Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 71
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-31523756

RESUMO

BACKGROUND: Marketing of new and existing drugs with new indications used alone or in combination is increasing. OBJECTIVE: To identify the advantages and disadvantages of indication-based pricing (IBP) systems for such drugs from the standpoint of economic theory, practical applications and international experiences. METHODS: We conducted a systematic review of published articles and reports using six bibliographic databases: PubMed, ASCO, Scopus, DARE, HTA and NHS EED. We also conducted a search of gray literature in Google Scholar. The same search terms were used as in Towse et al. (The debate on indication-based pricing in the U.S. and five major European countries. OHE Consulting Report, London, 2018). Articles and reports published from 1 January 2000 to 30 September 2018 were included. RESULTS: A total of 26 studies met the inclusion criteria. There are three main types of IBP: different brands with different prices for each indication, an averaged single price for all indications and a single price with differential discounts. The studies indicate that IBP systems are premised on the idea that charging a different price for different indications reflects the differences in their value and in social willingness to pay for each one and for the investment in R&D based on the indication's incremental clinical benefit. Some argue that a uniform price reduces access and increases the price for lower-value indications, while others contend that if IBP sets prices at the maximum threshold of social willingness to pay for each indication, all surplus is transferred to the producer and consumer surplus is reduced to zero. No practical applications of pure IBP were found. Single pricing for drugs is the most prevalent approach. The system that most closely approximates an IBP model consists of agreements that are generally confidential and linked to risk-sharing agreements. CONCLUSIONS: There are no applications of pure IBP systems and their practical consequences are therefore unknown. More economic theory-based assessments of the pros and cons of IBP and studies different from reviews are needed to capture their intricacies and specificities.

2.
Gac Sanit ; 2019 Sep 24.
Artigo em Espanhol | MEDLINE | ID: mdl-31558385

RESUMO

Fifteen years ago, Gaceta Sanitaria published the article entitled "What is an efficient health technology in Spain?" The growing interest in setting the price of new technologies based on the value they provide to health systems and the experience accumulated by the countries in our environment make it opportune to review what constitutes an efficient health intervention in Spain in 2020. Cost-effectiveness analysis continues to be the reference method to maximize social health outcomes with the available resources. The interpretation of its results requires establishing reference values that serve as a guide on what constitutes a reasonable value for the health care system. Efficiency thresholds must be flexible and dynamic, and they need to be updated periodically. Its application should be based on and transparency, and consider other factors that reflect social preferences. Although setting thresholds is down to political decision-makers, in Spain it could be reasonable to use thresholds of 25,000 and 60,000 Euros per QALY. However, currently, in addition to determining exact figures for the threshold, the key question is whether the Spanish National Health System is able and willing to implement a payment model based on value, towards achieving gradual financing decisions and, above all, to improve the predictability, consistency and transparency of the process.

3.
Lancet ; 393(10181): 1595, 2019 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-31007200
5.
Appl Health Econ Health Policy ; 16(3): 407-414, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29549661

RESUMO

BACKGROUND: Increasing patient contributions and reducing the population exempt from pharmaceutical co-payment and co-insurance rates were one of the most common measures in the reforms adopted in Europe during 2010-2015. OBJECTIVE: We estimated the association between the introduction of a capped co-payment of €1 per prescription and drug consumption of the publicly insured population of Catalonia (Spain). METHODS: We used administrative data on monthly pharmaceutical consumption (defined daily doses [DDDs]) from January 2012 to December 2014, for a representative sample of 85,000 people. RESULTS: Our results showed that consumption increased in the 2 months previous to the introduction of the measure, and fell with the introduction of the 'Euro per prescription' co-payment. The average net response associated with the reform (including anticipation) was a reduction of 4.1 DDDs per person per month, representing a 6.4% reduction. The decrease in pharmaceutical consumption was larger for those individuals who had free medicines prior to the reform compared with those who already paid a co-insurance rate (9.7 vs. 1.4 DDDs per person per month). The largest reduction in DDDs per person occurred in the following groups: dermatologic drugs, antihypertensives, non-insulin antidiabetic drugs, insulin antidiabetic drugs, and laxatives. CONCLUSION: A uniform capped low co-payment may give rise to a major reduction in drug consumption to a much greater extent among those who previously had free prescriptions.

6.
Appl Health Econ Health Policy ; 16(2): 147-151, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29468578
7.
Expert Rev Gastroenterol Hepatol ; 12(1): 19-30, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28844170

RESUMO

INTRODUCTION: There is an increasing interest in the indirect (or non-healthcare) costs of hepatitis C virus (HCV). Areas covered: Systematic review of original studies on the non-healthcare costs of HCV published in English or Spanish between January 2000 and March 2017. 19 studies addressing non-healthcare cost of HCV were included in the analysis. All studies but one contain treatments with monotherapy or dual therapy prior to the recent introduction of innovative and highly effective direct acting antivirals (DAAs). Five studies estimate the incremental non-healthcare cost of HCV with a control group, which is regarded as high-quality methodology. The incremental annual non-healthcare costs of HCV in untreated patients compared with non-HCV patients are €4,209 in the US, and taking data from 5 European countries costs range from €280 in the UK to €659 in France. Expert commentary: Available studies may be underestimating the true burden of non-healthcare costs for HCV as they are all partial studies, mainly including absenteeism and premature mortality estimates. Moreover, there is a need for studies addressing non-healthcare costs of HCV in settings where new treatments with DAAs have been implemented, as they are probably changing the current and future burden of the disease.


Assuntos
Absenteísmo , Efeitos Psicossociais da Doença , Hepatite C/economia , Presenteísmo/economia , Licença Médica/economia , Antivirais/uso terapêutico , Eficiência , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/mortalidade , Humanos , Incidência , Atividades de Lazer/economia , Prevalência
8.
Expert Rev Gastroenterol Hepatol ; 12(12): 1251-1263, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30791790

RESUMO

INTRODUCTION: High prices of second-generation direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C virus (HCV) patients led to reimbursement decisions based on cost per quality-adjusted life year (QALY). Areas covered: We performed a systematic review of cost-utility analyses (CUA) comparing interventions with second-generation DAA therapies with no treatment, and with previous therapies for chronic HCV patients until July 2017. A total of 36 studies were included: 30 studies from the perspective of the healthcare payer, 3 from the societal perspective, and 3 did not report the perspective. For genotype 1, the highest number of ICER comparison corresponds to sofosbuvir (SOF) triple therapy and SOF-based combinations which reported a cost per QALY systematically ranging from negative to lower than US$100,000 when compared with no treatment or dual therapy or Simeprevir triple therapy. Expert commentary: Selected studies may be overestimating the true cost per QALY of second-generation DAAs in the treatment of HCV, mainly because of neglecting non-healthcare costs, using official list prices which are higher than actual transaction prices and not adopting the long run drug price in a dynamic approach. In addition, the impact of important price reductions of several DAAs in recent years on cost per QALY should be considered.


Assuntos
Antivirais/economia , Antivirais/uso terapêutico , Custos de Medicamentos , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/economia , Antivirais/efeitos adversos , Análise Custo-Benefício , Quimioterapia Combinada , Genótipo , Hepacivirus/genética , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/virologia , Humanos , Modelos Econômicos , Qualidade de Vida , Resposta Viral Sustentada , Resultado do Tratamento
9.
Rev Esp Salud Publica ; 912017 Mar 09.
Artigo em Espanhol | MEDLINE | ID: mdl-28278149

RESUMO

BACKGROUND: Asthma is responsible for a large number of doctor and emergency visits due to exacerbations and inadequate control of the disease, which give rise to very high associated economic costs. The social cost of asthma comprises both the healthcare and non-healthcare costs. The purpose of this study was to analyse up-to-date estimates of the social cost of asthma, with special reference to the influence of level of severity and degree of control. METHODS: A systematic review of original cost-of-illness studies of asthma published in English or Spanish between January 2004 and December 2014 and indexed in PubMed, IBECS or IME was conducted. RESULTS: 29 cost-of-illness studies of asthma were identified, 21 of which used the societal perspective. Only 10 studies estimated the incremental cost of asthma with a control group, and none of them refers to EU countries. Of these 10, only 4 were regarded as high-quality evidence, insofar as they combined a matched control with regression models. The annual incremental cost of asthma in adults ranged from €416 to €5,317. The incremental healthcare cost of asthma increased with level of severity, from €964 for intermittent asthma to €11,703 for severe persistent asthma in adults. In adults, the incremental non-healthcare cost of asthma ranged from €136 to €3,461. CONCLUSIONS: Selected studies in this review show great heterogeneity due to different population characteristics, study designs and valuation methods, which limits their comparability. However, it can be concluded that incremental healthcare costs of asthma, compared to people without asthma, exceeds seven hundred Euros (valued in 2013) in most of the reviwed estimation for several countries. This figure is greater for studies from the United States. The incremental cost per patient increases very rapidly with level of severity and decreases with asthma patient control.


Assuntos
Asma/economia , Efeitos Psicossociais da Doença , Adulto , Canadá , União Europeia/economia , Custos de Cuidados de Saúde , Gastos em Saúde , Humanos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Espanha , Estados Unidos
10.
Heart ; 103(14): 1082-1088, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28249992

RESUMO

OBJECTIVES: Cost-sharing scheme for pharmaceuticals in Spain changed in July 2012. Our aim was to assess the impact of this change on adherence to essential medication in patients with acute coronary syndrome (ACS) in the region of Valencia. METHODS: Population-based retrospective cohort of 10 563 patients discharged alive after an ACS in 2009-2011. We examined a control group (low-income working population) that did not change their coinsurance status, and two intervention groups: pensioners who moved from full coverage to 10% coinsurance and middle-income to high-income working population, for whom coinsurance rose from 40% to 50% or 60%. Weekly adherence rates measured from the date of the first prescription. Days with available medication were estimated by linking prescribed and filled medications during the follow-up period. RESULTS: Cost-sharing change made no significant differences in adherence between intervention and control groups for essential medications with low price and low patient maximum coinsurance, such as antiplatelet and beta-blockers. For costlier ACE inhibitor or an angiotensin II receptor blocker (ACEI/ARB) and statins, it had an immediate effect in the proportion of adherence in the pensioner group as compared with the control group (6.8% and 8.3% decrease of adherence, respectively, p<0.01 for both). Adherence to statins decreased for the middle-income to high-income group as compared with the control group (7.8% increase of non-adherence, p<0.01). These effects seemed temporary. CONCLUSIONS: Coinsurance changes may lead to decreased adherence to proven, effective therapies, especially for higher priced agents with higher patient cost share. Consideration should be given to fully exempt high-risk patients from drug cost sharing.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Custos de Medicamentos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Adesão à Medicação , Cooperação do Paciente , Síndrome Coronariana Aguda/economia , Adulto , Idoso , Custo Compartilhado de Seguro , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Rev. esp. salud pública ; 91: 0-0, 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-161209

RESUMO

Fundamentos: El asma supone un número elevado de consultas médicas y urgencias por exacerbaciones y control inadecuado que se traduce en elevados costes económicos. El objetivo del artículo fue conocer el coste del asma con especial referencia a la influencia del nivel de gravedad y grado de control. Método: Se realizó una revisión sistemática de los estudios del coste del asma originales publicados en inglés y en español entre enero de 2004 y diciembre de 2014 e indexados en PubMed, Indice Bibliográfico Español de Ciencias de la Salud e Indice Médico Español. Resultados: Se identificaron 29 estudios, de los cuales 21 empleaban la perspectiva social. Solo 10 estudios estimaron el coste incremental del asma con un grupo control, ninguno de estos referido a países de la Unión Europea. De ellos 4 se pudieron considerar que producían evidencia de alta calidad al combinar una cohorte de pares (matched control) con modelos de regresión. El coste incremental anual del asma en adultos osciló entre 416 y 5.317 euros. El coste sanitario incremental del asma fue creciente con el nivel de gravedad desde 964 € para el asma intermitente hasta 11.703 € para el asma severo persistente en población adulta, en la que el coste no sanitario incremental del asma osciló entre 136 y 3.461 euros. Conclusiones: Los estudios revisados presentan una gran heterogeneidad por la inclusión de poblaciones, diseños y métodos de valoración diferentes, lo cual limita la comparabilidad entre ellos. Sin embargo, se puede concluir que el coste sanitario incremental del asma respecto a personas sin asma supera los setecientos euros (valorados en 2013) en la mayoría de las estimaciones revisadas para los países estudiados. Esta cifra resulta más elevada en los estudios de Estados Unidos. El coste incremental por paciente crece de forma muy rápida con el nivel de gravedad y se reduce con el control clínico de las personas con asma (AU)


Background: Asthma is responsible for a large number of doctor and emergency visits due to exacerbations and inadequate control of the disease, which give rise to very high associated economic costs. The social cost of asthma comprises both the healthcare and non-healthcare costs. The purpose of this study was to analyse up-to-date estimates of the social cost of asthma, with special reference to the influence of level of severity and degree of control. Methods: A systematic review of original cost-of-illness studies of asthma published in English or Spanish between January 2004 and December 2014 and indexed in PubMed, IBECS or IME was conducted. Results: 29 cost-of-illness studies of asthma were identified, 21 of which used the societal perspective. Only 10 studies estimated the incremental cost of asthma with a control group, and none of them refers to EU countries. Of these 10, only 4 were regarded as high-quality evidence, insofar as they combined a matched control with regression models. The annual incremental cost of asthma in adults ranged from €416 to €5,317. The incremental healthcare cost of asthma increased with level of severity, from €964 for intermittent asthma to €11,703 for severe persistent asthma in adults. In adults, the incremental non-healthcare cost of asthma ranged from €136 to €3,461. Conclusion: Selected studies in this review show great heterogeneity due to different population characteristics, study designs and valuation methods, which limits their comparability. However, it can be concluded that incremental healthcare costs of asthma, compared to people without asthma, exceeds seven hundred Euros (valued in 2013) in most of the reviwed estimation for several countries. This figure is greater for studies from the United States. The incremental cost per patient increases very rapidly with level of severity and decreases with asthma patient control (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Asma/economia , Asma/epidemiologia , Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , União Europeia/economia , Estados Unidos/epidemiologia , Canadá/epidemiologia , Modelos Logísticos
12.
BMC Health Serv Res ; 16: 230, 2016 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-27391312

RESUMO

BACKGROUND: Hospitals represent a significant proportion of health expenditures in Uganda, accounting for about 26 % of total health expenditure. Improving the technical efficiency of hospitals in Uganda can result in large savings which can be devoted to expand access to services and improve quality of care. This paper explores the technical efficiency of referral hospitals in Uganda during the 2012/2013 financial year. METHODS: This was a cross sectional study using secondary data. Input and output data were obtained from the Uganda Ministry of Health annual health sector performance report for the period July 1, 2012 to June 30, 2013 for the 14 public sector regional referral and 4 large private not for profit hospitals. We assumed an output-oriented model with Variable Returns to Scale to estimate the efficiency score for each hospital using Data Envelopment Analysis (DEA) with STATA13. Using a Tobit model DEA, efficiency scores were regressed against selected institutional and contextual/environmental factors to estimate their impacts on efficiency. RESULTS: The average variable returns to scale (Pure) technical efficiency score was 91.4 % and the average scale efficiency score was 87.1 % while the average constant returns to scale technical efficiency score was 79.4 %. Technically inefficient hospitals could have become more efficient by increasing the outpatient department visits by 45,943; and inpatient days by 31,425 without changing the total number of inputs. Alternatively, they would achieve efficiency by for example transferring the excess 216 medical staff and 454 beds to other levels of the health system without changing the total number of outputs. Tobit regression indicates that significant factors in explaining hospital efficiency are: hospital size (p < 0.01); bed occupancy rate (p < 0.01) and outpatient visits as a proportion of inpatient days (p < 0.05). CONCLUSIONS: Hospitals identified at the high and low extremes of efficiency should be investigated further to determine how and why production processes are operating differently at these hospitals. As policy makers gain insight into mechanisms promoting hospital services utilization in hospitals with high efficiency they can develop context-appropriate strategies for supporting hospitals with low efficiency to improve their service and thereby better address unmet needs for hospital services in Uganda.


Assuntos
Eficiência Organizacional/normas , Centros de Cuidados de Saúde Secundários/normas , Estudos Transversais , Feminino , Gastos em Saúde , Humanos , Masculino , Modelos Estatísticos , Setor Público , Análise de Regressão , Uganda
13.
Appl Health Econ Health Policy ; 14(3): 323-35, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27043330

RESUMO

BACKGROUND: Conventional intraoperative sentinel lymph node biopsy (SLNB) in breast cancer (BC) has limitations in establishing a definitive diagnosis of metastasis intraoperatively, leading to an unnecessary second operation. The one-step nucleic amplification assay (OSNA) provides accurate intraoperative diagnosis and avoids further testing. Only five articles have researched the cost and cost effectiveness of this diagnostic tool, although many hospitals have adopted it, and economic evaluation is needed for budget holders. OBJECTIVE: We aimed to measure the budget impact in Japanese BC patients after the introduction of OSNA, and assess the certainty of the results. METHODS: Budget impact analysis of OSNA on Japanese healthcare expenditure from 2015 to 2020. Local governments, society-managed health insurers, and Japan health insurance associations were the budget holders. In order to assess the cost gap between the gold standard (GS) and OSNA in intraoperative SLNB, a two-scenario comparative model that was structured using the clinical pathway of a BC patient group who received SLNB was applied. Clinical practice guidelines for BC were cited for cost estimation. RESULTS: The total estimated cost of all BC patients diagnosed by GS was US$1,023,313,850. The budget impact of OSNA in total health expenditure was -US$24,413,153 (-US$346 per patient). Two-way sensitivity analysis between survival rate (SR) of the GS and OSNA was performed by illustrating a cost-saving threshold: y â‰… 1.14x - 0.16 in positive patients, and y â‰… 0.96x + 0.029 in negative patients (x = SR-GS, y = SR-OSNA). Base inputs of the variables in these formulas demonstrated a cost saving. CONCLUSION: OSNA reduces healthcare costs, as confirmed by sensitivity analysis.


Assuntos
Neoplasias da Mama/economia , Técnicas de Amplificação de Ácido Nucleico/economia , Biópsia de Linfonodo Sentinela/economia , Neoplasias da Mama/patologia , Custos e Análise de Custo , Feminino , Humanos , Período Intraoperatório , Japão , Modelos Estatísticos , Metástase Neoplásica , Técnicas de Amplificação de Ácido Nucleico/métodos , Biópsia de Linfonodo Sentinela/métodos
14.
Rev Esp Salud Publica ; 90: E6, 2016 Apr 29.
Artigo em Espanhol | MEDLINE | ID: mdl-27125567

RESUMO

OBJECTIVE: In 2012 it changed the Spanish legislation regulating the pharmaceutical copayment by the National Health System (NHS). The objective was to know if the Spanish pharmaceutical copayment reform in 2012 has affected drugs consumptions for chronic diseases such as antidiabetics, antithrombotics and agents against obstructive conditions of the respiratory tract. METHODS: Retrospective longitudinal observational study, using general segmented linear regression models for interrupted time series. The variables analyzed were the number of defined daily doses (DDDs) and the amount corresponding to public funding and not public funding from the (NHS) since September 2010 to August 2015 (T=60). RESULTS: The estimated variation rate of DDDs is negative but decreasing for the three therapeutic subgroups at 6, 12, 24 and 38 months after the intervention: -0.1% for antidiabetics after 6 months and 0.3% after 38 months; -3.7% for antithrombotics after 6 months and -4.6% after 38 months; -2.7% for asthma and COPD drugs after 6 months and -1.3% after 38 months. A sustained and significant reduction in expenditure was estimated only in the subgroup of asthma and COPD drugs: -5.2% after 6 months, -7.0% after 12 months and after 24 months, and -6.2% after 38 months. CONCLUSIONS: The pharmaceutical copayment reform of 2012 led to an immediate and significant reduction in the number of DDDs of all three therapeutic subgroups selected in this study. This level effect is not permanent, as it is accompanied by a change in the growth trend in the post-intervention months, which has partly offset the effect on the level.


Assuntos
Dedutíveis e Cosseguros/legislação & jurisprudência , Revisão de Uso de Medicamentos , Fibrinolíticos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Broncodilatadores/economia , Broncodilatadores/uso terapêutico , Fibrinolíticos/economia , Gastos em Saúde , Humanos , Hipoglicemiantes/economia , Análise de Séries Temporais Interrompida , Modelos Lineares , Masculino , Estudos Retrospectivos , Espanha
15.
Health Econ ; 25(6): 750-67, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26082341

RESUMO

This paper examines the impact of coinsurance exemption for prescription medicines applied to elderly individuals in Spain after retirement. We use a rich administrative dataset that links pharmaceutical consumption and hospital discharge records for the full population aged 58 to 65 years in January 2004 covered by the public insurer in a Spanish region, and we follow them until December 2006. We use a difference-in-differences strategy and exploit the eligibility age for Social Security to control for the endogeneity of the retirement decision. Our results show that this uniform exemption increases the consumption of prescription medicines on average by 17.5%, total pharmaceutical expenditure by 25% and the costs borne by the insurer by 60.4%, without evidence of any offset effect in the form of lower short term probability of hospitalization. The impact is concentrated among consumers of medicines for acute and other non-chronic diseases whose previous coinsurance rate was 30% to 40%. Copyright © 2015 John Wiley & Sons, Ltd.


Assuntos
Dedutíveis e Cosseguros/economia , Custos de Medicamentos , Gastos em Saúde , Programas Nacionais de Saúde , Aposentadoria/economia , Uso de Medicamentos/economia , Hospitalização , Humanos , Renda , Pessoa de Meia-Idade , Alta do Paciente , Espanha
16.
Rev. esp. salud pública ; 90: 0-0, 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-152931

RESUMO

Fundamentos: En 2012 cambió la legislación española que regulaba el copago farmacéutico de la prestación farmacéutica del Sistema Nacional de Salud (SNS). El objetivo fue conocer si este cambio afecta al consumo de los medicamentos para enfermedades crónicas, tales como antidiabéticos, antitrombóticos y fármacos contra padecimientos obstructivos de las vías respiratorias. Método: Estudio observacional longitudinal retrospectivo. Se utilizaron modelos de regresión lineal segmentada general para series de tiempo interrumpido. Las variables analizadas fueron el número de dosis diarias definidas (DDDs) y el importe de la facturación de las dispensaciones financiadas y no financiadas por el SNS desde septiembre de 2010 hasta agosto de 2015 (T=60). Resultados: La tasa de variación estimada de las DDDs fue negativa pero decreciente para los 3 subgrupos terapéuticos a los 6, 12, 24 y 38 meses de la intervención: -0,1% para antidiabéticos a los 6 meses y 0,3% a los 38 meses; -3,7% para antitrombóticos a los 6 meses y -4,6% a los 38 meses; -2,7% a los 6 meses para anti-asma y EPOC y -1,3% a los 38 meses. Se estimó una reducción mantenida y significativa del gasto únicamente en el subgrupo para asma y EPOC: -5,2% a los 6 meses, -7,0% a los 12 meses y a los 24 meses y -6,2% a los 38 meses. Conclusiones: La reforma del copago farmacéutico de 2012 ocasionó una reducción inmediata y significativa en el número de dosis diarias definidas de los tres grupos terapéuticos estudiados. Este efecto nivel no fue permanente ya que se acompañó de un cambio en la tendencia de crecimiento en los meses post-intervención que, en parte, compensó el efecto sobre el nivel (AU)


Background: In 2012 it changed the Spanish legislation regulating the pharmaceutical copayment by the National Health System (NHS). The objective was to know if the Spanish pharmaceutical copayment reform in 2012 has affected drugs consumptions for chronic diseases such as antidiabetics, antithrombotics and agents against obstructive conditions of the respiratory tract. Methods: Retrospective longitudinal observational study, using general segmented linear regression models for interrupted time series. The variables analyzed were the number of defined daily doses (DDDs) and the amount corresponding to public funding and not public funding from the NHS since September 2010 to August 2015 (T=60). Results: The estimated variation rate of DDDs is negative but decreasing for the three therapeutic subgroups at 6, 12, 24 and 38 months after the intervention: The estimated variation rate of DDDs is negative but decreasing for the most part of the three therapeutic subgroups at 6, 12, 24 and 38 months after the intervention: -0.1% for antidiabetics after 6 months and 0.3% after 38 months; -3.7% for antithrombotics after 6 months and -4.6% after 38 months; -2.7% for asthma and COPD drugs after 6 months and -1.3% after 38 months. A sustained and significant reduction in expenditure was estimated only in the subgroup of asthma and COPD drugs: -5.2% after 6 months, -7.0% after 12 months and after 24 months, and -6.2% after 38 months. Conclusions: The pharmaceutical copayment reform of 2012 led to an immediate and significant reduction in the number of DDDs of all three therapeutic subgroups selected in this study. This level effect is not permanent, as it is accompanied by a change in the growth trend in the post-intervention months, which has partly offset the effect on the level (AU)


Assuntos
Humanos , Masculino , Feminino , Custo Compartilhado de Seguro/economia , Custo Compartilhado de Seguro/métodos , Custo Compartilhado de Seguro/normas , Hipoglicemiantes/economia , Hipoglicemiantes/uso terapêutico , Fibrinolíticos/economia , Fibrinolíticos/uso terapêutico , Obstrução das Vias Respiratórias/economia , Obstrução das Vias Respiratórias/epidemiologia , Farmacoeconomia/legislação & jurisprudência , Programas de Assistência Gerenciada/economia , Programas de Assistência Gerenciada , Estudos Retrospectivos , Modelos Lineares , Seguro de Serviços Farmacêuticos , Legislação de Medicamentos , Assistência Farmacêutica
17.
BMC Health Serv Res ; 15: 334, 2015 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-26290329

RESUMO

BACKGROUND: There is need for the Uganda Ministry of Health to understand predictors of primary health care pharmaceutical expenditure among districts in order to guide budget setting and to improve efficiency in allocation of the set budget among districts. METHODS: Cross sectional, retrospective observational study using secondary data. The value of pharmaceuticals procured by primary health care facilities in 87 randomly selected districts for the Financial Year 2011/2012 was collected. Various specifications of the dependent variable (pharmaceutical expenditure) were used: total pharmaceutical expenditure, Per capita district pharmaceutical expenditure, pharmaceutical expenditure per district health facility and pharmaceutical expenditure per outpatient department visit. Andersen's behaviour model of health services utilisation was used as conceptual framework to identify independent variables likely to influence health care utilisation and hence pharmaceutical expenditure. Econometric analysis was conducted to estimate parameters of various regression models. RESULTS: All models were significant overall (P < 0.01), with explanatory power ranging from 51 to 82%. The log linear model for total pharmaceutical expenditure explained about 80% of the observed variation in total pharmaceutical expenditure (Adjusted R(2) = 0.797) and contained the following variables: Immunisation coverage, Total outpatient department attendance, Urbanisation, Total number of government health facilities and total number of Health Centre IIs. The model based on Per capita Pharmaceutical expenditure explained about 50% of the observed variation in per capita pharmaceutical expenditure (Adjusted R(2) = 0.513) and was more balanced with the following variables: Outpatient per capita attendance, percentage of rural population below poverty line 2005, Male Literacy rate, Whether a district is characterised by MOH as difficult to reach or not and the Human poverty index. CONCLUSIONS: The log-linear model based on total pharmaceutical expenditure works acceptably well and can be considered useful for predicting future total pharmaceutical expenditure following observed trends. It can be used as a simple tool for rough estimation of the potential overall national primary health pharmaceutical expenditure to guide budget setting. The model based on pharmaceutical expenditure per capita is a more balanced model containing both need and enabling factor variables. These variables would be useful in allocating any set budget to districts.


Assuntos
Orçamentos , Gastos em Saúde , Medicamentos sob Prescrição/economia , Atenção Primária à Saúde , Alocação de Recursos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza/economia , Estudos Retrospectivos , Uganda , Adulto Jovem
18.
J Pharm Policy Pract ; 8(1): 3, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25815198

RESUMO

OBJECTIVES: A key policy question for the government of Uganda is how to equitably allocate primary health care pharmaceutical budgets to districts. This paper seeks to identify variables influencing current primary health care pharmaceutical expenditure and their usefulness in allocating prospective pharmaceutical budgets to districts. METHODS: This was a cross sectional, retrospective observational study using secondary administrative data. We collected data on the value of pharmaceuticals procured by primary health care facilities in each district from National Medical Stores for the financial year 2011/2012. The dependent variable was expressed as per capita district pharmaceutical expenditure. By reviewing literature we identified 26 potential explanatory variables. They include supply, need and demand, and health system organization variables that may influence the demand and supply of health services and the corresponding pharmaceutical expenditure. We collected secondary data for these variables for all the districts in Uganda (n = 112). We performed econometric analysis to estimate parameters of various regression models. RESULTS: There is a significant correlation between per capita district pharmaceutical expenditure and total district population, rural poverty, access to drinking water and outpatient department (OPD) per capita utilisation.(P < 0.01). The percentage of health centre IIIs (HC III) among each district's health facilities is significantly correlated with per capita pharmaceutical expenditure (P < 0.05). OPD per capita utilisation has a relatively strong correlation with per capita pharmaceutical expenditure (r = 0.498); all the other significant factors are weakly correlated with per capita pharmaceutical expenditure (r < 0.5). From several iterations of an initially developed model, the proposed final model for explaining per capita pharmaceutical expenditure explains about 53% of the variation in pharmaceutical expenditure among districts in Uganda (Adjusted R(2) = 0.528). All variables in the model are significant (p < 0.01). CONCLUSIONS: From evaluation of the various models, proposed variables to consider in allocating prospective primary health care pharmaceutical budgets to districts in Uganda are: district outpatient department attendance per capita, total district population, total number of government health facilities in the district and the district human poverty index.

19.
Semin Arthritis Rheum ; 44(5): 531-541, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25511476

RESUMO

OBJECTIVE: The burden of illness that can be attributed to osteoarthritis is considerable and ever increasing. The aim of this systematic review is to analyze currently available data derived from cost-of-illness studies on the healthcare and non-healthcare costs of osteoarthritis. METHODS: PubMed, Index Medicus Español (IME), and the Spanish Database of Health Sciences [Índice Bibliográfico Español en Ciencias de la Salud (IBECS)] were searched up to the end of April 2013. This study adhered to the PRISMA guidelines. Articles were reviewed and the study quality assessed by two independent investigators with consensus resolution of discrepancies. RESULTS: We identified 39 studies that investigated the socio-economic cost of osteoarthritis. Only nine studies took a social perspective. Rather than estimating the incremental cost of osteoarthritis, nine studies estimated the total cost of treating patients with osteoarthritis without a control for comorbidity. The other 30 studies determined the incremental cost with or without a control group. Only nine studies assessed a comprehensive list of healthcare resources. The annual incremental healthcare costs of generalized osteoarthritis ranged from €705 to €19,715. The annual incremental non-healthcare-related costs of generalized osteoarthritis ranged from €432 to €11,956. CONCLUSIONS: The study concludes that the social cost of osteoarthritis could be between 0.25% and 0.50% of a country׳s GDP. This should be considered in order to foster studies that take into account both healthcare and non-healthcare costs.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Osteoartrite/economia , Análise Custo-Benefício , Humanos , Fatores Socioeconômicos
20.
Gac. sanit. (Barc., Ed. impr.) ; 28(supl.1): 81-88, jun. 2014. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-149229

RESUMO

Se analizan los principales cambios en los patrones de utilización sanitaria que se están produciendo en España como consecuencia de la crisis y de las medidas adoptadas frente a ella. Se examina el impacto de la reforma en el diseño del copago farmacéutico, que ofrece como resultado una importante reducción en el número de recetas dispensadas en las oficinas de farmacia, si bien sus efectos sobre la adherencia al tratamiento, el acceso a tratamientos necesarios y efectivos, y en última instancia la salud, aún se desconocen. Asimismo, el artículo constata que en los años más recientes de la crisis se han producido aumentos en los tiempos y listas de espera de intervenciones quirúrgicas, y en la insatisfacción que los ciudadanos muestran hacia la sanidad pública. Del análisis de los datos de las Encuestas Nacionales de Salud 2006 y 2011/12 se concluye que, en lo que respecta a los servicios no cubiertos –en particular las visitas al dentista–, la crisis está teniendo un efecto disuasorio en la utilización sanitaria de las capas sociales más desfavorecidas. Se recomienda definir mejor el papel que deben tener las aportaciones de los usuarios dentro del ámbito del Sistema Nacional de Salud, y prestar atención y medios a quienes más lo necesitan, para evitar que los colectivos con mejor situación socioeconómica capturen los servicios que quedan disponibles tras los recortes de fondos públicos (AU)


This article analyzes the main changes in healthcare use patterns in Spain related to the economic recession and to the measures taken to address it. The impact of the reform of drug copayment is examined; the number of prescriptions has decreased, although the effects of this reform on adherence, access to necessary and effective treatments, and health, are still unknown. This article also describes how waiting times and waiting lists for surgery have increased in recent years, as has the population's dissatisfaction with the national health system. Analysis of microdata from the Spanish national health surveys for 2006 and 2011/12 show that the economic recession is deterring the use of uncovered dental visits among the lowest social class. We recommend clearer definition of the role played by copayments within the national health system, and focussing on those who most need healthcare in order to prevent the more socioeconomically advantaged collectives from consuming a larger share of available services after the cuts (AU)


Assuntos
Humanos , Recessão Econômica , Política , Espanha , Orçamentos , Mecanismo de Reembolso , Seguro Saúde
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA