Is Reclassification of the Oral Contraceptive Pill from Prescription to Pharmacist-Only Cost Effective? Application of an Economic Evaluation Approach to Regulatory Decisions.

BACKGROUND AND OBJECTIVE: Unplanned pregnancies can lead to poorer maternal and child health outcomes. The Australian Therapeutic Goods Administration committee rejected reclassifying a range of oral contraceptive pills (OCPs) from prescription to pharmacist-only medicines in 2015, mainly based on safety concerns. Improving access to OCPs may encourage some women to use contraceptives or switch from other contraceptive methods. However, some adverse events may increase and some women may stop using condoms, increasing their risk of sexually transmitted infections. This study aimed to estimate the cost effectiveness of reclassifying OCPs from prescription to pharmacist-only. PERSPECTIVE: Healthcare system. SETTING: Australian primary care. METHODS: A Markov model was used to synthesise data from a variety of sources. The model included all Australian women aged 15-49 years (N = 5,644,701). The time horizon was 35 years. Contraceptive use before reclassification was estimated using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, while survey data informed use after reclassification. Health outcomes included pregnancies, pregnancy outcomes (live birth, miscarriage, stillbirth, ectopic pregnancy and abortion), sexually transmitted infections, adverse events (venous thromboembolism, depression, myocardial infarction and stroke), ovarian cancer cases and quality-adjusted life-years. Costs included those related to general practitioner and specialist consultations, contraceptives and other medicines, pharmacist time, hospitalisations and adverse events. All costs were reported in 2016 Australian Dollars. A 5% discount rate was applied to health outcomes and costs. RESULTS: Reclassifying OCPs resulted in 85.70 million quality-adjusted life-years experienced and costs of $46,910.14 million over 35 years, vs. 85.68 million quality-adjusted life-years experienced and costs of $50,274.95 million with OCPs remaining prescription-only. Thus, reclassifying OCPs was more effective and cost saving. However, a sensitivity analysis found that more research on the probability of pregnancy in women not using contraception and not trying to conceive is needed. CONCLUSION: Reclassifying OCPs is likely to be considered cost effective by Australian decision makers.

Análisis de costes del programa de metadona en la Comunidad Autónoma de La Rioja / Costs-analysis of methadone program in the Autonomous Community La Rioja, Spain

Fundamento: Los programas de dispensación de metadona se han organizado en cada Comunidad Autónoma de una forma específica, desconociéndose sus costes derivados a pesar del interés que puede conllevar una gestión más eficiente. Nuestro estudio tiene por objetivo calcular los costes del programa de metadona en la ComunidadAutónoma de La Rioja. Métodos: El estudio se realizó en 2010. Los datos fueron recogidos a partir de los registros existentes en diferentes instituciones sanitarias, según las diferentes fases del programa. Los costes se clasificaron en función de las diferentes etapas y de los diferentes centros de dispensación. Resultados: El análisis de los datos muestra un coste total anual aproximado de 165.759 € para una concentración de 2 mg/ml de metadona, que significa un coste anual de 412,34 € por paciente . Conclusiones: La fase de dispensación de la metadona es la que mayor coste supone, el centro cuyos pacientes en términos relativos cuestan más al programa es el que cuenta con menor número de pacientes atendidos, debido a los costes fijos que han de repartirse entre menos personas, si bien el centro de Logroño tiene el mayor coste total por atender al mayor número de personas pero su coste medio por paciente es menor(AU)

Background: Methadone programs have been organized in each Spanish region in a specific way. In spite of the regional interests to manage those programs in a more efficient way, so far the costs of the programs are unknown. As a previous step, it would be desirable to understand the activities related to these programs as well as their respective costs. This article aims to calculate the cost of the Methadone program in the autonomous community of La Rioja, and to understand those parameters which generate a greater cost to this programme. Methods: The study followed a similar structure as the research recently applied to the region of Murcia. The reference year for the study of the annual costs of the Methadone program was 2010. Data were obtained fromdifferent registries of several institutions involved in the regional program. Costs were classified according to different stages and dispensation centres which participated in this programme. Results: Data analysis, for a concentration of 2 mg/ml of methadone, showed an approximate annual cost of 165.759 €. Taking the total number of patients into consideration the individual cost was 412,34€. Conclusions: Dispensation is the stage which caused the largest cost to the programme, the highest per patient cost corresponded to the centre with less patients due to the fact that fixed costs are shared by a smaller group of persons; the biggest global cost of the programme came from Logroño’s center but its average cost is lower(AU)

How can pharmacist remuneration systems in Europe contribute to generic medicine dispensing? / ¿Cómo pueden contribuir los sistemas de remuneración farmacéutica a la dispensación de medicamentos genéricos?

Generic medicines can generate larger savings to health care budgets when their use is supported by incentives on both the supply-side and the demand-side. Pharmacists’ remuneration is one factor influencing the dispensing of generic medicines. Objective: The aim of this article is to provide an overview of different pharmacist remuneration systems for generic medicines in Europe, with a view to exploring how pharmacist remuneration systems can contribute to generic medicine dispensing. Methods: Data were obtained from a literature review, a Master thesis in Pharmaceutical Care at the Catholic University of Leuven and a mailing sent to all members of the Pharmaceutical Group of the European Union with a request for information about the local remuneration systems of community pharmacists and the possible existence of reports on discounting practices. Results: Pharmacists remuneration in most European countries consists of the combination of a fixed fee per item and a certain percentage of the acquisition cost or the delivery price of the medicines. This percentage component can be fixed, regressive or capped for very high-cost medicines and acts as a disincentive for dispensing generic medicines. Discounting for generic medicines is common practice in several European countries but information on this practice tends to be confidential. Nevertheless, data for Belgium, France, the Netherlands and United Kingdom indicated that discounting percentages varied from 10% to 70% of the wholesale selling price. Conclusion: Pharmacists can play an important role in the development of a generic medicines market. Pharmacists should not be financially penalized for dispensing generic medicines. Therefore, their remuneration should move towards a fee-for-performance remuneration instead of a price-dependent reimbursement which is currently used in many European countries. Such a fee-for-performance remuneration system provides a stimulus for generic medicines dispensing as pharmacists are not penalized for dispensing them but also needs to account for the loss of income to pharmacists from prohibiting discounting practices (AU)

Los medicamentos genéricos pueden producir mayores ahorros a los presupuestos sanitarios cuando se apoyan con incentivos tanto a la oferta como a la demanda. La remuneración de los farmacéuticos es un factor que influye en la dispensación de medicamentos genéricos. Objetivos: El objetivo de este artículo es proporcionar una revisión de diferentes sistemas remunerativos de medicamentos genéricos en Europa, con idea de explorar con la remuneración de los farmacéuticos puede contribuir a la dispensación de genéricos. Métodos: Se obtuvieron datos de una revisión de la literatura, de una tesis de Master en Atención Farmacéutica en la Universidad Católica de Lovaina, y de un correo enviado a todos los miembros del Grupo Farmacéutico de la Unión Europea solicitando información sobre los sistemas locales de remuneración de farmacéuticos comunitarios y la posible existencia de informes sobre las prácticas de descuentos. Resultados: La remuneración de los farmacéuticos en la mayoría de los países europeos consiste en la combinación de una tasa fija por artículo y un cierto porcentaje del precio de compra o del precio de venta del medicamento. Este componente porcentual puede ser fijo, regresivo o con topes para los medicamentos de muy alto coste, y actúa como un desincentivo para dispensar medicamentos genéricos. Los descuentos para medicamentos genéricos son practica común en varios países Europeos, pero la información sobre esta práctica tiende s ser confidencial. Sin embargo, los datos de Bélgica, Francia, Holanda y Reino Unido indican que los porcentajes de descuento varían del 10% al 70% del precio del mayorista. Conclusión: Los farmacéuticos pueden jugar un papel importante en el desarrollo del mercado de genéricos. No se debería penalizar financieramente a los farmacéuticos por dispensar genéricos. Por tanto, su remuneración debería moverse hacia una tasa-por-acto en lugar de un rembolso precio-dependiente, que es lo que ocurre en la mayoría de los países Europeos. Este sistema de remuneración en tasa-por-acto produce estímulos para la dispensación de genéricos, ya que los farmacéuticos no son penalizados por dispensarlos, pero también necesita tener en cuenta las pérdidas de ingresos al prohibir las prácticas de descuentos (AU)

Efecto de un sistema automático de dispensación de medicamentos sobre el gasto farmacéutico y el grado de satisfacción del usuario / An automatic dispensing system medications effect in pharmaceutical expenditure and satisfaction user level

Objetivo: Evaluar en términos económicos el efecto de la sustitución de botiquines tradicionales por la implantación de Sistemas Automáticos de Dispensación de Medicamentos en la Unidad de Cuidados Intensivos. Analizar el grado de aceptación de dicho cambio por parte de los usuarios. Método: Para el análisis económico, se consideraron los costes directos e indirectos tangibles, derivados de la implantación: inversión inicial de capital, coste del personal implicado, coste en política de consumo de medicamentos. Todos estos aspectos se evaluaron antes y después de la implantación. El grado de satisfacción de los usuarios se evaluó a través de un cuestionario estandarizado. Resultados: Tras la estimación de los costes, comprobamos que el gasto realizado en la inversión inicial se verá rápidamente compensado fundamentalmente por el coste referido a la política de consumos de medicamentos con una reducción del 24% con respecto al sistema de dispensación anterior. El coste en el capitulo de personal también se ve reducido un 11%, así como el coste/estancia y coste/ingreso que disminuyen un 26% y 30% respectivamente en relación al sistema anterior. La evaluación del cuestionario reveló que los usuarios están satisfechos con la implantación y un 84% del personal de enfermería lo recomendaría a otras unidades. Conclusiones: Los Sistemas Automáticos de Dispensación de Medicamentos constituyen una nueva herramienta tecnológica para el control del gasto farmacéutico, con buena aceptación por parte de los usuarios (AU)

Objective: To evaluate in economic terms, the effect of replacing traditional kits for the implementation of automated dispensing of medications in the Intensive Care Unit. Analyze the degree of acceptance of such changeon the part of users. Method: For the economic analysis is considered tangible direct and indirect costs resulting from the implementation: initial capital investment, cost of staff involved, the political cost of drug consumption. All these aspects were evaluated before and after implantation. The degree of user satisfaction was assessed using a standardized questionnaire. Results: After the estimation of costs, we found that the expenditure incurred on the initial investment will be quickly offset by the cost mainly referred to the politics of consumption of drugs with a reduction of 24% over the previous delivery system. The cost in personal chapter is also reduced by 11%, and the cost per stay and cost / income fell by 26% and 30% respectively over the previous system. The evaluation questionnaire revealed that users are satisfied with the implementation and 84% of nurses would recommend it to other units. Conclusions: Automated Dispensing Systems Drugs are a new technological tool to control drug spending, with good acceptance by users (AU)

Behind-the-counter statins: a silver bullet for reducing costs and increasing access?

OBJECTIVE: To examine how the 2004 introduction of behind-the-counter (BTC) simvastatin in the United Kingdom affected utilization, prices, and expenditures. DATA SOURCES/STUDY SETTING: Secondary data on simvastatin utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries. STUDY DESIGN: We used a difference-in-differences approach to estimate how the introduction of BTC simvastatin affected utilization, prices, and expenditures. This approach compares outcomes in the United Kingdom before and after the introduction of BTC simvastatin, using outcomes in countries where the drug remained prescription only to control for possible confounders. DATA COLLECTION/EXTRACTION METHODS: Data on simvastain utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries were obtained from an outside vendor. PRINCIPAL FINDINGS: The introduction of BTC simvastatin in the United Kingdom led to a significant increase in utilization of simvastatin and a significant decline in expenditures for simvastatin purchases. Our results are robust to alternate model specifications. CONCLUSIONS: Behind-the-counter statins have the potential to simultaneously increase use of statins and lower expenditures.