Keeping Stuart, Deslandes Paul N, Haines Kathryn E, Routledge Philip A
All Wales Therapeutics and Toxicology Centre, University Hospital Llandough, Llandough, CF64 2XX, UK.
Pharmacoecon Open. 2019 Sep;3(3):343-350. doi: 10.1007/s41669-019-0116-5.
The All Wales Medicines Strategy Group (AWMSG) appraises the clinical and cost effectiveness of new medicines being considered for National Health Service (NHS) prescribing in Wales (UK). The aim of this study was to compare the estimated expenditure on selected medicines submitted by pharmaceutical companies for appraisal with the observed expenditure on these medicines following recommendation.
Medicines appraised and recommended for use in NHS Wales by AWMSG between May 2005 and December 2013 were identified for inclusion in the study. Estimates of expenditure were obtained from company submissions to AWMSG. Primary and secondary care dispensing databases were used to obtain observed expenditure. The Wilcoxon matched-pairs signed rank test was used to compare the observed and estimated expenditure in each of the 3 years after introduction of the medicine.
Forty-nine medicines appraised and recommended by AWMSG during the period of interest were included in the study. Median estimated and observed expenditure in each of the 3 years post-recommendation were as follows: year 1 £86,400 and £47,300; year 2 £175,500 and £73,200; year 3 £212,100 and £78,900 (p = 0.03, p = 0.006 and p = 0.001, respectively). The expenditure on 42 of the 49 medicines (82%) was overestimated in at least one of the 3 years post-introduction, with 32 (65%) overestimated in all 3 years.
In their applications for health technology appraisal, pharmaceutical companies tended to overestimate the expenditure of the majority of medicines recommended by AWMSG. These findings have implications for the assessment of predicted expenditure as part of the process of medicines appraisal in Wales.
全威尔士药品战略小组（AWMSG）评估威尔士国民医疗服务体系（NHS，英国）考虑用于处方的新药的临床和成本效益。本研究的目的是比较制药公司提交评估的特定药品的估计支出与推荐后这些药品的实际支出。
确定2005年5月至2013年12月期间由AWMSG评估并推荐在威尔士NHS使用的药品纳入研究。支出估计数来自公司提交给AWMSG的材料。使用初级和二级医疗配药数据库获取实际支出。采用Wilcoxon配对符号秩检验比较药品引入后3年中每年的实际支出和估计支出。
研究纳入了感兴趣期间由AWMSG评估并推荐的49种药品。推荐后3年中每年的估计支出中位数和实际支出中位数如下：第1年分别为86,400英镑和47,300英镑；第2年分别为175,500英镑和73,200英镑；第3年分别为212,100英镑和78,900英镑（p值分别为0.03、0.006和0.001）。49种药品中有42种（82%）在引入后的3年中至少有1年支出被高估，其中32种（65%）在所有3年中均被高估。
在健康技术评估申请中，制药公司往往高估了AWMSG推荐的大多数药品的支出。这些发现对威尔士药品评估过程中预测支出的评估有影响。
