Transcript QUALITY OF CARE AND MEDICATIONS

ENDEP : A virtual network to provide
evidence on pharmaceutical policies
Patient charges in Europe and patients and
physicians’ decision making process
Dr C Huttin
Coordinator ENDEP network, EIASM
Presentation for Gastein meeting, september 2002
Website: www.eiasm/internationalprojects/endep
HISTORY OF ENDEP
• CREATION in 1994 of a virtual think tank, to provide
scientific evidence to European decision-makers on the
impact of pharmaceutical policies
• DEVELOPMENT STAGE supported by the Human
capital and mobility program: sharing knowledge and
building trust
• Pilot study: comparing what a European consumer has to
pay out of pocket in different national health systems
• BIOMED: an integrated project with standardisation of
methodologies.
• CENTRALISATION OF DATA
Patient charges in Europe and patients and
physicians’ decision making process
• To examine whether and how cost to the patient
through different reimbursement systems in
Europe influence physicians treatment choices
and patient behaviours
• To cosntruct new indicators on cost to the
patient,cost to the providers and societal costs.
• To bring evidence useful for policy circles at EU
level,using international comparisons (in
particular in the context of the agenda of
monitoring of health systems (Sanco, e.g. Echi)
These costs correspond to different prescription
charge arrangements in European countries
Countries
Type of
charge and
level of
charge
Deductible and
ceiling on patient
AUSTRIA
Fixed
3.15 per pack
FINLAND
Graduated
above a
fixed cost
deductible
0;25;50% above
deductible
France
Graduated
0;35;65% of drug
cost
ITALY
Fixed
charge
GERMANY
Fixed
charge
UK
Fixed
charge
1.56;2.60;3.64
depending on pack
size
Patient charges and patients and
physicians’decision making process
(Methods on the physician side)
The conceptual basis: an adaptation of the Lens model
(Brunswick, 52; Cooksey, 90), Hammond,95:theoretical
background of probability functionalism)
Patient cues
True State
Corrected weights
Economic cues
Judged State
Clinical cues
Judged weights
Patient charges and cost sensitivity analysis
of GPs in various European countries
2. Final design for the research on cost sensitivity of GPs
jointly agreed between the ENDEP/EIASM consortium
and the commercial Skim partner using conjoint analysis
Given a patient profile:
Patient characteristics: patient affordability,patient requestfor cheaper treatment,
severity of disease (hay fever) or risk factors (hypertension), patients’expenses
On other diseases
Q1: How would you treat this patient ?
Q2: To what extent did you take patient cost into account when you decided how to treat
this Patient ? (scale 1-7)
PATIENT CHARGE AND
PHYSICIANS’COST SENSITIVITY
MAIN RESULTS
Results France: average utility values
other prescr FF 200
other prescr FF 50
no other disease
all season severe/ 40 cigarettes father died 52
all season/40 cigarettes
certain days/5 cigarettes
patient asks cheaper
patient doesn’t ask
poor/no insurance
poor/insurance
good income/insurance
-1
-0,5
0
hay fever
hypertension
0,5
1
Results the UK : average utility values
3 other prescr
1 other prescr
no other disease
all season severe/ 40 cigarettes father died 52
all season/40 cigarettes
certain days/5 cigarettes
patient asks cheaper
patient doesn’t ask
low income
moderate income
good income
-1
-0,5
0
hay fever
hypertension
0,5
1
Results Finland : average utility values
3 other prescr
1 other prescr
no other disease
all season severe/ 40 cigarettes father died 52
all season/40 cigarettes
certain days/5 cigarettes
patient asks cheaper
patient doesn’t ask
low income
moderate income
good income
-1
-0,5
0
hay fever
hypertension
0,5
1
Results Italy : average utility values
3 other prescr
1 other prescr
no other disease
all season severe/ 40 cigarettes father died 52
all season/40 cigarettes
certain days/5 cigarettes
patient asks cheaper
patient doesn’t ask
low income
moderate income
good income
-1
-0,5
0
hay fever
0,5
hypertension
1
LINKING COST SENSITIVTY INDEX FOR
EACH INDIVIDUAL PHYSICIAN WITH
PRESCRIBING INTENTION SHIFTS
PRESCRIBING INTENTION SHIFTS
FOR HYPERTENSION IN FRANCE
Diurétiques
IEC(s)
Inhibiteurs
calciques
Antagonistes
angiotensine 2
Beta bloqueurs
-0,15
-0,10
-0,05
0,00
0,05
0,10
0,15
PRESCRIBING INTENTION SHIFTS
FOR HYPERTENSION IN THE UK
diuretic
ACE inhibitor
calcium antagonist
beta blocker
other drug treatment
no drug treatment at
all
1 month
2-3 months
-0,10
-0,05
0,00
0,05
0,10
PRESCRIBING INTENTION SHIFTS
FOR HAY FEVER IN FRANCE
CLARITYNE
ZYRTEC
ALLERGODIL
OPTICRON
NASACORT
BECONASE
VIRLIX
NASONEX
MIZOLLEN
NASALIDE
DERINOX
FLIXONASE
TELFAST
PRIMALAN
LOMUSOL
-0,10
-0,05
0,00
0,05
0,10
PRESCRIBING INTENTION SHIFTS
FOR HAY FEVER IN THE UK
non-sedating antihistamine
nasal steroid
eye drops
no drug treatment at all
1 month
2-3 months
-0,20
-0,10
0,00
0,10
0,20
Patient charges and patients decision
making process
main hypotheses for EU policy making






H1 : Cost conscious patients have poorer health status
H2 : Cost conscious patients are higher users of
prescribed drugs and GP visits
H3 : Cost conscious patients are higher users of cost
reduction strategies
H4 : Non exempt patients are higher users of cost reduction
strategies
H5 : Lower household income groups are more cost conscious
H6 : Lower household income groups are higher users of
cost reduction strategies
Cost conscious hypertensive patients
have poorer health status only in
Finland and Austria
90
80
70
60
50
low comorb
40
high comorb
30
20
10
0
Fin cost
con
Fin non
cost
Aus cost c
Aus non
cost
Cost conscious patients are higher drug
users than non cost conscious patients in
Finland, Austria and Germany
100
90
80
70
60
50
high users cc
40
low users cc
30
20
10
0
Fin
cost
con
Fin
non
cost
Aus
cost
c
Aus
non
cost
Frg
cost
con
Frg
non
cost
Cost conscious patients are higher
users of GP visits only in Finland
100
90
80
70
60
high users cc
50
low users cc
40
30
20
10
0
Fin cost con
Fin non cost
Finnish, British and Italian cost
conscious patients significantly avoid
seeing their physicians
100
90
80
70
60
50
40
30
20
10
0
use
do not use
Fin
Fr
Aus
use
Frg
I
UK
British, Finnish,Italian and German cost
conscious patients significantly wait till they
are paid to get their prescriptions
100
90
80
70
60
50
40
30
20
10
0
use
do not use
Fin
Fr
Aus
use
Frg
I
UK
Finnish, British and Italian cost
conscious patients are predominant
users of the cost reduction strategies
initiated by the patient
45
40
35
use S1
30
use S2
25
use S3
20
15
use S4
10
use S5
5
use S6
0
Fin
Fr
Aus
Frg
I
UK
In fixed prescription charge systems, the
prescription of longer supply is the most
used cost reduction strategy with the GP
advice, by cost conscious patients
80
70
60
50
use S1
40
use S2
30
use S3
20
10
0
Fin
Fr
Aus
Frg
I
UK
French, British, Italian and Finnish cost
conscious patients
are high users of strategies where they
ask pharmacist's advice
70
60
use S1
50
use S2
40
use S3
30
use S4
20
use S5
10
use S6
0
Fin
Fr
Aus
Frg
I
UK
POLICY IMPLICATIONS
• ROLE OF SCIENCE AND EVIDENCE IN
EUROPEAN POLICY
• MORE CONVERGENCE OF HEALTH
INSURANCE SYSTEMS ?
• GENERATION OF PRIMARY DATA FOR
THE DEVELOPMENT OF HEALTH
MONITORING SYSTEMS