Abstract
Governments have several options to reduce the increasing costs of health care, including restrictions for the reimbursement of medicines. Next to the intended effect of reduced costs for medicines, reimbursement restriction can have unintended effects such as patients refraining from their treatment which may lead to health problems and increased use of health care. An example of a reimbursement restriction is the one for proton pump inhibitors (PPIs) that became effective in the Netherlands in January 2012. A major unintended effect of this measure could be that high-risk patients who start with non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin (aspirin) and who have an increased risk of gastric complications for which they are prescribed PPIs refrain from this PPI treatment. The aim of this study was to evaluate the effect of the reimbursement restriction among high-risk users of NSAIDs or aspirin. Do these patients refrain from their PPI treatment and if so do they have an increased risk of gastric complications? Part of the patients starting with NSAIDs or aspirin have an increased risk of gastric complications due to their age, comorbidities, or co-medication. The incidence of PPI use during the 2 years before the reimbursement restriction (2010 and 2011) and 2 years after the introduction of the reimbursement restriction was compared for patients on NSAIDs or aspirin with an increased risk of developing gastric complications. Impact of age, sex, and social economic status (SES) was taken into account. Hospital admissions due to gastric complications were studied over the same period (2010–2013). Data were obtained from a large population-based primary care database and a hospital database. The use of PPIs in patients with an increased risk of gastric complications who started NSAID/aspirin increased from 40% in 2010 to 55% in 2013. No impact was found of age, sex, or SES. There was no increase in hospital admissions due to gastric complications after the reimbursement restriction. The reimbursement restriction on PPIs was not associated with any detectable unintended effects for patients with an increased risk of gastric complications.
Highlights
Governments have several policy options to curb the expenses for health care
Of all patients of 20 years and older registered in the NIVEL-PCD, 15% had a prescription of non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin
The restriction in the reimbursement of pump inhibitors (PPIs) in the Netherlands did not lead to a reduced use of PPIs in patients who are at risk of gastrointestinal complications because of NSAID and/or aspirin use
Summary
Governments have several policy options to curb the expenses for health care. One of these options is through reimbursement restrictions for medication. Several studies have previously shown the importance of monitoring the effects of reimbursement restrictions on medication [1,2,3,4,5]. These restrictions may not always be successful if patients shift to other (more costly) treatments or if they do not lead to clinical benefits [6]
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