Variation in the pharmaceutical costs of New Zealand general practices: a national database linkage study.

BACKGROUND: Variation in prescription costs between general practices and within practices over time is poorly understood. METHODS: From New Zealand's national health data collections, we extracted dispensed medicines data for 1045 general practices in 2011 and 917 practices continuously existing 2008-11. Using indirect standardization to account for patient demographics and morbidity, a standardized prescribing cost ratio (SPR: the ratio of actual : expected prescription costs) was calculated for each practice in each year. Case studies of three outlier clinics explored reasons for their status. RESULTS: SPRs ranged from 0.53 to 2.28 (median = 0.98). Of 469 practices with higher than expected costs (SPR > 1.0) in 2011, 204 (43.5%) had a single medicine or therapeutic drug class accounting for >15% of total costs. Case studies contrasted practices with overall pharmaceutical expenditure influenced strongly by a few patients needing high-cost medicines, more patients using medicines in one high-cost therapeutic drug class (antiretrovirals), and high medicine use across all therapeutic drug classes. CONCLUSIONS: Routine data collections can measure inter-practice variation in prescription costs, adjusted for differences in the demography and morbidity profile of each practice's patients. Small groups of patients using high-cost medicines influence general practices' expenditure on pharmaceuticals.

Ethnic disparities in asthma treatment and outcomes in children aged under 15 years in New Zealand: analysis of national databases.

BACKGROUND: Mãori and Pacific children experience poorer outcomes relating to asthma management than other ethnicities. AIMS: To measure recommended treatment and outcomes for asthma in all New Zealand children by age, sex, and ethnic group. METHODS: Children aged <15 years dispensed >2 asthma medicines (N=80,514) were identified from the national pharmaceutical claims database. We measured the number of children dispensed oral steroids >2 times and hospital admissions with a primary diagnosis of asthma and compared asthma treatment steps and hospitalisation by age and ethnicity. RESULTS: 16.0% of children were dispensed asthma medicines, 9.2% were dispensed medicine >2 times, 3.6% of children were hospitalised at least once for asthma and 98.9% of admissions were acute. Mãori (OR 1.46, 95% CI 1.41 to 1.51) and Pacific children (OR 2.38, 95% CI 2.28 to 2.47) were more likely to remain on the lowest step of treatment. At all steps of treatment, Mãori and Pacific children had higher rates of oral steroid use. In all age groups, more Mãori children (5.1%, OR 1.88, 95% CI 1.73 to 2.04) and Pacific children (5.6%, OR 2.05, 95% CI 1.84 to 2.29) were hospitalised for asthma than children of other ethnicities (2.8%). CONCLUSIONS: Mãori and Pacific children are less likely to have their treatment escalated to a higher step than other children. They are also more likely to use oral steroids to control asthma exacerbations and be admitted to hospital for severe asthma episodes. New Zealand databases can be used to monitor these outcomes.