Pharmaceutical Expenditure Research Articles

OralOpioids: Harnessing R Programming and Data Science to Combat Opioid Misuse

Aims This study aims to introduce the OralOpioids R package, a novel research tool for the in-depth study and analysis of opioid prescriptions in Canada, which reports a significant per-capita pharmaceutical opioid consumption. Methods The OralOpioids R package employs data from Health Canada's Drug Product Database (DPD), focusing on authorized oral opioids. It systematically filters drug identification numbers (DINs) by narcotic schedules and administration routes. Moreover, it calculates the morphine equivalent dose (MED) for each DIN using the CDC table. Core functions include MED calculation for specific drugs, brand name retrieval, opioid content extraction, and unit computations based on Canadian MED guidelines. Results When juxtaposed against renowned opioid calculators such as MDCalc, Oregon Pain, and Ohio Pain, the OralOpioids package exhibited a near-perfect correlation, with R-squared values consistently at 0.99. Conclusions The OralOpioids package, distinctively tailored for research, marks a significant stride in understanding and monitoring Canada's opioid milieu. By encompassing data on discontinued opioids, it fosters a nuanced comprehension of the opioid panorama, enabling historical insight and post-marketing watchfulness. Primarily targeting researchers, its scope extends to healthcare providers, insurers, and administrative boards, all of whom can leverage its potent capabilities for informed decision-making. Although currently centered on Canadian opioids, its flexible design is primed for future expansion, potentially capturing a global audience and catalyzing efforts against the opioid crisis.

노인장기요양시설에서의 미사용 의약품 발생에 영향을 미치는 요인

As the number of elderly living in long-term care facilities increases, unused medicines are also increasing. This study investigated the status of unused medicines in long-term care facilities and the factors affecting it. Using National Health Insurance Claims Database(NHICB) and Long-term Care Insurance Claims Database(LTCHCD), 137,309 people who lived only in long-term care facilities and took prescription drugs in 2019 were analyzed in this study. Most of them were prescribed by the clinic (41%), and the days per prescription were 25 days in average. Only 1.8% of prescriptions were from tertiary general hospitals, but the days per prescription reached 85 days, accounting for 67% of prescriptions for more than 60 days. The average age of long-term care facility residents was 84.8 years, and 22.6% of them deceased in 2019. 33.7% of the subjects had unused medicines. The days of unused medicines due to duplication in pharmacologically equivalent groups were 13 days in average. The average days of unused medicine due to death were comparatively longer, which was 75.5 days. Unused medicine costs were about 0.9% of the total pharmaceutical expenditures and 77.8% of the costs was caused by death. Unused medicines increased as the number of outpatient visits increased (Relative Risk (RR): 1.14) or when the days per prescription were long (RR: 1.16). Older adults who died were 15 times more likely to have unused medicines than those who were alive. The amount of unused medicines in long-term care facilities is substantial, so it is necessary to establish appropriate policies to reduce it.

Catastrophic pharmaceutical expenditure in patients with type 2 diabetes in Iran

ObjectivesThis study aimed to assess the financial burden of out-of-pocket (OOP) payments to purchase antidiabetic medicines for type 2 patients in Iran.MethodThe “budget share” and “capacity to pay” approaches were employed to assess the catastrophic pharmaceutical expenditures of antidiabetic medication therapies. The catastrophic thresholds were adjusted for pharmaceutical sectors. The data was 2019 monthly household expenditures in rural and urban areas, insurance coverages of antidiabetic medicines and patients' out-of-pocket (OOP) payments in 30-day treatment schedules.ResultsThe results show that expenditure on diabetes medication therapies in the form of mono-dual therapy and some cases triple oral therapies were not catastrophic even for rural households. Insulin puts patients at risk of catastrophic pharmaceutical expenditures when added to the treatment schedules, and lack of financial protection intensifies it. In general, the poorer households and those resistant to first-line treatments were at increased risk of catastrophic pharmaceutical expenditures. The number of treatments that put patients at risk of catastrophic pharmaceutical expenditure in "budget share" was higher than the "capacity to pay" approach.ConclusionsAssessing medication treatment affordability instead of a single medicine assessment is needed. Assessment could be done by utilizing a macro-level data approach and applying adjusted pharmaceutical sector threshold values. Considering the variation between treatment schedules that put patients at risk of catastrophic pharmaceutical expenditures, targeted pharmaceutical policies and reimbursement decisions are recommended to promote Universal Health Coverage (UHC) and to protect vulnerable populations from hardship.

Main drivers of diabetes pharmaceuticals expenditures: evidence from OECD countries and Iran.

This study aimed to identify the impact of prominent drivers on drug expenditure for diabetes. Following the examination of previous studies, this study identified possible factors contributing to diabetes pharmaceutical expenditures. The explanatory variables for the study were the median population age, access to innovative drugs, GDP per capita, prevalence, price, and consumption of diabetes drugs. Then, to estimate the per capita expenditure among diabetic patients, this study developed the panel data model and two time-series regression models for OECD countries and Iran, respectively. In the panel data regression model, R2 was 0.43. The influence of the age, prevalence, consumption volume and GDP per capita coefficients were + 1.79, + 0.704, + 3.86057, + 0.00054, respectively. Also, the probability level of all variables was less than 0.05. In Iran's comparative time-series regression model, R2 was 0.9, and the only significant influence coefficient was the age (β=+0.91). In the another model for Iran, R2 was 0.99, the influence coefficient of age was + 0.249, the prevalence was + 0.131, innovation was + 0.029, and the price was + 0.00054; all the probability levels were less than 0.05. Pharmaceutical per capita expenditure is affected by several factors. These factors are not the same in various counties. Passing a judgment on drug utilization only based on pharmaceutical per capita expenditure cannot be perfect. Also, judging whether the per capita drug expenditure in one country is desirable without attention to the affecting factors and only relying on the value of utilized medicines is defective.

Minimizing the environmental impact of unused pharmaceuticals: Review focused on prevention

Pharmaceuticals are essential for human health, but they become an environmental concern when entering the environment which occurs when residues are excreted after consumption or when unused pharmaceuticals are discarded improperly. Although there are no developed detection methods for all pharmaceuticals that reach the ecosystem, certain groups have been proven to cause adverse effects on ecosystems, including increased mortality in aquatic species and changes in physiology, behavior, or reproduction. Particular attention is devoted to these groups of pharmaceuticals and their environmental impact. In this review, the authors suggest measures for the reduction of unused pharmaceuticals in the environment, with a strong emphasis on prevention. Various policy interventions are recommended across the lifecycle including source-directed, user-orientated, and waste management measures, to prevent the creation of household pharmaceutical waste and to ensure environmentally friendly ways of pharmaceutical household waste disposal. Preventive measures include rational pharmaceutical consumption, prescribing greener drugs, or designing pharmaceuticals that are benign and easily biodegradable, improved disease prevention, personalized medicine, enhanced dimensioning of pack sizes, and marketplaces for redistribution of unused pharmaceuticals. The next step is to prevent unavoidable waste to reach the environment, so proper collection and disposal of unused pharmaceuticals is of utmost importance. Finally, educating health professionals and the public and partnership between environmental and healthcare scientists are of vital significance in all stages of the pharmaceuticals’ lifecycle. Minimalization of the level of pharmaceuticals in the environment will benefit human life.

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.

Functional bioactive compounds in ginger, turmeric, and garlic.

Nutrition plays a very important role in the health promotion of individuals and brought about a global paradigm shift from pharmaceuticals to nutraceuticals. This is due to the high cost, non-availability, and side effects associated with the unregulated consumption of pharmaceuticals. Over the ages, nutraceuticals from food products were reported to contain bioactive compounds with great health and physiological benefits. This report reviews bioactive compounds in selected foods namely ginger (Zingiber officinale), turmeric (Curcuma longa), and garlic (Allium sativum) as potential natural therapeutics for ailments of cancer and heart-related diseases. Analytical profiles, functional activities, and characterization of these compounds were discussed with possible recommendations for the prospective treatment of diseases using these nutraceuticals.

HPR141 Modelling the Impact of Pricing Exceptions and Protections on Pharmaceutical Expenditure in Greece

HPR141 Modelling the Impact of Pricing Exceptions and Protections on Pharmaceutical Expenditure in Greece

HPR76 Implementing the Recovery and Resilience Fund Initiative to Reduce Pharmaceutical Expenditure Clawback in Greece: The Impact on Pharmaceutical Spending and on National Economy

HPR76 Implementing the Recovery and Resilience Fund Initiative to Reduce Pharmaceutical Expenditure Clawback in Greece: The Impact on Pharmaceutical Spending and on National Economy

HPR77 Variables Impacting Drugs Average Prices in Italy in 2016 - 2021 Period

The Italian Medicines Agency (AIFA) negotiates agreements to manage the pharmaceutical expenditure, especially for high-cost drugs. The analysis aimed to assess the most relevant variables impacting medicine prices (Average Price - AP) which account for both discounts negotiated with AIFA and further discounts applied in tenders.

HPR81 Evaluation of the Hungarian Generic Program Between 2010 and 2021

In Hungary, there is no regular price revision for originator products, so it is reasonable to assume that the distributor of the originator product would not in principle reduce the price. In 2010, the rules of the active substance or therapy based reference pricing were significantly tightened, allowing for a reduction in drug budget expenditure. In our research, we investigate how much the reference price reimbursement, which has been in place since 2011, has been able to reduce pharmaceutical expenditure and how much it has saved.

HPR192 An Assessment of the Impact of the Three Memorandum Policies on Health Outcomes of the Greek Population

Optimizing the value of pharmaceutical spending is an important goal for effective and sustainable health systems. During the economic crisis, Greece undertook a set of strict fiscal policies to contain public pharmaceutical expenditure. The objective of this study is to investigate the social inefficiencies stemming from the regulatory framework of the Greek health system, with an emphasis on the effects of the policy reforms during the economic crisis on health outcomes.

Trends in pharmaceutical opioid consumption in the WHO Eastern Mediterranean Region, 2010-2019.

Pharmaceutical opioid consumption has been increasing worldwide, but disparities in access to these medications exist. Few countries of the WHO Eastern Mediterranean Region have well defined pain management policies. This study presents trends in the consumption of pharmaceutical opioids in the 22 countries in the Eastern Mediterranean Region from 2010 to 2019, with comparative intra- and extra-regional analyses; the correlation between pharmaceutical opioid consumption and human development index rankings; and pharmaceutical opioids use in the region. We calculated the defined daily doses for statistical purposes (S-DDD) per million inhabitants per day of pharmaceutical opioids from 2010 to 2019, and used the mixed effects models to assess changes in consumption. We used regression analyses to establish the strength of associations between human development index level and consumption in the region and elsewhere. Pharmaceutical opioid use has fluctuated in the region since 2010, with a mean sum of S-DDD of 2547 for 2010-2019. Consumption is relatively low in the region irrespective of the human development index. The highest-consuming country reported 369 S-DDD in 2019 and the lowest reported 1 S-DDD. The most used pharmaceutical opioids in the region were fentanyl, morphine, pethidine, oxycodone, and codeine. Consumption could be considered inadequate in several countries of the region. Supporting these countries to improve collection and reporting of consumption data, and providing humanitarian assistance to enhance access to pain relief, should be a priority for the international community.

Health technology assessment in Türkiye: Current status and perspectives on future implementation

Objective: Türkiye's health care system reforms have led not only to increased access to health care but also to rising pharmaceutical expenditures. Therefore, health technology assessment (HTA) has become an important tool for evaluating priorities in reimbursement and budget allocation. Our study aimed to describe the current HTA environment in Türkiye and explore long-term perspectives from a broad spectrum of Turkish stakeholders on the development of HTA in the next ten years. Methods: In 2019, we used a convenience sampling method to conduct an online survey with stakeholders from different areas in the health system. Additional face-to-face discussions were conducted to clarify answers when needed. We assessed the current evaluation process for pharmaceuticals and examined the need for HTA in Türkiye. Online survey data were extracted into Microsoft Excel for analysis. Quantitative data were summarised descriptively. Results: A total of 27 Turkish stakeholders completed the survey; 21 were employed in the public sector, and 6, in the private sector. The majority of participants (18/27) suggested introducing HTA for all new health technologies considered for public reimbursement and instituting an additional review process for currently reimbursed technologies. Most respondents (25/27) agreed that a threshold for cost-effectiveness should be applied in the next ten years. Conclusion: The stakeholders concurred that Türkiye must implement an HTA process soon. However, further discussion and interaction between stakeholders are essential to ensure a broad commitment to the implementation of a structured HTA process in Türkiye.

A wastewater-based evaluation of the effectiveness of codeine control measures in Australia.

From 1 February 2018, codeine was rescheduled from an over-the-counter (OTC) to a prescription-only medicine in Australia. We used wastewater-based epidemiology to measure changes in population codeine consumption before and after rescheduling. We analysed 3703 wastewater samples from 48 wastewater treatment plants, taken between August 2016 and August 2019. Our samples represented 10.6 million people, 45% of the Australian population in state capitals and regional areas in each state or territory. Codeine concentrations were determined by liquid chromatography-tandem mass spectrometry and converted to per-capita consumption estimates using the site daily wastewater volume, catchment populations and codeine excretion kinetics. Average per-capita consumption of codeine decreased by 37% nationally immediately after the rescheduling in February 2018 [95% confidence interval (CI) = 35.3-39.4%] and substantially in all states between 24 and 51% (95% CI = 22.4-27.0% and 41.8-59.4%). The decrease was sustained at the lower level to August 2019. Locations with least pharmacy access decreased by 51% (95% CI = 41.7-61.7%), a greater decrease than 37% observed for those with greater pharmacy access (95% CI = 35.1-39.4%). Regional areas decreased by a smaller margin to cities (32 versus 38%, 95% CI = 30.2-34.1% versus 34.9-40.4%, respectively) from a base per-capita usage approximately 40% higher than cities. Wastewater analysis shows that codeine consumption in Australia decreased by approximately 37% following its rescheduling as a prescription-only medicine in 2018. Wastewater-based epidemiology can be used to evaluate changes in population pharmaceutical consumption in responses to changes in drug scheduling.

Changes in Treatment Patterns and Costs for Lung Cancer Have Not Resulted in Relevant Improvements in Survival: A Population-Based Observational Study in Catalonia.

Few published studies have described multidisciplinary therapeutic strategies for lung cancer. This study aims to describe the different approaches used for treating lung cancer in Catalonia in 2014 and 2018 and to assess the associated cost and impact on patient survival. A retrospective observational cohort study using data of patients with lung cancer from health care registries in Catalonia was carried out. We analyzed change in treatment patterns, costs and survival according to the year of treatment initiation (2014 vs. 2018). The Kaplan-Meier method was used to estimate survival, with the follow-up until 2021. From 2014 to 2018, the proportion of patients undergoing surgery increased and treatments for unresectable tumors decreased, mainly in younger patients. Immunotherapy increased by up to 9% by 2018. No differences in patient survival were observed within treatment patterns. The mean cost per patient in the first year of treatment increased from EUR 14,123 (standard deviation [SD] 4327) to EUR 14,550 (SD 3880) in surgical patients, from EUR 4655 (SD 3540) to EUR 5873 (SD 6455) in patients receiving curative radiotherapy and from EUR 4723 (SD 7003) to EUR 6458 (SD 10,116) in those treated for unresectable disease. From 2014 to 2018, surgical approaches increased in younger patients. The mean cost of treating patients increased, especially in pharmaceutical expenditure, mainly related to the use of several biomarker-targeted treatments. While no differences in overall patient survival were observed, it seems reasonable to expect improvements in this outcome in upcoming years as more patients receive innovative treatments.

Pharmaceutical cost implications for oral healthcare interventions at a dental clinic in Windhoek, Namibia

Half of the world’s 7.9 billion population suffers from oral health conditions. Most are largely preventable and treatable but costs are often unaffordable especially in developing countries. The World Health Organization (WHO) resolved in 2021 to include oral healthcare interventions in universal healthcare coverage (UHC) programmes. Although the general expenditure on oral healthcare services has been reported by some countries, amounts spent on particularly pharmaceuticals have not been reported. This study aimed to report on the prevalence of different types of oral health diseases in patients attending a dental clinic in Windhoek (Namibia) and quantify the pharmaceutical expenditure incurred. Records for all patients who visited the dental clinic at KIRH during a six-month period (1 January 2021 to 30 June 2021) were reviewed. Costs associated with the respective pharmaceutical management options for the most common oral conditions were calculated based on the approximated cost for a single treatment course per patient.Pharmaceutical expenditure on oral diseases was approximately 0.4% of the hospital’s annual budget. From this, 94.6% was due to treatment of dental caries which had a 90.1% prevalence. Prevalence of dental caries among 13-19 years age group (9.5%) was lower than for 1-12 years (18.6%) and 20-64 years (68.2%). Cases for dental caries were fewer for the 65+ years age group (3.8% of total cases) but had the highest prevalence (95.2%) of dental caries then other age groups. The proportion of the pharmaceutical budget spent on treating oral diseases was 0.4%, of which 94.6% was due to dental caries. Promotion of oral healthcare among children may be instrumental in reducing the pharmaceutical costs associated with treatment of dental carries.

More cost-sharing, less cost? Evidence on reference price drugs.

This paper evaluates the causal effects of changes in reference prices (RP) on prices, copayments, and overall expenditures for off-patent pharmaceuticals. With reference pricing, firms set prices freely and the health plan covers the expenses only up to a certain threshold. We use quarterly data of the German market for anti-epileptics at the package level and at the active substance level and exploit that the RP has been adjusted in some of the active substances but not in others in a difference-in-differences framework. At the product level, we find that a lower RP reduces prices for both brand-name drugs and generics, but leads to higher copayments, especially for brand-name drugs. At the aggregate level, we find that a lower RP leads to savings for the public health insurer since revenues decrease substantially for brand-name firms and, to a lesser extent, also for generic firms. Overall expenditures (payments by the health insurer and the patients) for brand-name drugs decrease in proportion to the decrease in the RP, while the adjustment does not significantly influence overall expenditures for generics.

The impact of zero markup drug policy on patients' healthcare utilization and expense: An interrupted time series study.

To curb the unreasonable growth of pharmaceutical expenditures, Beijing implemented the zero markup drug policy (ZMDP) in public hospitals in 2017, which focused on separating drug sales from hospital revenue. The purpose of this study is to evaluate the impacts of ZMDP on healthcare expenditures and utilization for inpatients. The Beijing claims data of inpatients diagnosed with ischemic heart disease (IHD), chronic renal failure (CRF), and lung cancer (LC) was extracted from the China Health Insurance Research Association (CHIRA) database. The study employed an interrupted time series to evaluate the impacts of ZMDP on healthcare expenditures and utilization. The changes in total hospitalization expenses, health insurance expenses, and out-of-pocket expenses were not statistically significant neither in level change nor in trend change for inpatients diagnosed with IHD, CRF, or LC after implementing ZMDP (all P > 0.05). The Western medicine expenses for the treatment of inpatients diagnosed with IHD significantly decreased by 1,923.38 CNY after the reform (P < 0.05). The Chinese medicine expenses of inpatients diagnosed with CRF instantaneously increased by 1,344.89 CNY (P < 0.05). The service expenses of inpatients diagnosed with IHD and LC instantaneously increased by 756.52 CNY (p > 0.05) and 2,629.19 CNY (p < 0.05), respectively. However, there were no significant changes (P > 0.05) in out-of-pocket expenses, medical consumables, imaging, and laboratory test expenses of inpatients diagnosed with IHD, CRF, or LC. The initiation of the intervention immediately increased the number of inpatient admissions with LC by 2.293 per month (p < 0.05). The ZMDP was effective in reducing drug costs, and the effects on healthcare utilization varied across diseases type. However, the increase in medical service and Chinese medicine expenses diminished the effect of containing healthcare expenses and relieving the financial burdens of patients. Policymakers are advised to take multiple and long-lasting measures, such as provider payment methods reform, volume-based drug procurement, and drug price negotiation to improve the affordability of patients thoroughly.

Zero-augmented beta-prime model for multilevel semi-continuous data: a Bayesian inference

Semi-continuous data characterized by an excessive proportion of zeros and right-skewed continuous positive values appear frequently in medical research. One example would be the pharmaceutical expenditure (PE) data for which a substantial proportion of subjects investigated may report zero. Two-part mixed-effects models have been developed to analyse clustered measures of semi-continuous data from multilevel studies. In this study, we propose a new flexible two-part mixed-effects model with skew distributions for nested semi-continuous cost data under the framework of a Bayesian approach. The proposed model specification consists of two mixed-effects models linked by the correlated random effects: Part I) a model on the occurrence of positive values using a generalized logistic mixed model; and Part II) a model on the magnitude of positive values using a linear mixed model where the model errors follow skew distributions including beta-prime (BP). The proposed method is illustrated with pharmaceutical expenditure data from a multilevel observational study and the analytic results are reported by comparing potential models under different skew distributions. Simulation studies are conducted to assess the performance of the proposed model. The DIC3, LPML, WAIC, and LOO as the Bayesian model selection criteria and measures of divergence used to compare the models.