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波兰患者自付费用对非典型抗精神病药物选择的影响:一旦出现非专利非典型药物的影响。

Influence of patient co-payments on atypical antipsychotic choice in Poland: implications once generic atypicals are available.

机构信息

HTA Consulting, Cracow, Poland.

出版信息

Appl Health Econ Health Policy. 2011 Mar 1;9(2):101-10. doi: 10.2165/11318840-000000000-00000.

Abstract

INTRODUCTION

Despite recent concerns over the effectiveness and safety of atypical antipsychotics compared with first-generation antipsychotics, prescribing of atypical antipsychotics continues to increase. The use of generic atypical antipsychotics is one way to address cost concerns, especially if there are no major differences in outcomes between generic and originator formulations. Market forces do appear to help lower prices if patients have to cover any difference between higher priced generics and originators and the current reference-priced products themselves, which they try to avoid, and if companies strive to gain market share. However, this approach may compromise individualizing atypical choice if reference classes consist of several atypicals between which there are significant co-payment differences.

OBJECTIVES

First, to assess whether differences in patient co-payment levels between the various atypical antipsychotic formulations alter the atypical formulation prescribed and/or dispensed in practice in Poland. Second, to assess whether market forces in Poland help drive down generic prices in reality as successive generics are launched. Third, to assess the impact of the reduction in reference prices on the overall expenditure on atypicals by the National Health Fund in Poland.

METHODS

Prescription and reimbursed expenditure data for olanzapine and risperidone were provided by the National Health Fund from 2002 to 2006, although no individual patient data were available. Reimbursement limits for the various presentations of olanzapine and risperidone were based on regulations from the Ministry of Health.

RESULTS

Analysis of the data showed that the level of patient co-payment appeared to impact on the atypical antipsychotic dispensed, with utilization of olanzapine growing once its co-payment was reduced when generic olanzapine became available. The reverse was seen with risperidone, with only limited growth in utilization when co-payment levels increased.Market forces resulted in a 40% reduction in the reimbursed reference price (based on the defined daily dose) of olanzapine and a 77% reduction for risperidone from 2002 to July 2008. These price reductions helped moderate the growth in atypical expenditure in Poland despite appreciably increased utilization, especially for olanzapine. Continued moderation (or even a reduction) in the growth of expenditure on atypicals is envisaged, despite increasing utilization, as more generic formulations are launched, with further reductions in the reference price for both olanzapine and risperidone.

CONCLUSIONS

Market forces appear to drive down the prices of generics and originators as more atypical formulations are launched. However, alternative approaches may be needed if significant co-payment differences compromise individualized care.

摘要

简介

尽管最近人们对非典型抗精神病药物与第一代抗精神病药物相比的疗效和安全性表示担忧,但非典型抗精神病药物的处方量仍在继续增加。使用非专利非典型抗精神病药物是解决成本问题的一种方法,尤其是在非专利药物和原研药物之间没有明显的结果差异的情况下。如果患者必须承担更高价格的仿制药和原研药与现行参考定价产品之间的差价,并且公司努力争取市场份额,那么市场力量似乎确实有助于降低价格。然而,如果参考类别包括几种非典型药物,其中存在显著的共付额差异,那么这种方法可能会影响到非典型药物的个体化选择。

目的

首先,评估波兰各种非典型抗精神病药物制剂之间的患者共付额水平差异是否会改变实际处方和/或配发的非典型药物制剂。其次,评估波兰市场力量是否有助于降低实际上市的仿制药价格。第三,评估参考价格降低对波兰国家卫生基金(National Health Fund)整体非典型支出的影响。

方法

2002 年至 2006 年,国家卫生基金提供了奥氮平和利培酮的处方和报销支出数据,但没有提供个别患者数据。奥氮平和利培酮的各种制剂的报销限制是根据卫生部的规定制定的。

结果

数据分析表明,患者共付额水平似乎影响了配发的非典型抗精神病药物,当奥氮平的仿制药上市且共付额降低时,奥氮平的利用率有所增加。利培酮则相反,当共付额水平增加时,利用率仅有限增加。市场力量导致奥氮平的报销参考价格(基于定义日剂量)降低了 40%,利培酮降低了 77%,从 2002 年到 2008 年 7 月。这些价格降低有助于减缓波兰非典型药物支出的增长,尽管利用率明显增加,特别是奥氮平。预计随着更多的仿制药上市,以及奥氮平和利培酮的参考价格进一步降低,尽管利用率增加,非典型药物支出的增长将继续适度(甚至减少)。

结论

随着更多非典型药物制剂的推出,市场力量似乎降低了仿制药和原研药的价格。然而,如果显著的共付额差异影响到个体化护理,可能需要采取其他方法。

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