Patients’ knowledge and attitude towards therapeutic reference pricing system in Slovenia

Patient views of therapeutic interchange of ACE inhibitors in Australian primary care: a qualitative study

OBJECTIVES

In Australia, therapeutic interchange of angiotensin-converting enzyme (ACE) inhibitors could generate savings for patients and the Pharmaceutical Benefits Scheme (PBS). The PBS subsidises nine drugs in the ACE inhibitor class. These drugs are therapeutically equivalent, but the price varies between each drug. Patients are key players in successful therapeutic interchange programmes, but little is known about their views. This study aims to explore patient views of therapeutic interchange of ACE inhibitors in Australian primary care.

DESIGN

Qualitative exploratory research study using semi-structured interviews, asking participants about therapeutic interchange and their attitude towards hypothetically switching ACE inhibitors. Data were analysed thematically.

SETTING

Australian primary care.

PARTICIPANTS

Fourteen adults in Australia currently taking an ACE inhibitor, recruited via general practices and pharmacies, social media and professional networks.

FINDINGS

Five key themes were identified: participants' limited understanding of medication; the expectation that a new drug would be 'the same'; the view that choice, convenience and fear of change outweigh the cost; altruism; and trust in health professionals, particularly participants' own general practitioner (GP).

CONCLUSIONS

Patients' limited understanding of medication changes poses a barrier to therapeutic interchange. Clinicians should explore patients' understanding and expectations of therapeutic interchange. Counselling from trusted health professionals, particularly GPs, could ameliorate concerns. Policymakers implementing therapeutic interchange programmes should ensure a trusted GP directs medication changes.

Introduction of therapeutic reference pricing in Slovenia and its economic consequences

OBJECTIVES

To evaluate the economic outcomes that arose from the introduction of therapeutic reference pricing (TRP) into Slovenian practice in 2013, based on the first three therapeutic classes, namely proton-pump inhibitors (PPIs), angiotensin-converting-enzyme inhibitors (ACEIs), and lipid-lowering agents (LLAs).

METHODS

National health claims data on prescription medicines from January 2011 to December 2015 were analyzed. Monthly medicine expenditure, medicine consumption, changes in medicine use, and market competition (Herfindahl-Hirschman index) were determined to assess the TRP impact on market dynamics. Interrupted time series analysis was used to assess the TRP cost-saving potential.

RESULTS

Medicine expenditure in all three therapeutic classes was decreasing prior to TRP; however, with the TRP introduction, the cost for ACEIs and LLAs fell 25 and 45%, respectively. The costs for PPIs decreased by 10%, but the cost reductions before TRP were greater. After TRP introduction, the downward trend for monthly medicine expenditure was less steep; coefficient changes from -20,798 to -363 for PPIs (p < 0.001), from -18,175 to -4862 for ACEIs (p = 0.001) and from -10,669 to -2761 for LLAs (p = 0.105) were observed. Consumption of any therapeutic class or their market competition were not changed significantly. An increased use of the reference pantoprazole (PPIs) was observed and the market position of ezetimibe was deteriorated significantly after TRP introduction. However, the demand for the references simvastatin (LLAs) and ramipril (ACEIs) did not increase.

CONCLUSIONS

The Slovenian TRP system was established as an effective cost-containment measure. However, pitfalls arising from a country-specific TRP should be considered when introducing this policy.