Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
Expert Rev Pharmacoecon Outcomes Res. 2012 Oct;12(5):661-71. doi: 10.1586/erp.12.48.
Multiple reforms have been introduced in the Republic of Srpska to enhance prescribing efficiency.
First, assess their influence on utilization and expenditure on proton-pump inhibitors, statins and renin-angiotensin inhibitor drugs. Second, assess whether the Republic can obtain low prices for generics. Third, suggest additional reforms that could be introduced.
Observational study of all ambulatory care patients between 2003 and 2010. Defined daily doses (DDDs) and DDDs per 1000 inhabitants per day used for measuring changes in utilization. Reimbursed expenditure used as health insurance perspective.
Increasing utilization in all three classes. Utilization of angiotensin-receptor blockers principally limited by prescribing restrictions. Reimbursed expenditure/DDD in all three classes decreased by up to 82% in 2010 versus 2004, appreciably improving prescribing efficiency for the statins. Increased utilization of esomeprazole at higher reimbursed expenditure/DDD, and similarly angiotensin-converting enzyme-inhibitor combinations at higher expenditure versus single drugs, limited the ability to fully capitalise on these reductions.
Multiple measures helped lower expenditure/ DDD, providing hope to countries with small populations. Additional measures are planned to further improve prescribing efficiency in the Republic of Srpska.
斯普斯卡共和国实施了多项改革以提高处方效率。
首先，评估这些改革对质子泵抑制剂、他汀类药物和肾素-血管紧张素抑制剂药物的使用和支出的影响。其次，评估共和国是否能够获得仿制药的低价。第三，提出可能引入的其他改革。
对 2003 年至 2010 年间所有门诊患者进行观察性研究。使用定义日剂量（DDD）和每 1000 居民每天的 DDD 来衡量使用变化。将报销支出用作医疗保险视角。
所有三类药物的使用均增加。血管紧张素受体阻滞剂的使用主要受到处方限制。与 2004 年相比，2010 年所有三类药物的报销支出/DDD 下降了 82%，他汀类药物的处方效率显著提高。埃索美拉唑的使用增加了，而在更高的报销支出/DDD 下，血管紧张素转换酶抑制剂联合使用比单一药物更多，这限制了充分利用这些降低的能力。
多项措施有助于降低支出/DDD，为人口较少的国家带来了希望。计划采取更多措施进一步提高斯普斯卡共和国的处方效率。
