian Godman
- i Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
- j Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden
- k Health Economics Centre , Liverpool University Management School , Liverpool , UK
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Costa JDO, Almeida-Brasil CC, Godman B, Fischer MA, Dartnell J, Heaney A, dos Santos CGB, Acurcio FDA, Álvares J, Guerra AA. Implementation of clinical guidelines in Brazil: should academic detailing be used? JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2016. [DOI: 10.1111/jphs.12133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Juliana de Oliveira Costa
- SUS Collaborating Centre - Health Technology Assessment & Excellence in Health; Department of Social Pharmacy; College of Pharmacy; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Celline Cardoso Almeida-Brasil
- SUS Collaborating Centre - Health Technology Assessment & Excellence in Health; Department of Social Pharmacy; College of Pharmacy; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences; Strathclyde University; Glasgow UK
- Division of Clinical Pharmacology; Karolinska University Hospital Huddinge; Karolinska Institutet; Stockholm Sweden
| | - Michael Adam Fischer
- National Resource Center for Academic Detailing; Division of Pharmacoepidemiology and Pharmacoeconomics; Department of Medicine; Brigham and Women's Hospital; Boston MA USA
- Harvard Medical School; Boston MA USA
| | | | | | - Carolina Greco Bernardes dos Santos
- SUS Collaborating Centre - Health Technology Assessment & Excellence in Health; Department of Social Pharmacy; College of Pharmacy; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Francisco de Assis Acurcio
- SUS Collaborating Centre - Health Technology Assessment & Excellence in Health; Department of Social Pharmacy; College of Pharmacy; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Juliana Álvares
- SUS Collaborating Centre - Health Technology Assessment & Excellence in Health; Department of Social Pharmacy; College of Pharmacy; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Augusto Afonso Guerra
- SUS Collaborating Centre - Health Technology Assessment & Excellence in Health; Department of Social Pharmacy; College of Pharmacy; Federal University of Minas Gerais; Belo Horizonte Brazil
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Riaz H, Godman B, Hussain S, Malik F, Mahmood S, Shami A, Bashir S. Prescribing of bisphosphonates and antibiotics in Pakistan: challenges and opportunities for the future. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2015. [DOI: 10.1111/jphs.12091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Humayun Riaz
- Faculty of Pharmacy; Sargodha University; Sargodha Pakistan
| | - Brian Godman
- Department of Laboratory Medicine; Division of Clinical Pharmacology; Karolinska Institute; Karolinska University Hospital Huddinge; Stockholm Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences; Strathclyde University; Glasgow UK
| | - Shahzad Hussain
- Drugs Control and Traditional Medicines Division; National Institute of Health; Islamabad Pakistan
| | - Farnaz Malik
- Drugs Control and Traditional Medicines Division; National Institute of Health; Islamabad Pakistan
| | - Sidra Mahmood
- Department of Pharmacy; Quaid e Azam University; Islamabad Pakistan
| | - Ali Shami
- Orthopaedic Department; Pakistan Institute of Medical Sciences; Islamabad Pakistan
| | - Sajid Bashir
- Faculty of Pharmacy; Sargodha University; Sargodha Pakistan
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Polić-Vižintin M, Štimac D, Šostar Z, Tripković I. Distribution and trends in outpatient utilization of generic versus brand name psychopharmaceuticals during a ten-year period in Croatia. BMC Health Serv Res 2014; 14:343. [PMID: 25128190 PMCID: PMC4261909 DOI: 10.1186/1472-6963-14-343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 08/12/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Drug costs increasingly pose a burden upon the otherwise inadequate health care resources and rational drug utilization is an important segment of every national health policy. Optimal patient care should be the goal of rational pharmacotherapy, whereby the economic burden of treatment is just one of the elements to be considered on choosing appropriate therapy.The aim of this study was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period. METHODS Using the World Health Organization Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from pharmacies on the number and size of drug packages. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization. RESULTS Total cost for psychopharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to financial indicators decreased by 9.6% and according to DDD/1000/day by 12%. The greatest decrease was in antidepressants, i.e. by 33.8% according to financial indicators and by 46% according to DDD/1000/day; and in antipsychotics by 30.9% according to DDD/1000/day, while showing an increase by 8.5% according to financial indicators. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day, but increased by 25.1% according to financial indicators. CONCLUSIONS The lack of uniform national guidelines and the still strong impact of pharmaceutical industry marketing continue favoring the rise in prescribing brand name antidepressants and antipsychotics. Depression, schizophrenia and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic psychopharmaceuticals.
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Affiliation(s)
- Marina Polić-Vižintin
- />Dr Andrija Štampar Institute of Public Health, Vrhovčev vijenac 22, HR 10000 Zagreb, Croatia
| | - Danijela Štimac
- />Dr Andrija Štampar Institute of Public Health, Vrhovčev vijenac 22, HR 10000 Zagreb, Croatia
- />School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zvonimir Šostar
- />Dr Andrija Štampar Institute of Public Health, Vrhovčev vijenac 22, HR 10000 Zagreb, Croatia
| | - Ingrid Tripković
- />Institute of Public Health of Split and Dalmatia County, Zagreb, Croatia
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Vogler S, Leopold C, Zimmermann N, Habl C, de Joncheere K. The Pharmaceutical Pricing and Reimbursement Information (PPRI) initiative—Experiences from engaging with pharmaceutical policy makers. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2014.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wladysiuk M, Tabor A, Godman B. ‘HTA for Crisis’: sharing experiences during the 7th EBHC Symposium. Expert Rev Pharmacoecon Outcomes Res 2014; 13:47-9. [DOI: 10.1586/erp.12.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yu SY, Yang BM, Kim JH. New anti-rebate legislation in South Korea. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:311-318. [PMID: 23645520 DOI: 10.1007/s40258-013-0029-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The South Korean Government recently announced a reform in the drug anti-rebate law, with the purpose of eradicating pervasive, unethical, and illegal rebate practices in pharmaceutical marketing. The main objective of this reform is to have the ability to bring criminal charges against doctors and pharmacists for receiving illegal kickbacks from drug companies. Previously, provision of illegal kickbacks by drug companies led to criminal punishment of the drug companies alone, leaving doctors and pharmacists unpunished as the recipients. With the introduction of the "Dual Punishment System (DPS)" reform, criminal punishment for illegal rebates is extended to those receiving illegal kickbacks. Although bitter controversy erupted among stakeholders when the reform was first drafted, a civic group participated in the reform process and effectively influenced the legislative process to a successful end. Some interim outcomes from the DPS in terms of bringing illegal practices to account have already been reported since the policy's implementation in November 2010. The reform background, goals, potential issues, and policy implications are explored in this study with the objective of providing further insight into drug policy for other countries that face similar challenges in the area of drug marketing.
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Affiliation(s)
- Su-Yeon Yu
- Graduate School of Public Health, Seoul National University, Seoul, Korea
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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, Bucsics A, Burkhardt T, Piessnegger J, Schmitzer M, Barbui C, Raschi E, Bennie M, Gustafsson LL. Potential to enhance the prescribing of generic drugs in patients with mental health problems in austria; implications for the future. Front Pharmacol 2013; 3:198. [PMID: 23308071 PMCID: PMC3538280 DOI: 10.3389/fphar.2012.00198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/06/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Scrutiny over pharmaceutical expenditure is increasing leading to multiple reforms. This includes Austria with measures to lower generic prices and enhance their utilization. However the situation for newer antidepressants and atypical antipsychotic medicines (AAPs) is different to PPIs, statins, and renin-angiotensin inhibitor drugs with greater tailoring of therapy and no wish to switch products in stable patients. Authorities welcome generics though given the high costs particularly of single-sourced AAPs. OBJECTIVE Assess (a) changes in utilization of venlafaxine versus other newer antidepressants before and after availability of generics, (b) utilization of generic versus originator venlafaxine, (c) price reductions of venlafaxine over time and their influence on total expenditure, (d) utilization of risperidone versus other AAPs, (e) suggest potential additional reforms that could be introduced if pertinent to further enhance the use of generics. METHODOLOGY A quasi-experimental study design with a segmented time series and an observational study. Utilization measured in defined daily doses (DDDs) and total expenditure per DDD and over time. RESULTS No appreciable changes in the utilization of venlafaxine and risperidone after generics. The reduction in expenditure/DDD for venlafaxine decreased overall expenditure on newer antidepressants by 5% by the end of the study versus just before generics despite a 37% increase in utilization. Expenditure will further decrease if reduced prescribing of duloxetine. CONCLUSION Depression, schizophrenia, and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic risperidone and venlafaxine when multiple choices are appropriate. Authorities cannot rely on a "Hawthorne" effect between classes to enhance the use of generics. Measures may include prescribing restrictions for duloxetine. No specific measures planned for AAPs with more multiple-sourced AAPs becoming available.
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Affiliation(s)
- Brian Godman
- Division of Clinical Pharmacology, Karolinska University Hospital Huddinge Stockholm, Sweden ; Mario Negri Institute for Pharmacological Research Milan, Italy ; Prescribing Research Group, University of Liverpool Management School Liverpool, UK
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