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

More documents

Recommendations

Info

56 Reference Price System KCE reports 126 A lanzoprazole A gliclazide C indapamide C other diuretics C atenolol & bisoprolol C other betablockers C diltiazem J quinolole M piroxicam N tramadol N citalopram R acetylcysteine Gender (0.69-1.14) (0.81-1.21) (1.60-2.05) (0.50-0.93) (0.82-1.35) (0.90-1.06) (1.21-1.50) (0.90-1.11) (0.98-1.10) (0.86-1.20) (0.74-1.00) (0.99-1.09) Patient in a MM/WG (lump sump) no 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 yes 1.08 0.97 1.11 0.99 1.19 1.15 0.93 1.09 1.22 1.13 1.08 1.15 Patient has a GMR (0.93-1.25) (0.86-1.11) (1.03-1.20) (0.94-1.04) (1.13-1.26) (1.10-1.20) (0.87-0.99) (0.82-1.45) (1.12-1.34) (1.06-1.20) (1.00-1.15) (1.09-1.21) no 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 yes 0.95 1.20 1.17 1.06 1.11 1.01 1.09 1.03 1.10 1.05 1.07 1.03 Receiving lump sum for chronic illness (0.91-0.99) (1.14- 1.27) (1.13-1.20) (1.04-1.08) (1.09-1.12) (1.00-1.02) (1.06-1.12) (0.99-1.08) (1.09-1.12) (1.02-1.07) (1.04-1.10) (1.02-1.05) no 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 yes 1.00 0.96 0.92 0.98 0.98 0.99 0.94 0.94 1.01 0.97 0.99 0.96 Physician speciality (0.93-1.07) (0.89-1.03) (0.88-0.97) (0.96-1.00) (0.95-1.01) (0.98-1.00) (0.91-0.97) (0.82-1.08) (0.98-1.05) (0.95-1.00) (0.95-1.03) (0.93-0.98) GP 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 SP 0.87 0.83 0.91 0.99 0.94 1.00 0.96 1.78 1.11 1.04 0.90 0.96 Physician gender (0.79-0.95) (0.75- 0.92) (0.87-0.97) (0.96-1.03) (0.91-0.97) (0.98-1.01) (0.93-0.99) (1.65-1.92) (1.08-1.14) (1.01-1.07) (0.84-0.95) (0.93-1.00) F 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 M 1.05 0.98 1.00 1.02 1.05 1.00 1.02 0.88 1.06 1.01 0.96 0.93 Physician age group (0.99-1.11) (0.92-1.04) (0.97-1.03) (0.99-1.04) (1.03-1.07) (0.99-1.01) (0.99-1.05) (0.79-0.98) (1.04-1.08) (0.99-1.04) (0.93-0.99) (0.92-0.95)
KCE Reports 126 Reference Price System 57 4.5.3 Socioeconomic characteristics of patients or physicians and therapeutic reference pricing: evidence in the literature Of the studies that considered the impact of the RPS on adherence to the system, health outcomes or the use of health services, only 4 studies were found that also 27, 57, 61, treated a possible differentiated effect according to certain patient characteristics. 81 These studies are all based on data for adults aged 65 and older living in British Columbia (Canada). It is important to mention that British Columbia implemented a RPS based on therapeutic equivalence of drugs within clusters (Level 2 – see Chapter 2). In the same way, although there is a vast literature on factors influencing physicians’ awareness of cost for patients 82 , only one study was found that considered how physician characteristics can affect patients’ adherence to the RPS. 65 This study is also based on data from British Columbia. Hereafter, we provide more details on the results from these studies. Hazlet et al. (2002) 81 investigated the effect of the introduction of a reference pricing policy for histamine2 (H2RA) receptor antagonist and proton pomp inhibitors (PPI) on the use of health services by senior citizens. After controlling for patients’ socioeconomic characteristics, they found no effect of the introduction of the RPS on the use of health services. Two studies assessed whether patient characteristics were associated with a differentiated impact of the RPS on health outcomes 27 and the use of health services 61 for angiotensin-converting enzyme inhibitors (ACE). Schneeweiss et al. (2002) 27 found that compared to high income patients, those on low and middle income were more likely to switch to the less expensive drug (the reference drug) or to switch from the expensive ACE drug (having a reference supplement ) to another antihypertensive therapy. However, the authors also mentioned that before and after the introduction of the RPS stopping any antihypertensive treatment was more likely for low income patients. The probability of stopping treatment was not higher after the implementation of the RPS. The second study explored the impact of the RPS on the use of health services for individuals receiving an ACE therapy. The study controls for patient socioeconomic characteristics. The authors found no association between patient characteristics and the impact of the RPS on physician visits, hospitalization, admission to long-term facilities and mortality. Schneeweiss et al. (2003) 57 analyzed the use of dihydropyridine calcium channel blockers (CCB) and the use of health services after the introduction of the RPS. They found that low-income patients had on average a higher probability to switch to the no-cost dihydropyridine CCB (reference drug) or to switch from the expensive CCB drug (having a reference supplement) to another antihypertensive therapy (nitrates). Patient characteristics were found not to be associated to the impact of the RPS on physician visits, hospitalization and admission to long-term facilities. Finally, one study 65 investigated the effect of physician gender on changes in prescribing patterns of angiotensin-converting enzyme (ACE) inhibitors after the introduction of reference pricing for prescription drugs in British Columbia. The authors found that patients of female physicians were more likely to remain on cost-sharing ACE inhibitors with an exemption. The authors argued that this difference might be related to the fact that female physicians are more responsive to their patients’ requests.
Page 1 and 2:
The reference price system and soci
Page 3 and 4:
The reference price system and soci
Page 5 and 6:
KCE reports 126C The reference pric
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
KCE Reports 126 Reference Price Sys
Page 15 and 16:
KCE Reports 126 Reference Price Sys
Page 17 and 18: KCE Reports 126 Reference Price Sys
Page 49 and 50: KCE Reports 126 Distributional effe
Page 65 and 66: KCE Reports 126 Distributional effe
Page 67: Gender KCE Reports 126 Reference Pr
Page 81: KCE Reports 126 Reference Price Sys
Page 84 and 85: Legal depot : D/2010/10.273/20
Page 86: 117. Use of point-of care devices i
show all

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

Create successful ePaper yourself

Delete template?

Save as template?