Annual Pharmaceutical Expenditure Research Articles

Trends in National Pharmaceutical Expenditure in Korea during 2011 - 2020.

This study aimed to identify the trends in pharmaceutical expenditure (PE), share of PE in health expenditure (HE), and trends in expenditure by pharmacological groups (ATC level 1 classification) in Korea for a 10-year period (2011 - 2020) and compare the data with those of other Organisation for Economic Co-operation and Development (OECD) countries. Using the findings, we determined the current status of pharmaceutical expenditure (PE) management in Korea and derived the implications for establishing future macroscopic policies on PE. We analyzed the OECD Health Statistics and the Korean national health insurance claims database from January 2011 through December 2020. The outcome measures were HE, PE, and pharmaceutical sales data for ATC level 1 medicines from OECD Health Statistics data during 2011 - 2020. As OECD collects limited ATC level 1 data, we used the HIRA health insurance claims data for PEs of ATC level-1 classification, including D, L, P, and S. PE in Korea increased by 38.5% from 19.9 billion USD in 2011 to 27.6 billion USD in 2020, whereas the share of PE in HE decreased by 6.3%p from 26.4% in 2011 to 20.1% in 2020. In 2020, Korea ranked third in PE per capita (760.9 USD PPP) and had the highest share of PE (20.1%) among the 19 OECD countries studied. By ATC level 1 class, the highest PE was A (alimentary tract and metabolism) at 4.3 billion USD, and L (antineoplastic and immunomodulating agents) had the highest increase at 13.4%; in contrast, J (anti-infectives for systemic use) had the lowest increase in annual average PE at -0.2% in 2020 relative to 2011. Among the 17 OECD countries, Korea had the highest and the third-highest expenditures for ATC codes A and J, respectively. PE in Korea has continued to increase between 2011 and 2020, indicating the need for macroscopic management of PE. Our results on PE by ATC code may help health authorities in establishing future policies on PE.

Trends in pharmaceutical expenditure in the Taiwan National Health Insurance database at different hospital levels.

Aim: This study aimed to understand the medication usage among different hospitals in Taiwan. Materials & methods: The NHI claims database consisting of claims prescription drugs in Taiwan was used to determine drug prescriptions in different hospitals. Results: In the medical center, L01X showed the highest drug expenditure and the drug prescription pattern in regional hospitals was similar to that in the medical center. The highest drug expenditure in the district hospital and clinics was A10B. Conclusion: Our analysis suggests that the annual pharmaceutical expenditures from 2016 to 2018 were increasing over time in all hospitals. The generic drug usage in medical centers/regional hospitals was lower than district hospitals/clinics.

Drug cost avoidance analysis of cancer clinical trials in Spain: a study on cost contributors and their impact

ObjectiveAnalyze the cost contributors and their impact on the drug cost avoidance (DCA) resulting from cancer clinical trials over the period of 2015–2020 in a tertiary-level hospital in Spain (HCUVA).MethodsWe performed a cross-sectional, observational, retrospective study of a total of 53 clinical trials with 363 patients enrolled. We calculated the DCA from the price of the best standard of care (i.e.: drugs that the institution would otherwise fund). A linear regression model was used to determine cost contributors and estimate their impact.ResultsThe total DCA was ~ 4.9 million euros (31 clinical trials; 177 enrollees), representing ~ 30% and ~ 0,05% approximately of the annual pharmaceutical expenditures at the HCUVA and for the Spanish Health System, respectively. Cancer type analysis showed that lung cancer had the highest average DCA by trial, indicating that treatments in these trials were the most expensive. Linear regression analysis showed that the number of patients in a trial did not significantly affect that trial's DCA. Instead, cancer type, phase trials, and intention of treatment were significant cost contributors to DCA. Compared to digestive cancer trials, breast and lung trials were significantly more expensive, (p < 0.05 and p < 0.1, respectively). Phase III trials were more expensive than Phase II (p < 0.01) and adjuvant trials were less expensive than palliative (p < 0.05).ConclusionWe studied cost contributors that significantly impacted the estimated DCA from cancer clinical trials. Our work provides the groundwork to explore DCA contributors with potential to enhance public relations material and serve as a negotiating tool for budgeting, thus playing an important role to inform decisions about resource allocation.

Inventory Management of Health Commodities in a Tertiary Teaching Hospital in Ethiopia.

Background: Analyzing purchased health commodities based on their budgetary consumption and importance is crucial for efficient utilization of a hospital’s budget. However, it is rarely seen when hospitals, mostly in developing countries, conduct such kinds of analyses and make an informed decision, including to utilize their limited budget efficiently. Therefore, the purpose of this study was to analyze a 3-year inventory of health commodities (medicines, medical supplies, and laboratory reagents and chemicals) in Saint Paul Hospital Millennium Medical College (SPHMMC). Methodology: The study was conducted in SPHMMC located in Addis Ababa, Ethiopia. It is one of the largest specialized public hospitals in the country. It is a huge teaching hospital in the country where a large amount of budget is utilized. Three years of data were collected and ABC, VEN, and ABC-VEN matrix techniques were applied for the analysis. The data collection period was from March to April 2017. Results: An average of 296 medicines, 194 laboratory commodities, and 105 medical supplies were purchased over 3 years. Class A medicines, which consume 80% of the total annual pharmaceutical expenditures (APE) account, are 17.8%–20% of the total medicines by quantity. Antibiotics (ceftriaxone 1 gm injection and metronidazole), IV fluids (sodium chloride 0.9% injection and dextrose 40% injection), and antidiabetic medication (insulin zin suspension and metformin) are among the top 10 medications by value that consume significant amounts of the budget of the hospital. On VEN analysis, an average of 24% of the items were vital, 67% were essential, and 4–8–8.9% were nonessential. Nonessential items consumed 0.49%, 9.9%, and 1.1% of Annual Expenditures (AEs) in 2013/14, 2014/15 and 2015/16, respectively. On ABC-VEN matrix analysis, a single expensive and nonessential medicine (valganciclovir HCL 450 mg tablet) consumed 9.4% of expenditure in 2014/15. Class A laboratory commodities, which consume 70%–80% of the total laboratory expenditures represented 8.5%–20% of the total laboratory commodities analyzed for the 3 years. From class A items, antimonoclonal antibodies in 2013/14, hemocue glucose 201 4 × 25 tests in 2014/15, and glucose tests in 2015/16 consumed the highest percentages: 9.2%, 8.2%, and 23.7% of the AEs, respectively. There were laboratory commodities procured out of the VEN list, and these accounted for 6.8%–31.2% of the total laboratory expenditures over the 3 years. Class A medical supplies, which consumed 80% of the total medical supply expenditures, represented only 8.2%–15.8% of the total items over the 3 years studied. Surgical gauze 90 cm × 100 m, surgical gloves sterile latex number 7.5, and examination gloves were the top three based on expenditures in all the studied years. In 2015/16, examination gloves alone consumed 71.9% of the total expenditure. Conclusion: SPHMMC manages large numbers of health commodities (more than 500 excluding program commodities) which necessitate efficient inventory management practice in place. However, the purchase of the commodities particularly those products used for laboratory diagnosis is not strictly based on the hospital’s VEN list, indicating the need for better communication of the laboratory unit with the Drug and Therapeutic Committee (DTC) of the hospital. The DTC of the hospital should update the VEN list of the health commodities and strictly enforce the hospital procurement to adhere to the agreed upon list of medicines. In addition, the hospital should prioritize and decide the quantity and frequency of ordering health commodities based on regular ABC-VEN results.

Antibiotic procurement and ABC analysis for a comprehensive primary health care clinic in the Eastern Cape province, South Africa.

BackgroundAntimicrobial resistance (AMR), a major threat to global public health, can be addressed using a managed care approach. This includes timely analysis of antibiotic consumption and procurement data to drive evidence-based policies and practices in healthcare facilities. ‘ABC analysis’ presents an opportunity for this.MethodsABC analysis data for a comprehensive Primary Health Care (PHC) clinic in the Eastern Cape province of South Africa was obtained from the Provincial Department of Health for 01 April 2015 to 31 March 2018. Procured antibiotics were analysed on the quantities purchased, total cost, route of administration and spectrum of activity. Antibiotic categorization was also carried out according to the World Health Organization Model List of Essential Medicines (WHO EML) 2017.ResultsAntibiotics made up approximately 7% of the total annual pharmaceutical expenditure. A total of 31, 35 and 34 antibiotics were procured in the first, second and third years, respectively. The most procured antibiotics were: (1) isoniazid, (2) flucloxacillin, (3) azithromycin, (4) a combination of rifampicin, isoniazid, pyrazinamide, and ethambutol and (5) amoxicillin. Overall, 55%, 2% and 15% of antibiotics accounted for the ‘Access’, ‘Watch’ and ‘Access and Watch’ categories, respectively, of the WHO EML. No ‘Reserve’ antibiotics were procured. The remaining 28% were antituberculosis medicines. Altogether, 89%, 8% and 3% of the antibiotics were respectively administered orally, systemically, and topically. A total of 58% were broad-spectrum and 42% were narrow-spectrum antibiotics.ConclusionOral antibiotics in the ‘Access’ category presented favourable usage of antibiotics. Decreasing the use of broad-spectrum antibiotics requires consideration.

The effect of clean air on pharmaceutical expenditures

Airborne emissions are detrimental to health. Low emission zones (LEZs) that restrict pollution-intensive vehicles from entering are popular measures to curb local emissions such as particulate matter. We evaluate how LEZs impact defensive pharmaceutical expenditures. To this end, we use the complete medical histories of 2.7M individuals insured with Germany’s largest public health insurer AOK. We identify causal effects exploiting the quasi-experimental, staggered introduction of LEZs in 49 cities. We find that LEZs reduce annual pharmaceutical expenditures for heart and respiratory diseases by 15.8M€, representing a significant fraction of policy costs.

Association Between Modifiable Risk Factors and Pharmaceutical Expenditures Among Adults With Atherosclerotic Cardiovascular Disease in the United States: 2012-2013 Medical Expenditures PanelSurvey.

BackgroundAtherosclerotic cardiovascular disease (ASCVD) causes most deaths in the United States and accounts for the highest healthcare spending. The association between the modifiable risk factors (MRFs) of ASCVD and pharmaceutical expenditures are largely unknown.Methods and ResultsWe examined the association between MRFs and pharmaceutical expenditures among adults with ASCVD using the 2012 and 2013 Medical Expenditure Panel Survey. A 2‐part model was used while accounting for the survey's complex design to obtain nationally representative results. All costs were adjusted to 2013 US dollars using the gross domestic product deflator. The annual total pharmaceutical expenditure among those with ASCVD was $71.6 billion, 33% of which was for medications for cardiovascular disease and 14% medications for diabetes mellitus. The adjusted relationship between MRFs and pharmaceutical expenditures showed significant marginal increase in average annual pharmaceutical expenditure associated with inadequate physical activity ($519 [95% confidence interval (CI), $12–918; P=0.011]), dyslipidemia ($631 [95% CI, $168–1094; P=0.008]), hypertension: ($1078 [95% CI, $697–1460; P<0.001)], and diabetes mellitus ($2006 [95% CI, $1470–2542]). Compared with those with optimal MRFs (0–1), those with average MRFs (2–3) spent an average of $1184 (95% CI, $805–1564; P<0.001) more on medications, and those with poor MRFs (≥4) spent $2823 (95% CI, $2338–3307; P<0.001) more.ConclusionsWorsening MRFs were proportionally associated with higher annual pharmaceutical expenditures among patients with established ASCVD regardless of non‐ASCVD comorbidity. In‐depth studies of the roles played by other factors in this association can help reduce medication‐related expenditures among ASCVD patients.

ABC analysis: a tool of effectively controlling pharmaceutical expenditure in Greek NHS hospitals

Objectives The technical cost analysis, in order to highlight expensive medicines, is an important factor in the administration of health units. The purpose of the study is to analyse the annual pharmaceutical expenditures in NHS hospitals and to investigate the therapeutic categories requiring greater supervisory, for years 2013–2014. Methods The study was conducted at 19 public hospitals (9900 beds) and the data of annual consumption and expenditure incurred on each medicine using ATC classification were collected via observe.net web system and then arranged in descending order based on the Pareto principle. Key findings ABC analysis revealed that 21% (J, B, L) items (at ATC-1 level) represented class A amounting for nearly 80% (91 150 641 euros) of annual NHS pharmaceutical expenditure. Furthermore, approximately 9% (30) items (at ATC-4 level) represents class A, accounting for nearly 70% of annual pharmaceutical expenditures for year 2013, and 11% of items are responsible for nearly 80% of cumulative ADE for year 2014. Conclusions The inventory control is an effective measure for cost management of pharmaceutical expenditure by identifying the drugs requiring stringent control for rational use of funds in public hospitals.

PMS119 - Access to Biological Therapies and Consumption Trends in Bosnia and Herzegovina

Biologics are used for treatment of different diseases from cancer to autoimmune diseases. According to IMS biologics share in total pharma market in 2002 was 11% and will reach 19-20% of market share in 2017. This class of drug bears high costs and this is the main reason of low access to these therapies in developing and low income countries. Due to the costs access to this therapeutics depends on public funding. We examined access and trends of consumption of novel biologics in Bosnia and Herzegovina. Data on consumption of biologics was generated from official report on annual pharmaceutical expenditure published by State agency for medicines and medical devices. We covered 6-years period (2009-2014). Access to biologics depends on public funding and has direct impact on expenditure and these data have been taken from official reimbursement lists of Health Insurance Funds financing expensive medicines. Data on expenditure are represented in value (EUR) and analysis did not consider volume sales. Market share of biologics in total B&H pharma-market in 2009 was 4% and increased to 8% in 2014 which is highly below global trend. Monoclonal antibodies for cancer are present at reimbursement lists from 2009 showing constant sales growth. Trastuzumab is most used biologic (1,9m€ in 2009 and 6,9m€ in 2014), followed by rituximab, sunitinib, sorafenib and bevacizumab. Impact of reimbursementis best shown in case of sunitinib and sorafenib with high sales increase reflecting medical need for these therapies. Imatinib sales significantly dropped after biosimilar introduction into the market in 2013. Lapatinib and nilotinib had been introdudec into the market in 2010 and palivizumab and adalimumab in 2011 showing constant sales growth Access to novel biologic depends on public funding and there is significant need to these therapies . Biosimilar introduction into market can significantly improve access to these therapies and decrease costs

Impacto presupuestario del tratamiento antirretroviral. Reflexión desde las guías de GESIDA

ObjectiveThe latest version of the Spanish clinical practice guidelines on antiretroviral therapy (ART) in HIV-infected adults, developed by the Spanish AIDS Study Group (GESIDA) and the National AIDS Plan, recommends initiating ART early in certain circumstances. The aim of this study was to estimate the budget impact of this recommendation by using the data from the VACH cohort. MethodsWe considered a scenario in which all naïve asymptomatic patients would initiate ART if they had <500 lymphocytes, or a CD4/μL count >500/μL if they were older than 55 years, or had high viral load, liver disease, chronic kidney disease or high cardiovascular risk. The study was designed as a cost analysis in terms of annual pharmaceutical expenditure. The only costs included were those relating to the ART combinations analyzed. To estimate these costs, we assumed that this guideline had a penetration of 80%, an adherence of 95% and 12% dropouts. ResultsA total of 12,500 patients were reviewed. Of these, 1,127 (10%) had not initiated ART; CD4 lymphocyte count was 350-500 in 294 (26.1%) and > 500 in 685 (60.8%). If the new clinical practice guideline were applied, 45.2% of naïve patients (95% CI: 42.4%-48.2%) would be advised to start ART. Carrying out this recommendation in hospitals of the VACH cohort would require an additional annual investment of € 3,270,975 and would increase the overall cost of antiretroviral drugs by 3%. ConclusionsIn the framework of health economics, incorporating economic impact estimates – such as those performed in this study – into clinical practice guidelines would be advisable to increase their feasibility.

Prescription Data Related to the Use of Calcium Channel Blockers, ACE Inhibitors and Angiotensin II Type 1 Receptor Antagonists (Angiotensin Receptor Blockers) in Combination Identify Savings Opportunities

Background: It is now recognized that treating hypertension with combination therapy is required to achieve target blood pressure in the majority of patients. Objective: To investigate the use of ACE inhibitors, angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) and calcium channel blockers (CCBs) within the Lombardia Region of Italy and to evaluate associated financial implications of the use of these drugs in free combinations. Methods: Prescription data in the Administrative National Health Service (NHS) Reimbursement Database of the Lombardia Region (2004-6) were analysed for ACE inhibitor, ARB and CCB use. Data included patient code, prescription date, drug class, product license number, number of packs dispensed and actual expenditure reimbursed by the NHS, and were used to calculate the mean daily cost of free combination antihypertensive treatments. Results: ACE inhibitors, ARBs or CCBs were prescribed at least once to 1.6 million patients (17% of Lombardia population) either as single therapy (51.5% of patients receiving these drugs) or in combination therapy (48.5%). Among patients who received these drugs, 22.5% received free combination therapy (primarily ACE inhibitor plus CCB or ARB plus CCB). The mean annual cost for these drugs was h342 million, representing 18% of the total annual pharmaceutical expenditure for the region. Free combinations accounted for 14.3% of treatment days, but 28.3% of annual expenditure for these drugs. Further analysis revealed that the mean expenditure for free combinations was 2.6–31.9% higher than the sum of their individual component costs (mean increase of 5.9% for the most commonly prescribed free combinations). Conclusions: Prescription of free combination of antihypertensive drugs is associated with additional financial burden to the NHS, which may be avoided by prescribing fixed combination therapy.

Psychoactive drugs and costs in the Madrid III (Valdemoro) prison

Annual pharmaceutical expenditures in prisons increases dramatically and the rising costs of psychoactive drugs have especially contributed to this. These drugs are often prescribed in order to find therapeutic uses in the field of personality disorders, addictions, and dysfunctional behaviours that are not included in the authorized indications (compassionate use). This study has enabled a detailed description of the use of psychoactive drugs at the Madrid III prison, a centre with one of the lowest levels of pharmaceutical expenditure in this autonomous community. During a 2-week period, all prescriptions of psychoactive drugs were collected and registered along with data of several possible conditioning factors. Twenty point five percent of the population was receiving some kind of psychoactive drug; 76% of those inmates undergoing treatment were receiving 1 or 2 substances; 65% were taking anxiolytic drugs, 38% antidepressants, and 27% antipsychotics. The total amount of psychoactive drugs consumed was 9840 defined daily doses, 46% of which were anxiolytic drugs, 17% antidepressants, and 14% antipsychotics. The total cost of the fortnight's treatment was €5379 with a saving of €611 due to requesting and selecting offers carried out by the pharmacist. Seventy-two percent of the costs were spent on antipsychotics and the newer psychoactive drugs, representing 66% of the prescriptions, accounted for 98% of expenditure. The prescriber was one of the key influential factors over the amount, type and cost of the treatments. There are signs that compassionate use of current antipsychotics and antiepileptics, and newer antidepressants are a main cause of the dramatic increase in the costs, with cost-efficiency not always clearly demonstrated. These results are not an isolated fact restricted only to prisons, as demonstrated by consumption data published by the National Health System in the same year.

The Determinants of Life Expectancy: An Analysis of the OECD Health Data

This study considers an aggregate life expectancy production function for a sample of developed countries. We find that pharmaceutical consumption has a positive effect on life expectancy at middle and advanced ages but is sensitive to the age distribution of a given country. Thus, ignoring age distribution in a regression of life expectancy on pharmaceutical consumption creates an omitted‐variable bias in the pharmaceutical coefficient. We find that doubling annual pharmaceutical expenditures adds about one year of life expectancy for males at age 40 and slightly less than a year of life expectancy for females at age 65. We also present results for lifestyle inputs into the production of life expectancy. For example, decreasing tobacco consumption by about two cigarettes per day or increasing fruit and vegetable consumption by 30% (one‐third pound per day) increases life expectancy approximately one year for 40‐year‐old females.

Analgesic therapy for headache: consumption, appropriateness and costs

Headache represents not only an individual disease, but also an important pathology for society because its prevalence in the population is about 50.0%. Its physical, emotional, social and economic impacts are often neglected and it is only recently that headache is being considered in a public health perspective, especially its disabling burden, its treatment and its costs. The aim of this work was to investigate the pharmacological treatment of headache and its costs. An anonymous questionnaire on headache was distributed in a waiting room of a general hospital in Rome, Italy. Both patients and visitors were included in the sample with the exclusion of those who had an appointment at Headache Centre of the hospital. The study was conducted on 294 subjects; the mean age was 46.7 years (SD=16.1). The prevalence of headache was 65.6% (95% CI, 60.0%–71.0%). There was no statistically significant difference between patients and visitors, while there was between men and women (53.0% vs. 79.4%; p<0.05). In the age group 30–49 years, the prevalence was significantly higher than in the other age groups (86.0%; p<0.05). Drugs only to treat headache were used by 67.9% of the sample and Aulin was the most used drug, followed by Novalgina and aspirin used, respectively, by 41.6%, 11.0% and 9.7% of the subjects. The economic evaluation of the pharmacological treatment of headache was conducted on the 101 patients (65.6%) who gave complete information on posology. Since the distribution of costs was strongly skewed to the right due to a few expensive treatments, the mean annual pharmaceutical expenditure per patient is not a good indicator, and we also calculated the median and the mode, the maximum and the minimum. Attention was focused also on two subgroups: those who used self-prescription and those who turned to healthcare specialists. The median annual pharmaceutical expenditure per patient was euro 4.30 for the whole group who used drugs and euro 3.93 and 8.51 for the self-prescription and the prescribed by specialist groups, respectively. In conclusion, considering the possible danger which may arise from inappropriate use of drugs and the costs of therapy, our data suggest that consultation with a specialist would be particularly helpful in patients with headache.

¿Existe conciencia de gasto farmacéutico en la atención primaria reformada?

To evaluate the effectiveness of feeding information on pharmacy back to primary care doctors in order to create awareness (knowledge) of pharmaceutical expenditure (PE). Retrospective cross-sectional study, through personal interview. Reformed PC, Sabadell, Barcelona. The 80 PC doctors working with primary care teams. As the personal feed-back on PE, each doctor was asked for the PE generated during 1997 and the mean cost of prescriptions to active and pensioner patients. The statistical test used was the t test to compare means for paired data, with p < 0.05 the required level of significance. Out of the total doctors interviewed (80), 71 replies were obtained for the annual PE and 76 for the mean cost of prescriptions, for both active and pensioner patients. Significant differences were found between the annual PE in reality and doctors' estimates: around twelve million pesetas. The differences between the real mean costs of prescription and the estimates were also significant. In view of the results, it is concluded that there is no awareness of PE among the doctors in the reformed PC in our area. This poses a question over the efficacy of feed-back of pharmacy information in order to create this awareness. This information needs to be more frequent and richer in content, and to be complemented by other measures.