Determinants of new drugs prescription in the Swiss healthcare market

Anne Decollogny,Patrick Taffé,Romain Piaget-Rossel,Yves Eggli

doi:10.1186/s12913-017-2775-1

Abstract

BackgroundDrug markets are very complex and, while many new drugs are registered each year, little is known about what drives the prescription of these new drugs. This study attempts to lift the veil from this important subject by analyzing simultaneously the impact of several variables on the prescription of novelty.MethodsData provided by four Swiss sickness funds were analyzed. These data included information about more than 470,000 insured, notably their drug intake. Outcome variable that captured novelty was the age of the drug prescribed. The overall variance in novelty was partitioned across five levels (substitutable drug market, patient, physician, region, and prescription) and the influence of several variables measured at each of these levels was assessed using a non-hierarchical multilevel model estimated by Bayesian Markov Chain Monte Carlo methods.ResultsMore than 92% of the variation in novelty was explained at the substitutable drug market-level and at the prescription-level. Newer drugs were prescribed in markets that were costlier, less concentrated, included more insured, provided more drugs and included more active substances. Over-the-counter drugs were on average 12.5 years older while generic drugs were more than 15 years older than non-generics. Regional disparities in terms of age of prescribed drugs could reach 2.8 years.ConclusionsRegulation of the demand has low impact, with little variation explained at the patient-level and physician-level. In contrary, the market structure (e.g. end of patent with generic apparition, concurrence among producers) had a strong contribution to the variation of drugs ages.

Highlights

Drug markets are very complex and, while many new drugs are registered each year, little is known about what drives the prescription of these new drugs
One additional motivation to focus researches on the determinants of new drugs prescription is that innovation and successful diffusion of new drugs are critical for financial performance of pharmaceutical companies [6]
In 2005 alone, 623 new drugs were registered on the Swiss Specialities List, generating a significant review and administrative work

Summary

Introduction

Drug markets are very complex and, while many new drugs are registered each year, little is known about what drives the prescription of these new drugs. In Switzerland, a recent study analyzed the impact of cardiovascular drug innovation on the longevity of elderly people and it was found that those “who used newer cardiovascular drugs in 2003 had longer time till death”, controlling for several demographic and health status characteristics [2]. Other authors stated that the substantial number of innovative pharmaceuticals introduced to the Swiss market should be examined in regard to the higher costs they generated [3]. In 2005 alone, 623 new drugs were registered on the Swiss Specialities List (a list published by the Federal Office of Public Health, which contains all the drugs reimbursed by the basic health insurance [7]), generating a significant review and administrative work.

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