National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland.
Clin Ther. 2012 Mar;34(3):632-9. doi: 10.1016/j.clinthera.2012.01.025. Epub 2012 Mar 3.
The majority of pharmaceutical expenditure in Ireland occurs in the community for services provided by general practitioners and pharmacists. In the current national and international economic climate, it is anticipated that demand on these services will continue to grow.
The aim of this article was to examine trends in expenditure of pharmaceuticals on the Community Drugs Schemes from 2005 to 2010, and to examine the impact of cost-containment interventions on expenditures that were introduced at this time and affected the pricing mechanism for pharmaceuticals in Ireland.
Prescription data were analyzed using an Irish national prescription claims database according to drug category, that is, generic, patent, and off patent for the 2 largest schemes; the publicly funded General Medical Services (GMS) Scheme and copayment Drugs Payment (DP) Scheme. Segmented regression analysis of interrupted time series was used to analyze the effects of the interventions on expenditure.
An increase in expenditure was noted across all schemes up to 2009 and declined thereafter to the end of the study period (October 2010). Significant reductions in expenditure were noted after introduction of a 20% price cut to patent-expired products (off patents) (P < 0.001). In July 2009, pharmacy and wholesale margins were reduced, resulting in significant reductions in expenditure for patented (GMS Scheme: P < 0.05 and DP Scheme: P < 0.001) and generic (DP Scheme only: P < 0.01) products. Significant reductions in expenditure were noted for off-patent products on the GMS Scheme at this time (P < 0.01). No significant reductions in expenditure were noted for off patents after a 15% price reduction in January 2009. An additional 40% price reduction in February 2010 resulted in significant reductions in expenditure for off-patent products on both the GMS (P < 0.01) and DP Scheme (P < 0.05).
Results from this study, based on a section of the total population of Ireland during a 6-year period, indicate that reductions in the wholesale margin and pharmacy markup had the largest impact on reducing pharmaceutical expenditure during the study period.
在爱尔兰，大部分药品支出发生在社区，用于支付全科医生和药剂师提供的服务。在当前的国家和国际经济环境下，预计这些服务的需求将继续增长。
本文旨在研究 2005 年至 2010 年社区药品计划中药品支出的趋势，并研究此时引入的控制成本干预措施对爱尔兰药品定价机制的影响。
根据药物类别，即通用、专利和过期专利，使用爱尔兰国家处方索赔数据库分析处方药数据，针对两个最大的计划；公共资助的一般医疗服务（GMS）计划和共付药品支付（DP）计划。使用中断时间序列的分段回归分析来分析干预措施对支出的影响。
在 2009 年之前，所有计划的支出都有所增加，此后一直下降到研究结束（2010 年 10 月）。专利过期产品（过期专利）的 20%价格削减（P < 0.001）后，支出显著减少。2009 年 7 月，降低了药房和批发利润率，导致专利（GMS 计划：P < 0.05 和 DP 计划：P < 0.001）和通用（仅 DP 计划：P < 0.01）产品的支出显著减少。此时，GMS 计划中的过期专利产品支出也显著减少（P < 0.01）。2009 年 1 月价格降低 15%后，过期专利产品的支出没有显著减少。2010 年 2 月进一步降低 40%的价格，导致 GMS（P < 0.01）和 DP 计划（P < 0.05）的过期专利产品支出显著减少。
基于 6 年期间爱尔兰总人口的一部分的这项研究结果表明，降低批发利润率和药房加价对研究期间降低药品支出的影响最大。
Zotero 插件