Prescribing Behaviour And Drug Use In Pakistan

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in EU member states.  Methods: To estimate the extent of the parallel export we used drug consumption data from the database Ex-PEND and IMS data. Since Ex-PEND considers the official health authority data based on health insurance companies reimbursement and IMS database considers the quantity of drugs that distributors supply to pharmacies, the difference between these two data can be roughly considered as a parallel export. Taking into account the structure of both databases, only prescription drugs could be evaluated. The difference in prices of most exported drugs we have obtained from the Ex-PRICE database, which collects drugs prices from officially published sources in EU member states.  Results: In 2015, the estimated share of prescription drugs parallel export on total market volume was 8.8% and share on market value was 15.3%. We have found out that in 10 drugs which are exported in the highest volumes, the difference in price in Slovakia vs. EU countries fell into the range of 37% - 94% (per pack difference: € 257.09 - € 1877.89).  Conclusions: We have found out that that there are significant price differences in drugs that are mostly exported from Slovakia compared with the member countries. These drugs are often not available to patients in Slovakia. Health system therefore should find mechanisms to ensure availability of medicines while maintaining basic European regulation on the free movement of goods within the EU. PHP72 Utilization And Cost Of Antimicrobials Used In Medicine And Surgery Departments Of A Tertiary Care Teaching Hospital Haligeri Veerana Goud B, Roy V Maulana Azad Medical College, University of Delhi, New Delhi, India

Objectives: Irrational use of antimicrobials has led to grave consequences of antimicrobial resistance and economic burden on the health care system. This study was conducted in find out the pattern and extent of antimicrobial usage in inpatients and outpatients of Medicine and Surgery department and also to determine the economic impact of antimicrobials against their usage.  Methods: The study was conducted over a period of 14 months in both outpatients and inpatients departments of two units of Medicine and Surgery. Prescriptions of inpatients and outpatients were analyzed using International Classification Code of Diseases for diagnosis and Anatomical Therapeutic Chemical Classification (ATC) and Defined Daily Doses (DDDs) for the antimicrobials used. A total of 2128 outpatient prescriptions and 400 inpatients case sheets from Medicine and Surgery were included in the study.  Results: In the outpatient department, the average number of medicines prescribed per patient was more in Medicine (3.0) than in Surgery (2.3). The most commonly used antimicrobial in both departments was amoxicillin+clavulanate. The use of antimicrobials in inpatient departments of both Medicine and Surgery was high, as 73.1% of the admitted patients were prescribed antimicrobials. The average antimicrobial prescribed per patient was 2.7. The most commonly used antimicrobials in the Medcine and Surgery inpatients were ceftriaxone, metronidazole and flouroquinolones. A total of 84 samples were sent for microbiological examination of which 39% were positive. Antimicrobial prescription for prophylactic conditions was greater in Surgery than in Medicine. The total DDDs/100 patient days in Medicine and Surgery were 3369 and 2247, respectively. Overall, the expenditure on the antimicrobials was 33% of the total cost of drug treatment. The average cost of antimicrobial per patient was INR 1501.  Conclusions: We propose routine practice of batcerial culture and sensitivity testing, formulation of an antibiotic policy, and antimicrobial stewardship program to improve usage and clnical outcome. PHP73 Economic Resources Optimisation In The Hcv Setting: The Role Of The Daas Garagiola E1, Ferrario L1, Croce D1, Menzaghi B2, Quirino T2, Rizzardini G3, Foglia E1 1LIUC University, Castellanza, Italy, 2ASST Valle Olona, Busto Arsizio, Italy, 3ASST Fatebenefratelli Sacco, Milano, Italy

Objectives: Over the period 2014-2015, the advent of DAAs generated widespread concern, particularly within the Italian setting, characterised by continuous spending review actions. The study aimed at estimating the budget impact of the introduction of novel drugs approved in May 2015, compared with the historical situation based on the different treatment options available prior to May 2015, assuming the Lombardy Region Health Service (RHS) perspective.  Methods: A budget impact analysis (BIA), representing Lombardy Region HCV healthcare expenditure evolution over three years, was developed, considering the overall HCV and HIV/HCV population. Patients’ previous medical history, degree of liver fibrosis, genotypes, achievement of sustained virological response (SVR) and direct healthcare total costs were the model input variables. Data were collected from scientific evidence, regional legislation and administrative information of two Lombardy Region Hospitals: Valle Olona and Fatebenefratelli Sacco.  Results: Two different populations were hypothesised: i) the population related to the regional spending cap (N= 13,658), and ii) the population related to the organizational and productive cap (starting from the Regional Decree 7826, 2015, N= 31,722). At the 36 month-horizon of the base-case scenario for market penetration, the introduction of the novel therapies could lead to i) a substantial increase in HCV and HIV/HCV patients achieving a SVR (+20%) and ii) significant economic savings to the RHS (-6.64%/-7.15%), even considering the adverse events’ impacts. The initial investment in innovative therapies would be recovered within 24 months, generating outcomes improvement and economic benefits for the RHS, which could be consolidated in time.  Conclusions: The results suggest the need of attentive healthcare planning that is able to 1) concentrate the therapeutic alternatives and 2) precisely forecast the HCV population, thus leading to: i) a reduction in health expenditure, ii) ensuring a better virological control, and iii) guaranteeing the best cost-effective result with a greater ledipasvir/ sofosbuvir consumption. PHP74 Market Uptake Models Of Biosimilars And Off-Patent Biological Medicines

Moorkens E1, Meuwissen N1, Huys I1, Vulto A2, Declerck P1, Simoens S1 Leuven, Leuven, Belgium, 2The Erasmus University Medical Center, Rotterdam, The Netherlands

1KU

Objectives: This study aims to identify different industrial players involved in reference biologic/biosimilar development, to investigate evolution in price, volume and market share of each class, and to identify market uptake models.  Methods: A literature review was carried out using the databases PubMed and Embase. Studies could be published in English or in Dutch. Additionally, articles were identified by searching on the website of the Generics and Biosimilars Initiative (GaBI) journal, GaBI Online. The reference list of articles was reviewed as well for relevant studies. This literature was coupled with market data on prices, volumes and market shares of biosimilars. Furthermore, semi-structured interviews were conducted with companies developing biologicals/biosimilars.  Results: Players on the biological market are the Big Pharma companies, biotechnological companies, generic companies, new entrants and companies from emerging countries. In Europe, an increase of volume of biosimilars is noticed. In the three best established markets with biosimilar competition (epoëtin, granulocyte-colony stimulating factor, and growth hormone), second-generation biologicals, or if not available non-referenced biologicals, compete with biosimilars. As a result, the market share of the reference product declined. Competition drives down prices in the epoëtin and granulocyte-colony stimulating factor markets where the number of biosimilars and price reductions are the largest. With respect to the global biological market, seven market uptake models were identified: no investment in biosimilars, investment in biotechnological companies, development of next-generation biologicals, development of biosimilars, investment in emerging countries, cooperation between companies, and revision of strategy for next-generation biologicals.  Conclusions: Cooperation between companies has been a common strategy for marketing new products. The market share of a product differs between classes, between countries and between uptake models, and is influenced by local regulatory frameworks and policies. PHP75 Prescribing Behaviour And Drug Use In Pakistan Aziz MM1, Ji W1, Gillani AH1, Raza MA2, Fang Y1 1Xi’an Jiaotong University, Xi’an, Shaanxi, P. R. China, Xi’an, China, 2Bahauddin Zakariya University Multan, Multan, Pakistan

Objectives: Irrational drug use and prescribing behavior is a global challenge, predominantly affecting the poor countries. The aim of this study was to evaluate rationality and prescription behavior on the basis of single prescription.  Methods: A total of 288 prescriptions were collected from the rural and urban areas of Multan division in 2015 and analyzed for prescribing behavior of health care professionals on the basis of average medicines per prescription. Among them 168 were collected from tertiary, secondary and primary care government hospitals. While 120 were collected from consultant physicians and general practicing doctors in private settings. SPSS version 18.0 was used for statistical analysis.  Results: Total 288 prescriptions were evaluated during the study. Total 1368 medicines were prescribed. Total prescribed generic medicines were 807 and total prescribed research brands were 561. Total 274 antibiotics were prescribed. Total 1096 medicines were national essential drug list of Pakistan (EDL). Total 297 injectable were prescribed. Total mineral, Vitamins and nutrients were 191 Average medicines per prescription were 4.75. Average generic medicines per prescription were 2.8 and average research brands per prescription were 1.94. Average of medicines from EDL in a prescription was 3.8. Average (0.95) antibiotics were found in a prescription. Average (0.75) injectable presented in a prescription Average of minerals and vitamins and nutrients per prescription were 0.66. The average cost per prescription for one day was 126.43 PKR. Moreover it observed in the study, the prescribing behavior of the healthcare professional is variable with respect to locality, spatiality, patient’s economics and educational level of the prescriber  Conclusions: The data reveals that there is an urgent need of educational intervention to change the behavior of health care professional. More managerial and regulatory efforts can rationalize the drug use in Pakistan

PHP76 Changing Of Prescriptions For Diabetes, Hyperlipidemia, And Hypertension, From Generic Drugs To Protected Brand Drugs : A Retrospective Cohort Study Using A National Inpatient Database In Japan Shimizu S Institute for Health Economics and Policy, minato-ku Tokyo, Japan

Objectives: Regulation of insurance reimbursement for drug prescriptions is less strict in Japan than in other OECD member countries, and physicians have greater discretion for prescriptions. In such a market, even if patients were being treated with generic drugs on a continuing basis, their prescriptions might be changed from generic drugs to protected brand drugs when they come on the market. This study aimed to clarify the switch from generic drugs to brand drugs in patients who had been treated with generic drugs, using nationwide administrative data.  Methods: Pharmacy dispensing data from April 2011 to December 2014 was analyzed for each year. 1) We targeted patients who were treated with only generic drugs from April to September of each year and for whom dispensing records for periods of three months or more were available. 2) If there were prescriptions of a targeted brand drug for the patients described in 1) between October and March of each year, we defined it as a switch/add-on to the brand drug.  Results: Of the diabetic patients (N=  181,378), hypertensive patients (N=  542,654), and hyperlipidemic patients (N=  343,188), brand drugs were prescribed for 81.6% of the diabetic patients, 79.3% of the hypertensive patients and 91.0% of the hyperlipidemic patients. Among the patients treated with only generic drugs, 7.4% of diabetic patients, 2.2% of hyperlipidemic patients, and 10.2% of diabetic patients were switched to brand drugs. Switches from generic drugs to protected brand drugs were more frequently observed in younger patients in their 40s and 50s than in the elderly patients (p< 0.05), and