The reference price system and socioeconomic differences in ... - KCE

28 Reference Price System KCE reports 126
3 IMPACT OF THE REFERENCE PRICE SYSTEM:
A LITERATURE REVIEW
3.1 INTRODUCTION
As we underlined in the previous chapter, the main objectives of a reference price
system are (1) to stimulate price competition in the pharmaceuticals market, (2) to
make consumers and physicians more sensitive to the relative price of drugs and (3) to
control drug expenditures for the third-party payer by encouraging physicians and
patients to use generic or low cost brand drugs. Since the adoption of a RPS by a long
list of countries, a number of studies have tried to evaluate its effect on outcome
measures such as drug use, use of hospital or physician services, patient health, cost for
the third-party payer and for patients. This chapter reviews available literature to
document the association of reference pricing with these outcome measures. Since the
main focus of the study is to assess whether unintended distributional effects result
from the RPS in Belgium, the impact of the RPS on outcomes is considered, where
possible, in patient groups with different socioeconomic backgrounds.
There is a vast amount of literature on the effects of prescription drug cost sharing on
access to prescription drugs, medical spending and health outcomes for vulnerable
populations. 10, 53 Such studies are not included in the review of this chapter, unless
reference pricing is one of the systems analysed.
3.2 METHODS
In order to find the relevant articles, we conducted electronic searches in Medline
(access: OVID), Embase (access: Embase.com), Econlit (access: OVID) and the
Cochrane Library database (Cochrane Database of Systematic Reviews) for studies
published between 1988 and 2009. The search was based on a set of key words (MeSH
terms and/or text words): reference pricing OR reference price OR reference prices OR
reference based pricing OR reference adj2 pric$. In parallel, we also searched using the
term “reference pricing” in Google. This initial process yielded 349 studies. We then
screened these studies based on titles and abstracts according to some inclusion
criteria. In addition to these inclusion criteria, we excluded issue briefs, comments and
letters. 91 references met all of these criteria. The inclusion criteria were:
1. The term “reference pricing” or its synonyms had to be present in the abstract
or the title of the study.
2. The study had to examine the effects of a reference price system on at least one
of the following outcomes: drug use (prescription utilization, dispensed drug,
actual use), health outcomes or costs (drug costs, co-payment for patient).
3. The study had to be based on empirical analysis (i.e. no purely theoretical
analysis or simulations).
4. The study had to be published in English, Dutch or French.
After reading the full text of the remaining articles (91), 61 were rejected because not
fulfilling the inclusion criteria or because they were not relevant. Hence 30 articles met
all eligibility criteria. 5 additional references were identified resulting in 35 studies
included in the final analysis.
Among the 35 references that met the study eligibility criteria, 4 are reviews of the
literature on the impact of a RPS on one or more of the selected outcome measures.
Since all individual studies (except one because published in 2009) were included in one
or more of the reviews, we decided to limit the description of the results to those
mentioned in the reviews. The review of the individual studies can be found in the
appendix to this chapter.