Increase In Pharmaceutical Expenditure Research Articles

Relationship between the number of hospital pharmacists and hospital pharmaceutical expenditure: a macro-level panel data model of fixed effects with individual and time

BackgroundThe rapid increase in pharmaceutical expenditure (PE) has been a main problem of global healthcare reform for decades. Previous studies demonstrated that pharmacists play an indispensable role in controlling PE, but macro-research evidence is scarce. Exploring the role of pharmacists from a macro-perspective is essential for pharmacy source allocation with an advantage of extensive applicability over regions. This study aimed to explore the relationship between the number of hospital pharmacists and hospital PE and to provide a macro-perspective evidence to curb the increasing PE and decline unnecessary medications.MethodsData were extracted from China Health Statistics Yearbook from 2011 to 2018. A panel dataset with 31 provinces from 2010 to 2017 was constructed. Amongst them, ‘Number of hospital pharmacists per 1 million of population’ (HLPT) was selected as an independent variable, ‘Per visit of hospital outpatient pharmaceutical expenditure’ (OTPE) and ‘Per capita of hospital inpatient pharmaceutical expenditure’ (ITPE) were selected as dependent variables, and ‘Number of hospital physicians per 1 million of population’ (HLPN) and ‘Drug price index’ (DPI) were applied as control variables. Fixed-effect panel data analysis was performed to evaluate the relationship between the number of hospital pharmacists and hospital PE.ResultsHLPT had a significant and negative relationships with OTPE (β1 = − 0.0893, p = 0.0132) and ITPE (β1 = − 4.924, p < 0.001). Considering the control variables, the significant and negative relationships with HLPT and OTPE remained unchanged (β1 = − 0.141, p < 0.001; β1 = − 4.771, p < 0.001, respectively), indicating that an increase in hospital pharmacist per 1 million of population led to a decrease of ¥474 million ($67.4 million) OTPE and ¥902 million ($128 million) ITPE in 2017. Overall, in 2017, an increase of 1 hospital pharmacist led to a decrease of approximately ¥1 million ($142 thousands) hospital PE nationwide.ConclusionThis study confirmed the negative relationship between hospital pharmacists and hospital PE, indicating that hospital pharmacists might play a significant role in controlling PE. Pharmacists were encouraged to participate in more drug-therapy-related activities, such as medication reconciliation.

The Impact of New Drug Launches on Hospitalization in 2015 for 67 Medical Conditions in 15 OECD Countries: A Two-Way Fixed-Effects Analysis

There are two types of prescription drug cost offsets. The first type of cost offset—from prescription drug use—is primarily about the effect of changes in drug quantity (e.g. due to changes in out-of-pocket drug costs) on other medical costs. The second type of cost offset—the cost offset from prescription drug innovation—is primarily about the effect of prescription drug quality on other medical costs. Two previous studies found that pharmaceutical innovation reduced hospitalization, and that the reduction in hospital cost from the use of newer drugs was considerably greater than the innovation-induced increase in pharmaceutical expenditure. In this study, we reexamine the impact that pharmaceutical innovation has had on hospitalization, employing a different type of 2-way fixed effects research design. We estimate the impact that new drug launches that occurred during the period 1982-2015 had on hospitalization in 2015 for 67 diseases in 15 OECD countries. Our models include both country fixed effects and disease fixed effects, which control for the average propensity of people to be hospitalized in each country and from each disease. The number of hospital discharges and days of care in 2015 is significantly inversely related to the number of drugs launched during 1982-2005, but not significantly related to the number of drugs launched after 2005. (Utilization of drugs during the first few years after they are launched is relatively low, and drugs for chronic conditions may have to be consumed for several years to achieve full effectiveness.) The estimates imply that, if no new drugs had been launched after 1981, total days of care in 2015 would have been 163% higher than it actually was. The estimated reduction in 2015 hospital expenditure that may be attributable to post-1981 drug launches was 5.3 times as large as 2015 expenditure on those drugs.

The Impact of New Drug Launches on Hospitalization in 2015 for 67 Medical Conditions in 15 OECD Countries: A Two-Way Fixed-Effects Analysis.

There are two types of prescription drug cost offsets. The first type of cost offset - from prescription drug use - is primarily about the effect of changes in drug quantity (e.g. due to changes in out-of-pocket drug costs) on other medical costs. Previous studies indicate that the cost offsets from prescription drug use may slightly exceed the cost of the drugs themselves. The second type of cost offset - the cost offset from prescription drug innovation - is primarily about the effect of prescription drug quality on other medical costs. Two previous studies (of a single disease or a single country) found that pharmaceutical innovation reduced hospitalization, and that the reduction in hospital cost from the use of newer drugs was considerably greater than the innovation-induced increase in pharmaceutical expenditure. In this study, we reexamine the impact that pharmaceutical innovation has had on hospitalization, employing a different type of 2-way fixed effects research design. In lieu of analyzing different countries over time for a single disease, or different diseases over time for a single country, we estimate the impact that new drug launches that occurred during the period 1982-2015 had on hospitalization in 2015 for 67 diseases in 15 OECD countries. Our models include both country fixed effects and disease fixed effects, which control for the average propensity of people to be hospitalized in each country and from each disease. The number of hospital discharges and days of care in 2015 is significantly inversely related to the number of drugs launched during 1982-2005, but not significantly related to the number of drugs launched after 2005. (Utilization of drugs during the first few years after they are launched is relatively low, and drugs for chronic conditions may have to be consumed for several years to achieve full effectiveness.) The estimates imply that, if no new drugs had been launched after 1981, total days of care in 2015 would have been 163% higher than it actually was. The estimated reduction in 2015 hospital expenditure that may be attributable to post-1981 drug launches was 5.3 times as large as 2015 expenditure on those drugs.

Impact of the implementation of a Fracture Liaison Service on pharmaceutical expenses for osteoporosis compared to an area without an FLS

ABSTRACTIntroduction: Fracture Liaison Service (FLS) model for secondary prevention of fractures has demonstrated its cost-effectiveness using decision models. We analyze the impact of a FLS on pharmaceutical expenditures for osteoporosis (OP) in real-world circumstances.Methods: Expenditures on OP medications from January 2011 to January 2017 were compiled. Pharmaceutical expenditures in the southern area of Gran Canaria were used as a control group to measure the impact of implementing an FLS in the northern area. We estimated generalized least squares regressions with interrupted time-series analysis where two interventions were considered: March 2012 (implementation of the FLS) and March 2016 (incorporation of nursing staff for inpatients with hip fracture).Results: The northern area incurred greater expenditures for group I and II drugs. The difference in bisphosphonates expenditures between areas varied from 10.5% higher in the northern area pre-FLS to 11.2% post-FLS and 18.3% since March 2016. However, interrupted time series models do not find a significant impact of implementation of FLS on the pharmaceutical expenditures for either drug group.Conclusion: The implantation of an FLS did not lead to an increase in pharmaceutical expenditures for OP over the 5-year period compared to the standard care provided for secondary fracture preventions.

Antifungal agents use in a French administrative region

BackgroundThe increased use of new costly antifungal agents has led to a considerable increase in pharmaceutical expenditure. In December 2011, the Lorraine Regional Health Agency commissioned the Antibiolor network to evaluate costly antifungal agent stewardship using as reference regional, French, and international recommendations. MethodsWe performed a regional retrospective multicenter study. The criteria for evaluation were the appropriateness of the indication for treatment, the choice of the agent or of a combination, compliance with dose and treatment duration, and the absence of any alternative. ResultsOne hundred and fourteen prescriptions were analyzed, in 7 intensive care units, 4 hematology units, and 1 infectious diseases unit. The indication for costly antifungal treatment was appropriate in 110 cases (96.5%), the choice of the antifungal agent in 102 cases (93%), the dose in 98 cases (89%), treatment duration in 102 cases (93%), and an alternative antifungal treatment was possible in 10 cases (9%). Eighty-two prescriptions (74.5%) complied with the marketing authorization, 19 (17%) were related to a protocol for temporary use, and 9 (8%) were considered as inappropriate. ConclusionOur results show a high rate of appropriate prescriptions. The easily accessible and regularly updated local recommendations probably resulted in the standardization and optimization of costly antifungal agent prescriptions.

Pharmaceutical Innovation, Longevity, and Medical Expenditure in Greece, 1995–2010

Longitudinal, disease-level data are used to analyze the impact of pharmaceutical innovation on longevity (mean age at death), hospital utilization, and medical expenditure in Greece during the period 1995–2010. The estimates indicate that pharmaceutical innovation increased mean age at death by 0.87 years (10.4 months) – about 44% of the total increase in longevity – and that diseases with larger increases in the cumulative number of drugs launched one to four years earlier had smaller increases in the number of hospital days. Real per capita pharmaceutical expenditure increased rapidly during this period, but 62% of the increase in pharmaceutical expenditure was offset by a reduction in hospital expenditure attributable to pharmaceutical innovation. The baseline estimate of the cost per life-year gained from pharmaceutical innovation in Greece is $17,117, which is a very small fraction of leading economists’ estimates of the value of (or consumers’ willingness to pay for) a one-year increase in life expectancy.

Impact of the economic crisis on healthcare resources: An European approach

BackgroundThe financial and economic crisis period that prevailed along the first decade of 2000 was a global phenomenon, during which healthcare systems were under the risk of an increasing pressure, mainly due to a loss of operational financial resources and potential increases in the healthcare demand.ObjectiveThis research intends to evaluate the impact of the crisis, taking into consideration the healthcare financing systems and healthcare resources utilization in Europe.Study design and settingWe considered as our sample the financial and healthcare data regarding the 27 European member states, from 2000 until 2009. The data were collected from Eurostat database (2011) and OECD database (2010), respectively. We perform a descriptive analysis, a correlation analysis, and a multivariate linear analysis by ordinary least squares.ResultsWe found that during economic crisis there was an increase in the total pharmaceutical expenditure as a percentage of total healthcare expenditure, and in the number of medical consultations per capita. Along with a rise of the unemployment rate, there was a decrease of total healthcare expenditure as a percentage of GDP.ConclusionDuring the crisis we found a decrease in healthcare expenditure and an increase in pharmaceutical expenditure and in the number of medical consultations. The results were sensitive to the financial healthcare system, except for healthcare expenditure. During crisis, social health insurance systems promote the use of healthcare resources at a higher price – due to a rise in pharmaceutical expenditure and number of medical consultations – than general taxation ones.

THERAPEUTIC SUBSTITUTION POST‐PATENT EXPIRY: THE CASES OF ACE INHIBITORS AND PROTON PUMP INHIBITORS

This paper examines whether there is a switch in total (originator and generic) consumption after generic entry from molecules that face generic competition towards other molecules of the same class, which are still in-patent. Data from six European countries for the time period 1991 to 2006 are used to study the cases of angiotensin-converting enzyme inhibitors and proton pump inhibitors. Empirical evidence shows that patent expiry of captopril and enalapril led to a switch in total (off-patent originator and generic) consumption towards other in-patent angiotensin-converting enzyme inhibitors, whereas patent expiry of omeprazole led to a switch in consumption towards other proton pump inhibitors. This phenomenon makes generic policies ineffective and results in an increase in pharmaceutical expenditure due to the absence of generic alternatives in the market of in-patent molecules.

PHP75 - Whether The Treatment Expenditures Or The Pharmaceutical Expenditures Of Social Security Institution (SSI) Have A Higher Increase Rate Between 2005 And 2011 In Turkey?

Turkey has accomplished remarkable improvements in terms of health status particularly after the implementation of the Health Transformation Program (HTP). Within the scope of HTP, the number of people covered by public health insurance, the number of hospital visits and also the number of physician consultation per capita has increased and disparities of benefit package between different sick funds have been unified. As a result, total health care expenditures have increased at a large extent. The aim of this study is to evaluate the rates of increases in the expenditures of Social Security Institution (SSI) in terms of pharmaceutical and treatment expenditures between 2005 and 2011. Databases of SSI, IMS, Ministry of Health and AIFD have been searched for the period of 2005 to 2011. Rates of increase in the health expenditures, number of people covered by public health insurance, hospital visits and the number of physician consultation per capita have been evaluated and compared. Between 2005 and 2011, coverage of public health insurance has risen from 89 to 96, physician consultation per capita has increased 63.8%, total health expenditures of SSI have increased 18% with a 23% increase in treatment expenditures and 12% increase in pharmaceutical expenditures. As a result of increase in the coverage of public health insurance and the number of hospital visits, treatment expenditures have risen at a large extent. But on the other hand, pharmaceutical expenditures’ increase rate was not at the same level. The main reasons are the global budget policy and the increases at the mandatory institutional discounts, which are being used as a major cost containment tool. Despite the success in the containment of pharmaceutical expenditures, any major cost containment policy for treatment expenditures haven’t been implicated, and in addition treatment expenditures are continuing to rise.

SHOULD THE DECISION-MAKING PROCESS OF REIMBURSING MEDICINES BE IMPROVED?

Pharmaceutical sales totaled an estimated USD 700 billion in OECD countries in 2011, approximately one-fifth of total healthcare spending (5). In the past, pharmaceutical expenditure has increased faster than total healthcare expenditure in many countries. The increase in pharmaceutical expenditure has slowed down in recent years due to the economic recession, patent expirations of important blockbusters, and cost-containment measures already taken. However, pharmaceutical expenditure still continues to rise, albeit at a reduced rate. Alongside an increased consumption of medicines, an important reason for growing costs is the adoption of new—and typically more expensive—products. To ensure that pharmaceutical expenditure does not become excessive and that patients have access to medicines they need, most countries now weigh up what products are to be included in the reimbursement system and at what price. Both the criteria to assess products and the processes to make reimbursement decisions vary from country to country and so far there have been no analytically oriented comparison studies.

Pharmacoeconomics; an appropriate tool for policy makers or just a new field of research in iran?

Pharmacoeconomics; an appropriate tool for policy makers or just a new field of research in iran?

Can savings induced by off-patent drugs balance the increase of pharmaceutical expense associated with the high ageing rate of the Italian population?

Background : The predicted ageing rate of the Italian population is one of the highest worldwide and this condition is expected to produce a growing increase in pharmaceutical expenditure. The objective of this study was to assess whether or not off-patent drugs could counterbalance the economic effects generated by the aging of the Italian population in the next ten years. Methods : On the basis of the predicted ageing rate of the Italian population for the period 2008-2018, the average annual cumulative increase of pharmaceutical expenditure and potential savings generated by the future loss of patent coverage have been considered in order to identify the year of the Breakeven Point. Results : The economic effect induced by the progressive ageing of population produces an average of 0.94% cumulative increase in local pharmaceutical expenditure per year, corresponding to an incremental pharmaceutical expenditure of about € 116 millions per year. A number of 509 brands (103 active substances) will lose their patent coverage in the next 10 years. Considering both the present legislation and a level of price reduction, after patent expiration, corresponding to 40%, it is predicted that the Breakeven Point will be achieved at the end of 2011. Conclusions : In this study, a long term balance between the predictable increase of pharmaceutical expenditure induced by the ageing of Italian population and savings produced by future off-patent drugs was not established. In order to assure the future sustainability of pharmaceutical expenditure, this study supports the need for the development of new health policy strategies.

Budget impact analysis of use of aliskiren in hypertension on the Italian Health Care System

Cardiovascular (CV) disease management and prevention has been the leading cost driver in health care expenditures of industrialized Countries for many years, and this trend is not expected to change in the next future. Although drugs used for the treatment of arterial hypertension and heart failure account for three fourths of the total Italian pharmaceutical expenditures in this disease area, population studies indicate that only about half of all hypertensive patients are treated for this condition, and that, among treated individuals, only a minority achieves a satisfactory and stable blood pressure control. A complementary observation is that drug expenditures, as high as they seem to be, actually account for only about a fourth of the total direct cost of CV illness, as they are exceeded by costs of hospitalizations required for the acute management of the clinical events that should be, at least partially, prevented by the same cardiovascular drugs. An often pointed out corollary to these findings is that an increase in the rate of controlled hypertension in the population, although surely linked to a further increase in pharmaceutical expenditures, carries the potential to reduce overall health care costs for the management of CV patients. As far as drug treatment is concerned, there seem to be three applicable strategies capable of increasing blood pressure control rates, i.e. interventions directed toward the increase of the treated population, interventions aimed at improving compliance, and the introduction of innovative drugs to cover unmet needs. Aliskiren is the first agent of the new direct renin inhibitors drug class, and has been recently approved in Italy under strict reimbursement restrictions. In this paper, the Authors present a budget impact analysis in the perspective of the National Health Service, conducted by estimating eligible populations according to reimbursement limitations, calculating differential costs by patient subgroups and possible strategies (addition to vs substitution of ACE-Is or ARBs), and finally by applying expected market shares to the identified population. The low forecast market penetration (0.2% and 0.6% of eligible patients, in the first and second year, respectively) drives the results: the treatment of 3,274-9,821 patients induces a yearly increase of 1.5 to 4.5 million € with aliskiren added to ACE-Is or ARBs, and of 917,000 to 2,751,000 € in the substitution scenario.

Pharmakoepidemiologie

Due to an increase in pharmaceutical expenditure and growing demands on the observation and analysis of the pharmaceutical use in the overall population, pharmacoepidemiology has increasingly gained importance. In the foreground of this scientific discipline is the analysis of drug use in every day treatment; pharmaceutical prescription data are a suitable data source as they are part of the health care routine. In Germany prescription data are collected as process data of the Statutory Health Insurance (GKV) under naturalistic conditions and are for this reason not distorted by study designs nor artificial survey conditions. The contribution at hand states the most common data sources und gives an overview on the character of pharmaceutical prescription data, their information content and how they can be used for scientific research. The prevailing study designs which are applied in pharmacoepidemiologic surveys and the prevalent methodological approaches of the pharmaceutical appliance research on the basis of secondary GKV data are presented. Furthermore, an outlook is given on Pharmacoepidemiological Databases (PDb) that are already well-established in other countries and possibilities will be shown for monitoring drug utilization and turnover.

Pharmaceutical Expenditures as a Correlate of Population Health in Industrialized Nations

In recent years, healthcare spending has outpaced economic growth in developed countries, with pharmaceutical expenditures being a key driver of this trend. While a significant number of studies investigating the effect of healthcare resource productivity on health status have been done, only a few have disaggregated pharmaceutical expenditures from total healthcare expenditures. To assess the independent association between pharmaceutical expenditures and health outcomes in 14 industrialized countries. We used data from the Organisation for Economic Co-operation and Development to construct a panel data set covering the years from 1985 to 2001. These data contain information on pharmaceutical expenditures, other healthcare expenditures, environmental health determinants, lifestyle health determinants, potential years of life lost, and life expectancy at ages 65 and 80 years across 14 industrialized nations. We estimated the relationship between pharmaceutical expenditures and potential years of life lost and life expectancy at ages 65 and 80 years for both males and females, using nonlinear fixed-effects regression models that corrected for serial correlation. All explanatory variables were lagged by 5 years to account for their cumulative effect on population health outcomes. Pharmaceutical expenditures proved to be a robust correlate of health outcomes from 1985 to 2001 in this sample of nations, when controlling for the effects of other variables likely to impact population health outcomes. Our estimates imply that a 10% increase in pharmaceutical expenditures during these years was associated with a 0.3% (95% CI 0.1% to 0.5%; approximately 21 days) increase in female life expectancy at age 65 years (p < 0.05), while a similar increase was associated with a 0.4% (95% CI 0.1 to 0.7; approximately 24 days) increase in male life expectancy at age 65 years (p < 0.05) and a 0.5% increase (95% CI 0.03 to 1.0; approximately 14 days) at age 80 years (p < 0.05). Our results suggest that significant, but small, marginal gains in population health outcomes were associated with increased pharmaceutical expenditures in developed nations during the period studied.

The Economics of Pharmacotherapy for Diabetes Mellitus

Diabetes mellitus is a chronic disease that has a major social impact. Proper planning for the management of patients with diabetes mellitus requires consideration of the important costs that diabetes imposes on the health system. Most of the indirect costs (lost productivity as a result of disability, absenteeism, loss of potential productive years of life), are related to diabetic complications, which greatly exceed the rest of the costs, and are also very difficult to classify in a standard manner. Direct costs (pharmacy, hospitalisation, consultations) mostly derive from healthcare strategies that aim to reduce late complications of the condition and maintain day-to-day quality of life. Therefore, it does not seem difficult to estimate pharmaceutical expenditures. The consumption of oral antihyperglycaemic agents, insulin, injection equipment and self-monitoring equipment indicates prescription tendencies and shows the influence on costs, and provides indirect information about the quality of healthcare or patients with diabetes mellitus. Over the last few years, some developed countries have shown a progressive increase in pharmaceutical expenditure on diabetic care, whereas economically depressed countries have experienced a dramatic shortage of basic medicines such as insulin. Considering the increase in consumers, and the international distribution of illnesses, both a hypothetical excess cost (related to consumerism; incurred by the health system and the diabetic population) and an irregular distribution of economic resources are evident. A co-ordinated health plan for patients with diabetes mellitus, involving the collaboration of diabetologists and epidemiologists with the pharmaceutical industry, and appropriate training measures for patients and professionals, would improve pharmacoeconomic efficiency in managing this disorder.

Battered bottom lines: The impact of eroding pharmaceutical discounts on health-care institutions

For several years, the American Society of Hospital Pharmacists (ASHP) has voiced concern about the impact of federally mandated changes on the pharmaceutical products marketplace. Since this marketplace is relatively inelastic, manipulating one segment in the interest of cost efficiencies is likely to result in price increases in other segments. That manipulation could come through such decisions as a "one-price" policy for pharmaceuticals, mandatory rebates for certain segments of the marketplace, or the elimination of discounts. The issue of cost-effective purchasing of prescription drugs and related supplies has recently come under increased scrutiny from the U.S. Congress, the Department of Health and Human Services, the General Accounting Office, and the Federal Trade Commission. In light of these and future activities, ASHP determined that there was a need to collect credible data on the potential impact of the termination of the Robinson-Patman Act's nonprofit institutional exemption, other discounts, or both on pharmaceutical expenditures in institutional health-care settings. The authors of this paper report the results and analysis of a 1990 mail survey conducted by ASHP and Concepts in Healthcare, Inc., to collect information on pharmaceutical purchasing and discounting procedures in community hospitals and selected nonhospital settings in the United States. Survey respondents reported that they would expect substantial increases in pharmaceutical expenditures if volume and nonprofit discounts were eliminated. Nonprofit hospitals expected a 24.4% increase in pharmaceutical expenditures in the wake of discount elimination, while for-profit institutions projected an 11.9% increase. Pharmaceutical expenditures of the study hospitals averaged $1.69 million per year; respondents estimated that this sum would increase by $390,000 (23.1%) if volume and nonprofit discounts were eliminated.