Can multiple demand side measures enhance prescribing efficiency: implications for sustaining health care systems.
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B. Godman (Mario Negri, Milan. KI, Sweden), B. Wettermark (KI), T. Burkhardt (HVB, Austria), C. Sermet (IRDES, France), F CTulunay (Ankara University, Turkey), C. Zara (Barcelona Health Region, Spain)
Countries have instigated a range of demand measures However, appreciable differences with limited demand side measures in some.
Figure 1 - PPIs pre patent loss (PL) and 2007
Considerable differences in expenditure for PPIs depending on intensity of supply and demand side reforms. Both needed for future sustainability.
Figure 3 - Impact on PPI expenditure in 2007
(PP = prescriptive pricing, MF = Market Forces, MA – Mixed Approach)
IntroductionDrug expenditure is growing and now the largest or equal largest component in ambulatory care. However, appreciable differences in generic utilisation provides considerable opportunities for countries to increase their prescribing efficiency.
Assess the impact of different demand side measures and their intensity on subsequent utilisation patterns of PPIs and statins post generic availability.
Methodology Retrospective analysis of the influence of demand side measures on PPI and statin utilisation (ATC Level 5) among 19 EU countries using DDDs (2010 ) and DDD/ TID from 2001 to 2007 (dates when generic omeprazole and generic simvastatin reimbursed in Western EU). Classes chosen as both generics and patent products in them with limited outcome differences between them. Demand side measures collated and validated using the 4 Es (Education, engineering, economics and enforcement).
Figure 4 – Limited impact of esomeprazole prescribing restrictions in Norway
Figure 2 – Statins pre patent loss (PL) and 2007
Considerable variation in utilisation of different PPIs and statins post generics due to different intensity of reforms (Figures 1 and 2). Multiple reforms typically needed to change physician behaviour. This variation, coupled with reforms to lower generic prices, led to appreciable differences in expenditure (Figure 3).
Care needed though when predicting impact of prescribing restrictions (Figure 4).
Dr Brian Godman
Division of Clinical Pharmacology
University Hospital, Huddinge SE-141 86
Telephone: 00468-585 81068