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Chung CH. Trends in pharmaceutical expenditure in the Taiwan National Health Insurance database at different hospital levels. J Comp Eff Res 2023; 12:e220162. [PMID: 36511826 PMCID: PMC10286779 DOI: 10.2217/cer-2022-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Aim: This study aimed to understand the medication usage among different hospitals in Taiwan. Materials & methods: The NHI claims database consisting of claims prescription drugs in Taiwan was used to determine drug prescriptions in different hospitals. Results: In the medical center, L01X showed the highest drug expenditure and the drug prescription pattern in regional hospitals was similar to that in the medical center. The highest drug expenditure in the district hospital and clinics was A10B. Conclusion: Our analysis suggests that the annual pharmaceutical expenditures from 2016 to 2018 were increasing over time in all hospitals. The generic drug usage in medical centers/regional hospitals was lower than district hospitals/clinics.
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Affiliation(s)
- Ching-Hu Chung
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
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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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Attaran A, Mackey T, Beall R. Lowering the High Cost of Cancer Drugs--III. Mayo Clin Proc 2016; 91:399-400. [PMID: 26944246 DOI: 10.1016/j.mayocp.2015.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/14/2015] [Accepted: 12/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Amir Attaran
- Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Mackey
- Department of Anesthesiology and Division of Global Public Health, University of California San Diego, San Diego, CA
| | - Reed Beall
- University of Ottawa, Ottawa, Ontario, Canada
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Merritt RJ, Goldsmith AH. Scientific, economic, regulatory, and ethical challenges of bringing science-based pediatric nutrition products to the U.S. market and ensuring their availability for patients. JPEN J Parenter Enteral Nutr 2014; 38:17S-34S. [PMID: 25249029 DOI: 10.1177/0148607114549771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Many nutrition products and related drugs are unavailable or not consistently available to clinicians despite a body of clinical data and experience supporting their use. Many of these can be related to drug shortages that have increased since 2009. In addition, there are potentially useful products that are not approved for a specific use or are no longer being manufactured. This review broadly examines the product availability gap from the perspectives of a clinician/former nutrition industry medical director and an economist. The process of pediatric nutrition product and related drug innovation, as well as its drivers and the steps involved in bringing a product to market, is first described. This is followed by an assessment of factors influencing product availability beyond the innovation process, including regulatory issues, manufacturing compliance, purchasing practices, and other factors related to drug and nutrition product pricing and reimbursement. Three pediatric case examples are reviewed and placed in the context of the prior review. Last, recent and future possible steps toward closing the product availability gap are discussed.
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Affiliation(s)
- Russell J Merritt
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Arthur H Goldsmith
- Department of Economics, Washington and Lee University, Lexington, Virginia
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Drugs cheaper than threepenny: the market of extremely low-priced drugs within the National Health Insurance in Taiwan. ScientificWorldJournal 2014; 2014:234941. [PMID: 24719568 PMCID: PMC3956290 DOI: 10.1155/2014/234941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/13/2014] [Indexed: 12/03/2022] Open
Abstract
While most drug policy researches paid attention to the financial impact of expensive drugs, the market situation of low-priced drugs in a country was seldom analyzed. We used the nationally representative claims datasets to explore the status within the National Health Insurance (NHI) in Taiwan. In 2007, a total of 12,443 distinct drug items had been prescribed 853,250,147 times with total expenditure of 105,216,950,198 new Taiwan dollars (NTD). Among them, 7,366 oral drug items accounted for 701,353,383 prescribed items and 68,133,988,960 NTD. Besides, 2,887 items (39.2% of oral drug items) belonged to cheap drugs with the unit price ≤1 NTD (about 0.03 of US dollar). While the top one item among all oral drugs had already a market share of 5.0%, 30 items 30.3% and 107 items 50.0%, the cheap drugs with aggregate 332,893,462 prescribed items (47.5% of all prescribed oral drug items) only accounted for 2,750,725,433 NTD (4.0% of expenditure for oral drugs and 2.6% of total drug expenditure). The drug market of Taiwan's NHI was abundant in cheap drugs. The unreasonably low prices of drugs might not guarantee the quality of pharmaceutical care and the sustainability of a healthy pharmaceutical industry in the long run.
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Kwon HY, Hong JM, Godman B, Yang BM. Price cuts and drug spending in South Korea: the case of antihyperlipidemic agents. Health Policy 2013; 112:217-26. [PMID: 24075008 DOI: 10.1016/j.healthpol.2013.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 08/26/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify the effect of price control policies on drug expenditure in South Korea. METHODS We retrospectively examined the effects of price-reduction policies on drug expenditures, in particular regarding anti-hyperlipidemic drugs. The National Health Insurance claims data for a 60-month period between 2006 and 2010 were analysed. A segmented regression analysis was conducted with three intervention variables: July 2008, April 2009, and January 2010. RESULTS Despite three rounds of price cuts, monthly drug expenditures increased by KRW 599.67 million (USD 523,726) after the third intervention (p=0.0781). The trend in volume increased consistently, but not significantly. The unit prices showed a steady downward trend over time, but rebounded after the third price cut. The number of patients with hyperlipidemia more than doubled to 3729 (p=0.0801) per month after the entry of generics for atorvastatin in July 2008. CONCLUSION Extensive price controls did not effectively suppress the growth of pharmaceutical expenditures. The increased number of patients, attributable to the newly launched generic drug atorvastatin, and the increased use of expensive drugs were major factors affecting the increase in drug spending. Policies that regulate both drug prices and utilisation, and that reduce financial burdens via enhanced use of generics need to be introduced.
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Affiliation(s)
- Hye-Young Kwon
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
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Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital. PLoS One 2012; 7:e39737. [PMID: 22761882 PMCID: PMC3383681 DOI: 10.1371/journal.pone.0039737] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/25/2012] [Indexed: 11/19/2022] Open
Abstract
Background Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices. Methods We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI), angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) following hospital admission from April 1st 2008-March 31st 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB) over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class. Results The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47%) for PPIs, $162 thousand (17%) for ACE inhibitors and $14 thousand (4%) for ARBs over the year following discharge. Interpretation In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.
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Rossetti CL, Handfield R, Dooley KJ. Forces, trends, and decisions in pharmaceutical supply chain management. INTERNATIONAL JOURNAL OF PHYSICAL DISTRIBUTION & LOGISTICS MANAGEMENT 2011. [DOI: 10.1108/09600031111147835] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chu HL, Liu SZ, Romeis JC. Assessing the effects of drug price reduction policies on older people in Taiwan. Health Serv Manage Res 2011; 24:1-7. [PMID: 21285360 DOI: 10.1258/hsmr.2010.010016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study investigates the initial effects of the government's prescription drug price reduction policies on outpatient hypertension treatment for the elderly in Taiwan. The National Health Insurance scheme has taken a number of steps in recent years to reduce drug prices. The data used in the study comprises the medical records of approximately 137,000 hypertension patients aged 65 and above. Regression analysis is used to determine whether the average cost of prescription drugs has declined as a result of the policy. In addition, the probit model is used to examine changes in physicians' prescribing behaviour for reduced-price and full-price drugs and the effect of drug substitution on health outcomes. We find that the average cost per prescription increased slightly despite the implementation of the price reduction policies. In addition, we found that physicians do substitute full-price drugs for reduced-price drugs. However, they appear to be reluctant to reduce the use of essential drugs, even when facing rate reductions. The evidence suggests that physicians consider the profit they can derive by prescribing certain drugs; hence, health policy officials should monitor the effects of possible drug substitutions when they design policies for their own countries.
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Affiliation(s)
- Hsuan-Lien Chu
- Department of Accounting, College of Commerce, National Taipei University, Taiwan, ROC.
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Dumont S, Jacobs P, Turcotte V, Anderson D, Harel F. The trajectory of palliative care costs over the last 5 months of life: a Canadian longitudinal study. Palliat Med 2010; 24:630-40. [PMID: 20501512 DOI: 10.1177/0269216310368453] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to highlight the trajectory of palliative care costs over the last five months of life in five urban centres across Canada. SUBJECTS The study sample was comprised of 160 terminally ill patients and their main informal caregivers. RESEARCH DESIGN A first interview took place in the patient's home, and subsequent follow-up interviews were conducted by telephone at two week intervals until the patient's passing. MEASURES Participants were asked to provide information on the goods and services they used related to the patients' health condition, and on informal caregiving time. RESULTS The overall costs of care gradually increased from the fifth to the last month of the patients' life. A large part of this cost increase was attributable to inpatient care. Among outpatient care costs the largest increase was observed for home care. Informal care costs were particularly high over the last 3 months of life. CONCLUSIONS The knowledge gained from this study would be useful to policy makers when developing policies that could help families caring for a terminally ill loved one at home.
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Affiliation(s)
- Serge Dumont
- School of Social Work, Pavillon Charles-De Koninck, Laval University, Quebec City, QC, Canada, Laval University Cancer Research Center, Quebec City, QC, Canada.
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Dumont S, Jacobs P, Fassbender K, Anderson D, Turcotte V, Harel F. Costs associated with resource utilization during the palliative phase of care: a Canadian perspective. Palliat Med 2009; 23:708-17. [PMID: 19837702 DOI: 10.1177/0269216309346546] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to evaluate prospectively the resource utilization and related costs during the palliative phase of care in five regions across Canada. SUBJECTS A cohort of 248 patients registered in a palliative care program and their main informal caregivers were consecutively recruited. RESEARCH DESIGN A prospective research design with repeated measures was adopted. Interviews were conducted at two-week intervals until the patient s passing or up to a maximum of 6 months. MEASURES The survey questions prompted participants to provide information on the types and number of goods and services they used, and who paid for these goods and services. RESULTS The largest cost component for study participants was inpatient hospital care stays, followed by home care and informal caregiving time. In regard to cost sharing, the public health care system (PHCS), the family, and not-for-profit organizations (NFPO) sustained respectively 71.3%, 26.6%, and 1.6% of the mean total cost per patient. CONCLUSION Such results provide a comprehensive picture of costs related to palliative care in Canada, by specifying the cost sharing between the PHCS, the family, and NFPO.
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Affiliation(s)
- Serge Dumont
- School of Social Work, Laval University; Laval University Cancer Research Center, Quebec, Quebec, Canada G1V 0A6.
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Armstrong K, Mitton C, Carleton B, Shoveller J. Drug formulary decision-making in two regional health authorities in British Columbia, Canada. Health Policy 2008; 88:308-16. [PMID: 18508151 DOI: 10.1016/j.healthpol.2008.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 04/13/2008] [Accepted: 04/14/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Growing pharmaceutical demands challenge healthcare organizations to set drug funding priorities (i.e. establish a formulary list). This responsibility typically rests with pharmacy and therapeutics (P&T) committees, yet how the process transpires within regional health authorities is unclear. The purpose of this study was to construct an explanatory model of drug formulary priority-setting as it occurs within regional health authorities. METHODS A grounded theory approach was employed to study the practices of two regional health authority P&T committees in British Columbia, Canada. Data sources spanned committee documents, meeting observations (n=4), and semi-structured interviews with committee members (n=15). Data analysis involved coding using the constant comparative technique and writing analytic memos. RESULTS Regional P&T committees engaged in two activities related to drug formulary priority-setting: developing auto-substitution policies and reviewing drug addition requests. Four processes were central to decision-making: (i) negotiating margins of therapeutic advantage; (ii) seeking value for the resources allocated; (iii) interfacing between community and institutional settings; (iv) situating decisions within an organizational context. CONCLUSIONS Findings highlight opportunities for institutions to improve the fairness of agenda-setting practices, and for additional collaboration between policy-makers who prioritize drugs for publicly funded formularies applicable to institutional versus community settings.
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Affiliation(s)
- Kristy Armstrong
- Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC V6T 1Z3, Canada.
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Kennedy J, Morgan S. A cross-national study of prescription nonadherence due to cost: data from the Joint Canada-United States Survey of Health. Clin Ther 2006; 28:1217-1224. [PMID: 16982299 DOI: 10.1016/j.clinthera.2006.07.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND In Canada and the United States, patients who have difficulty paying for prescribed medications are less likely to obtain them and may experience increased risks for morbidity and mortality and/or increased health care costs due to nonadherence. As prescription drug costs have risen, the ability to pay for medications has emerged as a critical public health issue. OBJECTIVES The objectives of this study were to estimate the rates of cost-associated nonadherence in Canada and the United States, and to identify factors that predict cost-associated nonadherence in both countries. METHODS This original analysis used data from the 2002/2003 Joint Canada-US Survey of Health, a household phone survey jointly conducted by Statistics Canada (Ottawa, Ontario, Canada) and the US National Center for Health Statistics (Hyattsville, Maryland). The sample included 3505 adults in Canada and 5183 adults in the United States. Weighted group comparisons and logistic regression analyses were used to identify population factors predictive of cost-associated prescription nonadherence. RESULTS Residents of Canada were much less likely than residents of the United States to report cost-associated nonadherence (5.1% vs 9.9%; P < 0.001). Americans without health insurance (28.2%) and Americans and Canadians without prescription-drug coverage (16.2%) were significantly more likely than those with insurance (6.2%) to report cost-associated nonadherence (P < 0.001). In addition to country of residence and insurance coverage, significant risk factors predictive of nonadherence were young age, poor health, chronic pain, and low household income. CONCLUSIONS The results of this analysis suggest that people with low incomes and inadequate insurance, as well as those with poor health and/or chronic symptoms, are more likely to report failing to fill a prescription due to cost. The overall rate of cost-associated nonadherence was significantly higher in the United States than in Canada, even when other person-level factors were controlled for, including health insurance and prescription-drug coverage.
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Affiliation(s)
- Jae Kennedy
- Department of Health Policy and Administration, School of Pharmacy, Washington State University, Spokane, Washington.
| | - Steve Morgan
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada
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Geitona M, Zavras D, Hatzikou M, Kyriopoulos J. Generics market in Greece: The pharmaceutical industry's beliefs. Health Policy 2006; 79:35-48. [PMID: 16386326 DOI: 10.1016/j.healthpol.2005.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2005] [Accepted: 11/07/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study was to investigate the beliefs and perspectives of the pharmaceutical industry on generic medication in Greece. Questionnaires were mailed to all 58 members of the Hellenic Association of Pharmaceutical Companies from November 2002 to February 2003. The response rate was 52%, namely 30 questionnaires were completed and returned. The questionnaire requested information on companies' involvement in generics, their opinion on generics' characteristics and on public policies affecting the demand and supply of generic medication. A descriptive analysis of the outcomes, that is percentage comparison through binomial tests and Fisher tests, was performed. According to our findings, 43% of the respondents were involved in the production and distribution of generics and the mean period of their involvement was 12 years. The majority of the respondents were in favor of their companies' involvement in generics, despite the relatively small market share of generics in Greece; 9.7% of total pharmaceutical market in 2003. Bearing in mind that in Greece the promotion of generics is not encouraged, pharmaceutical companies believe that the mandatory introduction of bioequivalence studies is an indirect promotional strategy towards generics. Additionally, the majority declared that their main competitive advantages are their safety, efficacy and effectiveness as well as their economic benefit to the society. Finally, the respondents expressed their preference for the introduction of pharmacoeconomic submissions for drugs' reimbursement by social insurance funds.
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Affiliation(s)
- Mary Geitona
- Department of Economics, University of Thessaly, 43 Korai Str., Volos 38 221, Greece.
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Access to drugs for cancer: Does where you live matter? Canadian Journal of Public Health 2005. [PMID: 16350873 DOI: 10.1007/bf03405189] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Provincial governments are responsible for administering publicly-funded anti-cancer drug benefit programs in Canada. This study examines inter-provincial variations in not only the content of such programs, but also the policies/processes used when considering a new drug for coverage. METHODS Pharmaceutical manufacturers and provincial/regional cancer boards were surveyed to identify the drugs covered by public drug benefit plans. Kappa coefficients were calculated to determine inter-provincial coverage variations. The comprehensiveness of availability of anti-cancer drugs across the country was also assessed. A semi-structured survey of all 10 provincial/regional cancer board pharmacy and therapeutics (P&T) committees was employed to examine decision-making policies/procedures. It included questions on committee composition and processes and on factors influencing decisions regarding the introduction of new drugs. Completed surveys were analyzed using qualitative and quantitative techniques. RESULTS All cancer boards and 75% of manufacturers contacted provided information on drugs covered in each province. Where lists were obtained from both sources, there was full agreement on content. Kappa values calculated ranged from -0.403 to 0.594, indicating poor to moderate agreement on anti-cancer drug coverage between provinces. Only 7 of the 115 drugs were available in all 10 provinces. Regarding decision-making processes, while ratings for both the relative importance and use of factors involved in decision-making (clinical effectiveness, patient preference, etc.) were similar across provinces, those for the relative importance and use of different information types (clinical trials, expert opinion, etc.) varied. CONCLUSION Access to anti-cancer drugs clearly varies across the country. In part, this may be due to differences in the views of P&T committees on the usefulness of information they use in their deliberations.
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Abstract
BACKGROUND Canadians spent almost dollars 15 billion, over dollars 460 per capita, on prescription drugs in 2002, yet there is little published evidence regarding the nature and causes of these expenditures. OBJECTIVE : The objective of this study was to describe the nature and determinants of prescription drug expenditures in Canada during a recent period of rapid expenditure inflation, 1998 to 2002. RESEARCH DESIGN : Trends in overall expenditures and investment in specific therapeutic categories are decomposed using nonstochastic index-theoretical methods. MEASURES Changes in per capita expenditures on oral solid prescription drugs are attributed to the cost-impact of changes in the 6 determinants that fall into 3 broad categories: volume effects, price effects, and therapeutic choices. RESULTS A majority of spending was concentrated among only 5 therapeutic classes. After adjusting for generic drug use, prices for unchanged drugs declined over the period of analysis. Increased utilization of prescription drugs explained over half of the overall increase in per capita spending. Changes in therapeutic choice also contributed to cost increases. CONCLUSIONS Findings suggest that the combined affect of federal price regulations, provincial price freezes, and generic substitution policies are controlling price-related determinants of drug spending in Canada. However, the cost-impact of increased drug utilization and changes in therapeutic choices illustrate the potential pitfalls of cost-management strategies that focus primarily on prices.
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Affiliation(s)
- Steve Morgan
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
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Anderson G, Frogner B. Comparative Drug Policies. J Ambul Care Manage 2004; 27:202-9. [PMID: 15287209 DOI: 10.1097/00004479-200407000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gerard Anderson
- Bloomberg School of Public Health, John Hopkins University, Room 300, 624 N Broadway, Baltimore, MD 21205, USA.
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