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Zhang Q, Wang R, Chen L, Chen W. Effect of China national centralized drug procurement policy on anticoagulation selection and hemorrhage events in patients with AF in Suining. Front Pharmacol 2024; 15:1365142. [PMID: 38444941 PMCID: PMC10912648 DOI: 10.3389/fphar.2024.1365142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
Background: Launched in March 2019, the National Centralized Drug Procurement (NCDP) initiative aimed to optimize the drug utilization framework in public healthcare facilities. Following the integration of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) into the procurement catalog, healthcare establishments in Suining swiftly transitioned to the widespread adoption of NOACs, beginning 1 March 2020. Objective: This study aims to comprehensively assess the impact of the NCDP policy on the efficacy of anticoagulation therapy, patient medication adherence, and the incidence of hemorrhagic events in individuals with non-valvular atrial fibrillation (NVAF) residing in Suining. The analysis seeks to elucidate the broader impacts of the NCDP policy on this patient demographic. Methods: This study analyzed patient hospitalization records from the Department of Cardiology at Suining County People's Hospital, spanning 1 January 2017, to 30 June 2022. The dataset included demographic details (age, sex), type of health insurance, year of admission, hospitalization expenses, and comprehensive information on anticoagulant therapy utilization. The CHA2DS2-VASc scoring system, an established risk assessment tool, was used to evaluate stroke risk in NVAF patients. Patients with a CHA2DS2-VASc score of 2 or higher were categorized as high-risk, while those with scores below 2 were considered medium or low-risk. Results: 1. Treatment Cost Analysis: The study included 3,986 patients diagnosed with NVAF. Following the implementation of the NCDP policy, a significant increase in the average treatment cost for hospitalized patients was observed, rising from 8,900.57 ± 9,023.02 CNY to 9,829.99 ± 10,886.87 CNY (p < 0.001). 2. Oral Anticoagulant Utilization: Overall, oral anticoagulant use increased from 40.02% to 61.33% post-NCDP (p < 0.001). Specifically, NOAC utilization among patients dramatically rose from 15.41% to 90.99% (p < 0.001). 3. Hemorrhagic Events: There was a significant decrease in hemorrhagic events following the NCDP policy, from 1.88% to 0.66% (p = 0.01). Hypertension [OR = 1.979, 95% CI (1.132, 3.462), p = 0.017], history of stroke [OR = 1.375, 95% CI (1.023, 1.847), p = 0.035], age ≥65 years [OR = 0.339, 95% CI (0.188, 0.612), p < 0.001], combination therapy of anticoagulants and antiplatelets [OR = 3.620, 95% CI (1.752, 7.480), p < 0.001], hepatic and renal insufficiency [OR = 4.294, 95% CI (2.28, 8.084), p < 0.001], and the NCDP policy [OR = 0.295, 95% CI (0.115, 0.753), p = 0.011] are significant risk factors for bleeding in patients with atrial fibrillation. 4. Re-hospitalization and Anticoagulant Use: Among the 219 patients requiring re-hospitalization, there was a notable increase in anticoagulant usage post-NCDP, from 36.07% to 59.82% (p < 0.001). NOACs, in particular, saw a substantial rise in usage among these patients, from 11.39% to 80.92% (p < 0.001). 5. Anticoagulant Type Change: The NCDP policy [OR = 28.223, 95% CI (13.148, 60.585), p < 0.001] and bleeding events [OR = 27.772, 95% CI (3.213, 240.026), p = 0.003] were significant factors influencing the alteration of anticoagulant medications in patients. Conclusion: The NCDP policy has markedly improved anticoagulation management in patients with AF. This policy has played a crucial role in enhancing medication adherence and significantly reducing the incidence of hemorrhagic events among these patients. Additionally, the NCDP policy has proven to be a key factor in guiding the selection and modification of anticoagulant therapies in the AF patient population.
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Affiliation(s)
- Qi Zhang
- Suining County People’s Hospital, Suining, China
| | - Ruili Wang
- Suining County People’s Hospital, Suining, China
| | - Lei Chen
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wensu Chen
- Suining County People’s Hospital, Suining, China
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Wang X, Huang H, Sun Y, Zhu Z, Jiang B, Yang L. Effects of volume-based procurement policy on the usage and expenditure of first-generation targeted drugs for non-small cell lung cancer with EGFR mutation in China: an interrupted time series study. BMJ Open 2023; 13:e064199. [PMID: 37407064 DOI: 10.1136/bmjopen-2022-064199] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES In December 2018, China launched national volume-based procurement (NVBP) to negotiate drug prices with manufacturers. Gefitinib was one of the 25 pilot drugs, which is used for treatment of non-small cell lung cancer. Lung cancer is the most common type of cancer in China and targeted drugs like gefitinib have been proven to provide clinical benefits to patients. This study aims to explore the impact of NVBP policy on the usage and expenditure of anticancer drugs. METHODS Gefitinib and alternative drugs (icotinib and erlotinib) were used as objects of study. Quarterly data from the China Hospital Pharmaceutical Audit database in 9454 hospitals in China were used for analysis. Descriptive analysis was conducted using purchase volume and expenditure as variables. Interrupted time-series (ITS) analysis was applied to further analyse the effect of NVBP policy on the medicines under study. RESULTS During the 12-month period before (2018Q2-2019Q1) and after (2019Q2-2020Q1) the NVBP policy, the total purchase volume of medicines rose from 4.48 million defined daily dose (DDD) to 7.02 million DDD, with an increase of 56.66%. Purchase volume of gefitinib and alternative drugs increased 100.61% and 14.88%, respectively. After the implementation of NVBP policy, procurement volume of alternative drugs decreased by 72 051 DDD (p value=0.044) and trend change decreased by 56 738 DDD (p value<0.01). The overall expenditure reduction was 14.7%, with the expenditure of gefitinib reducing by 38.47% and alternative drugs increasing by 10.70%. ITS analysis indicated statistically significant differences in level and trend changes for expenditure of total drugs and gefitinib. CONCLUSIONS The evidence provided in this study indicated that the implementation of NVBP policy was related to the expenditure reduction of the first generation of anti-EGFR lung cancer drugs. The policy effectively controlled the increase in expenditures for corresponding drugs while ensuring the use of drugs.
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Affiliation(s)
- Xiaoyang Wang
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Huang Huang
- Public Policy Research Center, Peking University, Beijing, China
| | - Yan Sun
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zheng Zhu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Bin Jiang
- Public Policy Research Center, Peking University, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Li Yang
- School of Public Health, Peking University Health Science Center, Beijing, China
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3
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Répásy B, Gazsó T, Elmer D, Pónusz-Kovács D, Kajos FL, Csákvári T, Kovács B, Boncz I. The long-term effect of generic price competition on the Hungarian statin market. BMC Health Serv Res 2023; 23:447. [PMID: 37147682 PMCID: PMC10163807 DOI: 10.1186/s12913-023-09431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/20/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Generic competition is a vital health policy tool used in regulating the pharmaceutical market. Drug group HMG-CoA reductase (3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase) inhibitors, widely known as "statins," was the first drug group in Hungary in which generic prescriptions became mandatory. Our aim is to analyze the changes in the retail and wholesale margins through the generic competition regarding "statins". METHODS Data was derived from the nationwide pharmaceutical database of the Hungarian National Health Insurance Fund Administration, the only health care financing agency in Hungary. We observed the turnover data regarding the HMG-CoA-reductase inhibitor "statins" from 2010 through 2019. As the drugs under review have a fixed price point in Hungary, we effectively calculated the margins. RESULTS In 2010, the consumer expenditure of statins was 30.7 billion HUF ($148 million), which decreased by 59%, to 12.5 billion HUF ($42.9 million) in 2019. In 2010, the annual health insurance reimbursement of statins was 23.7 billion HUF ($114 million), which underwent a 63% decrease to 8.6 billion HUF ($29.7 million) in 2019. In 2010, the DOT turnover was 287 million days, and it increased to above 346 million days for 2019, which reflects a 20% increase over the past nine years. The monthly retail margins decreased from 334 million HUF ($1.6 million), (January, 2010) to 176 million HUF ($0.61 million), (December, 2019). The monthly wholesale margins decreased from 96.3 million HUF ($0.46 million), (January, 2010) to 41.4 million HUF ($0.14 million), (December, 2019). The most significant downturn in margins was due to the introduction of the first two blind bids. The combined DOT turnover in reference to the examined 43 products consistently increased. CONCLUSIONS The decline in retail and wholesale margin and in health insurance expenditures was largely due to a reduction in the consumer price of generic medicines. DOT turnover of statins also increased significantly.
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Affiliation(s)
- Balázs Répásy
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
| | - Tibor Gazsó
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
| | - Diána Elmer
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Dalma Pónusz-Kovács
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Fanni Luca Kajos
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Tímea Csákvári
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Bettina Kovács
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
| | - Imre Boncz
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary.
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary.
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Kim W, Koo H, Lee HJ, Han E. The Effects of Cost Containment and Price Policies on Pharmaceutical Expenditure in South Korea. Int J Health Policy Manag 2022; 11:2198-2207. [PMID: 34814666 PMCID: PMC9808296 DOI: 10.34172/ijhpm.2021.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/19/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Policy-makers have proposed and implemented various cost-containment policies for drug prices and quantities to regulate rising pharmaceutical spending. Our study focused on a major change in pricing policy and several incentive schemes for curbing pharmaceutical expenditure growth during the 2010s in Korea. METHODS We constructed the longitudinal dataset from 2008-2017 for 12 904 clinics to track the prescriber behavior before and after the implemented policies. Applying an interrupted time series model, we analyzed changes in trends in overall monthly drug expenditure and antibiotic drug expenditure per prescription for outpatient claims diagnosed with three major diseases before and after the policies' implementation. RESULTS Significant price reductions and incentives for more efficient drug prescriptions resulted in an immediate decrease in monthly drug expenditures in clinics. However, we found attenuated effects over the long run. The top-spending clinics showed the highest rate of increase in drug costs. CONCLUSION Future policy interventions can maximize their effects by targeting high-spending providers.
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Affiliation(s)
- Woohyeon Kim
- Korea Institute of Public Finance, Sejong, South Korea
| | - Heejo Koo
- College of Pharmacy, Yonsei Institute of Pharmaceutical Research, Yonsei University, Seoul, South Korea
| | - Hye-Jae Lee
- College of Pharmacy, Woosuk University, Wanju, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Research, Yonsei University, Seoul, South Korea
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Wen X, Wang Z, Xu L, Luo J, Geng X, Chen X, Yang Y, Cui D, Mao Z. The impacts of the “4+7” pilot policy on the volume, expenditures, and daily cost of Serotonin-Specific Reuptake Inhibitors (SSRIs) antidepressants: A quasi-experimental study. Front Pharmacol 2022; 13:829660. [PMID: 36060003 PMCID: PMC9428282 DOI: 10.3389/fphar.2022.829660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/21/2022] [Indexed: 12/19/2022] Open
Abstract
Objectives: The purpose of this study was to quantitatively evaluate the impacts of the”4 + 7” pilot policy on purchase volume, purchase expenditures, and daily cost and to find the changes in the use of SSRIs. Methods: Data was collected covering 31 months, before, during, and after the “4 + 7” pilot policy was implemented in Shenzhen. Interrupted time-series (ITS) analysis was used to examine whether there had been a significant effect with the onset of the “4 + 7” pilot policy in March 2019. Findings: The daily cost of policy-related drugs had a substantial drop of 2.93 yuan under the “4 + 7” pilot policy. The result has shown a 76.70% increase in volume and a 3.39% decrease in the expenditure on policy-related drugs. This study found that the “4 + 7” pilot policy increased the proportion of purchasing winning drugs, with an increment of 85.60 percent. After the implementation of the “4 + 7” pilot policy, policy-related drugs decreased by 443.55thousand Chinese yuan. The study indicated that volume of winning products significantly increased as shown in the regression with a level coefficient (β2) of -224.17 (p < 0.001) and trend coefficient (β3) of 15.74 (p < 0.001). The result revealed that both volume and expenditures on branded products showed a significant decrease in the regression in the post-intervention period (level coefficient of volume: β2 = -57.65, p < 0.01, trend coefficient of volume: β3 = -3.44, p < 0.01; level coefficient of expenditure: β2 = -712.98, p < 0.01, trend coefficient of expenditure: β3 = -40.10, p < 0.01). Conclusion: The volume-based procurement has successfully led to price reductions and improved the affordability of medicines, especially for those with chronic diseases. The volume-based procurement has demonstrated initial success in reshaping the composition of the Chinese pharmaceutical market in favor of generics with high quality and low prices.
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Affiliation(s)
- Xiaotong Wen
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
- *Correspondence: Xiaotong Wen, ; Dan Cui, ; Zongfu Mao,
| | - Zhaolun Wang
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Luxinyi Xu
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Jia Luo
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Xin Geng
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Xiaoze Chen
- Xi’an Jiao Tong Liverpool University, Suzhou, China
| | - Ying Yang
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Dan Cui
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
- *Correspondence: Xiaotong Wen, ; Dan Cui, ; Zongfu Mao,
| | - Zongfu Mao
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
- *Correspondence: Xiaotong Wen, ; Dan Cui, ; Zongfu Mao,
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6
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Wen X, Yin S, Cui L, Mao L, Lin Z, Yaermaimaiti Z, Geng X, Li Y, Yang Y, Cui D, Mao Z. The Effects of the National Centralized Drug Purchasing Pilot Program on Nucleos(t)ide Analogs in Shenzhen City: An Interrupted Time Series Analysis. Front Public Health 2021; 9:718013. [PMID: 34760861 PMCID: PMC8572971 DOI: 10.3389/fpubh.2021.718013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/21/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives: To assess the effects of the National Centralized Drug Purchasing Pilot Program on nucleos(t)ide analogs (NAs) in Shenzhen city. Methods: Drugs procurement records in medical institutions were analyzed covering the period from January 2018 to December 2019. An interrupted time series (ITS) analysis was used to evaluate the impact of the "4+7" pilot policy on NAs in Shenzhen city. The outcome measures were usage volume, expenditures, daily cost, and distribution structure of NAs. Findings: After the introduction of the "4+7" pilot policy, the defined daily doses (DDDs) of NA drugs increased by 76.48%, the expenditures and defined daily dose cost (DDDc) of NAs decreased by 45.43 and 69.08%, respectively. The proportion of winning products in Entecavir and Tenofovir Fumarate DDDs was increased by 64.21 and 19.20%, respectively. The post-intervention period witnessed a significant increase in the regression level for NAs DDDs (level coefficient: β2 = 631.87, p < 0.05). The expenditures (trend coefficient: β3 = 392.24, p < 0.05) and DDDc (level coefficient: β2 = -6.17, p < 0.001; trend coefficient: β3 = -0.21, p < 0.05) of NAs showed decreasing trend in the post-intervention period. The expenditures of original products and generic products both showed a decreasing trend in the post-intervention period (trend coefficient: β3 = -372.78, p < 0.05, trend coefficient: β3 = -130.78, p < 0.05, respectively). The DDDc of original products in the policy-related varieties was a significant decrease in the regression slope and level (level coefficient: β2 = -2.18, p < 0.05; trend coefficient: β3 = -0.32, p < 0.01). Conclusion: After the implementation of the"4+7" policy, the DDDc of NAs decreased, the accessibility of policy-related drugs was improved, and the usage of generic medicine was promoted.
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Affiliation(s)
- Xiaotong Wen
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Shicheng Yin
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Lanyue Cui
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lining Mao
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Zhaoyu Lin
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Zilalai Yaermaimaiti
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Xin Geng
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Yingxia Li
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Ying Yang
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Dan Cui
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Zongfu Mao
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
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Yang Y, Chen L, Ke X, Mao Z, Zheng B. The impacts of Chinese drug volume-based procurement policy on the use of policy-related antibiotic drugs in Shenzhen, 2018-2019: an interrupted time-series analysis. BMC Health Serv Res 2021; 21:668. [PMID: 34238290 PMCID: PMC8265121 DOI: 10.1186/s12913-021-06698-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/24/2021] [Indexed: 12/19/2022] Open
Abstract
Background In 2019, Chinese government implemented volume-based procurement of 25 drugs in 4 municipalities and 7 sub-provincial cities, i.e. “4 + 7” policy. Competitive bidding was conducted by the government based on the annual agreed procurement volume submitted by each public medical institution in pilot cities. Pilot cities were required to implement bid winning results in March 2019 and the use volume of bid winning products was examined to ensure the completion of agreed procurement volume. In the policy, an oral antibiotic (cefuroxime) was included. Given the current condition of the irrational use of antibiotics in China, this study aims to evaluate the impact of “4 + 7” policy on the use of policy-related antibiotics. Methods This study used drug purchase data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Oral antibiotic drugs related to “4 + 7” policy were selected as study samples, including cefuroxime and 12 antibiotic drugs that have an alternative relationship with cefuroxime in clinical use. Purchase volume and expenditures were selected as outcome variables, and were measured using Defined Daily Doses (DDDs) and Chinese yuan, respectively. Segmented linear regression analysis with interrupted time series was adopted to examine the effect of “4 + 7” policy. Results After the implementation of “4 + 7” policy, the overall volume of cefuroxime and its alternative drugs increased from 9.47 million DDDs to 13.42 million DDDs, with an increase of 41.8 %. The results of segmented linear regression showed that the volume of cefuroxime significantly increased 161.16 thousand DDDs after “4 + 7” policy (95 % CI: 59.43 to 262.90, p-value = 0.004). The volume of alternative drugs significantly increased 273.65 thousand DDDs (95 % CI: 90.17 to 457.12, p-value = 0.006). The overall “4 + 7” policy-related antibiotics significantly increased 436.31 thousand DDDs (95 % CI: 190.81 to 681.81, p-value = 0.001) after “4 + 7” policy. Conclusions This study provides evidence that the implementation of “4 + 7” volume-based procurement policy was associated with significant increases in the volume of policy-related antibiotic drugs. The increase in antibiotic use after the policy needs special attention and vigilance. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06698-5.
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Affiliation(s)
- Ying Yang
- School of Health Sciences, Wuhan University, 115# Donghu Road, 430071, Wuhan, China.,Global Health Institute, Wuhan University, 115# Donghu Road, 430071, Wuhan, China
| | - Lei Chen
- School of Health Sciences, Wuhan University, 115# Donghu Road, 430071, Wuhan, China
| | - Xinfeng Ke
- School of Health Sciences, Wuhan University, 115# Donghu Road, 430071, Wuhan, China
| | - Zongfu Mao
- School of Health Sciences, Wuhan University, 115# Donghu Road, 430071, Wuhan, China. .,Global Health Institute, Wuhan University, 115# Donghu Road, 430071, Wuhan, China.
| | - Bo Zheng
- Institute of Clinical Pharmacology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China. .,Department of Pharmacy, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China.
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Chen L, Yang Y, Luo M, Hu B, Yin S, Mao Z. The Impacts of National Centralized Drug Procurement Policy on Drug Utilization and Drug Expenditures: The Case of Shenzhen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249415. [PMID: 33334027 PMCID: PMC7765443 DOI: 10.3390/ijerph17249415] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 02/08/2023]
Abstract
In 2019, the Chinese government implemented the first round of the National Centralized Drug Procurement (NCDP) pilot (so-called “4 + 7” policy) in mainland China, in which 25 drugs were included. We conducted this study to examine the impacts of NCDP policy on drug utilization and expenditures, and to clarify the main factors contributing to drug expenditure changes. This study used drug purchasing order data from the Centralized Drug Procurement Survey in Shenzhen 2019. Drugs related to the “4 + 7” policy were selected as study samples, including 23 “4 + 7” policy-related varieties and 15 basic alternative drugs. Driving factors for drug expenditures changes were analyzed using A.M. index system analysis (Addis A. & Magrini N.’ method). After the implementation of the NCDP policy, the volume of “4 + 7” policy-related varieties increased by 73.8%, among which winning products jumped by 1638.2% and non-winning products dropped by 70.8%; the expenditures of “4 + 7” policy-related varieties decreased by 36.9%. Structure effects (0.47) and price effects (0.78) negatively contributed to the increase in drug expenditures of “4 + 7” policy-related varieties, while volume effects (1.73) had positive influence. NCDP policy successfully decreased drug expenditures of “4 + 7” policy-related varieties with structure effects playing a leading role. However, total drug expenditures were not effectively controlled due to the increasing use of alternative drugs.
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Affiliation(s)
- Lei Chen
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Ying Yang
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Mi Luo
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
| | - Borui Hu
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
| | - Shicheng Yin
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
| | - Zongfu Mao
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
- Correspondence: ; Tel.: +86-27-6875-9118
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Kim S, Lee JH. Price-Cutting Trends in New Drugs after Listing in South Korea: The Effect of the Reimbursement Review Pathway on Price Reduction. Healthcare (Basel) 2020; 8:healthcare8030233. [PMID: 32722530 PMCID: PMC7551345 DOI: 10.3390/healthcare8030233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 01/29/2023] Open
Abstract
This study aims to analyze the trends of post-listing price changes for new drugs listed from 2007, when the health technology assessment (HTA) was introduced in South Korea, until 2017. We analyzed 135 products that have undergone price cuts. These products were analyzed by their respective review pathways, namely, pharmaco-economic study (PE), weighted average price (WAP), and the without a cost-effectiveness (CE) pathway. Prices were discounted faster in PE than in WAP (p = 0.002 in a comparison between PE and WAP). In addition, the median discount rate of the first price cut was 5.0% (range: 0.1–20.0) for PE, 3.0% (range: <0.1–30.0) for WAP, and 5.0% (range: 0.6–10.9) without a CE pathway. The median cumulative discount rate of PE and WAP showed that the PE pathway products’ discount rates were higher: 10.4% for PE and 6.0% for WAP (p = 0.025 for comparison between PE and WAP). It is necessary to discuss the practical effects of the price-cutting system from a myriad of perspectives, including insurance finance, the value of new drugs, and the accessibility of new drugs to patients.
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Affiliation(s)
- Sungju Kim
- Healthcare Group, Lee & Ko, Seoul 04532, Korea;
| | - Jong Hyuk Lee
- Department of Pharmaceutical Engineering, College of Life and Health Sciences, Hoseo University, Asan 31499, Korea
- Correspondence: ; Tel.: +82-41-540-9814
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10
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Guan X, Wushouer H, Yang M, Han S, Shi L, Ross-Degnan D, Wagner AK. Influence of government price regulation and deregulation on the price of antineoplastic medications in China: a controlled interrupted time series study. BMJ Open 2019; 9:e031658. [PMID: 31784440 PMCID: PMC6924745 DOI: 10.1136/bmjopen-2019-031658] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In October 2012, the Chinese government established maximum retail prices for specific products, including 30 antineoplastic medications. Three years later, in June 2015, the government abolished price regulation for most medications, including all antineoplastic medications. This study examined the impacts of regulation and subsequent deregulation of prices of antineoplastic medications in China. METHODS Using hospital procurement data and an interrupted time series with comparison series design, we examined the impacts of the policy changes on relative purchase prices (Laspeyres price index) and volumes of and spending on 52 antineoplastic medications in 699 hospitals. We identified three policy periods: prior to the initial price regulation (October 2011 to September 2012); during price regulation (October 2012 to June 2015); and after price deregulation (July 2015 to June 2016). RESULTS During government price regulation, compared with price-unregulated cancer medications (n=22, mostly newer targeted products), the relative price of price-regulated medications (n=30, mostly chemotherapeutic products) decreased significantly (β=-0.081, p<0.001). After the government price deregulation, no significant price change occurred. Neither government price regulation nor deregulation had a significant impact on average volumes of or average spending on all antineoplastic medications immediately after the policy changes or in the longer term (p>0.05). CONCLUSION Compared with unregulated antineoplastics, the prices of regulated antineoplastic medications decreased after setting price caps and did not increase after deregulation. To control the rapid growth of oncology medication expenditures, more effective measures than price regulation through price caps for traditional chemotherapy are needed.
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Affiliation(s)
- Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Haishaerjiang Wushouer
- Center for Strategic Studies, Chinese Academy of Engineering, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Mingchun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Sheng Han
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Anita Katharina Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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11
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Kang SO, Kim SJ, Park S, Jang SI, Park EC. Do cost containment policies save money and influence physicians' prescribing behavior? Lessons from South Korea's drug policy for diabetes medication. Int J Qual Health Care 2019; 31:96-102. [PMID: 29788203 DOI: 10.1093/intqhc/mzy114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 04/08/2018] [Accepted: 04/30/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We evaluate the effects of drug price reduction policy on pharmaceutical expenditure and prescription patterns in diabetes medication. DESIGN An interrupted time series study design using generalized estimating equations. SETTING This study used National Health Insurance claim data from 2010 to 2013. PARTICIPANTS A total of 68 127 diabetes patients and 12 465 hospitals. INTERVENTION(S) The drug price reduction policy. MAIN OUTCOME MEASURES The primary outcome is pharmaceutical expenditure and prescription rate. To evaluate changes in prescription rate, we measured prescription rates such a brand-name drug and drug price reduction rate. RESULTS Although the drug price reduction policy associated with decreased pharmaceutical expenditure (-13.22%, P < 0.0001), the trend (-0.01%, P = 0.9201) did not change significantly compared with the pre-intervention period. In addition, the trends in the monthly prescription rate of brand-name drugs decreased (-0.14%, P = 0.0091), while the immediate change was an increase (5.72%, P < 0.0001). Regardless of the drug reduction rate, the prescription rate after the introduction of the drug price reduction policy decreased compared with the pre-intervention period, and this decline was significant for reduction rates of 0% (-2.74%, P < 0.0001) and 10% (-0.13%, P = 0.0018). CONCLUSIONS Our results provide evidence of the effects of the drug price reduction policy on pharmaceutical expenditure and prescription patterns. This policy did not affect the prescribing behavior of healthcare providers and did not increase the use of drugs not subject to this policy. Although this study did not observe changes in the cost of pharmaceuticals after the introduction of the drug price reduction policy, further research is needed on the long-term changes in such costs.
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Affiliation(s)
- Shin-On Kang
- Department of Value Demonstration & Access, Shire Pharmaceuticals Korea, Seoul, Republic of Korea
| | - Seung Ju Kim
- Department of nursing, College of Nursing, Eulji University, Seongnam, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sohee Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
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12
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Selvaraj S, Farooqui HH, Mehta A. Does price regulation affect atorvastatin sales in India? An impact assessment through interrupted time series analysis. BMJ Open 2019; 9:e024200. [PMID: 30679294 PMCID: PMC6347882 DOI: 10.1136/bmjopen-2018-024200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine the impact of medicines price regulation (Drug Price Control Order, 2013) on the market share of atorvastatin in the Indian retail market for statins. SETTING All Indian states, January 2012 to December 2015. DESIGN Quasi-experimental-interrupted time series analysis. DATA Pharmaceutical sales audit data set from IMS Health (now IQVIA) for the 48-month period from January 2012 to December 2015. OUTCOME MEASURE Share of atorvastatin (in percentage) in the Indian market for statins in terms of sales volumes. RESULTS We observed that the price regulation notification (Drug Price Control Orders, 2013) was associated with 0.12% (p<0.001; 95% CI 0.06 to 0.18) increase in the trend of the average monthly market share of atorvastatin (5 mg and 10 mg). After 31 months of price ceilings notification, the average market share of atorvastatin was 3.41% higher than would have been expected had the price ceilings not been notified. In sensitivity analysis, with a control, our findings remain robust, we observed a 0.16% (p<0.001; 95% CI 0.08 to 0.24) rise in the trend of average monthly market share of atorvastatin (5 mg and 10 mg) as compared with the change in the control. CONCLUSIONS Price control as a public intervention did improve the relative sales of atorvastatin in the statin market in India.
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Affiliation(s)
- Sakthivel Selvaraj
- Health Economics and Financing, Public Health Foundation of India, New Delhi, Delhi, India
| | - Habib Hasan Farooqui
- Indian Institute of Public Health - Delhi, Public Health Foundation of India, New Delhi, Delhi, India
| | - Aashna Mehta
- Health Economics and Financing, Public Health Foundation of India, New Delhi, Delhi, India
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Kwon HY, Bae S, Choi SE, Park S, Lee EK, Park S, Kim J. Easy cuts, easy rebound: Drug expenditures with massive price cuts in Korea. Health Policy 2018; 123:388-392. [PMID: 30503763 DOI: 10.1016/j.healthpol.2018.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/31/2018] [Accepted: 11/04/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUNDS Since 2012, the Korean government has introduced 46.5% price cut for off-patent medicines in order to reign everescalating drug expenditure. This study sought to appraise the impact of the price cut measure (in the context of Korean National Health Insurance system). METHODS We employed Korean National Health Insurance database from January 2007 until December 2016 for 120 month period. An interrupted time series analysis with segmented regression analysis was conducted to estimate the impact of price cut on overall drug spending. RESULTS Drug spending significantly dropped with the price cut by 186.22 billlion Korean Won (KRW) (p < 0.0001) and the trend after the price cut has also significantly decreased by 1.33 billion KRW (p = 0.002). However, it was predicted that total expenditures showed an increasing trend and bounced back to the original level. Quantity prescribed had no significance with the price cut. Unit price had a substantial drop (β = -41.68, p < 0.0001) with the price-cut, but the trend after the intervention has increased (β = 0.16, p = 0.656) with no significance. CONCLUSIONS Although the price cut has successfully countered the everescalating pharmaceutical expenditures in Korea, the impact was temporary. A lack of demand-side measures resulted in an ineffectiveness and unsustainability of policy effect. Thus, more aggressive demand-side measures should be introduced in the Korean context,and both the demand and supply-sides should be balanced.
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Affiliation(s)
- Hye-Young Kwon
- Division of Biology & Public Health, Mokwon University, Daejeon, Republic of Korea
| | - Seungjin Bae
- College of Pharmacy, Ewha Women's University, Seoul, Republic of Korea.
| | - Sang-Eun Choi
- College of Pharmacy, Korea University, Osong, Republic of Korea
| | - Sylvia Park
- Korean Institute of Health and Social Affairs, Sejong, Republic of Korea
| | - Eui-Kyung Lee
- College of Pharmacy, Sungkyunkwon University, Suwon, Republic of Korea
| | | | - Jinhyun Kim
- College of Nursing, Seoul National University, Seoul, Republic of Korea.
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14
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Suh HS, Kim JA, Lee IH. Effects of a price cut reform on the cost and utilization of antidiabetic drugs in Korea: a national health insurance database study. BMC Health Serv Res 2018; 18:429. [PMID: 29879966 PMCID: PMC5992837 DOI: 10.1186/s12913-018-3255-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the potential widespread application and a significant need, the policy effectiveness of prescribed medications price controls has not been studied extensively. We aimed to explore the effects of a price cut introduced in April 1st of 2012 on the cost and utilization of antidiabetics in South Korea. METHODS We identified approximately four million outpatients who filed at least one diabetes-related claim during the index period (January 2010 to December 2012) using the National Health Insurance claims data. We performed interrupted time series analyses for cost and utilization of "overall," "reduced price," and "constant price" antidiabetics between January 2009 and June 2013, and measured the growth rate for incidents of medical and surgical procedures for diabetes-induced complications. RESULTS The segmented regression suggests that spending on overall and reduced price antidiabetics would drop by 6 and 23%, respectively; spending on constant price antidiabetics would rise by 16% in a year after the new pricing compared to if the policy were not in existence. There were a few immediate changes in utilization, and its trend indicated a significant decrease in reduced price antidiabetics and an increase in constant price antidiabetics. Incidents of medical and surgical procedures relating to diabetic complications were unaffected. CONCLUSIONS The Korean price cut program contained costs by immediately reducing the cost of pharmaceuticals without any major signals associated with compromised clinical conditions in diabetic patients.
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Affiliation(s)
- Hae Sun Suh
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Jee-Ae Kim
- Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Iyn-Hyang Lee
- College of Pharmacy, Yeungnam University, 280 Daehak-ro, Gyeongsan, Gyeongbuk-do, 38541, South Korea.
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15
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Guan X, Yang M, Man C, Tian Y, Shi L. The effect of the implementation of low price medicine policy on medicine price in China: A retrospective study. Int J Health Plann Manage 2018; 33. [PMID: 29709071 DOI: 10.1002/hpm.2537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/27/2018] [Accepted: 04/04/2018] [Indexed: 11/07/2022] Open
Abstract
In an effort to relieve the pressure of drug shortages, the Chinese government implemented Low-price Medicines (LPM) policy to raise the price cap in July 2014. The purpose of this study is to examine the effect of the implementation of this policy on drug price in China. Price data of 491 LPM, including 218 low-price chemical medicines (LPCM) and 273 low-price traditional Chinese medicines (LPTCM), were collected from 699 hospitals. We used interrupted time series design to identify the variation of monthly Laspeyres Indexes (LI) and Paasche Indexes (PI) for LPM, LPCM, and LPTCM. The result demonstrated that although LPM expenditures increased, the proportion of LPM expenditures accounting for all medicine expenditures fell from 3.6% to 3.2%. After the implementation of LPM policy, there was a significant increasing trend in LPM-PI, LPCM-PI, and LPTCM-PI. The trend in LPM-LI and LPCM-LI was found from descending to rising. However, for LPTCM, the trend in the LI remained to decrease after the policy implementation. Despite the LPM policy had an increasing impact on the LPM drug price, the proportion of LPM expenditures accounting for all medicine expenditures did not increase. More efforts are needed in the future to promote the rational drug use in China.
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Affiliation(s)
- Xiaodong Guan
- School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Mingchun Yang
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Chunxia Man
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Ye Tian
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Luwen Shi
- School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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16
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Affiliation(s)
- Soonman Kwon
- Seoul National University, Department of Health Policy and Management, Republic of Korea.
| | - Reinhard Busse
- Department of Health Care Management, Berlin University of Technology, Germany
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17
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Heo JH, Rascati KL, Lee EK. Prediction of Change in Prescription Ingredient Costs and Co-payment Rates under a Reference Pricing System in South Korea. Value Health Reg Issues 2017. [PMID: 28648319 DOI: 10.1016/j.vhri.2016.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The reference pricing system (RPS) establishes reference prices within interchangeable reference groupings. For drugs priced higher than the reference point, patients pay the difference between the reference price and the total price. OBJECTIVES To predict potential changes in prescription ingredient costs and co-payment rates after implementation of an RPS in South Korea. METHODS Korean National Health Insurance claims data were used as a baseline to develop possible RPS models. Five components of a potential RPS policy were varied: reference groupings, reference pricing methods, co-pay reduction programs, manufacturer price reductions, and increased drug substitutions. The potential changes for prescription ingredient costs and co-payment rates were predicted for the various scenarios. RESULTS It was predicted that transferring the difference (total price minus reference price) from the insurer to patients would reduce ingredient costs from 1.4% to 22.8% for the third-party payer (government), but patient co-payment rates would increase from a baseline of 20.4% to 22.0% using chemical groupings and to 25.0% using therapeutic groupings. Savings rates in prescription ingredient costs (government and patient combined) were predicted to range from 1.6% to 13.7% depending on various scenarios. Although the co-payment rate would increase, a 15% price reduction by manufacturers coupled with a substitution rate of 30% would result in a decrease in the co-payment amount (change in absolute dollars vs. change in rates). CONCLUSIONS Our models predicted that the implementation of RPS in South Korea would lead to savings in ingredient costs for the third-party payer and co-payments for patients with potential scenarios.
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Affiliation(s)
- Ji Haeng Heo
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Karen L Rascati
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Eui-Kyung Lee
- Pharmaceutical Policy and Outcomes Research, School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea.
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18
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Park SY, Han E, Kim J, Lee EK. Factors influencing the difference between forecasted and actual drug sales volumes under the price–volume agreement in South Korea. Health Policy 2016; 120:867-74. [DOI: 10.1016/j.healthpol.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 11/16/2022]
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Kwon HY, Godman B. Do newly marketed generic medicines expand markets using descriptive time series analysis and mixed logit models? Korea as an exemplar and its implications. BMC Health Serv Res 2016; 16:130. [PMID: 27080530 PMCID: PMC4832488 DOI: 10.1186/s12913-016-1356-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/18/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There have been concerns in Korea that the availability of cheaper generics can appreciably increase prescribed volumes thereby negating their beneficial effects on overall pharmaceutical expenditure. Consequently, this study aimed to explore market changes after newly entered generics including market expansion and substitution effects, and to examine factors contributing to the prescribing of newly entered generics using atorvastatin as an exemplar. This is because previous studies have shown market expansion had occurred following generic atorvastatin. METHODS Explore market expansion effects by extracting all statins users from July 2008 to June 2010 from the nationally representative dataset of 2008, combined with the National Health Insurance Claims data, with atorvastatin's patent expiring in July 2008. The data consisted of medical visit episodes of patients who had been prescribed statins at least once during the observational period. Patients who had been prescribed any statin before the observation period were classified as the previously treated group and those who had not as the newly treated group. Descriptive time series analysis was conducted and the mixed logit model applied to understand factors contributing to generic atorvastatin prescriptions. RESULTS Market expansion was observed after generic atorvastatin availability with an appreciable increase in number of newly treated patients, whereas substitution effect was found among previously treated patients. Newly treated patients tended to get significantly lower daily doses (p < 0.0001). According to the mixed logistic analysis, newly treated patients were more likely to be prescribed generic atorvastatin (OR = 2.58; 95% CI, 2.05-3.26) than their counterparts. Clinicians and secondary hospitals were also key drivers of generic atorvastatin (ORs were 10.41 and 9.81, respectively). CONCLUSIONS Newly marketed generic statins in Korea resulted in an expanding market by substantially increasing the number of new patients with clinics and hospitals appreciably using newly marketed generics. However lower doses of statins were prescribed. Policy makers do recognize that generic availability can save costs so should be encouraged. However, this is a concern when generic availability appreciably expands the market, potentially increasing the financial burden. This needs to be addressed. Additionally in Korea, the quality of prescribing should be monitored, especially focusing on clinics and secondary hospitals.
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Affiliation(s)
- Hye-Young Kwon
- Division of Biomedicine & Public Health, Mokwon University, Daejeon, 35349, South Korea
| | - Brian Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden. .,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK.
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20
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Thai LP, Moss JR, Godman B, Vitry AI. Cost driver analysis of statin expenditure on Australia’s Pharmaceutical Benefits Scheme. Expert Rev Pharmacoecon Outcomes Res 2016; 16:419-33. [DOI: 10.1586/14737167.2016.1136790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- L. P. Thai
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
| | - J. R. Moss
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - B. Godman
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, Scotland
| | - A. I. Vitry
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
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21
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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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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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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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Cho MH, Yoo KB, Lee HY, Lee KS, Kwon JA, Han KT, Kim JH, Park EC. The effect of new drug pricing systems and new reimbursement guidelines on pharmaceutical expenditures and prescribing behavior among hypertensive patients in Korea. Health Policy 2015; 119:604-11. [PMID: 25630635 DOI: 10.1016/j.healthpol.2015.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 01/04/2015] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effects of a new drug-pricing system (January 2012) and new prescription and reimbursement guidelines (January 2013) on hypertension-related pharmaceutical expenditures and prescribing behaviors in Korea. METHODS In all, 11,298 clinics and 2,667,132 patients with hypertension were included in our study. As dependent variables, we used the drug cost per patient, drug cost per prescribed day, number of drugs per prescription, number of prescribed days per visit, number of visits, number of original (vs. generic) drugs prescribed, and the percentage of original drug cost. Clinic characteristics and patients' age and sex were used as independent variables. Multi-level mixed-effect regression models were used. RESULTS The drug cost per patient decreased by -1446 KRW$ (-7.4%; p<0.001) in Q4 2012 and by -1833 (-9.3%; p<0.001) in Q2 2013 compared with Q4 2011. Number of drugs per prescription decreased significantly. The percentage of original drug cost and the number of original drugs also declined. CONCLUSION Reforms to the drug pricing policy and the new guidelines may reduce pharmaceutical expenditures without increasing number of drugs per prescription and the number of original drug used. Policy makers should consider the comprehensive effects of implementing new policies on both drug prices and consumption.
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Affiliation(s)
- Mee-Hyun Cho
- Health Insurance Review and Assessment Service, Republic of Korea
| | - Ki-Bong Yoo
- Department of Healthcare Management, Eulji University, Republic of Korea
| | - Hoo-Yeon Lee
- Department of Social Medicine, Dankook University, Republic of Korea
| | - Kwang-Sig Lee
- Department of Public Health, Graduate School, Yonsei University, Republic of Korea; Institute of Health Services Research, Yonsei University, Republic of Korea
| | - Jeoung A Kwon
- National Cancer Control Institute, National Cancer Center, Republic of Korea
| | - Kyu-Tae Han
- Department of Public Health, Graduate School, Yonsei University, Republic of Korea; Institute of Health Services Research, Yonsei University, Republic of Korea
| | - Jae-Hyun Kim
- Department of Public Health, Graduate School, Yonsei University, Republic of Korea; Institute of Health Services Research, Yonsei University, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Republic of Korea; Department of Preventive Medicine, College of Medicine Yonsei University, Republic of Korea.
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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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Bae G, Park C, Lee H, Han E, Kim DS, Jang S. Effective policy initiatives to constrain lipid-lowering drug expenditure growth in South Korea. BMC Health Serv Res 2014; 14:100. [PMID: 24589172 PMCID: PMC4015215 DOI: 10.1186/1472-6963-14-100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 01/23/2014] [Indexed: 11/30/2022] Open
Abstract
Background The rapid growth of prescription drug expenditures is a major problem in South Korea. Accordingly, the South Korean government introduced a positive listing system in 2006. They also adopted various price reduction policies. Nevertheless, the total expenditure for lipid-lowering drugs have steadily increased throughout South Korea. The present study explores the factors that have influenced the increased expenditures of lipid-lowering drugs with a particular focus on the effects of statins in this process. Methods This paper investigates the National Health Insurance claims data for prescribed lipid-lowering drugs collected between January 1, 2005 and December 31, 2009. We specifically focused on statins and assessed the yearly variation of statin expenditure by calculating the increased rate of paired pharmaceutical expenditures over a 2 year period. Our study classified statins into three categories: new entrants, core medicines and exiting medicines. For core medicines, we further examined influencing factors such as price, amount of drugs consumed by volume, and prescription changes (substitutes for other drug). Results Statin expenditure showed an average annual increase of 25.7% between 2005 and 2009. Among the different statins, the expenditure of atorvastatin showed a 36.6% annual increase rate, which was the most dramatic among all statins. Also we divided expenditure for core medicines by the price factor, volume factor, and prescription change. The result showed that annual weighted average prices of individual drug decreased each year, which clearly showed that price influenced statin expenditure in a negative direction. The use of generic drugs containing the same active ingredient as name-brand drugs increased and negatively affected statin expenditure (Generic Mix effect). However, the use of relatively expensive ingredients within statin increase, Ingredient Mix effect contributed to increased statin expenditure (Ingredient Mix effect). In particular, the volume effect was found to be critical for increasing statin expenditure as the amount of statin consumed increased steadily throughout the study period. Conclusions The recent rapid increase in statin expenditure can largely be attributed to an increase in consumption volume. In order to check drug expenditures effectively in our current situation, in which chronic diseases remain steadily on the rise, it is necessary to not only have supply-side initiatives such as price reduction, but also demand-side initiatives that could control drug consumption volume, for example: educational programs for rational prescription, generic drug promotional policies, and policies providing prescription targets.
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Affiliation(s)
| | | | | | | | | | - Sunmee Jang
- College of Pharmacy & Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoe-ro, Yeonsu-gu, Incheon 406-799, South Korea.
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