- Email: [email protected]
PHP29 REGULATION OF DRUG EXPENDITURES IN EUROPEAN COUNTRIES
Abstracts
A30 cuts in drug prices. The introduction of the policies will be phased in up until 2011. METHODS: This study examines the initiatives and estimates the savings that each will provide. It also examines the basis for the claimed long-term fiscal crisis. The analysis builds on earlier work presented at the 11th annual ISPOR conference in Philadelphia. Planned policy initiatives include mandatory price cuts for off-patent medicines and the adjustment of reimbursed prices to reflect manufacturer discounting. RESULTS: The estimated impact of the range of cost cutting measures should see pharmaceutical expenditures grow at less than 5% per annum over the next 5 years. The new policies will cut over A$2billion from Government expenditure. The underlying growth rate for pharmaceuticals expenditure, without any cost cutting initiatives, is estimated at 5% from the increase in volumes and 4% from growth in the average cost per unit sold. The “intergenerational report” is based on a number of flawed assumptions and has been used as justification for cutting health expenditures. In the same period defence expenditures have grown rapidly. CONCLUSION: The policy initiatives will cut deeply into pharmaceutical spending. These cuts have been justified by a spurious case built by Government to cut health expenditure and to shift funding into newer priority areas. The public has not been engaged in an open debate around which priorities they would select.
PHP27 HEALTH LOCUS OF CONTROL AND USE OF CONVENTIONAL AND ALTERNATIVE CARE: A COHORT STUDY
Tokuda Y1, Takahashi O1, Ohde S1,Yanai H2, Hinohara S1, Fukui T1 St. Luke’s Life Science Institute, Chuo, Tokyo, Japan, 2St. Luke’s School of Nursing, Chuo, Tokyo, Japan OBJECTIVES: Individual’s Health locus of control influence health-related behaviors, but their association with health care utilization is unclear. We aimed to investigate the association between an individual’s health locus of control and the use of conventional and alternative health care. METHODS: We conducted prospective cohort study of community-dwelling adults from the nationally representative random sample of households in Japan. We measured the health locus of control and symptomrelated visits to physicians and the use of dietary and physical complementary and alternative medicine (CAM). Dietary CAM included supplements, such as herbs and vitamins. Physical CAM included manipulations, such as acupuncture and acupressure. RESULTS: Of the 3568 subjects who participated in the study, 3477 participants completed the diary. Out of these subjects, there were 2,453 aged 18 years and older, of which, 2103 (86%; 95% CI, 84–88%) had developed at least one symptom during the 31-day study period. Of these symptomatic adults, 639 visited physicians (30%; 95% CI, 28–32%), 480 used dietary CAM (23%; 95% CI, 21–25%) and 156 (7%; 95% CI, 6–9%) used physical CAM. The likelihood of visiting a physician was not related significantly to an individual’s health locus of control. However, increased use of dietary CAM was possibly associated with control by spiritual powers (p = 0.028), internal control (p = 0.013) and less control by professionals (p = 0.020). Increased use of physical CAM was significantly associated with control by spiritual powers (p = 0.009). CONCLUSION: The likelihood of visiting physicians does not differ by the individual’s health locus of control. Control by spiritual powers is involved with increased CAM use. Internal control is possibly associated with greater use of dietary CAM; professional control is possibly associated with less use of dietary CAM. 7 modified by 157.104.15.177 on 1-4-2007.
1
PHP28 ASSESSING LEVELS OF ASSOCIATION BETWEEN HEALTH CARE EXPENDITURE AND HEALTH CARE INDICATORS IN ECONOMICALLY DEVELOPED COUNTRIES
Gani R, Ravndal F Heron Evidence Development Ltd, Letchworth Garden City, Hertfordshire, UK OBJECTIVES: To examine potential relationships between national expenditure and health care indicators across a number of economically developed countries. METHODS: The World Health Organisation (WHO) has recently made available a database containing a number of health care, demographic and economic indicators from a range of countries. From this database we have collated data on seven WHO health care indicators, estimated GDP and total health care expenditure (HCE) for 30 economically developed countries. The log-transformed values for GDP and HCE were then correlated with the health care indicators to determine their level of association. RESULTS: We find that all of the health care indicators are significantly correlated with both GDP and HCE (P < 0.05). GDP is more strongly correlated than HCE with infant mortality rates, maternal mortality ratios, neonatal mortality rates and the probability of dying under five years of age. HCE is more strongly correlated than GDP with healthy life expectancy (HALE) at birth, average life expectancy at birth and the probability of dying between ages 15 and 60 years old. The strongest correlation is between HALE and HCE, where r = 0.83 (P < 0.001). Outliers in this correlation are Japan, Spain and Sweden, which have a higher than expected HALE, and the USA and Hungary which have a lower than expected HALE. CONCLUSION: In general there is a high level of association between economic and health care indicators in economically developed countries. In particular there is a strong correlation between total health care expenditure and healthy life expectancy. This does not necessarily imply a causal relationship, as there are many other factors that may influence health care indicators. However, further analysis of these relationships may provide insight into differences in life expectancy, and the effectiveness of different national health care systems. PHP29 REGULATION OF DRUG EXPENDITURES IN EUROPEAN COUNTRIES
Praznovcova L Charles University in Prague / Faculty of Pharmacy, Hradec Kralove, Czech Republic OBJECTIVES:—Characterize dynamics of drug use in EU15 countries, with focus on CZ.—Define tools used to slow down unreasonable increase in drug expenditures. METHODS: Literature search on cost containment, EU prices, regulation of drug expenditures and drug policy in CZ. RESULTS: Regulation tools in EU countries used for drug expenditures are legislative or administrative, issued by executive institutions. Dynamics of expenditures increase is measured by % of GDP allocated for drugs, health care, and reimbursement level. Regulation is focused on drug demand and supply, precautions in drug policy, control of drug prices, co-payment by patient. Regulation systems are country specific. Reforms provided in the field of drug reimbursement from public aid showed that partial precautions focused on producers, drug distributors, care providers or patients have short term effect only. More effective are precautions of complex character, which affect behavior of producers, distributors, care providers and inhabitants on drug market. Significant instrument for effective drug policy is process of negotiation between the actors on drug market and process of systematic explanation of taken precautions in relation to
A31
Abstracts professionals and public. CONCLUSION: In last 15 years the EU15 countries realized the reforms concerning financing of health care. Main goal was to slow down an increased tempo in health care expenditures financed from public sources, with focus on drug reimbursement. Improvement of health care services, solidarity, equity, access of quality care for all, including lower income groups, are important tasks of reforms. Czech Republic, with its average expenses on drugs from GDP (2%) and its average expenses on health care (29% in 2004), belongs to countries with the highest drug consumption. Increase in drug expenses over last 5 years is mainly due to increase of average price for individual package, not by increasing of number of packages on patient, and increased number of prescriptions on inhabitant. PHP30 ATTITUDES OF CHAIN PHARMACY PERSONNEL TOWARD E-PRESCRIBING
Rupp MT1, Warholak-Jackson T2 Midwestern University—Glendale, Glendale, AZ, USA, 2University of Arizona, Tucson, AZ, USA OBJECTIVES: This project was conducted as part of a federally funded national pilot to evaluate electronic prescribing in the community practice setting. The objective of this analysis was to measure the attitudes of chain community pharmacists and technicians toward e-prescribing and the processing of e-prescriptions. METHODS: A self-administered survey was distributed to pharmacists and technicians practicing in 422 stores operated by seven chain pharmacy organizations in six states. RESULTS: A total of 1094 surveys were returned from pharmacy personnel practicing in 276 stores. Pharmacy personnel rated e-prescriptions as preferred to conventional prescriptions on each of seven desired outcomes of care. Pharmacists were found to view eprescribing more positively than technicians (p < 0.05) for its net effect on three key outcomes: patient safety, effectiveness of care and efficiency of care. No differences were found between personnel classes in their overall satisfaction with e-prescribing as all were found to be moderately satisfied when comparing this technology to conventional prescribing and prescription processing. A total of 2235 written comments were received on the returned surveys. Of these, 57% (1277) mentioned negative features of e-prescribing, while 43% (958) were positive features. Among the positive features mentioned, improved clarity and/or legibility of prescriptions was the most frequently cited advantage of e-prescribing, followed closely by improved speed or efficiency of processing. Prescribing errors, particularly those containing a wrong drug or wrong directions were the most commonly cited negative feature of e-prescribing (34.1%). CONCLUSION: Chain pharmacy personnel are generally satisfied with the current status of e-prescribing, but also perceive key weaknesses in how it has been implemented in physicians’ practices and their own organizations. From analysis of the data and follow-up interviews, twelve (12) best practice recommendations are offered to improve e-prescribing in the community setting.
1
PHP31 EXAMINATION OF THE VALUE OF LAB DATA IN HEALTH CARE MANAGEMENT
Ye X, Gams E, Anetsberger H, Asch K, Sun SX, Lee KY, Bertram CT Walgreens Health Services, Deerfield, IL, USA OBJECTIVES: The purpose of the study was to examine the value of the lab data in light of a participant’s self-reported, pharmacy claims, and medical claims information by comparing the distribution of the some common chronic conditions. A second purpose was to identify participants with different Body Mass
Index (BMI) who were at risk for certain conditions and examine their usage of medications. METHODS: Descriptive frequency distributions were conducted to address the research questions. The data for this study came from four sources of a large national pharmacy benefit manager’s client: Health Risk Assessment (HRA) questionnaire which consists of about 50 survey questions, pharmacy claims, medical claims and lab data. The total sample size was 341. We compared the distributions of four disease conditions in self-reported, pharmacy claims, medical claims, and lab tests. Secondly, we examined the number of participants in three body mass index BMI categories who are at risk for three conditions, yet who have not been taking any medications for these conditions. RESULTS: The results show that combined with the survey, pharmacy and medical data, the lab data helped to identify 84 participants at risk for diabetes, 95 participants at risk for dyslipidemia, 24 participants at risk for hypertension, and 8 participants at risk for kidney disease. These participants had abnormal lab values, but did not have a self report, pharmacy claims, or medical claims for the conditions. The results also show that the percentage of participants at risk for hypertension, dyslipidemia, and diabetes increased as their BMI goes up. In addition, a significant number of participants with abnormal lab values have not been on medications. CONCLUSION: The lab data helps identify a group of at-risk participants who may need to be targeted for some kind of medical intervention. This has a potential cost-saving effect.
PHP32 THE STATE OF HEALTH STATUS MEASUREMENT IN LATIN AMERICA
Zarate V1, Kind P2 1 Pontificia Universidad Catolica de Chile, Santiago, Chile, 2Outcomes Research Group, Centre for Health Economics, University of York, York, UK OBJECTIVES: Regulatory agencies and other national bodies in countries across the world now demand health-related quality of life (HRQOL) data—for multiple applications that range from technology appraisal to monitoring health inequalities and the measurement of population health. Little is known about the state of HRQOL research in Latin America over the last 20 years. METHODS: Systematic electronic searches of SCIELO, LILACS and MEDLINE were conducted to identify published studies that used SF-36, SF-12, SF-8, HUI or EQ-5D as a generic HRQOL instrument in 27 Latin American countries from 1987 onward. RESULTS: Prior to the 1990s there was virtually no evidence of the use of HRQOL instruments in the majority of the Latin American countries. Electronic searches retrieved 115 records from 12 different countries; only 6 records were multinational studies. The vast majority of published material has only emerged within the past 6 years. 105 records were published from 2000 onwards. Brazil was the highest producer of singlecountry HRQOL studies (n = 81 records). The SF-36 survey was the most frequently used instrument to measure generic HRQOL, followed by the HUI, the SF-12 and the EQ-5D VAS. The main use of generic HRQOL instruments has been in the evaluation of quality of life for particular health conditions and the validation of other, condition-specific instruments. CONCLUSION: Health status measurement is a field of growing interest in Latin America although much remains to be done in order to ease the process of incorporating the measurement of HRQOL to traditional health indicators of morbidity and mortality. The main barriers to overcome in the future for Latin American countries are firstly the lack of qualified or skilled outcome researchers and secondly the limited number of valida-
A30 cuts in drug prices. The introduction of the policies will be phased in up until 2011. METHODS: This study examines the initiatives and estimates the savings that each will provide. It also examines the basis for the claimed long-term fiscal crisis. The analysis builds on earlier work presented at the 11th annual ISPOR conference in Philadelphia. Planned policy initiatives include mandatory price cuts for off-patent medicines and the adjustment of reimbursed prices to reflect manufacturer discounting. RESULTS: The estimated impact of the range of cost cutting measures should see pharmaceutical expenditures grow at less than 5% per annum over the next 5 years. The new policies will cut over A$2billion from Government expenditure. The underlying growth rate for pharmaceuticals expenditure, without any cost cutting initiatives, is estimated at 5% from the increase in volumes and 4% from growth in the average cost per unit sold. The “intergenerational report” is based on a number of flawed assumptions and has been used as justification for cutting health expenditures. In the same period defence expenditures have grown rapidly. CONCLUSION: The policy initiatives will cut deeply into pharmaceutical spending. These cuts have been justified by a spurious case built by Government to cut health expenditure and to shift funding into newer priority areas. The public has not been engaged in an open debate around which priorities they would select.
PHP27 HEALTH LOCUS OF CONTROL AND USE OF CONVENTIONAL AND ALTERNATIVE CARE: A COHORT STUDY
Tokuda Y1, Takahashi O1, Ohde S1,Yanai H2, Hinohara S1, Fukui T1 St. Luke’s Life Science Institute, Chuo, Tokyo, Japan, 2St. Luke’s School of Nursing, Chuo, Tokyo, Japan OBJECTIVES: Individual’s Health locus of control influence health-related behaviors, but their association with health care utilization is unclear. We aimed to investigate the association between an individual’s health locus of control and the use of conventional and alternative health care. METHODS: We conducted prospective cohort study of community-dwelling adults from the nationally representative random sample of households in Japan. We measured the health locus of control and symptomrelated visits to physicians and the use of dietary and physical complementary and alternative medicine (CAM). Dietary CAM included supplements, such as herbs and vitamins. Physical CAM included manipulations, such as acupuncture and acupressure. RESULTS: Of the 3568 subjects who participated in the study, 3477 participants completed the diary. Out of these subjects, there were 2,453 aged 18 years and older, of which, 2103 (86%; 95% CI, 84–88%) had developed at least one symptom during the 31-day study period. Of these symptomatic adults, 639 visited physicians (30%; 95% CI, 28–32%), 480 used dietary CAM (23%; 95% CI, 21–25%) and 156 (7%; 95% CI, 6–9%) used physical CAM. The likelihood of visiting a physician was not related significantly to an individual’s health locus of control. However, increased use of dietary CAM was possibly associated with control by spiritual powers (p = 0.028), internal control (p = 0.013) and less control by professionals (p = 0.020). Increased use of physical CAM was significantly associated with control by spiritual powers (p = 0.009). CONCLUSION: The likelihood of visiting physicians does not differ by the individual’s health locus of control. Control by spiritual powers is involved with increased CAM use. Internal control is possibly associated with greater use of dietary CAM; professional control is possibly associated with less use of dietary CAM. 7 modified by 157.104.15.177 on 1-4-2007.
1
PHP28 ASSESSING LEVELS OF ASSOCIATION BETWEEN HEALTH CARE EXPENDITURE AND HEALTH CARE INDICATORS IN ECONOMICALLY DEVELOPED COUNTRIES
Gani R, Ravndal F Heron Evidence Development Ltd, Letchworth Garden City, Hertfordshire, UK OBJECTIVES: To examine potential relationships between national expenditure and health care indicators across a number of economically developed countries. METHODS: The World Health Organisation (WHO) has recently made available a database containing a number of health care, demographic and economic indicators from a range of countries. From this database we have collated data on seven WHO health care indicators, estimated GDP and total health care expenditure (HCE) for 30 economically developed countries. The log-transformed values for GDP and HCE were then correlated with the health care indicators to determine their level of association. RESULTS: We find that all of the health care indicators are significantly correlated with both GDP and HCE (P < 0.05). GDP is more strongly correlated than HCE with infant mortality rates, maternal mortality ratios, neonatal mortality rates and the probability of dying under five years of age. HCE is more strongly correlated than GDP with healthy life expectancy (HALE) at birth, average life expectancy at birth and the probability of dying between ages 15 and 60 years old. The strongest correlation is between HALE and HCE, where r = 0.83 (P < 0.001). Outliers in this correlation are Japan, Spain and Sweden, which have a higher than expected HALE, and the USA and Hungary which have a lower than expected HALE. CONCLUSION: In general there is a high level of association between economic and health care indicators in economically developed countries. In particular there is a strong correlation between total health care expenditure and healthy life expectancy. This does not necessarily imply a causal relationship, as there are many other factors that may influence health care indicators. However, further analysis of these relationships may provide insight into differences in life expectancy, and the effectiveness of different national health care systems. PHP29 REGULATION OF DRUG EXPENDITURES IN EUROPEAN COUNTRIES
Praznovcova L Charles University in Prague / Faculty of Pharmacy, Hradec Kralove, Czech Republic OBJECTIVES:—Characterize dynamics of drug use in EU15 countries, with focus on CZ.—Define tools used to slow down unreasonable increase in drug expenditures. METHODS: Literature search on cost containment, EU prices, regulation of drug expenditures and drug policy in CZ. RESULTS: Regulation tools in EU countries used for drug expenditures are legislative or administrative, issued by executive institutions. Dynamics of expenditures increase is measured by % of GDP allocated for drugs, health care, and reimbursement level. Regulation is focused on drug demand and supply, precautions in drug policy, control of drug prices, co-payment by patient. Regulation systems are country specific. Reforms provided in the field of drug reimbursement from public aid showed that partial precautions focused on producers, drug distributors, care providers or patients have short term effect only. More effective are precautions of complex character, which affect behavior of producers, distributors, care providers and inhabitants on drug market. Significant instrument for effective drug policy is process of negotiation between the actors on drug market and process of systematic explanation of taken precautions in relation to
A31
Abstracts professionals and public. CONCLUSION: In last 15 years the EU15 countries realized the reforms concerning financing of health care. Main goal was to slow down an increased tempo in health care expenditures financed from public sources, with focus on drug reimbursement. Improvement of health care services, solidarity, equity, access of quality care for all, including lower income groups, are important tasks of reforms. Czech Republic, with its average expenses on drugs from GDP (2%) and its average expenses on health care (29% in 2004), belongs to countries with the highest drug consumption. Increase in drug expenses over last 5 years is mainly due to increase of average price for individual package, not by increasing of number of packages on patient, and increased number of prescriptions on inhabitant. PHP30 ATTITUDES OF CHAIN PHARMACY PERSONNEL TOWARD E-PRESCRIBING
Rupp MT1, Warholak-Jackson T2 Midwestern University—Glendale, Glendale, AZ, USA, 2University of Arizona, Tucson, AZ, USA OBJECTIVES: This project was conducted as part of a federally funded national pilot to evaluate electronic prescribing in the community practice setting. The objective of this analysis was to measure the attitudes of chain community pharmacists and technicians toward e-prescribing and the processing of e-prescriptions. METHODS: A self-administered survey was distributed to pharmacists and technicians practicing in 422 stores operated by seven chain pharmacy organizations in six states. RESULTS: A total of 1094 surveys were returned from pharmacy personnel practicing in 276 stores. Pharmacy personnel rated e-prescriptions as preferred to conventional prescriptions on each of seven desired outcomes of care. Pharmacists were found to view eprescribing more positively than technicians (p < 0.05) for its net effect on three key outcomes: patient safety, effectiveness of care and efficiency of care. No differences were found between personnel classes in their overall satisfaction with e-prescribing as all were found to be moderately satisfied when comparing this technology to conventional prescribing and prescription processing. A total of 2235 written comments were received on the returned surveys. Of these, 57% (1277) mentioned negative features of e-prescribing, while 43% (958) were positive features. Among the positive features mentioned, improved clarity and/or legibility of prescriptions was the most frequently cited advantage of e-prescribing, followed closely by improved speed or efficiency of processing. Prescribing errors, particularly those containing a wrong drug or wrong directions were the most commonly cited negative feature of e-prescribing (34.1%). CONCLUSION: Chain pharmacy personnel are generally satisfied with the current status of e-prescribing, but also perceive key weaknesses in how it has been implemented in physicians’ practices and their own organizations. From analysis of the data and follow-up interviews, twelve (12) best practice recommendations are offered to improve e-prescribing in the community setting.
1
PHP31 EXAMINATION OF THE VALUE OF LAB DATA IN HEALTH CARE MANAGEMENT
Ye X, Gams E, Anetsberger H, Asch K, Sun SX, Lee KY, Bertram CT Walgreens Health Services, Deerfield, IL, USA OBJECTIVES: The purpose of the study was to examine the value of the lab data in light of a participant’s self-reported, pharmacy claims, and medical claims information by comparing the distribution of the some common chronic conditions. A second purpose was to identify participants with different Body Mass
Index (BMI) who were at risk for certain conditions and examine their usage of medications. METHODS: Descriptive frequency distributions were conducted to address the research questions. The data for this study came from four sources of a large national pharmacy benefit manager’s client: Health Risk Assessment (HRA) questionnaire which consists of about 50 survey questions, pharmacy claims, medical claims and lab data. The total sample size was 341. We compared the distributions of four disease conditions in self-reported, pharmacy claims, medical claims, and lab tests. Secondly, we examined the number of participants in three body mass index BMI categories who are at risk for three conditions, yet who have not been taking any medications for these conditions. RESULTS: The results show that combined with the survey, pharmacy and medical data, the lab data helped to identify 84 participants at risk for diabetes, 95 participants at risk for dyslipidemia, 24 participants at risk for hypertension, and 8 participants at risk for kidney disease. These participants had abnormal lab values, but did not have a self report, pharmacy claims, or medical claims for the conditions. The results also show that the percentage of participants at risk for hypertension, dyslipidemia, and diabetes increased as their BMI goes up. In addition, a significant number of participants with abnormal lab values have not been on medications. CONCLUSION: The lab data helps identify a group of at-risk participants who may need to be targeted for some kind of medical intervention. This has a potential cost-saving effect.
PHP32 THE STATE OF HEALTH STATUS MEASUREMENT IN LATIN AMERICA
Zarate V1, Kind P2 1 Pontificia Universidad Catolica de Chile, Santiago, Chile, 2Outcomes Research Group, Centre for Health Economics, University of York, York, UK OBJECTIVES: Regulatory agencies and other national bodies in countries across the world now demand health-related quality of life (HRQOL) data—for multiple applications that range from technology appraisal to monitoring health inequalities and the measurement of population health. Little is known about the state of HRQOL research in Latin America over the last 20 years. METHODS: Systematic electronic searches of SCIELO, LILACS and MEDLINE were conducted to identify published studies that used SF-36, SF-12, SF-8, HUI or EQ-5D as a generic HRQOL instrument in 27 Latin American countries from 1987 onward. RESULTS: Prior to the 1990s there was virtually no evidence of the use of HRQOL instruments in the majority of the Latin American countries. Electronic searches retrieved 115 records from 12 different countries; only 6 records were multinational studies. The vast majority of published material has only emerged within the past 6 years. 105 records were published from 2000 onwards. Brazil was the highest producer of singlecountry HRQOL studies (n = 81 records). The SF-36 survey was the most frequently used instrument to measure generic HRQOL, followed by the HUI, the SF-12 and the EQ-5D VAS. The main use of generic HRQOL instruments has been in the evaluation of quality of life for particular health conditions and the validation of other, condition-specific instruments. CONCLUSION: Health status measurement is a field of growing interest in Latin America although much remains to be done in order to ease the process of incorporating the measurement of HRQOL to traditional health indicators of morbidity and mortality. The main barriers to overcome in the future for Latin American countries are firstly the lack of qualified or skilled outcome researchers and secondly the limited number of valida-