Transcript Brazil - utilisation-1 - Klinik Farmakoloji Dosyası

Can multiple demand side measures enhance prescribing efficiency:
implications for sustaining health care systems
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)
Introduction
Results
Results (continued)
Drug 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.
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)
Objective
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 2 – Statins pre patent loss (PL) and 2007
Conclusions
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).
Karolinska Institutet
Dr Brian Godman
Researcher
Division of Clinical Pharmacology
University Hospital, Huddinge SE-141 86
E-mail: [email protected]
Telephone: 00468-585 81068
Figure 4 – Limited impact of esomeprazole
prescribing restrictions in Norway