Abstract
BackgroundWhile extensive evidence suggests that the economic recession has had far reaching effects on many economic sectors, little is known regarding its impact on prescription drug utilization. The purpose of this study is to describe the association between state-level unemployment rates and retail sales of seven therapeutic classes (statins, antidepressants, antipsychotics, angiotensin-converting enzyme [ACE] inhibitors, opiates, phosphodiesterase [PDE] inhibitors and oral contraceptives) in the United States.MethodsUsing a retrospective mixed ecological design, we examined retail prescription sales using IMS Health Xponent™ from September 2007 through July 2010, and we used the Bureau of Labor Statistics to derive population-based rates and mixed-effects modeling with state-level controls to examine the association between unemployment and utilization. Our main outcome measure was state-level utilization per 100,000 people for each class.ResultsMonthly unemployment levels and rates of use of each class varied substantially across the states. There were no statistically significant associations between use of ACE inhibitors or SSRIs/SNRIs and average unemployment in analyses across states, while for opioids and PDE inhibitors there were small statistically significant direct associations, and for the remaining classes inverse associations. Analyses using each state as its own control collectively exhibited statistically significant positive associations between increases in unemployment and prescription drug utilization for five of seven areas examined. This relationship was greatest for statins (on average, a 4% increase in utilization per 1% increased unemployment) and PDE inhibitors (3% increase in utilization per 1% increased unemployment), and lower for oral contraceptives and atypical antipsychotics.ConclusionWe found no evidence of an association between increasing unemployment and decreasing prescription utilization, suggesting that any effects of the recent economic recession have been mitigated by other market forces.
Highlights
While extensive evidence suggests that the economic recession has had far reaching effects on many economic sectors, little is known regarding its impact on prescription drug utilization
Little is known regarding how the recent economic recession has affected prescription drug utilization, several studies have examined the effects of the recession on other components of the health care sector (Table 1)
We focused on the use of seven therapeutic classes - statins, antidepressants, antipsychotics, Angiotensin-converting enzyme [ACE] inhibitors, opiates, phosphodiesterase (PDE) inhibitors, and oral contraceptives - that differ in terms of their indications, target population and importance of consistent use
Summary
While extensive evidence suggests that the economic recession has had far reaching effects on many economic sectors, little is known regarding its impact on prescription drug utilization. Little is known regarding how the recent economic recession has affected prescription drug utilization, several studies have examined the effects of the recession on other components of the health care sector (Table 1). Deductibles, copayments for office visits, and prescription drug copayments increased [12] These changes corresponded to a slowing of health care spending growth, which reached a rate in 2008 of 4.4%, the slowest rate of growth over the previous 48 years [13]. One cause of this slowing has been reduced private health insurance enrollment as a result of a continuing high unemployment and the expiration of subsidies for coverage provided through COBRA [14]
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