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Bioequivalence, Drugs with Narrow Therapeutic Index and the Phenomenon of Biocreep: A Critical Analysis of the System for Generic Substitution. Healthcare (Basel) 2022; 10:healthcare10081392. [PMID: 35893214 PMCID: PMC9394341 DOI: 10.3390/healthcare10081392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
The prescription of generic drugs represents one of the main cost-containment strategies of health systems, aimed at reducing pharmaceutical expenditure. In this context, most regulatory authorities encourage or obligate dispensing generic drugs because they are far less expensive than their brand-name alternatives. However, drug substitution can be critical in particular situations, such as the use of drugs with a narrow therapeutic index (NTI). Moreover, generics cannot automatically be considered bioequivalent with each other due to the biocreep phenomenon. In Italy, the regulatory authority has established the Transparency Lists which include the medications that will be automatically substituted for brand-name drugs, except in exceptional cases. This is a useful tool to guide prescribers and guarantee pharmaceutical sustainability, but it does not consider the biocreep phenomenon.
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Zielińska M, Hermanowski T. Sources of Information on Medicinal Products Among Physicians - A Survey Conducted Among Primary Care Physicians in Poland. Front Pharmacol 2022; 12:801845. [PMID: 35069213 PMCID: PMC8770910 DOI: 10.3389/fphar.2021.801845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/16/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Primary care physicians need to have access to up-to-date knowledge in various fields of medicine and high-quality information sources, but little is known about the use and credibility of sources of information on medicinal products among Polish doctors. The main goal of this study was to analyze the sources of information on medicinal products among primary care physicians in Poland. Methods: A survey was conducted among 316 primary care physicians in Poland. The following information was collected: demographic data of participants, type and frequency of using data sources on medicinal products, barriers to access credible information, assessment of the credibility of the sources used, impact of a given source and other factors on prescription decisions. Results: The most frequently mentioned sources of information were medical representatives (79%), medical journals (78%) and congresses, conventions, conferences, and training (76%). The greatest difficulty in finding the latest information about medicinal products was the lack of time. The surveyed doctors considered clinical guidelines to be the most credible source of information, and this source also had the greatest impact on the choice of prescribed medicinal products. Conclusion: The study showed that clinicians consider clinical guidelines as the most credible source of information with the greatest impact on prescribing medicinal products. However, it is not the source most often mentioned by doctors for obtaining knowledge about medicinal products. There is a need to develop strategies and tools to provide physicians with credible sources of information.
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Affiliation(s)
- Magdalena Zielińska
- Department of Bioanalysis and Drug Analysis, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Hermanowski
- Department of Bioanalysis and Drug Analysis, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
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Godman B, Wladysiuk M, McTaggart S, Kurdi A, Allocati E, Jakovljevic M, Kalemeera F, Hoxha I, Nachtnebel A, Sauermann R, Hinteregger M, Marković-Peković V, Tubic B, Petrova G, Tachkov K, Slabý J, Nejezchlebova R, Krulichová IS, Laius O, Selke G, Langner I, Harsanyi A, Inotai A, Jakupi A, Henkuzens S, Garuolienė K, Gulbinovič J, Bonanno PV, Rutkowski J, Ingeberg S, Melien Ø, Mardare I, Fürst J, MacBride-Stewart S, Holmes C, Pontes C, Zara C, Pedrola MT, Hoffmann M, Kourafalos V, Pisana A, Banzi R, Campbell S, Wettermark B. Utilisation Trend of Long-Acting Insulin Analogues including Biosimilars across Europe: Findings and Implications. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9996193. [PMID: 34676266 PMCID: PMC8526244 DOI: 10.1155/2021/9996193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes mellitus rates and associated costs continue to rise across Europe enhancing health authority focus on its management. The risk of complications is enhanced by poor glycaemic control, with long-acting insulin analogues developed to reduce hypoglycaemia and improve patient convenience. There are concerns though with their considerably higher costs, but moderated by reductions in complications and associated costs. Biosimilars can help further reduce costs. However, to date, price reductions for biosimilar insulin glargine appear limited. In addition, the originator company has switched promotional efforts to more concentrated patented formulations to reduce the impact of biosimilars. There are also concerns with different devices between the manufacturers. As a result, there is a need to assess current utilisation rates for insulins, especially long-acting insulin analogues and biosimilars, and the rationale for patterns seen, among multiple European countries to provide future direction. Methodology. Health authority databases are examined to assess utilisation and expenditure patterns for insulins, including biosimilar insulin glargine. Explanations for patterns seen were provided by senior-level personnel. RESULTS Typically increasing use of long-acting insulin analogues across Europe including both Western and Central and Eastern European countries reflects perceived patient benefits despite higher prices. However, activities by the originator company to switch patients to more concentrated insulin glargine coupled with lowering prices towards biosimilars have limited biosimilar uptake, with biosimilars not currently launched in a minority of European countries. A number of activities were identified to address this. Enhancing the attractiveness of the biosimilar insulin market is essential to encourage other biosimilar manufacturers to enter the market as more long-acting insulin analogues lose their patents to benefit all key stakeholder groups. CONCLUSIONS There are concerns with the availability and use of insulin glargine biosimilars among European countries despite lower costs. This can be addressed.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Magdalene Wladysiuk
- Chair of Epidemiology and Preventive Medicine, Medical College, Jagiellonian University, Krakow, Poland
- HTA Consulting, Starowiślna Str. 17/3, 31-038 Krakow, Poland
| | - Stuart McTaggart
- Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche ‘Mario Negri' IRCCS, Milan, Italy
| | - Mihajlo Jakovljevic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Institute of Comparative Economic Studies, Faculty of Economics, Hosei University Tokyo, Tokyo, Japan
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Anna Nachtnebel
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Robert Sauermann
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Manfred Hinteregger
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Vanda Marković-Peković
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Tubic
- Faculty of Medicine, Department of Medicinal Chemistry, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Agency for Medicinal Product and Medical Devices of Bosnia and Herzegovina, 78000 Banja Luka, Bosnia and Herzegovina
| | - Guenka Petrova
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Juraj Slabý
- State Institute for Drug Control, Prague, Czech Republic
| | | | - Iva Selke Krulichová
- Department of Medical Biophysics, Faculty of Medicine in Hradec Králové, Charles University, Simkova 870, 500 03 Hradec Králové, Czech Republic
| | - Ott Laius
- State Agency of Medicines, Nooruse 1, 50411 Tartu, Estonia
| | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, 10178 Berlin, Germany
| | - Irene Langner
- Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, 10178 Berlin, Germany
| | - András Harsanyi
- Department of Health Policy and Health Economics, Eotvos Lorand University, Budapest, Hungary
| | - András Inotai
- Syreon Research Institute and Semmelweis University, Center of Health Technology Assessment, Budapest, Hungary
| | - Arianit Jakupi
- Faculty of Pharmacy, UBT Higher Education Institute, Pristina, Kosovo
| | | | - Kristina Garuolienė
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Health Services Management, University of Malta, Valletta, Malta
| | - Jakub Rutkowski
- HTA Consulting, Starowiślna Str. 17/3, 31-038 Krakow, Poland
| | - Skule Ingeberg
- Medicines Committee, Oslo University Hospitals, Oslo, Norway
| | - Øyvind Melien
- Medicines Committee, Oslo University Hospitals, Oslo, Norway
| | - Ileana Mardare
- Faculty of Medicine, Public Health and Management Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, 050463 Bucharest, Romania
| | - Jurij Fürst
- Health Insurance Institute, Miklosiceva 24, SI-1507 Ljubljana, Slovenia
| | | | | | - Caridad Pontes
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Corinne Zara
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | - Marta Turu Pedrola
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | | | - Vasileios Kourafalos
- National Organization for the Provision of Healthcare Services (EOPYY), Athens, Greece
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rita Banzi
- Istituto di Ricerche Farmacologiche ‘Mario Negri' IRCCS, Milan, Italy
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Bjorn Wettermark
- Department of Pharmacy, Disciplinary Domain of Medicine and Pharmacy, Uppsala University, Uppsala, Sweden
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4
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Godman B, Haque M, Leong T, Allocati E, Kumar S, Islam S, Charan J, Akter F, Kurdi A, Vassalo C, Bakar MA, Rahim SA, Sultana N, Deeba F, Khan MAH, Alam ABMM, Jahan I, Kamal ZM, Hasin H, Munzur-E-Murshid, Nahar S, Haque M, Dutta S, Abhayanand JP, Kaur RJ, Rwegerera GM, do Nascimento RCRM, Dias Godói IP, Irfan M, Amu AA, Matowa P, Acolatse J, Incoom R, Sefah IA, Acharya J, Opanga S, Njeri LW, Kimonge D, Kwon HY, Bae S, Khuan KKP, Abubakar AR, Sani IH, Khan TA, Hussain S, Saleem Z, Malande OO, Piloya-Were T, Gambogi R, Hernandez Ortiz C, Alutuli L, Kalungia AC, Hoxha I, Marković-Peković V, Tubic B, Petrova G, Tachkov K, Laius O, Harsanyi A, Inotai A, Jakupi A, Henkuzens S, Garuoliene K, Gulbinovič J, Wladysiuk M, Rutkowski J, Mardare I, Fürst J, McTaggart S, MacBride-Stewart S, Pontes C, Zara C, Tagoe ET, Banzi R, Wale J, Jakovljevic M. The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future. Front Public Health 2021; 9:671961. [PMID: 34249838 PMCID: PMC8264781 DOI: 10.3389/fpubh.2021.671961] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Trudy Leong
- Essential Drugs Programme, South African National Department of Health, Pretoria, South Africa
| | - Eleonora Allocati
- Center for Health Regulatory Policies, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milan, Italy
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Farhana Akter
- Department of Endocrinology, Chittagong Medical College, Chittagong, Bangladesh
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Carlos Vassalo
- Facultad de Ciencias Médicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Muhammed Abu Bakar
- Department of Endocrinology and Metabolism, Chattogram Maa-O-Shishu Hospital Medical College, Chattogram, Bangladesh
| | - Sagir Abdur Rahim
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital, Dhaka, Bangladesh
| | - Nusrat Sultana
- Department of Endocrinology and Metabolism, Bangabandhu Sheik Mujib Medical University Hospital, Dhaka, Bangladesh
| | - Farzana Deeba
- Department of Obstetrics and Gynaecology, Bangabandhu Sheik Mujib Medical University, Dhaka, Bangladesh
| | | | | | - Iffat Jahan
- Department of Physiology, Eastern Medical College, Cumilla, Bangladesh
| | | | - Humaira Hasin
- Clinical Fellow, Epsom and St Helier University Hospitals NHS Trust, Surrey, United Kingdom
| | - Munzur-E-Murshid
- Women's Integrated Sexual Health (WISH) 2 Access Choice Together Innovate Ownership Now (ACTION) Project, Handicap International, Kurigram, Bangladesh
| | - Shamsun Nahar
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Monami Haque
- Human Resource Department, Square Toiletries Limited, Rupayan Center, Dhaka, Bangladesh
| | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Rimple Jeet Kaur
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Godfrey Mutashambara Rwegerera
- Department of Medicine, Sir Ketumile Masire Teaching Hospital, Gaborone, Botswana
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Isabella Piassi Dias Godói
- Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Cidade Universitária, Marabá, Brazil
- Group (CNPq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO), Universidade Federal do Sul e Sudeste do Pará, Marabá, Brazil
| | - Mohammed Irfan
- Faculdade de Odontologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | - Patrick Matowa
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | - Robert Incoom
- Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
- Pharmacy Practise Department of Pharmacy Practise, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | | | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practise, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - David Kimonge
- Department of Pharmaceutics and Pharmacy Practise, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, South Korea
| | - SeungJin Bae
- College of Pharmacy, Ewha Woman's University, Seoul, South Korea
| | | | - Abdullahi Rabiu Abubakar
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University, Kano, Nigeria
| | - Ibrahim Haruna Sani
- Unit of Pharmacology, College of Health Sciences, Yusuf Maitama Sule University (YUMSUK), Kano, Nigeria
| | | | | | - Zikria Saleem
- Department of Pharmacy Practise, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunisation (ECAVI), Kampala, Uganda
| | - Thereza Piloya-Were
- Paediatric Endocrinologist, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Luke Alutuli
- University Teaching Hospital Group, Department of Pharmacy, Lusaka, Zambia
| | | | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Vanda Marković-Peković
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Tubic
- Agency for Medicinal Products and Medical Devices of Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
- Department of Medicinal Chemistry, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | - András Harsanyi
- Department of Health Policy and Health Economics, Eotvos Lorand University, Budapest, Hungary
| | - András Inotai
- Syreon Research Institute, Budapest, Hungary
- Center of Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Arianit Jakupi
- Faculty of Pharmacy, UBT Higher Education Institute, Pristina, Kosovo
| | | | - Kristina Garuoliene
- Department of Pharmacy, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Magdalene Wladysiuk
- Chair of Epidemiology and Preventive Medicine Jagiellonian University, Medical College, Kraków, Poland
- HTA Consulting, Kraków, Poland
| | | | - Ileana Mardare
- Faculty of Medicine, Public Health and Management Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | | | | | - Caridad Pontes
- Drug Department, Catalan Health Service, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Corinne Zara
- Drug Department, Catalan Health Service, Barcelona, Spain
| | - Eunice Twumwaa Tagoe
- Department of Management Science, Business School, University of Strathclyde, Glasgow, United Kingdom
| | - Rita Banzi
- Center for Health Regulatory Policies, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milan, Italy
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Mihajlo Jakovljevic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Faculty of Economics, Institute of Comparative Economic Studies, Hosei University Tokyo, Tokyo, Japan
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5
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Moorkens E, Godman B, Huys I, Hoxha I, Malaj A, Keuerleber S, Stockinger S, Mörtenhuber S, Dimitrova M, Tachkov K, Vončina L, Palčevski VV, Achniotou G, Slabý J, Popelková L, Kohoutová K, Bartels D, Laius O, Martikainen JE, Selke GW, Kourafalos V, Magnússon E, Einarsdóttir R, Adams R, Joppi R, Allocati E, Jakupi A, Viksna A, Greičiūtė-Kuprijanov I, Vella Bonanno P, Suttorp V, Melien Ø, Plisko R, Mardare I, Meshkov D, Novakovic T, Fürst J, Zara C, Marković-Peković V, Grubiša N, Befrits G, Puckett R, Vulto AG. The Expiry of Humira ® Market Exclusivity and the Entry of Adalimumab Biosimilars in Europe: An Overview of Pricing and National Policy Measures. Front Pharmacol 2021; 11:591134. [PMID: 33519450 PMCID: PMC7839249 DOI: 10.3389/fphar.2020.591134] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Background: From October 2018, adalimumab biosimilars could enter the European market. However, in some countries, such as Netherlands, high discounts reported for the originator product may have influenced biosimilar entry. Objectives: The aim of this paper is to provide a European overview of (list) prices of originator adalimumab, before and after loss of exclusivity; to report changes in the reimbursement status of adalimumab products; and discuss relevant policy measures. Methods: Experts in European countries received a survey consisting of three parts: 1) general financing/co-payment of medicines, 2) reimbursement status and prices of originator adalimumab, and availability of biosimilars, and 3) policy measures related to the use of adalimumab. Results: In May 2019, adalimumab biosimilars were available in 24 of the 30 countries surveyed. Following introduction of adalimumab biosimilars, a number of countries have made changes in relation to the reimbursement status of adalimumab products. Originator adalimumab list prices varied between countries by a factor of 2.8 before and 4.1 after loss of exclusivity. Overall, list prices of originator adalimumab decreased after loss of exclusivity, although for 13 countries list prices were unchanged. When reported, discounts/rebates on originator adalimumab after loss of exclusivity ranged from 0% to approximately 26% (Romania), 60% (Poland), 80% (Denmark, Italy, Norway), and 80–90% (Netherlands), leading to actual prices per pen or syringe between €412 (Finland) and €50 – €99 (Netherlands). To leverage competition following entry of biosimilar adalimumab, only a few countries adopted measures specifically for adalimumab in addition to general policies regarding biosimilars. In some countries, a strategy was implemented even before loss of exclusivity (Denmark, Scotland), while others did not report specific measures. Conclusion: Even though originator adalimumab is the highest selling product in the world, few countries have implemented specific policies and practices for (biosimilar) adalimumab. Countries with biosimilars on the market seem to have competition lowering list or actual prices. Reported discounts varied widely between countries.
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Affiliation(s)
- Evelien Moorkens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Iris Hoxha
- Department of Pharmacy, University of Medicine Tirana, Tirana, Albania
| | - Admir Malaj
- Department of Pharmacy, University of Medicine Tirana, Tirana, Albania
| | | | | | | | - Maria Dimitrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | - Luka Vončina
- Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | | | | | - Juraj Slabý
- State Institute for Drug Control, Prague, Czechia
| | | | | | | | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | - Jaana E Martikainen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | | | - Vasileios Kourafalos
- National Organization for the Provision of Healthcare Services (EOPYY), Athens, Greece
| | | | | | | | - Roberta Joppi
- Clinical Research and Drug Evaluation Unit, Local Health Authority of Verona, Verona, Italy
| | - Eleonora Allocati
- Mario Negri Institute for Pharmacological Research (IRCCS), Milan, Italy
| | | | - Anita Viksna
- Department of Medicines and Medical Devices, The National Health Service, Riga, Latvia
| | | | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | | | - Øyvind Melien
- Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Ileana Mardare
- Public Health and Management Department, Faculty of Medicine, "Carol Davila", University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Dmitry Meshkov
- V. A. Trapeznikov Institute of Control Sciences of Russian Academy of Sciences, Moscow, Russia
| | | | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Corinne Zara
- Drug Area, Catalan Health Service, Barcelona, Spain
| | - Vanda Marković-Peković
- Department of Social Pharmacy and Pharmacy Practice, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Nataša Grubiša
- Health Insurance Fund, Banja Luka, Bosnia and Herzegovina
| | | | - Robert Puckett
- NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Erasmus University Medical Center, Rotterdam, Netherlands
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6
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Kurdi A, Elliott RA, Chen LC. Lessons from the failure of implementing the 'Better Care Better Value' prescribing indicator for renin-angiotensin system drugs in England: a qualitative study of general practitioners' perceptions using behavioural change framework. BMJ Open 2020; 10:e035910. [PMID: 32580986 PMCID: PMC7312337 DOI: 10.1136/bmjopen-2019-035910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To explore reasons for the lack of uptake of 'Better Care Better Value (BCBV)' prescribing indicators for renin-angiotensin-aldosterone system (RAAS) inhibitors and identify learning lessons to inform the implementation of future prescribing policies. DESIGN In-depth, semistructured interviews to explore: general practitioners' (GPs) experiences in prescribing RAAS, perceptions of the BCBV policy and potential barriers to policy implementation and suggestions for improving future policy implementation. Interviews were audio recorded, transcribed verbatim and analysed thematically, then mapped onto behavioural change frameworks (the Capability, Opportunity, Motivation and Behaviour) model and Behaviour Change Wheel (BCW)). SETTING Primary care setting in England PARTICIPANTS: Interviews were conducted with 16 GPs recruited from a purposive sample of 91 GP practices in three English counties. RESULTS Four factors/barriers, related mainly to GPs' psychological capability and reflective motivation, emerged as the possible barriers for the BCBV's lack of uptake, including: lack of the policy awareness, negative attitude to the policy, lack of incentives and GPs' reluctance to switch patients from angiotensin receptor blockers (ARBs) to ACE inhibitors (ACEIs). The participating GPs proposed interventions to improve future BCBV implementation and they were related to six intervention/policy functions of the BCW, addressing the four identified barriers: education/communication (increase GPs' awareness) and environmental restructuring/regulations (provide GPs with reminding alerts); incentivisation/fiscal (provide GPs with financial incentives); enablement/guidelines-regulations (provide GPs with benchmarking against peers) and enablement/regulations and education/guidelines (facilitate switching from ARBs to ACEIs). CONCLUSIONS The main reason underpinning the low uptake of the BCBV indicator appears to be lack of a proactive implementation strategy. This case study demonstrated that passively disseminating policy without an effective implementation strategy results in low uptake. Furthermore, multifaceted implementation strategies are necessary to influence complex clinical decision making in a time-limited environment, such as prescribing behaviours. These findings suggest that effective policy implementation requires the application of a systematic comprehensive behaviours change framework.
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Affiliation(s)
- Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Rachel Ann Elliott
- Manchester Centre for Health Economics, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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7
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Godman B, Basu D, Pillay Y, Mwita JC, Rwegerera GM, Anand Paramadhas BD, Tiroyakgosi C, Okwen PM, Niba LL, Nonvignon J, Sefah I, Oluka M, Guantai AN, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Distiller LA, Rampamba EM, Wing J, Mueller D, Alfadl A, Amu AA, Matsebula Z, Kalungia A, Zaranyika T, Masuka N, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer JC. Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future. Front Pharmacol 2020; 11:108. [PMID: 32265688 PMCID: PMC7098994 DOI: 10.3389/fphar.2020.00108] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities. Conclusion There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women's Health, National Department of Health, Pretoria, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Celda Tiroyakgosi
- Botswana Essential Drugs Action Program, Ministry of Health and Wellness, Gaborone, Botswana
| | - Patrick Mbah Okwen
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N Guantai
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Larry A Distiller
- Centre for Diabetes & Endocrinology (Pty) Ltd, Johannesburg, South Africa
| | - Enos M Rampamba
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Department Of Health, Shayandima, South Africa
| | - Jeffrey Wing
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Debjani Mueller
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.,Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan.,Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | | | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Nyasha Masuka
- Independent Health Systems Consultant, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, United Kingdom
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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8
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Mwita JC, Godman B, Esterhuizen TM. Statin prescription among patients with type 2 diabetes in Botswana: findings and implications. BMC Endocr Disord 2020; 20:36. [PMID: 32151249 PMCID: PMC7063760 DOI: 10.1186/s12902-020-0516-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/27/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There is evidence of statin benefit among patients with diabetes regardless of cholesterol levels or prior cardiovascular disease history. Despite the evidence, there is under-prescription of statins in clinical practice. This study aimed to assess statin prescriptions and associated factors among patients with type 2 diabetes in Botswana. METHODS The study was a secondary data analysis of 500 randomly selected type 2 diabetes patients at a specialised diabetes clinic at Gaborone, Botswana. We assessed the proportion of statin-eligible patients who are prescribed statins and evaluated the adjusted associations between various factors and statin prescriptions. RESULTS Overall, 477 (95.4%) participants were eligible for a statin prescription. Clinicians prescribed statins in 217 (45.5%) of eligible participants, and only one (4.4%) ineligible participant. The probability of a statin prescription was higher in participants with high baseline low-density lipoprotein cholesterol (risk ratio [RR]: 1.49; 95%CI: 1.17-1.89), increasing duration of diabetes (RR: 1.01; 95%CI 1.00-1.03) and the presence of chronic kidney disease (RR: 1.35; 95%CI: 1.06-1.74). CONCLUSION A large proportion with type 2 diabetes in Gaborone is not receiving statins. Clinicians did not consider most guideline-recommended indications for statin prescriptions. The findings call for improvement in diabetes quality of care by implementing evidence-based guideline recommendations.
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Affiliation(s)
- Julius Chacha Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag, 00713 Gaborone, Botswana
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE United Kingdom
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Tonya M. Esterhuizen
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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9
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Gad M, Salem A, Oortwijn W, Hill R, Godman B. Mapping of Current Obstacles for Rationalizing Use of Medicines (CORUM) in Europe: Current Situation and Potential Solutions. Front Pharmacol 2020; 11:144. [PMID: 32194401 PMCID: PMC7063972 DOI: 10.3389/fphar.2020.00144] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/04/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction There are increasing concerns regarding the inappropriate use of medicines with expenditure continuing to grow driven by increasing sales in oncology and orphan diseases, enhanced by their emotive nature. As a result, even high income countries are struggling to fund new premium priced medicines. These concerns have resulted in initiatives to better manage the entry of new medicines and enhance the rational use of medicines (RUM). However, there is a need to ascertain the current situation. We sought to address this by developing the Current Obstacles for Rationalizing Use of Medicines in Europe (CORUM) mapping tool to qualitatively investigate the current situation and provide analysis of current views on RUM and interventions among key European payers and their advisers. The findings will be used to provide future guidance. Methodology Descriptive study exploring and identifying perceived gaps to achieving optimal RUM. The CORUM tool was based on the WHO 12 key interventions to promote RUM. Results 62 participants took part with most respondents believing their country could improve RUM capacity. This included educational initiatives on the use of clinical guidelines (90%) and the inclusion of problem-based pharmacotherapy in undergraduate curricula and for Continued Professional Development. Key challenges included a lack of regular updates of guidelines, exacerbated by limited funding and a lack of follow-up to monitor adherence to agreed guidelines. RUM could also be enhanced by the development of regional formularies as well as implementing Drug and Therapeutic Committees where these are currently limited. There also needs to be greater co-ordination between RUM and Health Technology Assessment activities, with countries learning from each other. Conclusion There is an urgent need to improve RUM through improved educational and other activities among European countries, with countries learning from each other. This will involve addressing current challenges and we will be following this up.
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Affiliation(s)
- Mohamed Gad
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Ahmed Salem
- Real World Evidence Solutions, IQVIA, Zaventem, Belgium
| | - Wija Oortwijn
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
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10
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Yu SY, Lee B, McGuire TM, Lee HJ, Hollingworth SA. Consumption of medicines used for gastric acid-related disorders in Australia and South Korea: a cross-country comparison. Eur J Clin Pharmacol 2019; 76:547-555. [PMID: 31822956 DOI: 10.1007/s00228-019-02798-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE The study's aim was to compare the use of proton pump inhibitors (PPIs), histamine 2-receptor antagonists (H2RAs) and mucoprotective medicines (MPs) used for gastric acid-related disorders (GARD) in Australia and South Korea (Korea) from 2004 to 2017. METHODS Prescription data for PPIs, H2RAs and MPs for Australian outpatients were extracted from the Australian Statistics on Medicines annual reports, with dose-specific and expenditure data obtained from Medicare. Similar data were obtained from Korean National Health Insurance Service claims data. We analysed the volume and expenditure of medicines use annually using the defined daily dose per 1,000 population per day. We calculated which medicines accounted for 90% of use and estimated the proportions of use for low- and high-dose PPIs. RESULTS While total utilisation for GARD medicines increased over time in both countries, patterns of use differed. Overall, use was somewhat higher in Australia but increased more rapidly in Korea. PPIs were used more extensively in Australia, while more MPs and H2RAs were used in Korea. Expenditure and use of low-dose PPIs is escalating in Korea. CONCLUSION There were substantial differences in the use of GARD medicines in Australia and Korea over 14 years. Both countries face similar challenges to promote rational medicines use and contain medical care costs. The discrepant prescribing patterns can be attributed to differences in healthcare systems, pharmaceutical policies and demographics. This study provides a baseline to influence more rational use of these medicines. It provides insight into medicines policies for other countries that face similar challenges.
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Affiliation(s)
- Su-Yeon Yu
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Boram Lee
- Graduate School of Public Health, Seoul National University, Seoul, South Korea.
| | - Treasure M McGuire
- School of Pharmacy, The University of Queensland, Brisbane, Australia.,Mater Pharmacy, Mater Health, Brisbane, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Australia
| | - Hye-Jae Lee
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea
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11
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Stoker LJ, Heerdink ER, Janssen R, Egberts TCG. Effect of reimbursement restriction policy on the use of benzodiazepines in the Netherlands: an interrupted time series analysis. BMJ Open 2019; 9:e029148. [PMID: 31551375 PMCID: PMC6773356 DOI: 10.1136/bmjopen-2019-029148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/10/2019] [Accepted: 07/25/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Use of benzodiazepines has health risks. Reimbursement was restricted in the Netherlands from January 2009 onwards with the goal to reduce chronic use and healthcare expenditures. The aim of this study is to assess the initial and long-term effects of this policy on benzodiazepine use. DESIGN Interrupted time series analysis, segmented regression models, Kaplan-Meier survival analysis and Cox proportional hazards analysis. SETTING A 10% random sample of benzodiazepine dispensings by outpatient pharmacies between January 2002 and August 2015 were obtained from the PHARMO database. This database covered a catchment area representing about 3.6 million residents in 2015. PARTICIPANTS 2 500 800 benzodiazepine prescriptions from 128 603 patients were included. INTERVENTION Reimbursement restriction policy from January 2009 onwards. OUTCOME MEASURES Changes in: the volume of dispensed prescriptions and doses, the incidence, prevalence of incidental, regular and chronic use and discontinuation rates of benzodiazepines. RESULTS The volume of dispensed prescriptions and doses decreased by 12.5% (95% CI 9.0% to 15.9%) and 15.1% (95% CI 11.4% to 17.3%) respectively in January 2009 compared with December 2008. A clear initial effect on the overall incidence (-14.7%; 95% CI -19.8% to 9.6%) and the prevalence of incidental (-17.8%; 95% CI -23.9% to 11.7%), regular (-20.0%; 95% CI -26.1% to 13.9%) and chronic (-16.0%; 95% CI -23.1% to 8.9%) use was observed. A statistically significant reduction in the monthly trend per 1000 medication users was observed for the overall incidence (-0.017; 95% CI -0.031 to 0.003) and the prevalence of incidental (-3.624; 95% CI -4.996 to 2.252) but not for regular (-0.304; 95% CI -1.204 to 0.596) and chronic (0.136; 95% CI -0.858 to 1.130) use. Patients who started treatment before policy had a slightly higher probability of discontinuation (HR=1.013; 95% CI 1.004 to 1.022). CONCLUSIONS The reimbursement policy had a significant initial effect on the volume, incidence and prevalence of benzodiazepine use. In addition, there is a statistically significant reduction in the monthly trend of overall incidence and of the prevalence of incidental use. No statistically significant reduction in the monthly trend of chronic use, the main purpose of the reimbursement restriction, could be demonstrated.
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Affiliation(s)
- Lennart Jan Stoker
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Clinical Pharmacy, Medisch Centrum Haaglanden, Den Haag, Zuid-Holland, The Netherlands
| | - Eibert Roelof Heerdink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Research Group Innovations of Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Richard Janssen
- Erasmus School of Health Policy and Management/Health Care Governance, Erasmus Universiteit Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Brabant, The Netherlands
| | - Toine C G Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
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12
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Son KB. Generic atorvastatin and rosuvastatin in the South Korean market: time of introduction in relation to manufacturer characteristics. Expert Rev Pharmacoecon Outcomes Res 2019; 20:541-548. [PMID: 31483158 DOI: 10.1080/14737167.2019.1664291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The competition for and market dynamics of generic medicines can be understood by analyzing manufacturers' behavior. In this study, we analyzed the various types of generic atorvastatin and rosuvastatin that were introduced onto the South Korean market from 2002 to 2018 and their corresponding manufacturers. Methods: Based on publicly available data, we selected drugs containing atorvastatin and rosuvastatin as active ingredients for the analysis. We calculated the time between the date of marketing approval for the first generic and that of the remaining generics. Then, we categorized manufacturers that marketed generics into first movers and latecomers. Results: We confirmed that many manufacturers have marketed generic drugs in South Korea and that manufacturers can be categorized as first movers and latecomers. Interestingly, latecomers account for a large portion of the manufacturers of generics, and they have entered the market steadily, even after the market matured with a number of manufacturers. Additionally, the characteristics of the manufacturers were closely related to manufacturers' behaviors in the market. Conclusions: The order-of-entry effect, which is commonly observed in other markets, is marginal in the South Korean market, and this phenomenon is mainly explained by the rare price competition among generic manufacturers.
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Affiliation(s)
- Kyung-Bok Son
- College of Pharmacy, Ewha Womans University , Seoul, South Korea
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13
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Joshi SS, Shetty YC, Karande S. Generic drugs - The Indian scenario. J Postgrad Med 2019; 65:67-69. [PMID: 31036775 PMCID: PMC6515776 DOI: 10.4103/jpgm.jpgm_420_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S S Joshi
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Y C Shetty
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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14
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Son KB, Bae S. Patterns of statin utilisation for new users and market dynamics in South Korea: a 13-year retrospective cohort study. BMJ Open 2019; 9:e026603. [PMID: 30842117 PMCID: PMC6430099 DOI: 10.1136/bmjopen-2018-026603] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/16/2019] [Accepted: 01/28/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study analysed utilisation of statins for new statin users and assessed market dynamics of statins in South Korea. DESIGN This study is a retrospective cohort study. SETTING The yearly claims data for statins were retrieved from the National Health Insurance Service-National Sample Cohort. MAIN OUTCOME MEASURE We are interested in new statin users during 2003-2015 in Korea. Information on prescribed statins, including intensity of statins and entry of new and follow-on statins in the market, and healthcare institutions that prescribed the statins were also collected. In time series analysis, we estimated the effect of introduction of generics in the market, specifically for newly prescribed statin users. RESULTS This 13-year longitudinal study of a sample cohort provided by the National Health Insurance Service found that the incidence of new statin user increase from 838.1/100 000 persons in 2003 to 1626.9/100 000 persons in 2015. Most new users were initiated on a monotherapy that was prescribed at primary healthcare institutions. However, the statin market for new users were quite dynamic in Korea. First, the most commonly prescribed statin changed several times during the study period. Second, the use of moderate-intensity statins increased from 57% in 2003 to 92% in 2015. In line with this result, we could not observe substantial differences in prescription of statins in groups having selected diseases history. Lastly, we found market invasion or switch of statins among new statin users, specifically at primary healthcare institutions. CONCLUSION Similar to other countries, the incidence of new statin users has been increased in Korea. However, the statin market in Korea is quite dynamic compared with other countries. Interestingly, discounted price of originals after the introduction of generics immediately expand markets or substitute the market particularly in primary healthcare institutions in Korea.
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Affiliation(s)
- Kyung-Bok Son
- Ewha Womans University, College of Pharmacy, Seoul, The Republic of Korea
| | - SeungJin Bae
- Ewha Womans University, College of Pharmacy, Seoul, The Republic of Korea
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15
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Jakupi A, Godman B, Martin A, Haycox A, Baholli I. Utilization and Expenditure of Anti-cancer Medicines in Kosovo: Findings and Implications. PHARMACOECONOMICS - OPEN 2018; 2:423-432. [PMID: 29396661 PMCID: PMC6249196 DOI: 10.1007/s41669-017-0066-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE The Ministry of Health (MoH) leads and organizes health policy in Kosovo, which includes procurement and provision of medicines, including anti-cancer medicines, which compose a special group of medicines. However, there has been limited analysis of the utilization and expenditure on anti-cancer medicines in Kosovo; consequently, the objective of this study is to undertake research to provide future guidance on the use of anti-cancer medicines. METHOD National drug utilization data is available in Kosovo. Utilization and expenditure on anti-cancer medicines [Anatomical Therapeutic Chemical (ATC) code L], initially from 2011 to 2013, especially for anti-cancer medicines on the essential medicines list was analysed from national data. In addition, current systems for procuring and managing anti-cancer medicines in Kosovo was documented. RESULTS There was appreciable variability in the utilization of anti-cancer medicines over the years, with low or limited use of some anti-cancer medicines on the Essential Medicine List. This is a concern in view of their essential medicine status. From 2011 to 2013, €16.49 million was spent on anti-cancer medicines (ATC L). The process of selection of new medicines begins with suggestions from doctors at the University Clinical Centre in Kosovo. CONCLUSION The analysis has shown appreciable variation with current utilization patterns for anti-cancer medicines in Kosovo. This needs to be addressed as part of improving the drug management process to optimize patient care within available resources. Future years and reforms need to be assessed to improve current utilization and expenditure patterns.
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Affiliation(s)
- Arianit Jakupi
- Faculty of Pharmacy, UBT Higher Education Institution, Prishtina, Kosovo
- Pharmaceutical Consulting, Prishtina, Kosovo
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Antony Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Alan Haycox
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
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16
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Khandelwal N, Johns B, Hepp Z, Castelli-Haley J. The economic impact of switching from Synthroid for the treatment of hypothyroidism. J Med Econ 2018; 21:518-524. [PMID: 29458287 DOI: 10.1080/13696998.2018.1443110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS To compare hypothyroidism-related costs for patients who continuously used Synthroid and patients who switched from Synthroid to alternative therapies. MATERIALS AND METHODS Truven's Health Analytics MarketScan Commercial Claims and Encounters database from January 1, 2007 to June 30, 2014 was queried for US adults diagnosed with hypothyroidism who initiated Synthroid and adhered to such therapy for at least 6 months. Propensity score matching matched continuous users of Synthroid to patients who switched from Synthroid to alternative levothyroxine agents. Kruskal-Wallis tests assessed differences between the matched cohorts in several categories of costs, including disease-related drug costs, non-drug medical costs, and total direct medical costs. RESULTS There were 10,159 individuals included in the study, with 7,991 continuous users of Synthroid and 2,168 switchers. After matching (n = 2,052 for each cohort), continuous use of Synthroid was associated with significantly lower hypothyroidism-related non-drug medical costs ($595 vs $1,023; p = .003) and reduced hypothyroidism-related total medical costs ($757 vs $1,132; p = .010), despite being associated with significantly higher drug costs ($161 vs $109; p < .001). Hypothyroidism-related total medical costs rose as the number of switches of hypothyroidism treatment increased, with continuous users having significantly lower hypothyroidism-related total medical costs ($757) compared with patients who switched twice ($1,179; p = .001) or three or more times ($1,268; p = .004). LIMITATIONS The analyses focused on continuously insured patients who were adherent to Synthroid for at least 6 months and results may not be generalizable. The reliance on claims data does not allow for clinical examination of hypothyroidism or inclusion of some factors that may be associated with outcomes. The analyses assume that all prescriptions filled are taken as prescribed. CONCLUSIONS Results indicate that there are significant direct economic healthcare costs associated with switching from Synthroid to alternative levothyroxine therapies, and that these costs increase as patients switch therapies more frequently.
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Affiliation(s)
| | | | - Zsolt Hepp
- a AbbVie, Inc. , North Chicago , IL , USA
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17
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Moorkens E, Vulto AG, Huys I, Dylst P, Godman B, Keuerleber S, Claus B, Dimitrova M, Petrova G, Sović-Brkičić L, Slabý J, Šebesta R, Laius O, Karr A, Beck M, Martikainen JE, Selke GW, Spillane S, McCullagh L, Trifirò G, Vella Bonanno P, Mack A, Fogele A, Viksna A, Władysiuk M, Mota-Filipe H, Meshkov D, Kalaba M, Mencej Bedrač S, Fürst J, Zara C, Skiöld P, Magnússon E, Simoens S. Policies for biosimilar uptake in Europe: An overview. PLoS One 2017; 12:e0190147. [PMID: 29284064 PMCID: PMC5746224 DOI: 10.1371/journal.pone.0190147] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/09/2017] [Indexed: 12/04/2022] Open
Abstract
Background Across European countries, differences exist in biosimilar policies, leading to variations in uptake of biosimilars and divergences in savings all over Europe. Objectives The aim of this article is to provide an overview of different initiatives and policies that may influence the uptake of biosimilars in different European countries. Recommendations will be formulated on how to create sustainable uptake. Methods An overview of policies on biosimilars was obtained via a questionnaire, supplemented with relevant articles. Topics were organized in five themes: availability, pricing, reimbursement, demand-side policies, and recommendations to enhance uptake. Results In all countries studied, biological medicines are available. Restrictions are mainly dependent on local organization of the healthcare system. Countries are willing to include biosimilars for reimbursement, but for commercial reasons they are not always marketed. In two thirds of countries, originator and biosimilar products may be subjected to internal reference pricing systems. Few countries have implemented specific incentives targeting physicians. Several countries are implementing pharmacist substitution; however, the scope and rules governing such substitution tend to vary between these countries. Reported educational policies tend to target primarily physicians, whereas fewer initiatives were reported for patients. Recommendations as proposed by the different country experts ranged from the need for information and communication on biosimilars to competitive pricing, more support for switching and guidance on substitution. Conclusions Most countries have put in place specific supply-side policies for promoting access to biosimilars. To supplement these measures, we propose that investments should be made to clearly communicate on biosimilars and educate stakeholders. Especially physicians need to be informed on the entry and use of biosimilars in order to create trust. When physicians are well-informed on the treatment options, further incentives should be offered to prescribe biosimilars. Gainsharing can be used as an incentive to prescribe, dispense or use biosimilars. This approach, in combination with binding quota, may support a sustainable biosimilar market.
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Affiliation(s)
- Evelien Moorkens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- * E-mail:
| | - Arnold G. Vulto
- Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabelle Huys
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Pieter Dylst
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- Medicines for Europe, Brussels, Belgium
| | - Brian Godman
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Simon Keuerleber
- Main Association of Austrian Social Security Institutions, Vienna, Austria
| | - Barbara Claus
- Faculty of pharmaceutical sciences, Ghent University, Ghent, Belgium
| | - Maria Dimitrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | - Juraj Slabý
- State Institute for Drug Control, Prague, Czech Republic
| | - Robin Šebesta
- State Institute for Drug Control, Brno, Czech Republic
| | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia
| | - Allan Karr
- Karr Consultancy Ltd, Hertfordshire, United Kingdom
| | - Morgane Beck
- OMEDIT Alsace, Agence Régionale de Santé du Grand Est, Strasbourg, France
| | | | | | - Susan Spillane
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland
| | - Laura McCullagh
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Patricia Vella Bonanno
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Asbjørn Mack
- Division Pharmaceuticals, Norwegian Hospital Procurement Trust, Oslo, Norway
| | - Antra Fogele
- Department of Medicines and Medical Devices, The National Health Service, Riga, Latvia
| | - Anita Viksna
- Department of Medicines and Medical Devices, The National Health Service, Riga, Latvia
| | | | | | - Dmitry Meshkov
- Semashko National Research Institute for Public Health, Moscow, Russia
| | | | - Simona Mencej Bedrač
- Agency for Medicinal Products and Medical Devices of the Republic of Slovenia, Ljubljana, Slovenia
| | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Corrine Zara
- Barcelona Health Region, Catalan Health Service, Barcelona, Spain
| | | | | | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
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18
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Vella Bonanno P, Ermisch M, Godman B, Martin AP, Van Den Bergh J, Bezmelnitsyna L, Bucsics A, Arickx F, Bybau A, Bochenek T, van de Casteele M, Diogene E, Eriksson I, Fürst J, Gad M, Greičiūtė-Kuprijanov I, van der Graaff M, Gulbinovic J, Jones J, Joppi R, Kalaba M, Laius O, Langner I, Mardare I, Markovic-Pekovic V, Magnusson E, Melien O, Meshkov DO, Petrova GI, Selke G, Sermet C, Simoens S, Schuurman A, Ramos R, Rodrigues J, Zara C, Zebedin-Brandl E, Haycox A. Adaptive Pathways: Possible Next Steps for Payers in Preparation for Their Potential Implementation. Front Pharmacol 2017; 8:497. [PMID: 28878667 PMCID: PMC5572364 DOI: 10.3389/fphar.2017.00497] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/12/2017] [Indexed: 01/11/2023] Open
Abstract
Medicines receiving a conditional marketing authorization through Medicines Adaptive Pathways to Patients (MAPPs) will be a challenge for payers. The "introduction" of MAPPs is already seen by the European Medicines Agency (EMA) as a fait accompli, with payers not consulted or involved. However, once medicines are approved through MAPPs, they will be evaluated for funding by payers through different activities. These include Health Technology Assessment (HTA) with often immature clinical data and high uncertainty, financial considerations, and negotiations through different types of agreements, which can require monitoring post launch. Payers have experience with new medicines approved through conditional approval, and the fact that MAPPs present additional challenges is a concern from their perspective. There may be some activities where payers can collaborate. The final decisions on whether to reimburse a new medicine via MAPPs will have more variation than for medicines licensed via conventional processes. This is due not only to increasing uncertainty associated with medicines authorized through MAPPs but also differences in legal frameworks between member states. Moreover, if the financial and side-effect burden from the period of conditional approval until granting full marketing authorization is shifted to the post-authorization phase, payers may have to bear such burdens. Collection of robust data during routine clinical use is challenging along with high prices for new medicines during data collection. This paper presents the concept of MAPPs and possible challenges. Concerns and potential ways forward are discussed and a number of recommendations are presented from the perspective of payers.
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Affiliation(s)
- Patricia Vella Bonanno
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, United Kingdom
| | - Michael Ermisch
- Pharmaceutical Department, National Association of Statutory Health Insurance FundsBerlin, Germany
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, United Kingdom.,Health Economics Centre, University of Liverpool Management SchoolLiverpool, United Kingdom.,Division of Clinical Pharmacology, Karolinska InstitutetStockholm, Sweden
| | - Antony P Martin
- Health Economics Centre, University of Liverpool Management SchoolLiverpool, United Kingdom
| | | | | | - Anna Bucsics
- Mechanism of Coordinated Access to Orphan Medicinal Products (MoCA)Brussels, Belgium
| | - Francis Arickx
- Department of Pharmaceutical Policy, National Institute for Health and Disability InsuranceBruxelles, Belgium
| | | | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical CollegeKraków, Poland
| | - Marc van de Casteele
- Department of Pharmaceutical Policy, National Institute for Health and Disability InsuranceBruxelles, Belgium
| | - Eduardo Diogene
- Clinical Pharmacology Service, University Hospital Vall d'Hebron, Universitat Autonoma de BarcelonaBarcelona, Spain
| | - Irene Eriksson
- Department of Healthcare Development, Stockholm County CouncilStockholm, Sweden.,Department of Medicine Solna, Karolinska InstitutetStockholm, Sweden
| | - Jurij Fürst
- Medicinal Products Department, Health Insurance Institute of SloveniaLjubljana, Slovenia
| | - Mohamed Gad
- Global Health and Development Group, Imperial CollegeLondon, United Kingdom
| | | | | | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius UniversityVilnius, Lithuania.,State Medicines Control AgencyVilnius, Lithuania
| | - Jan Jones
- Scottish Medicines ConsortiumGlasgow, United Kingdom
| | - Roberta Joppi
- Clinical Research and Drug Assessment UnitVerona, Italy
| | - Marija Kalaba
- Pediatric Cardiology, Primary Healthcare Centre "Zemun"Belgrade, Serbia
| | - Ott Laius
- Department of Post-authorisation Safety, State Agency of MedicinesTartu, Estonia
| | | | - Ileana Mardare
- Faculty of Medicine, Public Health and Management Department, "Carol Davila" University of Medicine and Pharmacy BucharestBucharest, Romania
| | - Vanda Markovic-Pekovic
- Ministry of Health and Social WelfareBanja Luka, Bosnia and Herzegovina.,Department of Social Pharmacy, Medical Faculty, University of Banja LukaBanja Luka, Bosnia and Herzegovina
| | - Einar Magnusson
- Department of Health Services, Ministry of HealthReykjavík, Iceland
| | | | | | - Guenka I Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of SofiaSofia, Bulgaria
| | | | - Catherine Sermet
- Institut de Recherche et Documentation en Economie de la Santé (IRDES)Paris, France
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological SciencesLeuven, Belgium
| | - Ad Schuurman
- National Health Care Institute (ZIN)Diemen, Netherlands
| | - Ricardo Ramos
- Health Technology Assessment, Pricing and Reimbursement Department, Central Administration of the Health System, National Authority of Medicines and Health Products (I.P., INFARMED)Lisboa, Portugal
| | - Jorge Rodrigues
- Health Technology Assessment, Pricing and Reimbursement Department, Central Administration of the Health System, National Authority of Medicines and Health Products (I.P., INFARMED)Lisboa, Portugal
| | - Corinne Zara
- Barcelona Health Region, Catalan Health ServiceBarcelona, Spain
| | - Eva Zebedin-Brandl
- Department of Pharmaceutical Affairs, Main Association of Austrian Social Insurance InstitutionsVienna, Austria
| | - Alan Haycox
- Health Economics Centre, University of Liverpool Management SchoolLiverpool, United Kingdom
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19
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Kshirsagar NA. Rational use of medicines: Cost consideration & way forward. Indian J Med Res 2017; 144:502-505. [PMID: 28256457 PMCID: PMC5345295 DOI: 10.4103/0971-5916.200901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nilima A Kshirsagar
- National Chair Clinical Pharmacology (ICMR), National Institute for Research in Reproductive Health, J. M. Street, Parel, Mumbai 400 012, Maharashtra, India
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20
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Kriegbaum M, Liisberg KB, Wallach-Kildemoes H. Pattern of statin use changes following media coverage of its side effects. Patient Prefer Adherence 2017; 11:1151-1157. [PMID: 28744105 PMCID: PMC5513880 DOI: 10.2147/ppa.s133168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The media plays a role in shaping opinions about medical decisions, for example, whether to initiate or stop treatment. An association between negative media attention and statin discontinuation has been demonstrated, but it may differ depending on the reason for prescription and whether the user is new (incident) or long term (prevalent). AIM The aim of this study is to explore whether a Danish newspaper article featuring the side effects of statins affects statin discontinuation in incident versus prevalent users, with the reason for prescription also taken into account. METHODS The study relies on a quasi-experimental design and uses registry data on statin purchases to explore discontinuation and treatment duration. As a proxy for reason for prescription, data on filled prescriptions and hospital diagnoses from a Danish registry were used. We compared statin discontinuation in all statin users in Denmark in 2007 before the media event (n=343,438) and after it in 2008 (n=404,052). RESULTS Compared to 2007, statin discontinuation among prevalent users in 2008 increased by 2.97 percentage points (pp). The change in discontinuation varied with the indication for statin use. Those with myocardial infarction had the smallest increase (1.98 pp) and those with hypercholesterolemia or primary hypertension had the largest increase (3.54 pp). Incident statin users had a higher level of discontinuation and a larger difference in discontinuation between 2007 and 2008. Compared to 2007, more people (5.52 pp) discontinued statin treatment in 2008. Again, those with myocardial infarction had the smallest decrease in statin discontinuation (1.49 pp), while those with a potential atherosclerotic condition (7.05 pp) and hypercholesterolemia or primary hypertension (6.10 pp) had the largest increase. CONCLUSION Statin discontinuation increased in 2008 following a media event, but especially among individuals prescribed statins for primary prevention and among new statin users.
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Affiliation(s)
- Margit Kriegbaum
- Department of Public Health
- Correspondence: Margit Kriegbaum, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen, Denmark, Tel +45 35 33 73 26, Fax +45 35 32 76 29, Email
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21
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Ermisch M, Bucsics A, Vella Bonanno P, Arickx F, Bybau A, Bochenek T, van de Casteele M, Diogene E, Fürst J, Garuolienė K, van der Graaff M, Gulbinovič J, Haycox A, Jones J, Joppi R, Laius O, Langner I, Martin AP, Markovic-Pekovic V, McCullagh L, Magnusson E, Nilsen E, Selke G, Sermet C, Simoens S, Sauermann R, Schuurman A, Ramos R, Vlahovic-Palcevski V, Zara C, Godman B. Payers' Views of the Changes Arising through the Possible Adoption of Adaptive Pathways. Front Pharmacol 2016; 7:305. [PMID: 27733828 PMCID: PMC5039228 DOI: 10.3389/fphar.2016.00305] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/26/2016] [Indexed: 12/29/2022] Open
Abstract
Payers are a major stakeholder in any considerations and initiatives concerning adaptive licensing of new medicinal products, also referred to as Medicines Adaptive Pathways to patients (MAPPs). Firstly, the scope and necessity of MAPPs need further scrutiny, especially with regard to the definition of unmet need. Conditional approval pathways already exist for new medicines for seriously debilitating or life-threatening diseases and only a limited number of new medicines are innovative. Secondly, MAPPs will result in new medicines on the market with limited evidence about their effectiveness and safety. Additional data are to be collected after approval. Consequently, adaptive pathways may increase the risk of exposing patients to ineffective or unsafe medicines. We have already seen medicines approved conventionally that subsequently proved ineffective or unsafe amongst a wider, more co-morbid population as well as medicines that could have been considered for approval under MAPPs but subsequently proved ineffective or unsafe in Phase III trials and were never licensed. Thirdly, MAPPs also put high demands on payers. Routine collection of patient level data is difficult with high transaction costs. It is not clear who will fund these. Other challenges for payers include shifts in the risk governance framework, implications for evaluation and HTA, increased complexity of setting prices, difficulty with ensuring equity in the allocation of resources, definition of responsibility and liability and implementation of stratified use. Exit strategies also need to be agreed in advance, including price reductions, rebates, or reimbursement withdrawals when price premiums are not justified. These issues and concerns will be discussed in detail including potential ways forward.
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Affiliation(s)
- Michael Ermisch
- Pharmaceuticals Department, National Association of Statutory Health Insurance Funds Berlin, Germany
| | - Anna Bucsics
- Department of Finance, University of Vienna Vienna, Austria
| | | | - Francis Arickx
- National Institute for Health and Disability Insurance Bruxelles, Belgium
| | | | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College Krakow, Poland
| | | | - Eduardo Diogene
- Clinical Pharmacology Service, Vall d'Hebron University Hospital, Fundació Institut Català de Farmacologia Barcelona, Spain
| | - Jurij Fürst
- Medicinal Products Department, Health Insurance Institute of Slovenia Ljubljana, Slovenia
| | - Kristina Garuolienė
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius UniversityVilnius, Lithuania; Medicines Reimbursement Department, National Health Insurance FundVilnius, Lithuania
| | | | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius UniversityVilnius, Lithuania; State Medicines Control AgencyVilnius, Lithuania
| | - Alan Haycox
- Health Economics Centre, University of Liverpool Management School Liverpool, UK
| | - Jan Jones
- Scottish Medicines Consortium Glasgow, UK
| | - Roberta Joppi
- Pharmaceutical Drug Department, Azienda Sanitaria Locale of Verona Verona, Italy
| | - Ott Laius
- State Agency of Medicines Tartu, Estonia
| | - Irene Langner
- Wissenschaftliches Institut der AOK (WIdO) Berlin, Germany
| | - Antony P Martin
- Health Economics Centre, University of Liverpool Management School Liverpool, UK
| | - Vanda Markovic-Pekovic
- Ministry of Health and Social WelfareBanja Luka, Bosnia and Herzegovina; Department of Social Pharmacy, Medical Faculty, University Banja LukaBanja Luka, Bosnia and Herzegovina
| | - Laura McCullagh
- Pharmacoeconomics and Health Technology Assessment, Department of Pharmacology and Therapeutics, Trinity College Dublin, Ireland
| | - Einar Magnusson
- Department of Health Services, Ministry of Health Reykjavík, Iceland
| | | | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO) Berlin, Germany
| | - Catherine Sermet
- Institut de Recherche et Documentation en Economie de la Santé (IRDES) Paris, France
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Leuven, Belgium
| | - Robert Sauermann
- Department of Pharmaceutical Affairs, Main Association of Austrian Social Insurance Institutions Vienna, Austria
| | - Ad Schuurman
- National Health Care Institute Diemen, Netherlands
| | - Ricardo Ramos
- Health Technology Assessment, Prices and Reimbursement Department, INFARMED - National Authority of Medicines and Health Products, I. P., Parque de Saúde de Lisboa Lisbon, Portugal
| | | | - Corinne Zara
- Barcelona Health Region, Catalan Health Service Barcelona, Spain
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management SchoolLiverpool, UK; Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, UK; Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
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22
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de Bruijn W, Ibáñez C, Frisk P, Bak Pedersen H, Alkan A, Vella Bonanno P, Brkičić LS, Bucsics A, Dedet G, Eriksen J, Fadare JO, Fürst J, Gallego G, Godói IP, Guerra Júnior AA, Gürsöz H, Jan S, Jones J, Joppi R, Kerman S, Laius O, Madzikwa N, Magnússon E, Maticic M, Markovic-Pekovic V, Massele A, Ogunleye O, O'Leary A, Piessnegger J, Sermet C, Simoens S, Tiroyakgosi C, Truter I, Thyberg M, Tomekova K, Wladysiuk M, Vandoros S, Vural EH, Zara C, Godman B. Introduction and Utilization of High Priced HCV Medicines across Europe; Implications for the Future. Front Pharmacol 2016; 7:197. [PMID: 27516740 PMCID: PMC4964878 DOI: 10.3389/fphar.2016.00197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/21/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Infection with the Hepatitis C Virus (HCV) is a widespread transmittable disease with a diagnosed prevalence of 2.0%. Fortunately, it is now curable in most patients. Sales of medicines to treat HCV infection grew 2.7% per year between 2004 and 2011, enhanced by the launch of the protease inhibitors (PIs) boceprevir (BCV) and telaprevir (TVR) in addition to ribavirin and pegylated interferon (pegIFN). Costs will continue to rise with new treatments including sofosbuvir, which now include interferon free regimens. OBJECTIVE Assess the uptake of BCV and TVR across Europe from a health authority perspective to offer future guidance on dealing with new high cost medicines. METHODS Cross-sectional descriptive study of medicines to treat HCV (pegIFN, ribavirin, BCV and TVR) among European countries from 2008 to 2013. Utilization measured in defined daily doses (DDDs)/1000 patients/quarter (DIQs) and expenditure in Euros/DDD. Health authority activities to influence treatments categorized using the 4E methodology (Education, Engineering, Economics and Enforcement). RESULTS Similar uptake of BCV and TVR among European countries and regions, ranging from 0.5 DIQ in Denmark, Netherlands and Slovenia to 1.5 DIQ in Tayside and Catalonia in 2013. However, different utilization of the new PIs vs. ribavirin indicates differences in dual vs. triple therapy, which is down to factors including physician preference and genotypes. Reimbursed prices for BCV and TVR were comparable across countries. CONCLUSION There was reasonable consistency in the utilization of BCV and TVR among European countries in comparison with other high priced medicines. This may reflect the social demand to limit the transmission of HCV. However, the situation is changing with new curative medicines for HCV genotype 1 (GT1) with potentially an appreciable budget impact. These concerns have resulted in different prices across countries, with their impact on budgets and patient outcomes monitored in the future to provide additional guidance.
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Affiliation(s)
- Winnie de Bruijn
- Department of Pharmaceutical Sciences, Utrecht UniversityUtrecht, Netherlands
| | - Cristina Ibáñez
- Catalan Health Service - Servei Català de la SalutBarcelona, Spain
| | - Pia Frisk
- Public Health Services Committee, Stockholm County CouncilStockholm, Sweden
| | - Hanne Bak Pedersen
- Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for EuropeCopenhagen, Denmark
| | - Ali Alkan
- Turkish Medicines and Medical Devices Agency, Ministry of HealthAnkara, Turkey
| | | | | | - Anna Bucsics
- Department of Finance, University of ViennaVienna, Austria
| | | | - Jaran Eriksen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
| | - Joseph O. Fadare
- Department of Pharmacology, Ekiti State UniversityAdo-Ekiti, Nigeria
| | - Jurij Fürst
- Health Insurance InstituteLjubljana, Slovenia
| | - Gisselle Gallego
- School of Medicine, The University of Notre Dame AustraliaDarlinghurst, NSW, Australia
- Department of Pharmacology and Clinical Neuroscience, Umea UniversityUmea, Sweden
| | - Isabella P. Godói
- School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas GeraisBelo Horizonte, Brazil
- Department of Social Pharmacy, SUS Collaborating Centre – Health Technology Assessment and Excellence in Health, College of Pharmacy, Federal University of Minas GeraisBelo Horizonte, Brazil
| | - Augusto A. Guerra Júnior
- School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas GeraisBelo Horizonte, Brazil
- Department of Social Pharmacy, SUS Collaborating Centre – Health Technology Assessment and Excellence in Health, College of Pharmacy, Federal University of Minas GeraisBelo Horizonte, Brazil
| | - Hakkı Gürsöz
- Turkish Medicines and Medical Devices Agency, Ministry of HealthAnkara, Turkey
| | - Saira Jan
- Clinical Pharmacy, Rutgers State University of New JerseyPiscataway, NJ, USA
- Horizon Blue Cross Blue Shield of New JerseyNewark, NJ, USA
| | - Jan Jones
- Scottish Medicines ConsortiumGlasgow, UK
| | - Roberta Joppi
- Pharmaceutical Drug Department, Azienda Sanitaria Locale of VeronaVerona, Italy
| | - Saim Kerman
- Turkish Medicines and Medical Devices Agency, Ministry of HealthAnkara, Turkey
| | - Ott Laius
- State Agency of MedicinesTartu, Estonia
| | | | - Einar Magnússon
- Department of Health Services, Ministry of HealthReykjavík, Iceland
| | - Mojca Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre LjubljanaLjubljana, Slovenia
| | - Vanda Markovic-Pekovic
- Faculty of Medicine, University of Banja LukaBanja Luka, Bosnia and Herzegovina
- Ministry of Health and Social WelfareBanja Luka, Bosnia and Herzegovina
| | - Amos Massele
- Department of Clinical Pharmacology, School of Medicine, University of BotswanaGaborone, Botswana
| | - Olayinka Ogunleye
- Clinical Pharmacology Unit, Department of Medicine, Lagos State University Teaching HospitalLagos, Nigeria
- Department of Pharmacology and Therapeutics, Lagos State University College of MedicineLagos, Nigeria
| | | | - Jutta Piessnegger
- Hauptverband der Österreichischen SozialversicherungsträgerWien, Austria
| | | | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU LeuvenLeuven, Belgium
| | | | - Ilse Truter
- Drug Utilisation Research Unit, Faculty of Health Sciences, Nelson Mandela Metropolitan UniversityPort Elizabeth, South Africa
| | - Magnus Thyberg
- Stockholms Läns Landsting, Hälso-och SjukvårdsförvaltningenStockholm, Sweden
| | | | | | - Sotiris Vandoros
- School of Management and Business, King's College LondonLondon, UK
| | - Elif H. Vural
- Turkish Medicines and Medical Devices Agency, Ministry of HealthAnkara, Turkey
| | - Corinne Zara
- Catalan Health Service - Servei Català de la SalutBarcelona, Spain
| | - Brian Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, UK
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Vancheri F, Backlund L, Strender LE, Godman B, Wettermark B. Time trends in statin utilisation and coronary mortality in Western European countries. BMJ Open 2016; 6:e010500. [PMID: 27029774 PMCID: PMC4823395 DOI: 10.1136/bmjopen-2015-010500] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To determine whether there is a relation between statin utilisation and coronary heart disease (CHD) mortality in populations with different levels of coronary risk, and whether the relation changes over time. DESIGN Ecological study using national databases of dispensed medicines and mortality rates. SETTING Western European countries with similar public health systems. MAIN OUTCOME MEASURES Population CHD mortality rates (rate/100,000) as a proxy for population coronary risk level, and statin utilisation expressed as Defined Daily Dose per one Thousand Inhabitants per Day (DDD/TID), in each country, for each year between 2000 and 2012. Spearman's correlation coefficients between CHD mortality and statin utilisation were calculated. Linear regression analysis was used to assess the relation between changes in CHD mortality and statin utilisation over the years. RESULTS 12 countries were included in the study. There was a wide range of CHD mortality reduction between the years 2000 and 2012 (from 25.9% in Italy to 57.9% in Denmark) and statin utilisation increase (from 121% in Belgium to 1263% in Denmark). No statistically significant relations were found between CHD mortality rates and statin utilisation, nor between changes in CHD and changes in statin utilisation in the countries over the years 2000 and 2012. CONCLUSIONS Among the Western European countries studied, the large increase in statin utilisation between 2000 and 2012 was not associated with CHD mortality, nor with its rate of change over the years. Factors different from the individual coronary risk, such as population ageing, health authority programmes, guidelines, media attention and pharmaceutical industry marketing, may have influenced the large increase in statin utilisation. These need to be re-examined with a greater emphasis on prevention strategies.
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Affiliation(s)
- Federico Vancheri
- Department of Internal Medicine, Ospedale S Elia, Caltanissetta, Italy
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Backlund
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Erik Strender
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Björn Wettermark
- Centre for Pharmacoepidemiology & Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
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The impact of changes in national prescribing conditions for statins on their public expenditure and utilization in the Czech Republic 1997–2013. Health Policy 2015; 119:1255-64. [DOI: 10.1016/j.healthpol.2015.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 11/22/2022]
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Fraeyman J, Peeters L, Van Hal G, Beutels P, De Meyer GRY, De Loof H. Consumer choice between common generic and brand medicines in a country with a small generic market. J Manag Care Spec Pharm 2015; 21:288-96. [PMID: 25803762 PMCID: PMC10398248 DOI: 10.18553/jmcp.2015.21.4.288] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Generic medicines offer an opportunity for governments to contain pharmaceutical expenditures, since generics are generally 10%-80% lower in price than brand medicines. Belgium has a small generic market that takes up 15% of the total pharmaceutical market in packages sold. OBJECTIVE To determine the knowledge of consumers about the different available packages of a common over-the-counter medicine (acetaminophen) with regard to price advantage, quality, and effectiveness in a country with a small generic market. METHODS We conducted an online survey in the general Flemish population using a questionnaire with 25 statements. The questionnaire also contained 2 informative interventions. First, we showed the price per package and per tablet that the patient would pay in the pharmacy. Second, we provided the respondent with general information about generic medication (equivalence, effectiveness, price, and recognition). Before and after the interventions, we probed for preferences and knowledge about the different packages. Multivariate logistic models were used to examine the independent effects of consumer characteristics on responses to the survey statements. RESULTS We obtained a sample of 1,636 respondents. The general attitude towards generic medication was positive-only 5% would rather not use a generic. Nevertheless, only 17% of the respondents were able to recognize a generic medicine. Older consumers (aged 60 years and above) were more often confused about the different packages (OR = 2.59, 95% CI = 1.76-3.80, P ≤ 0.001). Consumers without a higher education degree tended to be more doubtful about the difference in effectiveness and quality between the different brands (OR = 0.59, 95% CI = 0.44-0.79, P ≤ 0.001). Consumer recognition of the name of the active substance of acetaminophen was poor. When different brands were displayed, possible price advantage seemed to be an important motive to switch to a cheaper brand. Consumers generally found medicines to be too expensive; however, consumers with medical or paramedical training had a different opinion. CONCLUSIONS Two main recommendations can be made to increase the knowledge and enhance the trust in cheaper equivalent medicines. First, highlighting the name of the active substance on the label of medicine packages can reduce confusion and avoid health risks, especially among older consumers. Second, new investments or reallocation of budgets should be considered in order to provide consumers with authoritative information on the bioequivalence and price differences between the different available brands. This would be a cost-effective and potentially cost-saving investment for health care payers.
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Affiliation(s)
- Jessica Fraeyman
- University of Antwerp, Universiteitsplein 1, 2610 Wilrijk (Antwerp), Belgium.
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26
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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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Kumar R, Hassali MA, Saleem F, Alrasheedy AA, Kaur N, Wong ZY, Kader MASA. Knowledge and perceptions of physicians from private medical centres towards generic medicines: a nationwide survey from Malaysia. J Pharm Policy Pract 2015; 8:11. [PMID: 25861452 PMCID: PMC4376509 DOI: 10.1186/s40545-015-0031-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/25/2015] [Indexed: 11/15/2022] Open
Abstract
Objectives Generic medicine prescribing has become a common practice in public hospitals. However, the trend in private medical centres seems to be different. The objective of this study was to investigate knowledge, perceptions and behavior of physicians from private medical centres in Malaysia regarding generic medicines. Methods This study was a cross-sectional nationwide survey targeting physicians from private medical centres in Malaysia. The survey was conducted using questionnaire having (i) background and demographic data of the physicians, volume of prescription in a day, stock of generic medicines in their hospital pharmacy etc. (ii) their knowledge about bioequivalence (iii) prescribing behavior (iv) physicians’ knowledge of quality, safety and efficacy of generic medicines, and their cost (v) perceptions of physicians towards issues pertaining to generic medicines utilization. Results A total of 263 questionnaires out of 735 were received, giving a response rate of 35.8%. Of the respondents, 214 (81.4%) were male and 49 (18.6%) were females. The majority of the participants were in the age range of 41–50 years and comprised 49.0% of the respondents. Only 2.3% of physicians were aware of the regulatory limits of bioequivalence standards in Malaysia. Of the respondents, 23.2% agreed that they ‘always’ write their prescriptions using originator product name whereas 50.2% do it ‘usually’. A number of significant associations were found between their knowledge, perceptions about generic medicines and their demographic characteristics. Conclusions The majority of the physicians from private medical centres in Malaysia had negative perceptions about safety, quality and the efficacy of generic medicines. These negative perceptions could be the cause of the limited use of generic medicines in the private medical centres. Therefore, in order to facilitate their use, it is recommended that the physicians need to be reassured and educated about the drug regulatory authority approval system of generic medicines with regard to their bioequivalence, quality, efficacy and safety. Apart from the policy on generic substitution, it would also be recommended to have a national medicine pricing policy, which controls drug prices, in both the public and private sector. These efforts are worthwhile to reduce the drug expenditure and improve the medicine affordability in Malaysia.
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Affiliation(s)
- Rohit Kumar
- Discipline of Administrative and Social Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800 Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Administrative and Social Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800 Malaysia
| | - Fahad Saleem
- Discipline of Administrative and Social Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800 Malaysia
| | - Alian A Alrasheedy
- Pharmacy Practice Department, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Navneet Kaur
- Discipline of Physiology and Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800 Malaysia
| | - Zhi Yen Wong
- Pharmacy Department, Hospital Teluk, Intan, Perak Malaysia
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Zeng W, Finlayson AE, Shankar S, de Bruyn W, Godman B. Prescribing efficiency of proton pump inhibitors in China: influence and future directions. BMC Health Serv Res 2015; 15:11. [PMID: 25609265 PMCID: PMC4308879 DOI: 10.1186/s12913-014-0638-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/08/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables. METHODS Observational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China. RESULTS Appreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (-34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (-19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral PPIs as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%. CONCLUSIONS Encouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, No.66 Xuefu Road, Nan'an District, Chongqing, 400074, China.
| | | | - Sushma Shankar
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, OX3 9DU, UK.
| | - Winnie de Bruyn
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, SE-141 86, Sweden. .,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK. .,Liverpool Health Economics Centre, Liverpool University, Chatham Street, Liverpool, L69 7ZH, UK.
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29
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Moon JC, Godman B, Petzold M, Alvarez-Madrazo S, Bennett K, Bishop I, Bucsics A, Hesse U, Martin A, Simoens S, Zara C, Malmström RE. Different initiatives across Europe to enhance losartan utilization post generics: impact and implications. Front Pharmacol 2014; 5:219. [PMID: 25339902 PMCID: PMC4189327 DOI: 10.3389/fphar.2014.00219] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 09/09/2014] [Indexed: 12/13/2022] Open
Abstract
Introduction: There is an urgent need for health authorities across Europe to fully realize potential savings from increased use of generics to sustain their healthcare systems. A variety of strategies were used across Europe following the availability of generic losartan, the first angiotensin receptor blocker (ARB) to be approved and marketed, to enhance its prescribing vs. single-sourced drugs in the class. Demand-side strategies ranged from 100% co-payment for single-sourced ARBs in Denmark to no specific measures. We hypothesized this heterogeneity of approaches would provide opportunities to explore prescribing in a class following patent expiry. Objective: Contrast the impact of the different approaches among European countries and regions to the availability of generic losartan to provide future guidance. Methodology: Retrospective segmented regression analyses applying linear random coefficient models with country specific intercepts and slopes were used to assess the impact of the various initiatives across Europe following the availability of generic losartan. Utilization measured in defined daily doses (DDDs). Price reductions for generic losartan were also measured. Results: Utilization of losartan was over 90% of all ARBs in Denmark by the study end. Multiple measures in Sweden and one English primary care group also appreciably enhanced losartan utilization. Losartan utilization actually fell in some countries with no specific demand-side measures. Considerable differences were seen in the prices of generic losartan. Conclusion: Delisting single-sourced ARBs produced the greatest increase in losartan utilization. Overall, multiple demand-side measures are needed to change physician prescribing habits to fully realize savings from generics. There is no apparent “spill over” effect from one class to another to influence future prescribing patterns even if these are closely related.
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Affiliation(s)
- James C Moon
- Heart Hospital Imaging Centre, The Heart Hospital, University College Hospital London, UK
| | - Brian Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden ; Medicine Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK ; National Institute for Science and Technology on Innovation on Neglected Diseases, Centre for Technological Development in Health, Oswaldo Cruz Foundation (Fiocruz) Rio de Janeiro, Brazil
| | - Max Petzold
- Occupational and Environmental Medicine, Centre for Applied Biostatistics, University of Gothenburg Gothenburg, Sweden
| | - Samantha Alvarez-Madrazo
- Medicine Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James Hospital Dublin, Ireland
| | - Iain Bishop
- Public Health and Intelligence Business Unit, NHS National Services Scotland Edinburgh, UK
| | - Anna Bucsics
- Department of Finance, Faculty of Business, Economics and Statistics, University of Vienna Vienna, Austria ; Hauptverband der Österreichischen Sozialversicherungsträger Vienna, Austria
| | - Ulrik Hesse
- National Institute for Health Data and Disease Control Copenhagen, Denmark
| | - Andrew Martin
- NHS Greater Manchester Commissioning Support Unit Salford, Manchester, UK
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences Leuven, Belgium
| | - Corinne Zara
- Barcelona Health Region, Catalan Health Service Barcelona, Spain
| | - Rickard E Malmström
- Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna Stockholm, Sweden
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30
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Campbell SM, Godman B, Diogene E, Fürst J, Gustafsson LL, MacBride-Stewart S, Malmström RE, Pedersen H, Selke G, Vlahović-Palčevski V, van Woerkom M, Wong-Rieger D, Wettermark B. Quality indicators as a tool in improving the introduction of new medicines. Basic Clin Pharmacol Toxicol 2014; 116:146-57. [PMID: 25052464 DOI: 10.1111/bcpt.12295] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/07/2014] [Indexed: 01/18/2023]
Abstract
Quality indicators are increasingly used as a tool to achieve safe and quality clinical care, cost-effective therapy, for professional learning, remuneration, accreditation and financial incentives. A substantial number focus on drug therapy but few address the introduction of new medicines even though this is a burning issue. The objective was to describe the issues and challenges in designing and implementing a transparent indicator framework and evaluation protocol for the introduction of new medicines and to provide guidance on how to apply quality indicators in the managed entry of new medicines. Quality indicators need to be developed early to assess whether new medicines are introduced appropriately. A number of key factors need to be addressed when developing, applying and evaluating indicators including dimensions of quality, suggested testing protocols, potential data sources, key implementation factors such as intended and unintended consequences, budget impact and cost-effectiveness, assuring the involvement of the medical professions, patients and the public, and reliable and easy-to-use computerized tools for data collection and management. Transparent approaches include the need for any quality indicators developed to handle conflict of interests to enhance their validity and acceptance. The suggested framework and indicator testing protocol may be useful in assessing the applicability of indicators for new medicines and may be adapted to healthcare settings worldwide. The suggestions build on existing literature to create a field testing methodology that can be used to produce country-specific quality indicators for new medicines as well as a cross international approach to facilitate access to new medicines.
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Affiliation(s)
- Stephen M Campbell
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, UK
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Martin A, Godman B, Miranda J, Tilstone J, Saleem N, Olsson E, Acosta A, Restrepo L, Bennie M. Measures to improve angiotensin receptor blocker prescribing efficiency in the UK: findings and implications. J Comp Eff Res 2014; 3:41-51. [PMID: 24345256 DOI: 10.2217/cer.13.83] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Generic losartan provides an opportunity to enhance angiotensin receptor blocker (ARB) prescribing efficiency, with all ARBs essentially being similar. Initially, there was limited activity in NHS Bury (UK). This changed in March 2011 with therapeutic switching and other measures encouraging the prescribing of losartan following generics to enhance its utilization versus patented ARBs. AIM This study aims to assess the impact of multiple measures on losartan utilization, its price and total ARB expenditure. METHODS An interrupted time series analysis was performed. Utilization was measured as prescription items dispensed, typically 28 days. RESULTS No immediate change in losartan utilization was observed following generics. This changed after the multiple initiatives with losartan accounting for 65% of all single ARB items dispensed by the study end. ARB expenditure was 59% below prestudy levels by the study end, which was helped by a 92% reduction in expenditure per item for losartan. Annual net savings from the program were estimated at just under GB£290,000, which is over eight-times the cost of implementation. CONCLUSION Multiple measures can enhance prescribing efficiency. Health authorities cannot rely on a 'spillover' effect from other classes in order to affect changes in physician prescribing habits.
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Affiliation(s)
- Andrew Martin
- NHS Greater Manchester Commissioning Support Unit, Salford, Manchester, UK
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Polić-Vižintin M, Štimac D, Šostar Z, Tripković I. Distribution and trends in outpatient utilization of generic versus brand name psychopharmaceuticals during a ten-year period in Croatia. BMC Health Serv Res 2014; 14:343. [PMID: 25128190 PMCID: PMC4261909 DOI: 10.1186/1472-6963-14-343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 08/12/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Drug costs increasingly pose a burden upon the otherwise inadequate health care resources and rational drug utilization is an important segment of every national health policy. Optimal patient care should be the goal of rational pharmacotherapy, whereby the economic burden of treatment is just one of the elements to be considered on choosing appropriate therapy.The aim of this study was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period. METHODS Using the World Health Organization Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from pharmacies on the number and size of drug packages. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization. RESULTS Total cost for psychopharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to financial indicators decreased by 9.6% and according to DDD/1000/day by 12%. The greatest decrease was in antidepressants, i.e. by 33.8% according to financial indicators and by 46% according to DDD/1000/day; and in antipsychotics by 30.9% according to DDD/1000/day, while showing an increase by 8.5% according to financial indicators. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day, but increased by 25.1% according to financial indicators. CONCLUSIONS The lack of uniform national guidelines and the still strong impact of pharmaceutical industry marketing continue favoring the rise in prescribing brand name antidepressants and antipsychotics. Depression, schizophrenia and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic psychopharmaceuticals.
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Affiliation(s)
- Marina Polić-Vižintin
- />Dr Andrija Štampar Institute of Public Health, Vrhovčev vijenac 22, HR 10000 Zagreb, Croatia
| | - Danijela Štimac
- />Dr Andrija Štampar Institute of Public Health, Vrhovčev vijenac 22, HR 10000 Zagreb, Croatia
- />School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zvonimir Šostar
- />Dr Andrija Štampar Institute of Public Health, Vrhovčev vijenac 22, HR 10000 Zagreb, Croatia
| | - Ingrid Tripković
- />Institute of Public Health of Split and Dalmatia County, Zagreb, Croatia
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Woerkom MV, Piepenbrink H, Godman B, Metz JD, Campbell S, Bennie M, Eimers M, Gustafsson LL. Ongoing measures to enhance the efficiency of prescribing of proton pump inhibitors and statins in The Netherlands: influence and future implications. J Comp Eff Res 2014; 1:527-38. [PMID: 24236472 DOI: 10.2217/cer.12.52] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multiple reforms have recently been introduced in The Netherlands to improve prescribing efficiency. These include preference pricing policies for multiple sourced products, guidelines, and quality and efficiency targets, as well as regular pharmacotherapy meetings. OBJECTIVES Assess the influence of these multiple measures on prescribing efficiency. METHODS Retrospective observational study of all reimbursed prescriptions for proton pump inhibitors and statins between 2000 and 2010 using the Genees-en hulpmiddelen Informatie Project (Health Insurance) database. Utilization measured in defined daily doses. Narrative review of reforms. RESULTS Reimbursed expenditure for the proton pump inhibitors fell by 58% in 2010 versus 2000 despite a threefold increase in utilization, helped by increasing utilization of generic omeprazole at only 2% of the prepatent loss price in 2010. Similarly, reimbursed expenditure for the statins fell by 14% in 2010 versus 2000 despite a 3.8-fold increase in utilization. Again, this was helped by increasing utilization of generic simvastatin at only 2% of the prepatent loss originator price. CONCLUSION Multiple supply and demand measures, including the preference pricing policy, appear to have appreciably enhanced proton pump inhibitor and statin prescribing efficiency, providing examples to other countries.
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Affiliation(s)
- Menno van Woerkom
- Dutch Institute for Rational Use of Medicines, Churchillaan 11, 3527 GV Utrecht, The Netherlands
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Kalaba M, Godman B, Vuksanović A, Bennie M, Malmström RE. Possible ways to enhance renin-angiotensin prescribing efficiency: Republic of Serbia as a case history? J Comp Eff Res 2014; 1:539-49. [PMID: 24236473 DOI: 10.2217/cer.12.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multiple reforms have been instigated across Europe to enhance prescribing efficiency. Supply-side reforms in the Republic of Serbia include measures to lower the price of generics and originators, with demand-side measures including patient copayments and prescribing restrictions. Specific measures for renin-angiotensin inhibitor drugs include a 50% copayment for angiotensin receptor blockers (ARBs) versus approximately 50 cents per prescription for established angiotensin-converting enzyme inhibitors (ACEIs), as there is no perceived difference in effectiveness between the two classes. OBJECTIVES To assess the influence of these measures on ARB utilization, as well as reimbursed prices of ACEIs and ARBs over time. METHOD Observational retrospective case study of all ambulatory care patients in the Republic of Serbia's Health Insurance Fund database who were dispensed at least one ACEI or ARB alone or in combination (fixed dose combination [FDC]) between 2005 and 2011. Utilization measured in defined daily doses (DDDs) and only reimbursed expenditure (overall and expenditure/DDD) as Health Insurance perspective. RESULTS There was a 1.8-fold increase in renin-angiotensin inhibitor drug utilization, rising to 207.4 DDDs/1000 inhabitants per day in 2011. This is driven principally by a 19.6-fold increase in ACEI FDCs. There was only limited utilization of ARBs at just 2% of total renin-angiotensin inhibitor drugs in 2011. Reimbursed expenditure increased 2.54-fold due to an appreciable increase in ACEI FDC utilization at approximately twice the cost of ACEIs in recent years. Alongside this, we noted considerable differences in expenditure/DDD for different ACEIs. CONCLUSION & FUTURE PERSPECTIVE: High patient copayments for ARBs appreciably limited their utilization in Serbia, which mirrors the findings from other studies. Potential future measures to enhance prescribing efficiency include reference pricing for ACEIs based on the lowest price of an established ACEI. In addition, reference pricing for FDCs should be based on the reference price of the individual components combined. This builds on recent reforms restricting the reimbursement of FDCs until 3 months after individual components have been prescribed separately.
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Affiliation(s)
- Marija Kalaba
- Republic Fund for Health Insurance Jovana Marinoviča 2, 11000 Belgrade, Serbia
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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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Godman B, Petzold M, Bennett K, Bennie M, Bucsics A, Finlayson AE, Martin A, Persson M, Piessnegger J, Raschi E, Simoens S, Zara C, Barbui C. Can authorities appreciably enhance the prescribing of oral generic risperidone to conserve resources? Findings from across Europe and their implications. BMC Med 2014; 12:98. [PMID: 24927744 PMCID: PMC4073810 DOI: 10.1186/1741-7015-12-98] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/23/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Generic atypical antipsychotic drugs offer health authorities opportunities for considerable savings. However, schizophrenia and bipolar disorders are complex diseases that require tailored treatments. Consequently, generally there have been limited demand-side measures by health authorities to encourage the preferential prescribing of generics. This is unlike the situation with hypertension, hypercholaesterolaemia or acid-related stomach disorders.The objectives of this study were to compare the effect of the limited demand-side measures in Western European countries and regions on the subsequent prescribing of risperidone following generics; to utilise the findings to provide future guidance to health authorities; and where possible, to investigate the utilisation of generic versus originator risperidone and the prices for generic risperidone. METHODS Principally, this was a segmented regression analysis of retrospective time-series data of the effect of the various initiatives in Belgium, Ireland, Scotland and Sweden following the introduction of generic risperidone. The study included patients prescribed at least one atypical antipsychotic drug up to 20 months before and up to 20 months after generic risperidone. In addition, retrospective observational studies were carried out in Austria and Spain (Catalonia) from 2005 to 2011 as well as one English primary care organisation (Bury Primary Care Trust (PCT)). RESULTS There was a consistent steady reduction in risperidone as a percentage of total selected atypical antipsychotic utilisation following generics. A similar pattern was seen in Austria and Spain, with stable utilisation in one English PCT. However, there was considerable variation in the utilisation of generic risperidone, ranging from 98% of total risperidone in Scotland to only 14% in Ireland. Similarly, the price of generic risperidone varied considerably. In Scotland, generic risperidone was only 16% of pre-patent loss prices versus 72% in Ireland. CONCLUSION Consistent findings of no increased prescribing of risperidone post generics with limited specific demand-side measures suggests no 'spillover' effect from one class to another encouraging the preferential prescribing of generic atypical antipsychotic drugs. This is exacerbated by the complexity of the disease area and differences in the side-effects between treatments. There appeared to be no clinical issues with generic risperidone, and prices inversely reflected measures to enhance their utilisation.
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Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
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Larsen MD, Schou M, Kristiansen AS, Hallas J. The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care. Eur J Clin Pharmacol 2014; 70:859-65. [PMID: 24770928 DOI: 10.1007/s00228-014-1681-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 04/07/2014] [Indexed: 01/02/2023]
Abstract
AIM This study had two aims: Firstly, to describe how prescriptions for proton pump inhibitor (PPI) in primary care were influenced by a change of the hospital drug policy, and secondly, to describe if a large discount on an expensive PPI (esomeprazole) to a hospital would influence prescribing patterns after discharge. METHODS This register study was conducted at Odense University Hospital, Denmark, and by use of pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the medication regimens of patients were followed across hospitalisation. The influence of hospital drug policy on prescribings in primary care was measured by the likelihood of having a high-cost PPI prescribed before and after change of drug policy. RESULTS In total, 9,341 hospital stays in 2009 and 2010 were included. The probability of a patient to be prescribed an expensive PPI after discharge decreased from 33.5 to 9.4%, corresponding to a risk ratio of 0.28. In primary care after discharge, 13.4% of esomeprazole use was initiated in the hospital, and this was 8.4% for PPIs in general. After the change of hospital drug policy, this decreased to 6.5% for esomeprazole and increased for the recommended PPIs pantoprazole and lansoprazole to 14.6 and 26.1%, respectively. The effect of a large discount on expensive PPI to hospital was 14.7%, and this decreased to 2.6% when coordinating drug policy in hospital and primary care. CONCLUSION The likelihood of having an expensive PPI prescribed after hospital stay decreased when coordinating drug policy and the influence of a large discount to hospital could be minimised.
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Affiliation(s)
- Michael Due Larsen
- Faculty of Health Sciences, Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, J. B. Winsløwsvej 19, 2. sal, Odense M, 5000, Denmark,
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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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Dylst P, Vulto A, Simoens S. Demand-side policies to encourage the use of generic medicines: an overview. Expert Rev Pharmacoecon Outcomes Res 2014; 13:59-72. [DOI: 10.1586/erp.12.83] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Bucsics A, Godman B, Burkhardt T, Schmitzer M, Malmström RE. Influence of lifting prescribing restrictions for losartan on subsequent sartan utilization patterns in Austria: implications for other countries. Expert Rev Pharmacoecon Outcomes Res 2014; 12:809-19. [DOI: 10.1586/erp.12.71] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Godman B, Bishop I, Finlayson AE, Campbell S, Kwon HY, Bennie M. Reforms and initiatives in Scotland in recent years to encourage the prescribing of generic drugs, their influence and implications for other countries. Expert Rev Pharmacoecon Outcomes Res 2014; 13:469-82. [DOI: 10.1586/14737167.2013.820956] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Garuoliene K, Godman B, Gulbinovič J, Wettermark B, Haycox A. European countries with small populations can obtain low prices for drugs: Lithuania as a case history. Expert Rev Pharmacoecon Outcomes Res 2014; 11:343-9. [DOI: 10.1586/erp.11.24] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dylst P, Vulto A, Godman B, Simoens S. Generic medicines: solutions for a sustainable drug market? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:437-443. [PMID: 23846572 DOI: 10.1007/s40258-013-0043-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Generic medicines offer equally high-quality treatment as originator medicines do at much lower prices. As such, they represent a considerable opportunity for authorities to obtain substantial savings. At the moment, the pharmaceutical landscape is changing and many pharmaceutical companies have altered their development and commercial strategies, combining both originator and generic divisions. In spite of this, the generic medicines industry is currently facing a number of challenges: delayed market access; the limited price differential with originator medicines; the continuous downwards pressure on prices; and the negative perception regarding generic medicines held by some key stakeholder groups. This could jeopardize the long-term sustainability of the generic manufacturing industry. Therefore, governments must focus on demand-side policies, alongside policies to accelerate market access, as the generic medicines industry will only be able to deliver competitive and sustainable prices if they are ensured a high volume. In the future, the generic medicines industry will increasingly look to biosimilars and generic versions of orphan drugs to expand their business.
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Affiliation(s)
- Pieter Dylst
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium Herestraat 49, O&N 2, P.O. Box 521, 3000, Leuven, Belgium,
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Godman B, Persson M, Miranda J, Barbui C, Bennie M, Finlayson AE, Raschi E, Wettermark B. Can authorities take advantage of the availability of generic atypical antipsychotic drugs? Findings from Sweden and potential implications. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine; Division of Clinical Pharmacology; Karolinska Institute; Karolinska University Hospital Huddinge; Stockholm Sweden
- Liverpool Health Economics Centre; University of Liverpool; Liverpool UK
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
| | - Marie Persson
- Unit of Medicine Support; Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
| | - Jamilette Miranda
- Department of Healthcare Development; Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation; Department of Public Health and Community Medicine, Section of Psychiatry; University of Verona; Verona Italy
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
- Information Services Division; NHS National Services Scotland; Edinburgh UK
| | - Alexander E Finlayson
- King's Centre for Global Health; Global Health Offices; Weston Education Centre; London UK
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences; Pharmacology Unit; Alma Mater Studiorum - University of Bologna; Bologna Italy
| | - Bjorn Wettermark
- Department of Laboratory Medicine; Division of Clinical Pharmacology; Karolinska Institute; Karolinska University Hospital Huddinge; Stockholm Sweden
- Department of Healthcare Development; Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
- Centre for Pharmacoepidemilogy; Karolinska Institute; Karolinska University Hospital Solna; Stockholm Sweden
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Simoens S, De Bruyn K, Miranda J, Bennie M, Malmström RE, Godman B. Measures to enhance angiotensin-receptor blocker prescribing efficiency in Belgium following generic losartan: impact and implications for the future. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences; Leuven Belgium
| | - Kristien De Bruyn
- Centre for Statistics; Belgian Pharmaceutical Society; Brussels Belgium
| | - Jamilette Miranda
- Department of Healthcare Development; Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
- Information Services Division; NHS National Services Scotland; Edinburgh UK
| | - Rickard E. Malmström
- Department of Medicine; Clinical Pharmacology Unit; Karolinska Institutet, Karolinska University Hospital Solna; Stockholm Sweden
| | - Brian Godman
- Department of Laboratory Medicine; 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; University of Liverpool Management School; Liverpool UK
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Malmström RE, Godman BB, Diogene E, Baumgärtel C, Bennie M, Bishop I, Brzezinska A, Bucsics A, Campbell S, Ferrario A, Finlayson AE, Fürst J, Garuoliene K, Gomes M, Gutiérrez-Ibarluzea I, Haycox A, Hviding K, Herholz H, Hoffmann M, Jan S, Jones J, Joppi R, Kalaba M, Kvalheim C, Laius O, Langner I, Lonsdale J, Lööv SÄ, Malinowska K, McCullagh L, Paterson K, Markovic-Pekovic V, Martin A, Piessnegger J, Selke G, Sermet C, Simoens S, Tulunay C, Tomek D, Vončina L, Vlahovic-Palcevski V, Wale J, Wilcock M, Wladysiuk M, van Woerkom M, Zara C, Gustafsson LL. Dabigatran - a case history demonstrating the need for comprehensive approaches to optimize the use of new drugs. Front Pharmacol 2013; 4:39. [PMID: 23717279 PMCID: PMC3653065 DOI: 10.3389/fphar.2013.00039] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/20/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There are potential conflicts between authorities and companies to fund new premium priced drugs especially where there are safety and/or budget concerns. Dabigatran, a new oral anticoagulant for the prevention of stroke in patients with non-valvular atrial fibrillation (AF), exemplifies this issue. Whilst new effective treatments are needed, there are issues in the elderly with dabigatran due to variable drug concentrations, no known antidote and dependence on renal elimination. Published studies have shown dabigatran to be cost-effective but there are budget concerns given the prevalence of AF. There are also issues with potentially re-designing anticoagulant services. This has resulted in activities across countries to better manage its use. OBJECTIVE To (i) review authority activities in over 30 countries and regions, (ii) use the findings to develop new models to better manage the entry of new drugs, and (iii) review the implications for all major stakeholder groups. METHODOLOGY Descriptive review and appraisal of activities regarding dabigatran and the development of guidance for groups through an iterative process. RESULTS There has been a plethora of activities among authorities to manage the prescribing of dabigatran including extensive pre-launch activities, risk sharing arrangements, prescribing restrictions, and monitoring of prescribing post-launch. Reimbursement has been denied in some countries due to concerns with its budget impact and/or excessive bleeding. Development of a new model and future guidance is proposed to better manage the entry of new drugs, centering on three pillars of pre-, peri-, and post-launch activities. CONCLUSION Models for introducing new drugs are essential to optimize their prescribing especially where there are concerns. Without such models, new drugs may be withdrawn prematurely and/or struggle for funding.
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Affiliation(s)
- Rickard E. Malmström
- Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital SolnaStockholm, Sweden
| | - Brian B. Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
- Liverpool Health Economics Centre, University of LiverpoolLiverpool, UK
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, UK
| | - Eduard Diogene
- Unitat de Coordinació i Estratégia del Medicament, Direcció Adjunta d’Afers Assistencials, Catalan Institute of HealthBarcelona, Spain
| | | | - Marion Bennie
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, UK
- Information Services Division, NHS National Services ScotlandEdinburgh, UK
| | - Iain Bishop
- Information Services Division, NHS National Services ScotlandEdinburgh, UK
| | | | - Anna Bucsics
- Hauptverband der Österreichischen SozialversicherungsträgerWien, Austria
| | - Stephen Campbell
- Centre for Primary Care, Institute of Population Health, University of ManchesterManchester, UK
| | | | - Alexander E. Finlayson
- King’s Centre for Global Health, Global Health Offices, Weston Education CentreLondon, UK
| | - Jurij Fürst
- Health Insurance InstituteLjubljana, Slovenia
| | - Kristina Garuoliene
- Medicines Reimbursement Department, National Health Insurance FundVilnius, Lithuania
| | - Miguel Gomes
- Instituto Nacional da Farmácia e do MedicamentoLisboa, Portugal
| | - Iñaki Gutiérrez-Ibarluzea
- Osteba Basque Office for Health Technology Assessment, Ministry of Health of the Basque CountryDonostia-San Sebastian, Vitoria-Gasteiz, Basque Country, Spain
| | - Alan Haycox
- Liverpool Health Economics Centre, University of LiverpoolLiverpool, UK
| | | | - Harald Herholz
- Kassenärztliche Vereinigung HessenFrankfurt am Main, Germany
| | - Mikael Hoffmann
- Nätverk för läkemedelsepidemiologi, Department of Health Analysis, University HospitalLinköping, Sweden
| | - Saira Jan
- Clinical Programs, Pharmacy Management, Horizon Blue Cross Blue Shield of New JerseyNewark, USA
| | - Jan Jones
- Ninewells Hospital, NHS TaysideDundee, UK
| | - Roberta Joppi
- Pharmaceutical Department, Local Health Unit of VeronaVerona, Italy
| | - Marija Kalaba
- Republic Institute for Health InsuranceBelgrade, Serbia
| | | | - Ott Laius
- State Agency of MedicinesTartu, Estonia
| | | | - Julie Lonsdale
- Lancashire Commissioning Support Unit, Jubilee HouseLeyland, Lancashire, UK
| | - Sven-Äke Lööv
- Department of Healthcare Development, Stockholm County CouncilStockholm, Sweden
| | - Kamila Malinowska
- HTA ConsultingCracow, Poland
- Public Health School, The Medical Centre of Postgraduate EducationWarsaw, Poland
| | - Laura McCullagh
- National Centre for Pharmacoeconomics, St James’s HospitalDublin, Ireland
| | | | - Vanda Markovic-Pekovic
- Faculty of Medicine, University of Banja LukaBanja Luka, Bosnia and Herzegovina, Republic of Srpska
- Ministry of Health and Social WelfareBanja Luka, Bosnia and Herzegovina, Republic of Srpska
| | | | - Jutta Piessnegger
- Hauptverband der Österreichischen SozialversicherungsträgerWien, Austria
| | | | - Catherine Sermet
- Institut de Recherche et Documentation en Économie de la SantéParis, France
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological SciencesLeuven, Belgium
| | - Cankat Tulunay
- President of the Turkish Rational Drug Use PlatformAnkara, Turkey
| | - Dominik Tomek
- Faculty of Pharmacy, Comenius UniversityBratislava, Slovakia
- Faculty of Medicine, Slovak Medical UniversityBratislava, Slovakia
| | | | | | - Janet Wale
- Independent Consumer AdvocateBrunswick, VIC, Australia
| | - Michael Wilcock
- Prescribing Support Unit, c/o Pharmacy Department, Royal Cornwall Hospitals NHS TrustTruro, Cornwall, UK
| | | | | | - Corrine Zara
- Barcelona Health Region, Catalan Health ServiceBarcelona, Spain
| | - Lars L. Gustafsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
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Bennie M, Bishop I, Godman B, Barbui C, Raschi E, Campbell S, Miranda J, Gustafsson LL. Are specific initiatives required to enhance prescribing of generic atypical antipsychotics in Scotland?: International implications. Int J Clin Pract 2013; 67:170-80. [PMID: 23305478 DOI: 10.1111/ijcp.12100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 11/28/2012] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND National and regional authorities in Scotland have introduced multiple measures to appreciably enhance prescribing efficiency for the proton pump inhibitors (PPIs), statins and renin-angiotensin inhibitor drugs. Generic oral risperidone recently became available in Scotland; however, schizophrenia is a complex disease with advice from respected authorities suggesting that treatment should be individualised. AIMS To assess (i) changes in atypical antipsychotic drug (AAP) utilisation and expenditure following the availability of oral generic risperidone in Scotland; (ii) to determine (a) current INN prescribing rates for risperidone following generic availability and (b) decrease in expenditure/DDD for generic risperidone; (iii) to suggest additional measures that could possibly be introduced in Scotland to further enhance prescribing of generic AAPs; and (iv) to provide guidance to NHS Scotland as well as other European authorities on the implications. METHODS Retrospective observational study and an interrupted time series design. RESULTS No appreciable change in the utilisation patterns of risperidone pre- and postgeneric availability. Appreciable INN prescribing averaged 93-98% of total oral risperidone. Generic risperidone was 84% below prepatent loss prices by study end, reducing annual expenditure for oral risperidone in 2010 by GB£3.19mn compared with prepatent loss situation. However, overall expenditure on AAPs increased by 42% from 2005 to 2010. DISCUSSION As expected, there was no change in utilisation patterns for risperidone, although potential to influence prescribing patterns. Continued high INN prescribing suggests no problems with generic risperidone in practice. Costs will start to decrease as more AAPs lose their patents (olanzapine and quetiapine). There is the possibility to accelerate this reduction through educational activities. CONCLUSION There is potential to realise some savings with generic AAPs. However, this is limited by the complexity of the disease area. Any measures introduced must aim at increasing the prescribing of generic AAPs first line in suitable patients.
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Affiliation(s)
- M Bennie
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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Godman B, Bucsics A, Burkhardt T, Piessnegger J, Schmitzer M, Barbui C, Raschi E, Bennie M, Gustafsson LL. Potential to enhance the prescribing of generic drugs in patients with mental health problems in austria; implications for the future. Front Pharmacol 2013; 3:198. [PMID: 23308071 PMCID: PMC3538280 DOI: 10.3389/fphar.2012.00198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/06/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Scrutiny over pharmaceutical expenditure is increasing leading to multiple reforms. This includes Austria with measures to lower generic prices and enhance their utilization. However the situation for newer antidepressants and atypical antipsychotic medicines (AAPs) is different to PPIs, statins, and renin-angiotensin inhibitor drugs with greater tailoring of therapy and no wish to switch products in stable patients. Authorities welcome generics though given the high costs particularly of single-sourced AAPs. OBJECTIVE Assess (a) changes in utilization of venlafaxine versus other newer antidepressants before and after availability of generics, (b) utilization of generic versus originator venlafaxine, (c) price reductions of venlafaxine over time and their influence on total expenditure, (d) utilization of risperidone versus other AAPs, (e) suggest potential additional reforms that could be introduced if pertinent to further enhance the use of generics. METHODOLOGY A quasi-experimental study design with a segmented time series and an observational study. Utilization measured in defined daily doses (DDDs) and total expenditure per DDD and over time. RESULTS No appreciable changes in the utilization of venlafaxine and risperidone after generics. The reduction in expenditure/DDD for venlafaxine decreased overall expenditure on newer antidepressants by 5% by the end of the study versus just before generics despite a 37% increase in utilization. Expenditure will further decrease if reduced prescribing of duloxetine. CONCLUSION Depression, schizophrenia, and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic risperidone and venlafaxine when multiple choices are appropriate. Authorities cannot rely on a "Hawthorne" effect between classes to enhance the use of generics. Measures may include prescribing restrictions for duloxetine. No specific measures planned for AAPs with more multiple-sourced AAPs becoming available.
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Affiliation(s)
- Brian Godman
- Division of Clinical Pharmacology, Karolinska University Hospital Huddinge Stockholm, Sweden ; Mario Negri Institute for Pharmacological Research Milan, Italy ; Prescribing Research Group, University of Liverpool Management School Liverpool, UK
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Brkicic LS, Godman B, Voncina L, Sovic S, Relja M. Initiatives to improve prescribing efficiency for drugs to treat Parkinson's disease in Croatia: influence and future directions. Expert Rev Pharmacoecon Outcomes Res 2012; 12:373-84. [PMID: 22812560 DOI: 10.1586/erp.12.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parkinson's disease (PD) is the second most common neurological disease affecting older adults. Consequently, this disease should be a focus among payers, with increasing utilization of newer premium-priced patent-protected add-on therapies to stabilize or even improve motor function over time. However, expenditure can be moderated by reforms. Consequently, there is a need to assess the influence of these reforms on the prescribing efficiency for drugs to treat PD in Croatia before proposing additional measures. Prescribing efficiency is defined as increasing the use of add-on therapies for similar expenditure. An observational retrospective study of the Croatian Institute for Health Insurance database of drugs to treat patients with PD in Croatia from 2000 to 2010 was carried out, with utilization measured in defined daily doses (defined as the average maintenance dose of a drug when used in its major indication in adults). The study years were chosen to reflect recent reforms. Only reimbursed expenditure is measured from a health insurance perspective. Utilization of drugs to treat PD increased by 218% between 2000 and 2010. Reimbursed expenditure increased by 360%, principally driven by increasing utilization of premium-priced patent-protected add-on therapies, including ropinirole and pramipexole. However, following recent reforms, reducing expenditure/defined daily dose for the different drugs, as well as overall expenditure, stabilized reimbursed expenditure between 2005 and 2010. Treatment of PD is complex, and add-on therapies are needed to improve care. Reimbursed expenditure should now fall following stabilization, despite increasing volumes, as successive add-on therapies lose their patents, further increasing prescribing efficiency.
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50
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Cahir C, Fahey T, Tilson L, Teljeur C, Bennett K. Proton pump inhibitors: potential cost reductions by applying prescribing guidelines. BMC Health Serv Res 2012; 12:408. [PMID: 23163956 PMCID: PMC3529111 DOI: 10.1186/1472-6963-12-408] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 10/23/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing. METHODS Retrospective population-based cohort study in the Republic of Ireland using the Health Services Executive (HSE) Primary Care Reimbursement Services (PCRS) pharmacy claims database. The HSE-PCRS scheme is means tested and provides free health care including medications to approximately 30% of the Irish population. Prescription items are WHO ATC coded and details of every drug dispensed and claimants' demographic data are available. Potential cost savings (net ingredient cost) were estimated according to UK NICE clinical guidelines for all HSE-PCRS claimants on PPI therapy for ≥3 consecutive months starting in 2007 with a one year follow up (n=167,747). Five scenarios were evaluated; (i) change to PPI initiation (cheapest brand); and after 3 months (ii) therapeutic switching (cheaper brand/generic equivalent); (iii) dose reduction (maintenance therapy); (iv) therapeutic switching and dose reduction and (v) therapeutic substitution (H2 antagonist). RESULTS Total net ingredient cost was €88,153,174 for claimants on PPI therapy during 2007. The estimated costing savings for each of the five scenarios in a one year period were: (i) €36,943,348 (42% reduction); (ii) €29,568,475 (34%); (iii) €21,289,322 (24%); (iv) €40,505,013 (46%); (v) €34,991,569 (40%). CONCLUSION There are opportunities for substantial cost savings in relation to PPI prescribing if implementation of clinical guidelines in terms of generic substitution and step-down therapy is implemented on a national basis.
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Affiliation(s)
- Caitriona Cahir
- HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
| | - Lesley Tilson
- National Centre for Pharmacoeconomics, St James Hospital, Dublin 8, Ireland
| | - Conor Teljeur
- Health Information and Quality Authority (HIQA), George's Court, George's Lane, Dublin 7, Ireland
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin 8, Ireland
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