Fraeyman Jessica, Verbelen Moira, Hens Niel, Van Hal Guido, De Loof Hans, Beutels Philippe
Department of Epidemiology and Social Medicine, Research Unit of Medical Sociology and Health Policy, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk (Antwerp), Belgium,
Appl Health Econ Health Policy. 2013 Oct;11(5):543-52. doi: 10.1007/s40258-013-0054-9.
In Belgium, a co-insurance system is applied in which patients pay a portion of the cost for medicines, called co-payment. Co-payment is intended to make pharmaceutical consumers more responsible, increase solidarity, and avoid or reduce moral hazards.
Our objective was to study the possible influence of co-payment on sales volume and generic market share in two commonly used medicine groups: cholesterol-lowering medication [statins (HMG-CoA reductase inhibitors) and fibrates] and acid-blocking agents (proton pump inhibitors and histamine H2 receptor antagonists).
The data were extracted from the Pharmanet database, which covers pharmaceutical consumption in all Belgian ambulatory pharmacies. First, the proportion of sales volume and costs of generic products were modelled over time for the two medicine groups. Second, we investigated the relation between co-payment and contribution by the national insurance agency using change-point linear mixed models.
The change-point analysis suggested several influential events. First, the generic market share in total sales volume was negatively influenced by the abolishment of the distinction in the maximum co-payment level for name brands and generics in 2001. Second, relaxation of the reimbursement conditions for generic omeprazole stimulated generic sales volume in 2004. Finally, an increase in co-payment for generic omeprazole was associated with a significant decrease in omeprazole sales volume in 2005. The observational analysis demonstrated several changes over time. First, the co-payment amounts for name-brand and generic drugs converged in the observed time period for both medicine groups under study. Second, the proportion of co-payment for the total cost of simvastatin and omeprazole increased over time for small packages, and more so for generic than for name-brand products. For omeprazole, both the proportion and the amount of co-payment increased over time. Third, over time the prescription of small packages shifted to an emphasis on larger packages.
As maximum co-payment levels decreased over time, they overruled the reference pricing system in Belgium. The changes in co-payment share over time also significantly affected sales volume, but whether physicians or patients are the decisive actors on the demand side of pharmaceutical consumption remains unclear.
在比利时，实行了一种共同保险制度，即患者需支付一部分药品费用，称为自付费用。自付费用旨在使药品消费者更加负责，增强团结，并避免或减少道德风险。
我们的目的是研究自付费用对两类常用药品的销量和仿制药市场份额的可能影响：降胆固醇药物[他汀类药物（HMG-CoA还原酶抑制剂）和贝特类药物]以及抑酸剂（质子泵抑制剂和组胺H2受体拮抗剂）。
数据从Pharmanet数据库中提取，该数据库涵盖了比利时所有门诊药房的药品消费情况。首先，对这两类药品随时间推移的仿制药销量和成本比例进行建模。其次，我们使用变点线性混合模型研究自付费用与国家保险机构贡献之间的关系。
变点分析表明了几个有影响的事件。首先，2001年取消品牌药和仿制药最高自付费用水平的区分对仿制药在总销量中的市场份额产生了负面影响。其次，2004年仿制药奥美拉唑报销条件的放宽刺激了仿制药销量。最后，2005年仿制药奥美拉唑自付费用的增加与奥美拉唑销量的显著下降相关。观察性分析显示了随时间的几个变化。首先，在研究的两类药品的观察期内，品牌药和仿制药的自付费用金额趋于一致。其次，辛伐他汀和奥美拉唑小包装的自付费用占总成本的比例随时间增加，仿制药比品牌药增加得更多。对于奥美拉唑，自付费用的比例和金额都随时间增加。第三，随着时间的推移，小包装处方转向更强调大包装。
随着最高自付费用水平随时间下降，它们推翻了比利时的参考定价系统。自付费用份额随时间的变化也显著影响了销量，但在药品消费需求方面，医生还是患者是决定性因素仍不清楚。
