[Establishing an insight-gaining area in pharmacoeconomics]. / Establecimiento de un área de profundización en farmacoeconomía.

INTRODUCTION: The use of economic evaluation methods is very important in health care, in order to select those medicines that could be funded by National Health Services, or that could be included in the hospital or primary health care formularies. The development of the Clearinghouse on Pharmacoeconomics, available for health care professionals, represents an important advance for the information-knowledge system which is basic for professionals to understand how important it is to incorporate efficiency into decision making. Both primary health care and hospitals, need to assure the quality of pharmacoeconomic information that must be taken into account when evaluating the use of new or in use drugs. OBJECTIVES: To establish a Clearinghouse on Pharmacoeconomics with the most important resources on this subject available in Internet from the countries of the European Union, United States and Canada. METHODS: Descriptive study of web sites of institutions and centers and other pharmacoeconomics and health economics resources from 24 OECD countries mainly from the European Union, United States and Canada. RESULTS: The Clearinghouse of Pharmacoeconomics has identified information from 55 centers of pharmacoeconomics and health economics, 20 journals, 32 books, 19 data bases of medicines, 14 periodic bulletins of pharmacoeconomics subjects, and 16 professional associations. It also includes articles, two-monthly bulletins and health news which can all be found in a web site under the denomination of Clearinghouse on Pharmacoeconomics. The number of visits has been of 8,488 since June 30th of the year 2000. CONCLUSIONS: A Clearinghouse on Pharmacoeconomics that includes the most important resources from the countries in the European Union, the United States and Canada related to pharmacoeconomics and health economics has been established. The number of visits from June 2000 to May 2003 was 8,488. To establish, increase and maintain the number of users who visit and obtain data from the clearinghouse on pharmacoeconomics, the use of an alert system every fifteen days has proved effective.

Establecimiento de un área de profundización en farmacoeconomía / Establishing an insight-gaining are in pharmacoeconomics

Introducción: En la asistencia sanitaria es muy importante el uso de métodos de evaluación económica para seleccionar los medicamentos que pueden financiarse por los servicios de salud. El desarrollo de un área de profundización en farmacoeconomía, disponible para los profesionales de la salud, expertos y estudiosos, es un avance considerable para la permeabilización de los profesionales en la importancia de incorporar la eficiencia en la toma de decisiones. Tanto Atención Primaria como los hospitales necesitan información garantizada para valorar la utilización alternativa de medicamentos nuevos o consolidados. Material y métodos: Estudio descriptivo de páginas web de instituciones y centros y otros recursos relacionados con farmacoeconomía y economía de la salud de los 24 países de la OECD y dentro de estos principalmente de la Unión Europea, EE.UU. y Canadá. Resultados: En el área de profundización en farmacoeconomía se ha identificado información de 55 centros de farmacoeconomía y economía de la salud, 20 revistas, 32 libros, 19 bases de datos de medicamentos, 14 boletines periódicos de temas farmacoeconómicos, 16 asociaciones profesionales, además de la inclusión de artículos, boletines bimensuales y noticias de salud y todo ello forma parte de un web en internet con la denominación área de profundización en farmacoeconomía. El número de visitas ha sido de 8.488 desde el 30 de junio de 2000. Conclusiones: Se ha establecido un área de profundización en farmacoeconomía que incluye los recursos más importantes de los países de la Unión Europea, EE.UU. y Canadá, relacionados con farmacoeconomía y economía de la salud. El número de visitas, al área de profundización en farmacoeconomía en el tiempo de realización de este trabajo, ha pasado desde cero, en junio de 2000, hasta un total de 8.488, en mayo de 2003. Para establecer, aumentar y conservar el número de usuarios que visitan y obtienen información del área de profundización en farmacoeconomía, es efectivo la utilización de un sistema de alerta quincenal (AU)

Estudio sobre el uso de los medicamentos en unárea de salud por medio de una encuesta / The application of survey methodology for research on the use of medicines in health care services

Fundamentos: La Organización Mundial de la Salud (OMS) estableció un instrumento que permite además de describir las prácticas terapéuticas, comparar el funcionamiento de servicios o prescriptores en atención primaria así como evaluar el efecto de una intervención. Métodos: Encuesta voluntaria realizada a pensionistas a la salida de 6 centros de la zona urbana del Área 8 de Madrid. La encuesta es una adaptación para países desarrollados, de la propuesta por la OMS, para países en vías de desarrollo. El análisis se realiza sobre un total de 1.200 encuestas válidas obtenidas con la diferencia de un año. Resultados: En ambos años la tasa de repuesta a la encuesta es superior al 78 por ciento. No se encontraron, en las dos encuestas, diferencias significativas, en edad y sexo, entre las poblaciones encuestadas. Respecto a los indicadores básicos de la encuesta: se prescribieron 2,47 medicamentos por consulta en 1997 y 2,60 en 1998 en un total de 2,98 y 3,10 recetas por paciente en cada año. El tiempo medio de consulta fue similar en ambos años. Se observa una mejora significativa en el número de pacientes que dicen saben para lo que sirven los medicamentos, en el número de prescripciones que tienen escrita la pauta de dosificación así como en el número de pacientes que es capaz de repetir a la salida de la consulta la pauta posológica. Se encontraron un total de 14 guías farmacoterapéuticas en las consultas. En cuanto a los indicadores complementarios: El grado de satisfacción con la atención sanitaria recibida superó ambos años el 97 por ciento, encontrando respecto a la información imparcial sobre medicamentos encontrada en los centros que el boletín Información Terapéutica del Sistema Nacional de Salud es el más frecuentemente localizado, al menos uno por centro y en libros, en el 50 por ciento, el libro USP Información de Medicamentos para Profesionales Sanitarios. Respecto a los medicamentos prescritos en ambos periodos solamente se encontraron diferencias significativas en la prescripción de cefalosporinas, que aumentó en 1998. Conclusiones: Es posible utilizar en un país desarrollado como España, con pequeñas modificaciones, el instrumento propuesto por la OMS, para medir el funcionamiento de servicios en atención primaria relacionado con el uso de los medicamentos (AU)

Genéricos y precios de referencia, rangode precios y fuentes de información / Generic medicines and Reference Pricing System, price rating and information

El consumo de las Especialidades Farmacéuticas Genéricas (EFG) en España en el Sistema Nacional de Salud no se puede precisar, ya que no existen datos fiables publicados de los mismos, solo declaraciones y notas de prensa. Se podría decir que el consumo de EFG en España, estimado en un 2 por ciento de la facturación del Sistema Nacional de Salud en 2000, ha crecido pero es todavía demasiado bajo comparado con el consumo en la Unión Europea y EE.UU. Se estudia un grupo de seis principios activos (10 por ciento de los existentes) en forma de EFG, seleccionados entre los principios activos mas consumidos en envases en 1999 en el Sistema Nacional de Salud. La información obtenida en fuentes de información accesibles, sobre las EFG registradas y comercializadas en España de este grupo, no es coincidente y es difícil de obtener. De este grupo, una selección aleatoria de formatos que tienen un conjunto homogéneo (alprazolam comprimidos, amoxicilina sobres, captopril comprimidos, diclofenaco supositorios, omeprazol cápsulas y ranitidina comprimidos), presenta una variabilidad de precios expresado en coste de una Dosis Diaria Definida que puede llegar a ser hasta tres veces mayor el más alto que el más bajo (rango 1,2 - 3 veces).En seis conjuntos homogéneos seleccionados aleatoriamente entre los anteriores, existe un rango amplio de los precios (24 por ciento - 89 por ciento, precio más bajo con relación al precio de referencia), lo que indica que no se aplica estrictamente las reglas del mercado (precio de referencia el más barato). El Proceso de puesta en marcha de los precios de referencia ha sido largo; el número de conjuntos homogéneos ha sido menor que las posibilidades existentes; y el sistema de establecimiento del precio de referencia ha sido restrictivo (precio de referencia no es el más barato) (AU)

[The impact of an intervention strategy in the prescription of generic drugs in a primary care area]. / Impacto de una estrategia de intervención en la prescripción de genéricos en un área de atención primaria.

OBJECTIVE: To examine the effects of specific interventions on generic prescribing in general practices. DESIGN: Non randomized controlled study. SETTING: General practices in 2 health areas of Madrid. PARTICIPANTS: 5 general practices (intervention group) and 5 general practices (control group). INTERVENTIONS: In 1994, intervention group received monthly educational seminars on generic drugs and computer-produced prescribing feedback. The control group received not seminars and not feedback. Prescription monitoring of both groups continued during 1994. MEASUREMENTS AND MAIN RESULTS: Area factor before and during intervention, and intervention factor for both areas (control and intervention) related with prescribing volume and costs of generics were analysis. Prescribing volume of generics in the intervention group was significantly greater than for control group (p < 0.01) by both area and intervention factors. Prescribing costs of generics in the intervention group was significantly greater for control group (p < 0.05) by area factor but both groups were significantly different by intervention factor. CONCLUSION: Educational seminars and feedback information on generics improve generic prescribing but it should be evaluated for broader areas of physicians on prescribing costs.

[Indicators of drug provision and cost in the Avila health sector (1995)]. / Indicadores de la prestación farmacéutica y coste en el Area de Salud de Avila (1995).

OBJECTIVES: To analyse the prescription patterns in rural, urban and semi-urban Primary Care teams (PCT) and to study the variables which are correlated with the pharmaceutical cost, with special reference to medicines of low therapeutic value (LTV). DESIGN: Descriptive, crossover study. SETTING: Avila Health Area, 1995. PATIENTS AND OTHER PARTICIPANTS: Prescription profiles of 199 Primary Care doctors from Avila's 21 Health Districts, using the number of holders of the Individual Health Card (IHC) to determine population size. MAIN RESULTS: There were notable differences in prescription patterns between urban, rural and semi-urban PCTs, with the "Drug cost per inhabitant per year" higher in rural than in urban PCTs (24,082 pesetas vs. 14,804), and the "Cost per prescription" less (1,417 vs. 1,577). In the simple regression analysis, there was a significant correlation between the variables "Number of LTV packages per inhabitant per year" and "Drug cost per inhabitant per year" (r = 0.68, 0.51 and 0.64 for urban, semi-urban and rural PCTs); between "Number of LTV packages per inhabitant per year" and "Number of prescriptions per inhabitant per year" (r = 0.79, 0.80 and 0.82); between "Drug cost per inhabitant per year" and "Number of prescriptions per inhabitant per year" (r = 0.81, 0.85 and 0.88); between "Number of IHCs per doctors" and "Drug cost per inhabitant per year" (r = -0.62, -0.57 and -0.31) and between "Number of IHCs per doctor" and "Number of prescriptions per inhabitant per year" (r = -0.51, -0.62 and -0.36). In the multiple regression analysis, if "Drug cost per inhabitant per year" was used as a dependent variable, the variable "Number of LTV packages per inhabitant per year" entered the model in urban and rural PCTs (Adjusted r2 = 0.55 and 0.60). If "Number of prescriptions per inhabitant per year" was used as dependent variable, the variable "Number of LTV packages per inhabitant per year" again explained, for all kinds of PCT, most of the variability (Adjusted r2 = 0.65, 0.65 and 0.76). CONCLUSIONS: The drug cost per inhabitant per year is less in urban than in rural Centres, while the cost per prescription is greater. The cost per inhabitant per year and the number of prescriptions per inhabitant per year have an inverse relationship to the population size. LTV medicines behave as pharmacy cost predictors, since a consistent relationship between their prescription, the cost per inhabitant per year and the number of prescriptions per inhabitant per year can be shown.

[An analysis of the diagnoses and prescription for chronic patients at a health center]. / Análisis de diagnósticos y prescripción de crónicos en un centro de salud.

OBJECTIVE: To find out if there are differences between inhabitants ages 14-64 with prescription charge (group A), pensioners ages 14-64 without prescription charge (group B), and pensioners aged over 64 without prescription charge (group C), related with chronic morbidity, associated treatment and costs data. DESIGN: A crossover descriptive study (1995). SETTING: Urban primary health care centre. PATIENTS AND OTHER PARTICIPANTS: Participants are inhabitants 14 and over assigned to this health centre (12,605), included in a data bank register, patients are participants with at least a chronic diagnostic (7,007). MEASUREMENTS AND MAIN RESULTS: Participants data were transferred to a practice computer system. Three groups (above) were established according to age band and prescription charge status: group A (73.6% participants), B (8.4%), and C (18%). CONCLUSIONS: Inhabitants ages 14-64 without prescription charge were a differentiated group related with number of chronic diagnoses, number of items to chronic treatment prescribed, and annual average chronically drug costs. So they are intended for use in the future in allocation of budgets to primary health care centres.

[Utilization of medication by the elderly in Argentine]. / Utilización de medicamentos por ancianos en Argentina.

BACKGROUND: The implementation of an information system on prescription drug plan that includes the pharmacological classification and the composition of the drugs. In addition to economic data, makes it possible to analyze prescriptions from a pharmacotherapeutic and economic perspective and, accordingly, carry out administrative and information interventions that improve the quality and reduce the cost of prescriptions. METHODS: The study will be conducted at the National Institute of Social Services for Retirees and Pensioners of Argentine (INSSJP), which basically covers the population aged 60 and over. The data source was the computerized billing of the prescriptions, used up to that time only as a mechanism to monitor billing; this was cross-referenced with a database in which the drugs were broken down into therapeutic groups and subgroups with the composition of the active ingredients. Beginning in 1987, a series of periodic monthly reports was issued on container consumption and expenditures, by therapeutic groups and subgroups and by the active ingredients; this was done at the national level and regionally, according to the INSSJP divisions. These reports gave rise to a series of interventions, such as the establishment of a drug formulary and two changes in the system of coverage that attempted to promote the use of single-ingredient drugs of proven efficacy. RESULTS: The 1987 analysis of consumption revealed that the therapeutic group that accounted for the highest container consumption and expenditures was cardiovascular drugs (21% in number of containers and 32% in expenditures) and within this, cerebral and peripheral vasodilators represented 42% of the container consumption and 52% of the expenditures; antihypertensive drugs, 21% and 19%, and coronary drugs, 19% and 22%. The establishment of the drug formulary and the changes in the system of coverage caused a decline in the use of cardiovascular drugs in 1990 in terms of expenditures (19% and 26%); within this category, vasodilators came to represent 27% of the container consumption and 18% of expenditures, while antihypertensive drugs rose to 28% and 35%, and coronary drugs to 27% and 32%. CONCLUSIONS: Implementation of an Information System makes it possible: a) to periodically evaluate the profile of prescriptions at the country and regional levels; b) to appropriately introduce a drug formulary and modifications in the system of coverage; c) to assess the consequences of the interventions carried out.