Fraeyman J, Van Hal G, De Loof H, Remmen R, De Meyer G R Y, Beutels P
Epidemiology and Social Medicine, University of Antwerp, Wilrijk, Antwerp, Belgium.
Acta Clin Belg. 2012 May-Jun;67(3):160-71. doi: 10.2143/ACB.67.3.2062650.
Pharmaceutical expenditures are increasing as a proportion of health expenditures in most rich countries. Antidepressants, acid blocking agents and cholesterol lowering medication are major contributors to medicine sales around the globe.
We aimed to document the possible impact of policy regulations and generic market penetration on the evolution of sales volume and average cost per unit (Defined Daily Doses and packages) of antidepressants, acid blocking agents and cholesterol lowering medication. We extracted data from the IMS health database regarding the public price and sales volume of the antidepressants (selective serotonin reuptake inhibitors (SSRI's), monoamine oxidase inhibitors (MAOl's) and tricyclic and remaining antidepressants (TCA's)), acid blocking agents (proton pump inhibitors (PPl's) and H2 receptor antagonists) and cholesterol lowering medication (statins and fibrates) in Belgium between 1995 and 2009. We describe these sales data in relation to various national policy measures which were systematically searched in official records.
Our analysis suggests that particular policy regulations have had immediate impact on sales figures and expenditures on pharmaceuticals in Belgium: changes in reimbursement conditions, a public tender and entry of generic competitors in a reference pricing system. However, possible sustainable effects seem to be counteracted by other mechanisms such as marketing strategies, prescribing behaviour, brand loyalty and the entry of pseudogenerics. It is likely that demand-side measures have a more sustainable impact on expenditure.
Compared with other European countries, generic penetration in Belgium remains low. Alternative policy regulations aimed at enlarging the generic market and influencing pharmaceutical expenditures deserve consideration. This should include policies aiming to influence physicians' prescribing and a shared responsibility of pharmacists, physicians and patients towards expenditures.
在大多数富裕国家，药品支出在卫生支出中所占的比例正在增加。抗抑郁药、抑酸剂和降胆固醇药物是全球药品销售的主要贡献者。
我们旨在记录政策法规和仿制药市场渗透率对抗抑郁药、抑酸剂和降胆固醇药物的销量及每单位（限定日剂量和包装）平均成本变化的可能影响。我们从IMS健康数据库中提取了1995年至2009年比利时抗抑郁药（选择性5-羟色胺再摄取抑制剂（SSRI）、单胺氧化酶抑制剂（MAOI）以及三环类和其他抗抑郁药（TCA））、抑酸剂（质子泵抑制剂（PPI）和H2受体拮抗剂）和降胆固醇药物（他汀类和贝特类）的公开价格和销量数据。我们结合在官方记录中系统搜索到的各种国家政策措施来描述这些销售数据。
我们的分析表明，特定的政策法规对比利时的药品销售数据和支出产生了直接影响：报销条件的变化、公开招标以及仿制药竞争对手进入参考定价系统。然而，其他机制，如营销策略、处方行为、品牌忠诚度和伪仿制药的进入，似乎抵消了可能产生的可持续影响。需求侧措施可能对支出产生更可持续的影响。
与其他欧洲国家相比，比利时的仿制药渗透率仍然较低。旨在扩大仿制药市场和影响药品支出的替代性政策法规值得考虑。这应包括旨在影响医生处方的政策，以及药剂师、医生和患者在支出方面的共同责任。
