Cost containment of pharmaceutical use in Iceland: the impact of liberalization and user charges.

OBJECTIVES: Iceland was the first Nordic country to liberalise its drug distribution system, in March 1996. Subsequent regulation in January 1997 increased patients' share of drug costs. The objectives of this study were to test the assumptions that liberalizing community pharmacy ownership would lower reimbursement costs for the state's Social Security Institute and that increasing patient charges would reduce use and, therefore, lower the cost to the Institute. METHODS: Based on the assumptions, we built and tested two models using interrupted time series designs that contrast the monthly reimbursement costs before and after the legislation and regulation took effect. A control variable (the number of office visits to general practitioners) was tested to assess other events in the health care arena. Monthly data on these variables were provided by the Icelandic State Social Security Institute for January 1993 to August 1998 for reimbursement costs and to December 1998 for office visits to general practitioners. RESULTS: Reimbursement costs have risen steadily throughout the period under study. The interrupted time series analysis did not show a substantial effect from the legislative change in March 1996 or from the regulatory intervention in January 1997. CONCLUSIONS: The main argument used for liberalizing community pharmacy ownership in Iceland was built on false assumptions regarding the effect on drug reimbursement costs to the state. It will be necessary to find more promising interventions to halt the rapidly increasing cost of drugs.

Over-the-counter codeine use in Iceland: the impact of increased access.

BACKGROUND: The objective of this study was to test the assumption that liberalizing community pharmacy ownership in Iceland would lead to increased irrational use of over-the-counter pain relievers containing codeine. METHODS: Based on this assumption we built and tested a model using an interrupted time series design that contrasts the monthly sales data for over-the-counter pain relievers containing codeine before and after the legislation took effect. RESULTS: The total use of over-the-counter pain relievers containing codeine as well as those containing paracetamol and codeine has risen steadily throughout the period under study. The interrupted time series did not show a substantial effect from the legislative change on the use of all over-the-counter codeine pain relievers, paracetemol with codeine, and aspirin with codeine combinations. CONCLUSION: The assumption that increased access leads to irrational use of over-the-counter medicines is not substantiated in the case of over-the-counter pain relievers containing codeine.

Quality assessment of drug sales data: the case of antibacterials in Iceland.

BACKGROUND: Two sets of drug sales data, published by the Icelandic Ministry of Health, did not match for antibacterials in 1989. The search for causes turned out to be a project in itself. OBJECTIVE: To analyze quality problems in the sales data on antibacterials and describe a method for systematic quality assessment of drug sales data. METHODS: Documentary analysis based on the following sources: 1) Nordic Statistics on Medicines, 1975-95; 2) Drug Use (Notkun Iyfja), 1975-93; 3) Icelandic Drug Market, 1975-94; 4) Unpublished data from the Icelandic Ministry of Health. The following framework was developed to evaluate the quality of drug sales data: 1. Completeness of registration; 2. Accuracy and degree of completeness of data; 3. Size and coverage of the data source; 4. Data format; 5. Data accessibility, availability and cost. RESULTS: Four discrepancies were found, two due to changes in DDD, and two larger ones stemming from errors in calculating DDD, resulting in an overestimation of the contribution of the respective products to the total DDD/1000 inhabitants/day. Errors were detected in available sales data at least back to 1980, resulting in sales being overestimated by up to 13%. The reasons for the discrepancies were found mostly under point 2 in the framework. CONCLUSION: The errors uncovered by this study indicate a possible low quality of drug statistics which might lead to wrong conclusions about the level and development of sales of drugs. As a tool, the framework might be used for quality assessment of drug sales data.

Etudes sur la consommation pharmaceutique : méthodes et applications

La consommation pharmaceutique a été définie récemment comme suit : «Commercialisation, distribution, prescription et utilisation des médicaments au sein d'une société donnée, plus particulièrement du point de vue de leurs conséquences médicales, sociales et économiques» . Depuis cent ans, la mise au point de médicaments toujours plus efficacesa permis d'améliorer de façon spectaculaire les thérapeutiques. D'autre part, il ne faut utiliser qu'avec beaucoup de précautions les médicaments puissants qui se trouvent aujourd'hui sur le marché, car beaucoup d'entre eux, s'ils sont administrés en doses trop fortes ou pendant trop longtemps, peuvent provoquer des effets secondaires dangereux. Pour que les patients reçoivent le médicament qui convient, à la bonne dose et pendant le temps voulu, le médecin qui établit les ordonnances doit connaître à fond la pharmacologie et les thérapeutiques. Les sont aussi, général, très coûteux, leurprescription en grandes quantités impose une lourde charge sur les budgets desservices de santé. Economistes et politiciens, comme la population en général d'ailleurs, se sont joints aux médecins et aux pharmaciens pour exprimer lescraintes qu'ils éprouvent devant ces énormes dépenses et ont demandé dans quelle mesure.

Control of addictive drugs in Iceland 1976--78.

During the years 1972--76 drug prescriptions and sales of drugs were surveyed in Iceland. Compared with the other Nordic countries, except Denmark, sales of the psychotropic drugs which may lead to addiction were highest in Iceland, as previously reported. Here we explain the efforts of the Icelandic health authorities to reduce the legitimate consumption of psychotropic drugs. These efforts are mainly directed towards doctors' prescriptions to outpatients. A survey of prescriptions and sales of drugs in Iceland in 1976--78 revealed that (1) the number of individuals receiving drugs subject to reporting in Iceland decreased by 40% between 1976 and 1978; (2) the prescribed amount of hypnotics and sedatives subject to reporting decreased by 45% in the same period; (3) the prescribed amount of narcotic analgesics decreased by 20%; (4) the prescribed amount of amphetamines and related drugs decreased by 40%; and (5) the amount sold of diazepam and related drugs decreased by 20%. The available data suggest that EDB-registration of prescriptions subject to recording and feedback to doctors about their prescribing habits contributes to a reduction in the use of the drugs recorded.

Studies in drug utilization: methods and applications

Drug utilization has recently been defined as follows: "The marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences ". During the last hundred years, the development of more efficient drugs has led to dramatic improvements in health care. On the other hand, the potentdrugs available today must be used with great caution, because many of them, if given in too high a dosage or for too long a period, can produce dangerous adverse reactions. In order to ensure that patients will receive the right drug inthe right dosage and for the right period of time, the prescribing physician has to have a thorough knowledge of pharmacology and therapeutics.Modern drugs also tend to be very expensive and the large quantities in which they are prescribed add heavily to the cost of the health services. Economists and politicians, as well as the general public, have joined the medical profession and the pharmacists in expressing anxiety about such vast expenditure on drugs and have asked whether the extent of drug use is medically justified.

Drug prescription in Iceland.

Two ad hoc surveys on drugs prescribed in Reykjavik during November 1972 and November 1974 were made. After the first survey a publicity campaign was launched and doctors were encouraged to change their prescribing habits; only minor changes in docotors' prescribing habits were noticed, although it is realised that this type of programme will require a longer period to prove its effectiveness. The surveys showed that benzodiazepines are more widely prescribed than chlorodiazepoxide. Doctors have been warned of the probable addictive effect of benzodiazepines (Grimsson et al., 1974). Drug addicts who used to go from one surgery to another have now been identified and they can only receive drugs on prescription from their own family doctor or his deputy.