Department of Social Policy, London School of Economics and Political Science, London, UK.
LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
Eur J Health Econ. 2017 Dec;18(9):1095-1105. doi: 10.1007/s10198-016-0855-5. Epub 2016 Dec 9.
Little comparative evidence is available on utilisation of cancer medicines in different countries and its determinants. The aim of this study was to develop a statistical model to test the correlation between utilisation and possible determinants in selected European countries.
A sample of 31 medicines for cancer treatment that obtained EU-wide marketing authorisation between 2000 and 2012 was selected. Annual data on medicines' utilisation covering the in- and out-patient public sectors were obtained from national authorities between 2008 and 2013. Possible determinants of utilisation were extracted from HTA reports and complemented by contacts with key informants. A longitudinal mixed effect model was fitted to test possible determinants of medicines utilisation in Belgium, Scotland and Sweden.
In the all-country model, the number of indications reimbursed positively correlated with increased consumption of medicines [one indication 2.6, 95% CI (1.8-3.6); two indications 2.4, 95% CI (1.4-4.3); three indications 4.9, 95% CI (2.2-10.9); all P < 0.01], years since EU-wide marketing authorisation [1.2, 95% CI (1.02-1.4); p < 0.05], price per DDD [0.9, 95% CI (0.998-0.999), P < 0.01], and Prescrire rating [0.5, 95% CI (0.3-0.9), P < 0.05] after adjusting for time and other covariates.
In this study, the most important correlates of increased utilisation in a sample of cancer medicines introduced in the past 15 years were: medicines coverage and time since marketing authorisation. Prices had a negative effect on consumption in Belgium and Sweden. The positive impact of financial MEAs in Scotland suggests that the latter may remove the regressive effect of list prices on consumption.
关于不同国家癌症药物的使用情况及其决定因素，目前仅有少量比较性证据。本研究旨在建立一个统计模型，以检验在选定的欧洲国家中使用情况与可能决定因素之间的相关性。
选择了 2000 年至 2012 年期间获得欧盟范围内上市许可的 31 种癌症治疗药物作为样本。从 2008 年至 2013 年，从国家主管部门获得了涵盖门诊和住院公共部门的药物使用年度数据。从 HTA 报告中提取可能的决定因素，并通过与关键信息提供者联系进行补充。为了检验比利时、苏格兰和瑞典药物使用的可能决定因素，建立了一个纵向混合效应模型。
在全国模型中，被报销的适应证数量与药物使用量的增加呈正相关[一个适应证 2.6，95%CI（1.8-3.6）；两个适应证 2.4，95%CI（1.4-4.3）；三个适应证 4.9，95%CI（2.2-10.9）；所有 P<0.01]、自欧盟范围内上市许可以来的年限[1.2，95%CI（1.02-1.4）；P<0.05]、每 DDD 价格[0.9，95%CI（0.998-0.999），P<0.01]和 Prescrire 评分[0.5，95%CI（0.3-0.9），P<0.05]，在调整时间和其他协变量后。
在这项研究中，过去 15 年内引入的一组癌症药物使用量增加的最重要相关因素是：药物覆盖范围和上市许可时间。在比利时和瑞典，价格对消费有负面影响。苏格兰金融 MEAs 的积极影响表明，后者可能会消除目录价格对消费的倒退影响。
