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Shibabaw AD, Nakambale HN, Bangalee V. Inventory management practices: implications on the pharmaceuticals expenditure of rabies vaccine in public health facilities, Namibia. BMC Health Serv Res 2023; 23:823. [PMID: 37533090 PMCID: PMC10394911 DOI: 10.1186/s12913-023-09790-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND To achieve well-regulated distribution, storage, and utilization of the rabies vaccine, health facilities should adhere to standard operating procedures. In Namibia, information on inventory management, utilization, monitoring, and reporting of rabies vaccine adherence to standard operating procedures in public healthcare facilities is insufficient. The aim of this study was to assess adherence to rabies vaccine standard operating procedures and inventory management and to compare rabies vaccine expenditure to the number of patients who received rabies vaccination at the Ministry of Health and Social Services' public healthcare facilities from 2018 to 2020. METHODS A cross-sectional, web-based questionnaire consisting of closed-ended questions was sent to 147 pharmacy staff and warehouse managers working in the 14 regions of Namibia during the period of May 1, 2021, to June 2, 2021. The overall expenditure and the total number of patients vaccinated from 2018 to 2020 were obtained from national-level logistic and vaccination program coordinators. Data were coded and transcribed into Microsoft® Excel® 2013 and analyzed using SPSS® version 27. RESULTS One hundred and thirty-three completed questionnaires were received from sixty-nine public health centers and hospitals. The group of respondents consisted of pharmacist assistants (50%), pharmacy technicians (12%), pharmacists (36.8%), senior pharmacists (0.8%), and chief pharmacists (1.5%). Overall, adherence to standard operating procedures was poor (27.1%). Rabies vaccine distributed to public health facilities from 2018 to 2020 was worth N$75,381,419.91 (~ US$4,074,671.46) and was expected to vaccinate 87,269 patients; however, only 95 cases of both rabies and rabid dog-bite patients were reported. The major inventory management challenges for public healthcare facilities include an inadequate number of pharmacy staff, poor adherence to standardized pharmaceutical warehousing, lack of regular supervision, and inadequate staff training. CONCLUSION Inventory management practices in public healthcare facilities were not in compliance with standard operating procedures. There is a significant discrepancy between rabies vaccine expenditure and the number of patients that were vaccinated. Therefore, there is a need for adequate staff training on inventory management and regular facility supervision to enforce optimal rabies vaccine inventory management practices.
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Affiliation(s)
- Alemnew Dessie Shibabaw
- School of Health Sciences, Department of Pharmaceutical Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Hilma N Nakambale
- School of Health Sciences, Department of Pharmaceutical Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa.
| | - Varsha Bangalee
- School of Health Sciences, Department of Pharmaceutical Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
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Kamyari N, Soltanian AR, Mahjub H, Moghimbeigi A, Seyedtabib M. Zero-augmented beta-prime model for multilevel semi-continuous data: a Bayesian inference. BMC Med Res Methodol 2022; 22:283. [PMID: 36324066 PMCID: PMC9628168 DOI: 10.1186/s12874-022-01736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023] Open
Abstract
Semi-continuous data characterized by an excessive proportion of zeros and right-skewed continuous positive values appear frequently in medical research. One example would be the pharmaceutical expenditure (PE) data for which a substantial proportion of subjects investigated may report zero. Two-part mixed-effects models have been developed to analyse clustered measures of semi-continuous data from multilevel studies. In this study, we propose a new flexible two-part mixed-effects model with skew distributions for nested semi-continuous cost data under the framework of a Bayesian approach. The proposed model specification consists of two mixed-effects models linked by the correlated random effects: Part I) a model on the occurrence of positive values using a generalized logistic mixed model; and Part II) a model on the magnitude of positive values using a linear mixed model where the model errors follow skew distributions including beta-prime (BP). The proposed method is illustrated with pharmaceutical expenditure data from a multilevel observational study and the analytic results are reported by comparing potential models under different skew distributions. Simulation studies are conducted to assess the performance of the proposed model. The DIC3, LPML, WAIC, and LOO as the Bayesian model selection criteria and measures of divergence used to compare the models.
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Affiliation(s)
- Naser Kamyari
- Department of Biostatistics and Epidemiology, School of Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Ali Reza Soltanian
- grid.411950.80000 0004 0611 9280Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Street of Mahdieh, Hamadan, Iran
| | - Hossein Mahjub
- grid.411950.80000 0004 0611 9280Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moghimbeigi
- grid.411705.60000 0001 0166 0922Department of Biostatistics and Epidemiology, School of Health, Research Center for Health, Safety and Environment, Alborz University of Medical Sciences, Karaj, Iran
| | - Maryam Seyedtabib
- grid.411230.50000 0000 9296 6873Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Yousefi N, Hemmati F, Jaddi ZS, Salamzadeh J. A ten-year study of anti-diabetic drugs utilization in Iran. J Diabetes Metab Disord 2022; 21:361-367. [PMID: 35673483 PMCID: PMC9167247 DOI: 10.1007/s40200-022-00983-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
Abstract
Objectives According to the world health organization (WHO), by the year 2030 diabetes will become the world's seventh leading cause of death. This study aimed to design and conduct a descriptive pharmacoepidemiological investigation of anti-diabetic drugs utilization during a ten-year period using the anatomical therapeutic classification/defined daily dose (ATC / DDD) system in Iran. Methods Based on pharmaceutical wholesalers' sale reports, sale data, including value and volume, were retrieved from the Iranian Annual Pharma Statistics for 2009-2018. The ATC/DDD system was used to standardize the raw sales data. Anti-diabetic drug utilization was reported as DDD per 1000 person in the population per day. Expenditure was calculated as USD per DDD. Results were then analyzed descriptively. Results During the ten-year study period, total anti-diabetic drug consumption increased by 235.53%. Insulin utilization grew by 148.65%, whereas non-insulin agents' use showed a 132.68% increase. Anti-diabetic drugs' expenditure increased by almost 9-fold, but changes were accompanied with many fluctuations. Although the absolute expenditure of almost all classes of anti-diabetic drugs were increasing, this growth was greater in biguanides, which only includes metformin in Iran. Approximately one-third of anti-diabetic drugs expenditures were related to fast-acting insulins. Imported drugs share in cost was significant, but not in consumption. The overall share of insulin consumption was less than 19%, but their share of total value reached 60% of the anti-diabetic market. Conclusions The growing trend in both insulin and non-insulin anti-diabetic drugs utilization is a substantial issue for health authorities' policy making for sustainable access to medicine.
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Affiliation(s)
- Nazila Yousefi
- grid.411600.2Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hemmati
- grid.411600.2Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Sadat Jaddi
- grid.411600.2Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamshid Salamzadeh
- grid.411600.2Food Safety Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Clinical Pharmacy Department, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kadkhodamanesh A, Varahrami V, Zarei L, Peiravian F, Hadidi M, Yousefi N. Investigation the determinants of pharmaceutical expenditure share of GDP in Iran and selected OECD countries. J Pharm Policy Pract 2021; 14:82. [PMID: 34641978 PMCID: PMC8513196 DOI: 10.1186/s40545-021-00371-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/02/2021] [Indexed: 11/26/2022] Open
Abstract
Aim This study estimated the GDP share of pharmaceuticals in Iran based on the drivers of pharmaceutical expenditure and compared it with that of 31 members of the Organisation for Economic Cooperation and Development (OECD). Subject and methods The factors contributing to pharmaceutical expenditure were identified through literature review and studied by 8 experts to classify the factors. Then, using the panel data method, a model was built to estimate the GDP share of pharmaceutical expenditure based on the extracted factors of the selected countries in Iran’s model. To explain the observed differences, several regression analyses were performed based on cross-sectional data. The analyses were performed using EVIEWS software, version 10. Results The explanatory variables for the selected countries in the panel model (R2 = 0.98) were specified. Government health expenditure (β = 0.1432), the share of generic drugs (β = − 0.0143), gross domestic product (GDP) per capita (β = − 0.0058) and the rate of disability-adjusted life-years (DALY) (β = 0.0028) contributed most to pharmaceutical expenditure. In comparison, in the Iranian estimation model (R2 = 0.84), government health expenditure (β = 0.0536) and the share of generic drugs (β = 0.0369) had a significant impact on pharmaceutical expenditure. In the estimation model with more estimators for Iran (R2 = 0.99), government health expenditure (β = 0.1694), disease prevalence (β = 0.0537), the share of generic drugs (β = 0.0102), the DALY rate (β = 0.0039), GDP per capita (β = − 0.0033), and the drug price index (β = 0.0007) contribute most to pharmaceutical expenditure. Conclusion In the models of the study, factors related to the structure of the healthcare system and the pharmaceutical system contributed most to pharmaceutical expenditure as a share of GDP. Moreover, disease profiles show its predictive role in the second model for Iran.
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Affiliation(s)
- Azin Kadkhodamanesh
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vida Varahrami
- Department of Economics, Shahid Beheshti University, Tehran, Iran
| | - Leila Zarei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzad Peiravian
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hadidi
- School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazila Yousefi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Moodley L, Suleman F, Perumal-Pillay VA. Perceptions from pharmaceutical stakeholders on how the pharmaceutical budget is allocated in South Africa. J Pharm Policy Pract 2021; 14:78. [PMID: 34548094 PMCID: PMC8453029 DOI: 10.1186/s40545-021-00362-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022] Open
Abstract
Background South Africa faces a heavy burden of disease, which impacts resource allocation. The needs of South Africa require efficient translation into pharmaceutical expenditure for medicine provision, to ensure availability of medicines. Given that South Africa faces various challenges with medicine provision accompanied by rising pharmaceutical expenditure, this study aimed to report on the considerations and methods used to determine the healthcare budget for South Africa, and how it is translated into pharmaceutical expenditure for medicines provision on the Standard Treatment Guidelines and Essential Medicines List and non-essential medicines in the public sector. Method Qualitative, semi-structured interviews guided by a discussion guide were conducted with seven pharmaceutical officials involved in the budget and resource allocation process, between October 2019 and March 2020. Interviews were recorded and transcribed verbatim. Once the interviews were coded by the first author they were verified by the other authors. Data were thematically analysed. Results This study depicted the knowledge and participation of pharmaceutical services in the budget process. The National and Provincial Department of Health have improved pharmaceutical budgeting by making strides towards a collaborative, informed, and more evidence-based approach. Pharmaceutical services have roles in advising on requirements; commenting where necessary, constantly monitor and taking accountability for their budget. The main considerations that determined the budget included population size and growth, historical expenditure, the extra heavy burden of disease and incidence rate, demand data and forecasting. The local and provincial pharmacy and therapeutics committee play a vital role in monitoring the budget and expenditure; ensuring adherence to guidelines; controlling the extent to which non-Essential Medicine List items are used and advising accordingly. Conclusion This was the first study to report on the decision and thought processes of the healthcare budget and its translation into pharmaceutical expenditure for medicine provision in South Africa. Many factors were considered to inform the budget, with the Standard Treatment Guideline and Essential Medicines List being the principal guide for medicine provision. This process was well-controlled and monitored by the pharmaceutical therapeutics committee. Documenting the South African experience can assist other countries in their budget decisions for medicines.
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Affiliation(s)
- Lirosha Moodley
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - Velisha Ann Perumal-Pillay
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa.
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Abstract
Background and objective Little is known about how much public payers spend on orphan medicines. This study aimed at identifying information on orphan medicine expenditure incurred by public payers that was published in literature globally and at possibly synthesising their shares as portion of the total pharmaceutical expenditure. Methods A literature review was undertaken using Medline, the Orphanet Journal of Rare Diseases and Google Scholar. Titles and abstracts were screened, and full texts of potentially qualifying studies were reviewed for inclusion. Included articles were analysed, and bibliometric parameters as well as public expenditure data on orphan medicines were retrieved. Results Six hundred forty three articles excluding duplicates were identified. After screening of the abstracts and a review of the full texts, 13 articles qualified for in-depth analysis.The 13 selected articles on orphan pharmaceutical expenditure were published between 2010 and 2018. Survey periods varied between 1 year and 12 years. One publication included 22 countries but the majority of the studies were related to a single country. Expenditure data was available in five of the 13 articles, and eight articles used 'expenditure proxies' such as sales data. Spending data had been sourced from public institutions (4 studies), private providers (5 studies) and a combination of both (3 studies, no information on data source in 1 study). In all included studies, secondary data were analysed. Reported expenditure shares for orphan medicines in relation to total pharmaceutical spend was frequently below 3%. Countries with higher shares included the USA, Canada, the Netherlands and Bulgaria-the latter reporting spending on orphan medicines as high as 9%. Conclusions A low number of studies that informed about pharmaceutical spending on orphan medicines was published, thereof only a few explicitly analysed expenditure data of public payers. A conclusive synthesis of public spending on orphan medicines is a challenge given to the diversity in methodologies to measure expenditure. There is a need for further research to survey primary data of public spending for orphan medicines, based on a sound methodology to measure these data and to compare them internationally.
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Affiliation(s)
- Margit Gombocz
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG / Austrian National Public Health Institute), Vienna, Austria
| | - Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG / Austrian National Public Health Institute), Vienna, Austria
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Son KB. The speed of adoption of new drugs and prescription volume after the amendments in reimbursement coverage: the case of non-vitamin K antagonist oral anticoagulants in South Korea. BMC Public Health 2020; 20:797. [PMID: 32460730 PMCID: PMC7251874 DOI: 10.1186/s12889-020-08929-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background The speed of adoption of new drugs and frequencies of substitutions leads to changes in health care expenditures as well as patient outcomes. In this study, we aim to understand the speed of adoption of new drugs and their prescription volume in health care institutions and evaluate the impact of policy options to manage pharmaceutical expenditure. Methods We conducted a retrospective cohort study of health care institutions prescribing NOACs, including Apixaban, Dabigatran, and Rivaroxaban, to address the speed of adoption and their substitution from October 1, 2010, through December 31, 2015, using the National Health Insurance Service-National Sample Cohort. Two threshold time points, including the extension of reimbursement with the need for the letter of opinion and the withdrawal of the letter of opinion, were noted in this study. Then, we applied a survival analysis to elucidate factors that affected the speed of adoption of NOACs, and interrupted time series analysis to estimate the effect of amendments in reimbursement coverage in prescription volume. Results Among 934 health care institutions in a study population, 334 institutions (36%) had prescribed NOACs at least one time during the study period, indicating that health care institutions were conservative in adopting new drugs. However, the speed of adoption was related to the characteristics of health care institution. We also found that prescriptions of NOACs before the withdrawal of the need for the letter of opinion were marginal, and the prescription volume of NOACs was significantly increased after the withdrawal of a letter of opinion. Conclusions Health care institutions were conservative in adopting new drugs, and the speed of adoption is not closely related to an increased prescription volume in the short run. Thus, policies that are centered on managing pharmaceutical expenditure should be devised with considering the impact of introducing new drugs in the long run. A letter of opinion, which was devised to manage prescriptions of NOACs, was effective in managing pharmaceutical expenditures in health care institutions, particularly for tertiary institutions. Conversely, the withdrawal of the need for the letter of opinion should be implemented with caution.
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Affiliation(s)
- Kyung-Bok Son
- College of Pharmacy, Ewha Womans University, 52Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea.
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Linnér L, Eriksson I, Persson M, Wettermark B. Forecasting drug utilization and expenditure: ten years of experience in Stockholm. BMC Health Serv Res 2020; 20:410. [PMID: 32393238 PMCID: PMC7212573 DOI: 10.1186/s12913-020-05170-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background Operating under constrained budgets, payers and providers globally face challenges in enabling appropriate and sustainable access to new medicines. Among payer initiatives aiming to improve preparedness of healthcare systems for the introduction of new medicines, drug utilization and expenditure forecasting has played an increasingly important role. This study aims to describe the forecasting model used in Region Stockholm and to evaluate the accuracy of the forecasts produced over the past decade. Methods In this repeated cross-sectional study, we compared the predicted pharmaceutical expenditure with actual expenditure during the entire available follow-up period (2007–2018) both for overall drug utilization and for individual therapeutic groups. All analyses were based on pharmaceutical expenditure data that include medicines used in hospitals and dispensed prescription medicines for all residents of the region. Results According to the forecasts, the total pharmaceutical expenditure was estimated to increase between 2 and 8% annually. Our analyses showed that the accuracy of these forecasts varied over the years with a mean absolute error of 1.9 percentage points. Forecasts for the same year were more accurate than forecasts for the next year. The accuracy of forecasts also differed across the therapeutic areas. Factors influencing the accuracy of forecasting included the timing of the introduction of both new medicines and generics, the rate of uptake of new medicines, and sudden changes in reimbursement policies. Conclusions Based on the analyses of all forecasting reports produced since the model was established in Stockholm in the late 2000s, we demonstrated that it is feasible to forecast pharmaceutical expenditure with a reasonable accuracy. A number of factors influencing the accuracy of forecasting were also identified. If forecasting is used to provide data for decisions on budget allocation and agreements between payers and providers, we advise to update the forecast as close as possible prior to the decision date.
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Affiliation(s)
- Love Linnér
- Public Healthcare Services Committee, Region Stockholm, Stockholm, Sweden
| | - Irene Eriksson
- Public Healthcare Services Committee, Region Stockholm, Stockholm, Sweden. .,Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.
| | - Marie Persson
- Public Healthcare Services Committee, Region Stockholm, Stockholm, Sweden
| | - Björn Wettermark
- Public Healthcare Services Committee, Region Stockholm, Stockholm, Sweden.,Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
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Wei M, Wang X, Zhang D, Zhang X. Relationship between the number of hospital pharmacists and hospital pharmaceutical expenditure: a macro-level panel data model of fixed effects with individual and time. BMC Health Serv Res 2020; 20:91. [PMID: 32024515 PMCID: PMC7003417 DOI: 10.1186/s12913-020-4907-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid increase in pharmaceutical expenditure (PE) has been a main problem of global healthcare reform for decades. Previous studies demonstrated that pharmacists play an indispensable role in controlling PE, but macro-research evidence is scarce. Exploring the role of pharmacists from a macro-perspective is essential for pharmacy source allocation with an advantage of extensive applicability over regions. This study aimed to explore the relationship between the number of hospital pharmacists and hospital PE and to provide a macro-perspective evidence to curb the increasing PE and decline unnecessary medications. METHODS Data were extracted from China Health Statistics Yearbook from 2011 to 2018. A panel dataset with 31 provinces from 2010 to 2017 was constructed. Amongst them, 'Number of hospital pharmacists per 1 million of population' (HLPT) was selected as an independent variable, 'Per visit of hospital outpatient pharmaceutical expenditure' (OTPE) and 'Per capita of hospital inpatient pharmaceutical expenditure' (ITPE) were selected as dependent variables, and 'Number of hospital physicians per 1 million of population' (HLPN) and 'Drug price index' (DPI) were applied as control variables. Fixed-effect panel data analysis was performed to evaluate the relationship between the number of hospital pharmacists and hospital PE. RESULTS HLPT had a significant and negative relationships with OTPE (β1 = - 0.0893, p = 0.0132) and ITPE (β1 = - 4.924, p < 0.001). Considering the control variables, the significant and negative relationships with HLPT and OTPE remained unchanged (β1 = - 0.141, p < 0.001; β1 = - 4.771, p < 0.001, respectively), indicating that an increase in hospital pharmacist per 1 million of population led to a decrease of ¥474 million ($67.4 million) OTPE and ¥902 million ($128 million) ITPE in 2017. Overall, in 2017, an increase of 1 hospital pharmacist led to a decrease of approximately ¥1 million ($142 thousands) hospital PE nationwide. CONCLUSION This study confirmed the negative relationship between hospital pharmacists and hospital PE, indicating that hospital pharmacists might play a significant role in controlling PE. Pharmacists were encouraged to participate in more drug-therapy-related activities, such as medication reconciliation.
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Affiliation(s)
- Ming Wei
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuemei Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dandan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Martínez-Gorostiaga J, Echevarría-Orella E, Calvo-Hernáez B. [Influential factors in the quality of prescription in primary care and relation to pharmaceutical expenditure]. Rev Esp Salud Publica 2019; 93:e201908054. [PMID: 31378781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/01/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE The high pharmaceutical consumption requires establishing improvement measures with the collaboration of all the agents involved. The objective of the study was to analyze the pharmaceutical expenditure generated by prescriptions made by physicians working in a primary care area and assess its relationship with the quality indicators of the prescription. METHODS The prescriptions of 200 family physicians of the Basque Health Service Araba Countyand dispensed by the community pharmacies between 2009 and 2016 were studied. The variables evaluated retrospectively corresponded to the quality indicators of the pharmaceutical prescription included in the Contract-Program of the Basque Department Health of 2016. Prediction models were developed using linear regression and binary logistic regression analysis. RESULTS The main factors which increased the pharmaceutical expenditure per person were: the use of novel drugs which do not offer therapeutic improvements, the proportion of pensioners, the use of statins and the use of antiulcer the proton pump inhibitors (PPI). On the contrary, the factors that reduced this expense were: the seniority in the medical position, the physician job stability and the prescription quality index. The profile of the doctor who generated the greatest expense of pharmaceutical prescription was mainly that of a professional who was responsible for a high percentage of pensioners, prescribed a high amount of inhibitors of the enzyme angiotensin converting enzyme inhibitors (ACEI), prescribed a high amount of first level non-steroidal anti-inflammatory drugs (NSAIDs) and also showed high use of antiulcer PPI. CONCLUSIONS There is a statistically significant correlation between physicians who generate lower pharmaceutical expenditure and have a higher quality of prescription. The most influencing factors in the pharmaceutical expenditure are a high percentage of pensioners in the medical quota, the use of novel drugs that do not provide therapeutic improvements and the prescription of statins and anti-ulcer PPI drugs.
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Affiliation(s)
- Javier Martínez-Gorostiaga
- Unidad de Farmacia. Dirección de Integración Asistencial. Organización Sanitaria Integrada Araba. Osakidetza. Vitoria-Gasteiz (Álava). España
| | - Enrique Echevarría-Orella
- Facultad de Farmacia. Departamento de Fisiología. Universidad del País Vasco (UPV/EHU). Cibersam. Vitoria-Gasteiz (Álava). España
| | - Begoña Calvo-Hernáez
- Facultad de Farmacia. Área de Farmacia y Tecnología Farmacéutica. Universidad del País Vasco (UPV/EHU). Vitoria-Gasteiz (Álava). España
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Florido Alba F, García-Agua Soler N, Martín Reyes Á, García Ruiz AJ. [Crisis, Public Spending on Health and Policy]. Rev Esp Salud Publica 2019; 93:e201902007. [PMID: 30783077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/01/2019] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE The Spanish economic crisis began in 2008 and according to the Ministry of Economy, Industry and Compe- titiveness it concluded in 2014. During the crisis the main macroeconomic indicators had an adverse evolution and the effects have lasted for more than six years to the present. Aim: To assess the influence on public spending (health and pharmaceutical) that the governing policies have had and the time of crisis suffered. METHODS Public expenditure per inhabitant (health and pharmaceutical) is compared according to the study period (pre, crisis and post), the political ideology of the ruling party (conservative/ progressive) and each autonomous community in reference to GDP per inhabitant in each of they respect the national average (poor, average or rich) according to the quartiles. The sources of the data have been the National Statistics Institute (GDP and inhabitants of each Autonomous Community and study period) and the Ministry of Health, Social Services and Equality (public health and pharmaceutical expenditure). The statistical procedures (SPSS v24) included descriptive and inferential analysis for public healthcare and pharmaceutical expenditure according to the period of study and ideology. There was also a regression fit to know the relative importance of predictor varibles. RESULTS During the crisis period there were differences in public health expenditure per inhabitant in the different types of Autonomous Communities (poor / medium / rich) and according to political ideology (p <0.05). Public pharmaceutical expenditure was € 327 / inhab (pre-crisis) to € 366 / inhabitant in the final period of the study. There were statistically significant differences in pharmaceutical expenditure according to the different types of CCAA. Likewise, differences were found in per capita pharmaceutical expenditure between the Autonomous Communities run by conservatives and type of Autonomous Communities throughout the study period. CONCLUSIONS The community pharmaceutical expenditure per capita has decreased by more than 13% since 2006 until 2017, while the hospital pharmaceutical expenditure has increased by more than 84%. Rich regions invest more in the health care costs and the poor more than drugs.
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Affiliation(s)
| | - Nuria García-Agua Soler
- Ilustre Colegio Oficial de Farmacéuticos de Málaga. Málaga. España
- Cátedra de Economía de la Salud y Uso Racional del Medicamento. Departamento de Farmacología y Terapéutica Clínica. Instituto de Investigación Biomédica de Málaga (IBIMA). Universidad de Málaga. Málaga. España
| | - Ángel Martín Reyes
- Ilustre Colegio Oficial de Farmacéuticos de Málaga. Málaga. España
- Cátedra de Economía de la Salud y Uso Racional del Medicamento. Departamento de Farmacología y Terapéutica Clínica. Instituto de Investigación Biomédica de Málaga (IBIMA). Universidad de Málaga. Málaga. España
| | - Antonio J García Ruiz
- Cátedra de Economía de la Salud y Uso Racional del Medicamento. Departamento de Farmacología y Terapéutica Clínica. Instituto de Investigación Biomédica de Málaga (IBIMA). Universidad de Málaga. Málaga. España
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Kim TH, Lee EK, Han E. Incremental impact of body mass status with modifiable unhealthy lifestyle behaviors on pharmaceutical expenditure. Res Social Adm Pharm 2016; 12:990-1003. [PMID: 26810936 DOI: 10.1016/j.sapharm.2015.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/20/2015] [Accepted: 12/20/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Overweight/obesity is a growing health risk in Korea. The impact of overweight/obesity on pharmaceutical expenditure can be larger if individuals have multiple risk factors and multiple comorbidities. The current study estimated the combined effects of overweight/obesity and other unhealthy behaviors on pharmaceutical expenditure. METHODS An instrumental variable quantile regression model was estimated using Korea Health Panel Study data. The current study extracted data from 3 waves (2009, 2010, and 2011). RESULTS The final sample included 7148 person-year observations for adults aged 20 years or older. Overweight/obese individuals had higher pharmaceutical expenditure than their non-obese counterparts only at the upper quantiles of the conditional distribution of pharmaceutical expenditure (by 119% at the 90th quantile and 115% at the 95th). The current study found a stronger association at the upper quantiles among men (152%, 144%, and 150% at the 75th, 90th, and 95th quantiles, respectively) than among women (152%, 150%, and 148% at the 75th, 90th, and 95th quantiles, respectively). The association at the upper quantiles was stronger when combined with moderate to heavy drinking and no regular physical check-up, particularly among males. CONCLUSION The current study confirms that the association of overweight/obesity with modifiable unhealthy behaviors on pharmaceutical expenditure is larger than with overweight/obesity alone. Assessing the effect of overweight/obesity with lifestyle risk factors can help target groups for public health intervention programs.
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Affiliation(s)
- Tae Hyun Kim
- Graduate School of Public Health and Institute of Health Services Research, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, 300 Cheonchoen-dong, Jangan-gu, Suwon, Gyeonggi-do 440-746, South Korea
| | - Euna Han
- College of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 162-1 Songdo-Dong, Yeonsu-Gu, Incheon, South Korea.
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Sancho-Mestre C, Vivas-Consuelo D, Alvis-Estrada L, Romero M, Usó-Talamantes R, Caballer-Tarazona V. Pharmaceutical cost and multimorbidity with type 2 diabetes mellitus using electronic health record data. BMC Health Serv Res 2016; 16:394. [PMID: 27534391 PMCID: PMC4989292 DOI: 10.1186/s12913-016-1649-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the study is to estimate the frequency of multimorbidity in type 2 diabetes patients classified by health statuses in a European region and to determine the impact on pharmaceutical expenditure. METHODS Cross-sectional study of the inhabitants of a southeastern European region with a population of 5,150,054, using data extracted from Electronic Health Records for 2012. 491,854 diabetic individuals were identified and selected through clinical codes, Clinical Risk Groups and diabetes treatment and/or blood glucose reagent strips. Patients with type 1 diabetes and gestational diabetes were excluded. All measurements were obtained at individual level. The prevalence of common chronic diseases and co-occurrence of diseases was established using factorial analysis. RESULTS The estimated prevalence of diabetes was 9.6 %, with nearly 70 % of diabetic patients suffering from more than two comorbidities. The most frequent of these was hypertension, which for the groups of patients in Clinical Risk Groups (CRG) 6 and 7 was 84.3 % and 97.1 % respectively. Regarding age, elderly patients have more probability of suffering complications than younger people. Moreover, women suffer complications more frequently than men, except for retinopathy, which is more common in males. The highest use of insulins, oral antidiabetics (OAD) and combinations was found in diabetic patients who also suffered cardiovascular disease and neoplasms. The average cost for insulin was 153€ and that of OADs 306€. Regarding total pharmaceutical cost, the greatest consumers were patients with comorbidities of respiratory illness and neoplasms, with respective average costs of 2,034.2€ and 1,886.9€. CONCLUSIONS Diabetes is characterized by the co-occurrence of other diseases, which has implications for disease management and leads to a considerable increase in consumption of medicines for this pathology and, as such, pharmaceutical expenditure.
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Affiliation(s)
- Carla Sancho-Mestre
- Research Centre for Health Economics and Management, Universitat Politècnica de València, Edificio 7J, Cno de Vera s/n., 46022 Valencia, Spain
| | - David Vivas-Consuelo
- Research Centre for Health Economics and Management, Universitat Politècnica de València, Edificio 7J, Cno de Vera s/n., 46022 Valencia, Spain
| | - Luis Alvis-Estrada
- Universidad de Cartagena, Av. del Consulado # Calle 30 No. 48 – 152, Cartagena, Bolívar Colombia
| | - Martin Romero
- Fundación Salutia, Carrera 71B # 116A-12, PBX: [571] Bogotá D.C, Colombia
| | - Ruth Usó-Talamantes
- Valencian Health Department (Conselleria de Sanitat), General Directorate of Pharmacy and Pharmaceutical Products, Valencia, Spain
| | - Vicent Caballer-Tarazona
- Research Centre for Health Economics and Management, Universitat Politècnica de València, Edificio 7J, Cno de Vera s/n., 46022 Valencia, Spain
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Mujasi PN, Puig-Junoy J. What variables should be considered in allocating Primary health care Pharmaceutical budgets to districts in Uganda? J Pharm Policy Pract 2015; 8:3. [PMID: 25815198 DOI: 10.1186/s40545-014-0023-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/11/2014] [Indexed: 11/14/2022] Open
Abstract
Objectives A key policy question for the government of Uganda is how to equitably allocate primary health care pharmaceutical budgets to districts. This paper seeks to identify variables influencing current primary health care pharmaceutical expenditure and their usefulness in allocating prospective pharmaceutical budgets to districts. Methods This was a cross sectional, retrospective observational study using secondary administrative data. We collected data on the value of pharmaceuticals procured by primary health care facilities in each district from National Medical Stores for the financial year 2011/2012. The dependent variable was expressed as per capita district pharmaceutical expenditure. By reviewing literature we identified 26 potential explanatory variables. They include supply, need and demand, and health system organization variables that may influence the demand and supply of health services and the corresponding pharmaceutical expenditure. We collected secondary data for these variables for all the districts in Uganda (n = 112). We performed econometric analysis to estimate parameters of various regression models. Results There is a significant correlation between per capita district pharmaceutical expenditure and total district population, rural poverty, access to drinking water and outpatient department (OPD) per capita utilisation.(P < 0.01). The percentage of health centre IIIs (HC III) among each district’s health facilities is significantly correlated with per capita pharmaceutical expenditure (P < 0.05). OPD per capita utilisation has a relatively strong correlation with per capita pharmaceutical expenditure (r = 0.498); all the other significant factors are weakly correlated with per capita pharmaceutical expenditure (r < 0.5). From several iterations of an initially developed model, the proposed final model for explaining per capita pharmaceutical expenditure explains about 53% of the variation in pharmaceutical expenditure among districts in Uganda (Adjusted R2 = 0.528). All variables in the model are significant (p < 0.01). Conclusions From evaluation of the various models, proposed variables to consider in allocating prospective primary health care pharmaceutical budgets to districts in Uganda are: district outpatient department attendance per capita, total district population, total number of government health facilities in the district and the district human poverty index.
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