Forecasting drug utilization and expenditure: ten years of experience in Stockholm

Love Linnér,Björn Wettermark,Irene Eriksson,Marie Persson

doi:10.1186/s12913-020-05170-0

Love Linnér, Björn Wettermark + Show 2 more

Open Access

https://doi.org/10.1186/s12913-020-05170-0

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Abstract

BackgroundOperating under constrained budgets, payers and providers globally face challenges in enabling appropriate and sustainable access to new medicines. Among payer initiatives aiming to improve preparedness of healthcare systems for the introduction of new medicines, drug utilization and expenditure forecasting has played an increasingly important role. This study aims to describe the forecasting model used in Region Stockholm and to evaluate the accuracy of the forecasts produced over the past decade.MethodsIn this repeated cross-sectional study, we compared the predicted pharmaceutical expenditure with actual expenditure during the entire available follow-up period (2007–2018) both for overall drug utilization and for individual therapeutic groups. All analyses were based on pharmaceutical expenditure data that include medicines used in hospitals and dispensed prescription medicines for all residents of the region.ResultsAccording to the forecasts, the total pharmaceutical expenditure was estimated to increase between 2 and 8% annually. Our analyses showed that the accuracy of these forecasts varied over the years with a mean absolute error of 1.9 percentage points. Forecasts for the same year were more accurate than forecasts for the next year. The accuracy of forecasts also differed across the therapeutic areas. Factors influencing the accuracy of forecasting included the timing of the introduction of both new medicines and generics, the rate of uptake of new medicines, and sudden changes in reimbursement policies.ConclusionsBased on the analyses of all forecasting reports produced since the model was established in Stockholm in the late 2000s, we demonstrated that it is feasible to forecast pharmaceutical expenditure with a reasonable accuracy. A number of factors influencing the accuracy of forecasting were also identified. If forecasting is used to provide data for decisions on budget allocation and agreements between payers and providers, we advise to update the forecast as close as possible prior to the decision date.

Highlights

Operating under constrained budgets, payers and providers globally face challenges in enabling appropriate and sustainable access to new medicines
We found that for the same year forecast the error was less than 1.5 percentage point in 5 out of 10 forecasts
Regression analyses of predicted and actual change in total expenditure indicated that the forecasts done for the same year were closer to the actual expenditure than the forecasts done in the previous year

Summary

Introduction

Payers and providers globally face challenges in enabling appropriate and sustainable access to new medicines. Pharmaceutical expenditure has been rising in many countries [1,2,3] This growth has been attributed to a number of factors including ageing populations, increasing patient expectations, as well as the introduction of new and more expensive medicines [4, 5]. Drug utilization and expenditure forecasts should provide decision makers with necessary information to allocate resources and set up activities promoting the rational uptake and use of new and established medicines [10]. Both horizon scanning and forecasting have been adopted as tools by many payers internationally

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