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Impact of pharmaceutical policy interventions on utilization of antipsychotic medicines in Finland and Portugal in times of economic recession: interrupted time series analyses.

Leopold C, Zhang F, Mantel-Teeuwisse AK, Vogler S, Valkova S, Ross-Degnan D, Wagner AK - Int J Equity Health (2014)

Bottom Line: Both countries' policy approaches were associated with slight, likely unintended, decreases in overall use of antipsychotic medicines and with increases in generic market shares of major antipsychotic products.The policy interventions in Portugal resulted in a substantially increased generic market share for amisulpride (estimate one year post-policy compared to before: 22.95% [21.01%, 24.90%]; generic risperidone already dominated the market prior to the policy interventions.These findings highlight the importance of monitoring and evaluating the effects of pharmaceutical policy interventions on use of medicines and health outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Economics, Gesundheit Österreich GmbH/Austrian Health Institute/WHO Collaborating Centre for Pricing and Reimbursement Policies, Vienna, Austria. Christine.leopold@goeg.at.

ABSTRACT

Objectives: To analyze the impacts of pharmaceutical sector policies implemented to contain country spending during the economic recession--a reference price system in Finland and a mix of policies including changes in reimbursement rates, a generic promotion campaign and discounts granted to the public payer in Portugal - on utilization of, as a proxy for access to, antipsychotic medicines.

Methodology: We obtained monthly IMS Health sales data in standard units of antipsychotic medicines in Portugal and Finland for the period January 2007 to December 2011. We used an interrupted time series design to estimate changes in overall use and generic market shares by comparing pre-policy and post-policy levels and trends.

Results: Both countries' policy approaches were associated with slight, likely unintended, decreases in overall use of antipsychotic medicines and with increases in generic market shares of major antipsychotic products. In Finland, quetiapine and risperidone generic market shares increased substantially (estimates one year post-policy compared to before, quetiapine: 6.80% [3.92%, 9.68%]; risperidone: 11.13% [6.79%, 15.48%]. The policy interventions in Portugal resulted in a substantially increased generic market share for amisulpride (estimate one year post-policy compared to before: 22.95% [21.01%, 24.90%]; generic risperidone already dominated the market prior to the policy interventions.

Conclusions: Different policy approaches to contain pharmaceutical expenditures in times of the economic recession in Finland and Portugal had intended--increased use of generics--and likely unintended--slightly decreased overall sales, possibly consistent with decreased access to needed medicines--impacts. These findings highlight the importance of monitoring and evaluating the effects of pharmaceutical policy interventions on use of medicines and health outcomes.

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Interrupted time series of retail generic market shares in (a) Finland and (b) Portugal. Observed values and interrupted time series estimates of the retail generic market shares (percentage, standard units of generics per month) of the three top active substances in the antipsychotic market before and after the phase-in period of the policy interventions in Finland and Portugal. Data source: IMS MIDAS®, January 2007 and December 2011, IMS Health Incorporated. All Rights Reserved.
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Figure 2: Interrupted time series of retail generic market shares in (a) Finland and (b) Portugal. Observed values and interrupted time series estimates of the retail generic market shares (percentage, standard units of generics per month) of the three top active substances in the antipsychotic market before and after the phase-in period of the policy interventions in Finland and Portugal. Data source: IMS MIDAS®, January 2007 and December 2011, IMS Health Incorporated. All Rights Reserved.

Mentions: Figure 1(a,b) and Table 1 show the total monthly sales of antipsychotics in standard units per capita in both countries. In Finland, prior to the implementation of the reference price system, antipsychotic sales were increasing by 704 SU (95% CI: 519, 889) per 100,000 people per month; after the policy intervention, sales growth decreased by 273 SU (95% CI: -572, 26) per 100,000 people per month compared to pre-policy sales growth. There was no discontinuity in level of sales at the time of intervention. This resulted in an estimated, not statistically significant reduction of 3,550 SU (95% CI: -7,354, 254) per 100,000 people in actual sales compared to predicted sales (or around 2.3% of predicted sales) one year after the implementation of the reference price system. In Portugal, sales remained constant prior to the policies; however after the policy interventions, there was an estimated, statistically significant decrease in level of antipsychotic sales of 4,686 SU (95% CI: -8,913, -458) per 100,000 people (or 4.5% of predicted sales), which remained constant in the year after the policy.Figure 2(a,b) displays the time series of generic market shares as percentage of total standard units for the three leading antipsychotic substances in each country. We examined quetiapine, clozapine and risperidone in Finland and amisulpride and risperidone in Portugal; there were no generic quetiapine products on the market in Portugal at the time of the intervention.


Impact of pharmaceutical policy interventions on utilization of antipsychotic medicines in Finland and Portugal in times of economic recession: interrupted time series analyses.

Leopold C, Zhang F, Mantel-Teeuwisse AK, Vogler S, Valkova S, Ross-Degnan D, Wagner AK - Int J Equity Health (2014)

Interrupted time series of retail generic market shares in (a) Finland and (b) Portugal. Observed values and interrupted time series estimates of the retail generic market shares (percentage, standard units of generics per month) of the three top active substances in the antipsychotic market before and after the phase-in period of the policy interventions in Finland and Portugal. Data source: IMS MIDAS®, January 2007 and December 2011, IMS Health Incorporated. All Rights Reserved.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126811&req=5

Figure 2: Interrupted time series of retail generic market shares in (a) Finland and (b) Portugal. Observed values and interrupted time series estimates of the retail generic market shares (percentage, standard units of generics per month) of the three top active substances in the antipsychotic market before and after the phase-in period of the policy interventions in Finland and Portugal. Data source: IMS MIDAS®, January 2007 and December 2011, IMS Health Incorporated. All Rights Reserved.
Mentions: Figure 1(a,b) and Table 1 show the total monthly sales of antipsychotics in standard units per capita in both countries. In Finland, prior to the implementation of the reference price system, antipsychotic sales were increasing by 704 SU (95% CI: 519, 889) per 100,000 people per month; after the policy intervention, sales growth decreased by 273 SU (95% CI: -572, 26) per 100,000 people per month compared to pre-policy sales growth. There was no discontinuity in level of sales at the time of intervention. This resulted in an estimated, not statistically significant reduction of 3,550 SU (95% CI: -7,354, 254) per 100,000 people in actual sales compared to predicted sales (or around 2.3% of predicted sales) one year after the implementation of the reference price system. In Portugal, sales remained constant prior to the policies; however after the policy interventions, there was an estimated, statistically significant decrease in level of antipsychotic sales of 4,686 SU (95% CI: -8,913, -458) per 100,000 people (or 4.5% of predicted sales), which remained constant in the year after the policy.Figure 2(a,b) displays the time series of generic market shares as percentage of total standard units for the three leading antipsychotic substances in each country. We examined quetiapine, clozapine and risperidone in Finland and amisulpride and risperidone in Portugal; there were no generic quetiapine products on the market in Portugal at the time of the intervention.

Bottom Line: Both countries' policy approaches were associated with slight, likely unintended, decreases in overall use of antipsychotic medicines and with increases in generic market shares of major antipsychotic products.The policy interventions in Portugal resulted in a substantially increased generic market share for amisulpride (estimate one year post-policy compared to before: 22.95% [21.01%, 24.90%]; generic risperidone already dominated the market prior to the policy interventions.These findings highlight the importance of monitoring and evaluating the effects of pharmaceutical policy interventions on use of medicines and health outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Economics, Gesundheit Österreich GmbH/Austrian Health Institute/WHO Collaborating Centre for Pricing and Reimbursement Policies, Vienna, Austria. Christine.leopold@goeg.at.

ABSTRACT

Objectives: To analyze the impacts of pharmaceutical sector policies implemented to contain country spending during the economic recession--a reference price system in Finland and a mix of policies including changes in reimbursement rates, a generic promotion campaign and discounts granted to the public payer in Portugal - on utilization of, as a proxy for access to, antipsychotic medicines.

Methodology: We obtained monthly IMS Health sales data in standard units of antipsychotic medicines in Portugal and Finland for the period January 2007 to December 2011. We used an interrupted time series design to estimate changes in overall use and generic market shares by comparing pre-policy and post-policy levels and trends.

Results: Both countries' policy approaches were associated with slight, likely unintended, decreases in overall use of antipsychotic medicines and with increases in generic market shares of major antipsychotic products. In Finland, quetiapine and risperidone generic market shares increased substantially (estimates one year post-policy compared to before, quetiapine: 6.80% [3.92%, 9.68%]; risperidone: 11.13% [6.79%, 15.48%]. The policy interventions in Portugal resulted in a substantially increased generic market share for amisulpride (estimate one year post-policy compared to before: 22.95% [21.01%, 24.90%]; generic risperidone already dominated the market prior to the policy interventions.

Conclusions: Different policy approaches to contain pharmaceutical expenditures in times of the economic recession in Finland and Portugal had intended--increased use of generics--and likely unintended--slightly decreased overall sales, possibly consistent with decreased access to needed medicines--impacts. These findings highlight the importance of monitoring and evaluating the effects of pharmaceutical policy interventions on use of medicines and health outcomes.

Show MeSH
Related in: MedlinePlus