Abstract
BackgroundThe study covered in- and out-of-hospital care in a region in north-western Spain. The intervention evaluated took the form of a change in the hospital drugs formulary. Before the intervention, the formulary contained four of the five low molecular weight heparins (LMWHs) marketed in Spain. The intervention consisted of withdrawing two LMWHs (bemiparin and dalteparin) from the formulary and restricting the use of another (tinzaparin), leaving only enoxaparin as an unrestricted prescription LMWH.Accordingly, the aim of this study was to evaluate the effect on in- and outpatient drug prescriptions of removing and restricting the use of several LMWHs in a hospital drugs formulary.MethodsWe used a natural, before-after, quasi-experimental design with a control group and monthly data from January 2011 to December 2016. Based on data drawn from official Public Health Service sources, the following dependent variables were extracted: defined daily doses (DDD) per 1000 inhabitants per day (DDD/TID), DDD per 100 stays per day, and expenditure per DDD.ResultsThe two compounds that were removed from the formulary registered an immediate decrease at both an intra- and out-of-hospital level (66.6% and 55.6% for bemiparin and 73.0% and 92.2% for dalteparin, respectively); similarly, the compound that was restricted also registered an immediate decrease (36.1% and 9.0% at the in- and outpatient levels, respectively); in contrast, the remaining LMWH (enoxaparin) registered an immediate, significant increase at both levels (44.9% and 32.6%, respectively). The intervention led to an immediate reduction of 6.8% and a change in trend in out-of-hospital cost/DDD; it also avoided an expenditure of €477,317.1 in the 21 months following the intervention.ConclusionsThe results indicate that changes made in a hospital drugs formulary towards more efficient medications may lead to better use of pharmacotherapeutic resources in its health catchment area.
Highlights
The viability of public health services and their financing is one of the major global health policy debates [1,2,3], due to the constant increase in costs [4]
Ninety-nine percent of the population is covered by the Spanish National Health Service (SNHS) with a public health insurance system; a quarter of the population is over 65 years of age
Visits to the doctor are free of charge; out-of-hospital pharmaceutical service is subject to a financial contribution, whereas in-hospital service is free of charge
Summary
The viability of public health services and their financing is one of the major global health policy debates [1,2,3], due to the constant increase in costs [4]. The main factors involved in high pharmacy costs are the appearance of new drugs, the intensification of treatments, polytherapy, or their prices [6], the promotion of pharmaceutical companies [7, 8], and the induced prescriptions of hospital doctors to primary care doctors [9,10,11]. Hospital drugs formularies are lists of drugs drawn up to optimise inpatient care and ensure clinically appropriate, safe and cost-effective access [12, 13], and are a common tool for rational drug use in developed countries [14,15,16]. The aim of this study was to evaluate the effect on in- and outpatient drug prescriptions of removing and restricting the use of several LMWHs in a hospital drugs formulary
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