engleski

52. Combining Drug Utilization and Health Policy Studies Demonstrates Multiple Supply and Demand Side Reforms Enhance Prescribing Efficiency ; Implications for future CNC Studies

Background: Recent studies have shown considerable variation in generic utilisation depending on initiatives influencing prescribing efficiency. Objectives: Assess the influence of supply and demand side measures on prescribing efficiency. Methods: CN retrospective analysis of reimbursed utilisation (2010 DDDs, DDDs/ TID) and expenditure (and /1000 inhabitants/ year) of PPIs (A02BC) and statins (C10AA) among 19 European countries/ regions principally from 2001 to 2007. Classes chosen as contain originators, generics and patented products with limited differences in effectiveness between them. Years chosen as generics became available in Western EU countries during this time. Supply and demand side reforms validated with countries. No allowance for inflation. Efficiency 3 criteria chosen and validate: No efficiency rate of increase in expenditure exceeds utilisation ; efficient countries - rate of increase in utilisation more than double expenditure ; very efficient countries - reimbursed expenditure typically decreasing despite increasing utilisation. Results: Countries demonstrating considerable efficiency for PPIs through a combination of reforms include Norway, Spain (Catalonia), Sweden and UK. Statins also include Austria and Finland (prescribing restrictions) and Germany (atorvastatin removed from reimbursement list). Countries with more limited/ no efficiency included France, Ireland (GMS population), Portugal and Turkey principally due to limited demand side reforms. This is changing in France through e.g. CAPI. Efficiency considerations hampered in central and eastern European countries as typically only generics reimbursed initially/ over time. Findings reflected in appreciable differences in /1000 inhabitants/ year in 2007, e.g. PPIs: England - 6166 ; France - 15, 194, Portugal - 15, 157 ; Sweden - 5832. Conclusions: Multiple interventions typically needed to change physician prescribing. These coupled with supply side reforms to lower generic prices result in appreciable efficiency differences. Combining CNC DU studies with health policy should become a standard.

health policy; reforms; drug utilization; CNC studies

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