Community drug expenditure and recent cost containment measures.

The annual cost of medicines under the community drugs schemes increased from Euro 564 m in 2000 to Euro 1,961 m in 2009 before falling an estimated 8% by 2011. Escalating public health costs, fiscal stress and the unsustainability of the previous growth in expenditure has led to the increased use of pharmaceutical cost containment measures in Ireland. Collectively, these measures are estimated to have reduced public expenditure on community drugs by Euro 380 m in 2011 and involve addressing; (1) the ex-factory price of drugs including price cuts of up to 40% on off-patent and generic drugs leading to an estimated Euro 200 m saving (53%); (2) pharmacy dispensing fees and mark-ups via a new dispensing fee structure and reducing both retail and wholesale mark-ups with a Euro 100 m saving (26%); and (3) scheme coverage and patient co-payments including restricting scheme coverage for persons over 70 years and increasing the level of co-payments with savings of Euro 80 m (21%).

Cost effectiveness of statin therapy for the primary prevention of coronary heart disease.

Cholesterol lowering statin therapy accounted for over 10% of total drug acquisition costs (87.5 million euros) under the Community Drugs Schemes in Ireland in 2004. Not surprisingly, the issue of value for money and cost effectiveness arises. Whilst statin therapy has proven cost effective in patients with established cardiovascular disease this is the first economic evaluation of statin therapy for primary prevention in the Irish healthcare setting. Using economic modelling techniques the incremental cost effectiveness of statin therapy in high risk individuals i.e. 10 year risk exceeding 15% ranged from 17,900 euros per life year gained (LYG) to 33,800 euros/LYG under the GMS scheme. Corresponding figures for the Drug Payment scheme were 24,500 euros/ LYG to 48,500 euros/LYG. All the statins could be considered cost effective i.e. threshold below 50,000 euros/LYG however atorvastatin proved the most cost effective statin in this pharmacoeconomic study.

"Best practice' for Helicobacter pylori eradication in the primary care setting.

This study determined the relative cost effectiveness of proton pump inhibitor (PPI) based triple therapy regimens for Helicobacter pylori eradication in the primary care setting. Using decision tree analysis the expected cost for each H. pylori eradication strategy was determined from the cost of each treatment option multiplied by the probability of that option occurring. Probabilities were obtained using the GMS prescribing database where all patients who received amoxycillin, clarithromycin and a PPI in the ERHA region in 2002 were followed for one year. Depending on the regimen adopted, 40.8% to 46.1% of patients did not require any further medication in the year following H. pylori eradication treatment. The strategy of rabeprazole, amoxycillin and clarithromycin was the most cost effective option with a cost of Euro466 per asymptomatic patient. Two-way sensitivity analysis indicated that the cost of rabeprazole triple therapy and the duration of rabeprazole maintenance therapy would each have to increase by 30% before this strategy ceased to be the most cost effective and hence best practice option for eradicating Helicobacter pylori in the primary care setting in Ireland.