RESUMEN
BACKGROUND: Several measures are in force in Switzerland to control the cost of drugs, but are not effective enough. There are many determinants influencing these expenditures, related to treatments, markets, physicians, patients and regions, but their impact on costs is not clear. METHODS: We applied a Bayesian multilevel model with five levels to adjust for patients, drugs' market, and physicians 'characteristics, treatment type, and district (i.e. Swiss canton). We used data of the Swiss drugs' market in 2006, offering real choices for doctors and patients (multiple products for similar active substances), with a neutral position of pharmacists (no financial incentives). RESULTS: Variance partitioning of yearly drugs' cost per insured showed that market level (delivered substance) contributed to 76% of the variance, treatment level (delivered product) to 20%, whereas patients' and physicians' levels accounted for only 2% each, without significant differences between Swiss cantons. After adjusting for covariables at each level, the model explained about 51% of the variation at the market and 20% at the treatment levels. We found that older but substitutable drugs, generics, larger size of the market and physician's specialty were associated with lower expenditure, whereas drugs requiring a physician's prescription, the number of prescribers per patient, patient' age, male gender, and comorbidities increased expenditure. Our results show that for a specific medication the yearly cost of recently released drugs was 36 CHF higher than for similar and substitutable drugs introduced 15 years earlier, corresponding to one third of the average annual treatment cost observed in our dataset. Competition did not seem to be effective to reduce expenditure on the drug market. CONCLUSION: The main finding of this study is that recentness of drugs was associated with an increase in drug expenditure in 2006, even after adjustment for all non-controllable determinants. Further research is recommended to confirm those results with updated data.
Asunto(s)
Sector de Atención de Salud , Gastos en Salud , Teorema de Bayes , Costos de los Medicamentos , Medicamentos Genéricos/uso terapéutico , Humanos , Masculino , SuizaRESUMEN
OBJECTIVE: This study aimed to examine the prevalence and determinants of benzodiazepine prescription among older adults in Switzerland, and analyse association with hospitalisation and costs. DESIGN: Retrospective analysis of claims data. SETTING: The study was conducted in nine cantons in Switzerland. PARTICIPANTS: Older adults aged 65 years and older enrolled with a large Swiss health insurance company participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was prevalence of benzodiazepine prescription. The secondary outcomes were (1) determinants of any benzodiazepine prescription; (2) the association between any prescription and the probability of hospitalisation for trauma and (3) the association between any prescription and total healthcare expenditures. RESULTS: Overall, 69 005 individuals were included in the study. Approximately 20% of participants had at least one benzodiazepine prescription in 2017. Prescription prevalence increased with age (65-69: 15.9%; 70-74: 18.4%; 75-80: 22.5%; >80: 25.8%) and was higher in women (25.1%) compared with men (14.6%). Enrollees with the highest deductible of Swiss Francs (CHF) 2500 were 70% less likely to receive a prescription than enrollees with the lowest deductible of CHF 300 (adjusted OR=0.29, 95% CI 0.24 to 0.35).Individuals with at least one prescription had a higher probability of hospitalisation for trauma (OR=1.31, 95% CI 1. 20 to 1.1.44), and 70% higher health care expenditures (ß=0.72, 95% CI 0. 67 to 0.77). Enrollees in canton Valais were three times more likely to receive a prescription compared to enrollees from canton Aargau (OR=2.84, 95% 2.51 to 3.21). CONCLUSIONS: The proportion of older adults with at least one benzodiazepine prescription is high, as found in the data of one large Swiss health insurance company. These enrollees are more likely to be hospitalised for trauma and have higher healthcare expenditures. Important differences in prescription prevalence across cantons were observed, suggesting potential overuse. Further research is needed to understand the drivers of variation, prescription patterns across providers, and trends over time.
Asunto(s)
Benzodiazepinas/farmacología , Prescripciones de Medicamentos/estadística & datos numéricos , Gastos en Salud , Revisión de Utilización de Seguros/estadística & datos numéricos , Trastornos Psicóticos/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Trastornos Psicóticos/epidemiología , Estudios Retrospectivos , SuizaRESUMEN
BACKGROUND: Drug markets are very complex and, while many new drugs are registered each year, little is known about what drives the prescription of these new drugs. This study attempts to lift the veil from this important subject by analyzing simultaneously the impact of several variables on the prescription of novelty. METHODS: Data provided by four Swiss sickness funds were analyzed. These data included information about more than 470,000 insured, notably their drug intake. Outcome variable that captured novelty was the age of the drug prescribed. The overall variance in novelty was partitioned across five levels (substitutable drug market, patient, physician, region, and prescription) and the influence of several variables measured at each of these levels was assessed using a non-hierarchical multilevel model estimated by Bayesian Markov Chain Monte Carlo methods. RESULTS: More than 92% of the variation in novelty was explained at the substitutable drug market-level and at the prescription-level. Newer drugs were prescribed in markets that were costlier, less concentrated, included more insured, provided more drugs and included more active substances. Over-the-counter drugs were on average 12.5 years older while generic drugs were more than 15 years older than non-generics. Regional disparities in terms of age of prescribed drugs could reach 2.8 years. CONCLUSIONS: Regulation of the demand has low impact, with little variation explained at the patient-level and physician-level. In contrary, the market structure (e.g. end of patent with generic apparition, concurrence among producers) had a strong contribution to the variation of drugs ages.
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Medicamentos Genéricos , Sector de Atención de Salud , Pautas de la Práctica en Medicina/estadística & datos numéricos , Medicamentos bajo Prescripción , Adulto , Anciano de 80 o más Años , Teorema de Bayes , Niño , Estudios Transversales , Prescripciones de Medicamentos , Medicamentos Genéricos/uso terapéutico , Femenino , Humanos , Revisión de Utilización de Seguros , Masculino , Medicamentos bajo Prescripción/uso terapéutico , SuizaRESUMEN
BACKGROUND: Pharmacy-based case mix measures are an alternative source of information to the relatively scarce outpatient diagnoses data. But most published tools use national drug nomenclatures and offer no head-to-head comparisons between drugs-related and diagnoses-based categories. The objective of the study was to test the accuracy of drugs-based morbidity groups derived from the World Health Organization Anatomical Therapeutic Chemical Classification of drugs by checking them against diagnoses-based groups. METHODS: We compared drugs-based categories with their diagnoses-based analogues using anonymous data on 108,915 individuals insured with one of four companies. They were followed throughout 2005 and 2006 and hospitalized at least once during this period. The agreement between the two approaches was measured by weighted kappa coefficients. The reproducibility of the drugs-based morbidity measure over the 2 years was assessed for all enrollees. RESULTS: Eighty percent used a drug associated with at least one of the 60 morbidity categories derived from drugs dispensation. After accounting for inpatient under-coding, fifteen conditions agreed sufficiently with their diagnoses-based counterparts to be considered alternative strategies to diagnoses. In addition, they exhibited good reproducibility and allowed prevalence estimates in accordance with national estimates. For 22 conditions, drugs-based information identified accurately a subset of the population defined by diagnoses. CONCLUSIONS: Most categories provide insurers with health status information that could be exploited for healthcare expenditure prediction or ambulatory cost control, especially when ambulatory diagnoses are not available. However, due to insufficient concordance with their diagnoses-based analogues, their use for morbidity indicators is limited.
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Atención Ambulatoria/estadística & datos numéricos , Grupos Diagnósticos Relacionados , Clasificación Internacional de Enfermedades/estadística & datos numéricos , Medicamentos bajo Prescripción/uso terapéutico , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Estado de Salud , Humanos , Pacientes Internos/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Modelos Estadísticos , Morbilidad , Medicamentos bajo Prescripción/clasificación , Suiza/epidemiologíaRESUMEN
BACKGROUND: Since generic drugs have the same therapeutic effect as the original formulation but at generally lower costs, their use should be more heavily promoted. However, a considerable number of barriers to their wider use have been observed in many countries. The present study examines the influence of patients, physicians and certain characteristics of the generics' market on generic substitution in Switzerland. METHODS: We used reimbursement claims' data submitted to a large health insurer by insured individuals living in one of Switzerland's three linguistic regions during 2003. All dispensed drugs studied here were substitutable. The outcome (use of a generic or not) was modelled by logistic regression, adjusted for patients' characteristics (gender, age, treatment complexity, substitution groups) and with several variables describing reimbursement incentives (deductible, co-payments) and the generics' market (prices, packaging, co-branded original, number of available generics, etc.). RESULTS: The overall generics' substitution rate for 173,212 dispensed prescriptions was 31%, though this varied considerably across cantons. Poor health status (older patients, complex treatments) was associated with lower generic use. Higher rates were associated with higher out-of-pocket costs, greater price differences between the original and the generic, and with the number of generics on the market, while reformulation and repackaging were associated with lower rates. The substitution rate was 13% lower among hospital physicians. The adoption of the prescribing practices of the canton with the highest substitution rate would increase substitution in other cantons to as much as 26%. CONCLUSIONS: Patient health status explained a part of the reluctance to substitute an original formulation by a generic. Economic incentives were efficient, but with a moderate global effect. The huge interregional differences indicated that prescribing behaviours and beliefs are probably the main determinant of generic substitution.
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Sustitución de Medicamentos/estadística & datos numéricos , Medicamentos Genéricos/uso terapéutico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prescripciones de Medicamentos , Femenino , Humanos , Formulario de Reclamación de Seguro , Modelos Logísticos , Masculino , Análisis Multivariante , Curva ROC , Mecanismo de Reembolso/economía , SuizaRESUMEN
OBJECTIVES: To measure the positive predictive value (PPV) of the cost of drug therapy (threshold = 2000 Swiss francs [CHF], US$1440,
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Servicios Comunitarios de Farmacia/organización & administración , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Administración del Tratamiento Farmacológico/economía , Farmacéuticos , Factores de Edad , Anciano , Anciano de 80 o más Años , Costos de los Medicamentos , Interacciones Farmacológicas , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Preparaciones Farmacéuticas/administración & dosificación , Preparaciones Farmacéuticas/economía , Polifarmacia , Factores de Riesgo , SuizaRESUMEN
The Canton of Vaud introduced a development programme of palliative care in 2002. The goal of the programme was to ensure equal access to palliative care for anyone suffering from chronic progressive disease. One cornerstone of this programme is the desire to focus the intervention in the person's home, when desired by the patient and his family. Care networks are responsible for the implementation of this programme. The model presented here illustrates the means implemented and makes a preliminary assessment, which confirms the relevance of the main axes of the programme--training front-line teams, mobile second line teams specialized in palliative care and bed units.