Utilization patterns of subsidized and nonsubsidized reimbursable peptic ulcer medication in Belgium

Abstract

AbstractStudy objective — To provide an exploratory description of a dynamic population of Belgian patients treated with reimbursable peptic ulcer medications (ATC Class A20B) and to estimate the annual number (prevalence) of patients treated with reimbursable peptic ulcer medications per 1000 inhabitants in Belgium in 1991.Setting — Community pharmacies in Belgium, a country with 107 inhabitants, where reimbursement of attack therapy (3 months) and maintenance therapy (9 months) is only possible after endoscopic or radiologic confirmation of ulcer or severe esophagitis.Design — Cross‐sectional two month registration study of consecutive recipients of reimbursable peptic ulcer medication in a convenience sample of 31 volunteer community pharmacists (a 0.5% sample of Belgian community pharmacies).Methods — Data from a simple, self‐administered (with assistance from the pharmacist) questionnaire of two pages were used to classify patients in one of four patterns of therapy (attack therapy, relapse therapy, maintenance therapy for 9 months, maintenance therapy longer than 9 months) and to determine the average consumption of medication packages within each pattern. The number of patients using reimbursable peptic ulcer medication over one year was estimated from these observational data and from the annual sales volume with a theoretical model.Results — The questionnaire was completed by 432 of 481 elegible patients (an 89.9% response rate) in 27 participating pharmacies. Ninety‐two per cent of the patients had requested or had obtained reimbursement; 74% had at least one EDG in the past 12 months (1/3 combined with at least one X‐ray). Only nine patients of the small subgroup of 34 patients without reimbursement had undergone diagnostic examinations.Discussion — The study of complex utilization patterns with a simplified model provides a rough estimation of the annual number of medication users.Conclusions — In Belgium, a country with strict reimbursement control, mainly based on EGD performed by medical specialists, the annual prevalence of patients using reimbursable peptic ulcer medication is estimated at 30.5 patients/1000 inhabitants/ year. In this country, there is a high utilization of EGD, a high rate of 9 months maintenance therapy and some evidence for channelling of omeprazole. Further longitudinal follow up and comparison with different reimbursement systems in other countries is needed to evaluate the cost‐effectiveness and the impact of different regulatory approaches to reimbursement regulation on medication utilization.