Prescribing of selective serotonin reuptake inhibitors (SSRIs) has increased dramatically.
To compare the sales of benzodiazepines and SSRIs within the primary care sector in Denmark and relate changes in usage to number of indications and products on the market.
We used data from various sources to establish the sales curves of psychotropic drugs in the period 1970 to 2007, based on the Anatomic Therapeutic Classification system and Defined Daily Doses.
Fluctuations in sales of psychotropic drugs that cannot be explained by disease prevalence were caused by changes in sales of the benzodiazepines and SSRIs. We found a decline in the sales of benzodiazepines after a peak in 1986, likely due to the recognition that they cause dependence. From a low level in 1992, we found that the sales of SSRIs increased almost linearly by a factor of 18, up to 44 DDD per 1000 inhabitants, which was closely related to the number of products on the market that increased by a factor of 16.
Sales of antidepressant drugs are mainly determined by market availability of products indicating that marketing pressures are playing an important role. Thus the current level of use of SSRIs may not be evidence-based, which is supported by studies showing that the effect of SSRIs has been overestimated.
There is a six-fold increase in the costs for antiepileptic drug prescriptions in Sweden from 1990 to 2000. This is mainly caused by a gradual increase in the prescribing of new and more expensive drugs, since the total use of antiepileptic drugs, expressed as defined daily doses per 1,000 inhabitants, is almost unchanged during the same time period. A marked variation in the prescribing of new antiepileptic drugs between different counties in Sweden, suggests that the role of the new compounds is still unclear. The cost effectiveness of new antiepileptic drugs in relation to the older drugs requires further evaluation.
Prescription drug expenditures in North America have nearly doubled in the past 5 years, creating intense pressure for all public and private benefits managers and policymakers.
The objective of this study was to describe age-specific drug expenditure trends from 1996 to 2002 for the Canadian province of British Columbia.
This study shows changes in expenditures per capita quantified for 5 age categories: residents aged 0 to 19, 20 to 44, 45 to 64, 65 to 84, and 85 and older. The cost impacts of 7 determinants of prescription drug expenditures are quantified.
This study describes population-based, patient-specific pharmaceutical data showing the type, quantity, and cost of every prescription drug purchased by virtually all residents of British Columbia.
Population-wide expenditures per capita grew at a rate of 11.6% per annum. Growth was primarily driven by the selection of more costly drugs per course of treatment and increases in the number concomitant treatments received per patient. Population aging did not have a major impact on expenditures. However, expenditure per capita grew most rapid among residents aged 45 to 64, the cohort that expended most over the period. The aging of this demographic cohort may threaten the financial viability of age-based drug benefit programs.
Information on medicine use among coronary heart disease (CHD) patients with diabetes in unselected patient populations is scarce. This study examines the use of medication to prevent new cardiac events among newly diagnosed CHD patients with diabetes comparing them to patients without diabetes and examines socioeconomic differences in medicine use in these patient groups.
Data on CHD patients (43,501 men and 31,125 women) with or without diabetes were individually linked from nationwide registers (covering both patients treated in ambulatory and in hospital inpatient care). Age-standardised rates for medication use were calculated and differences between patient groups examined using Poisson regression.
beta-blocker use was high in all patient groups in 1997-2002, angiotensin-converting enzyme (ACE) inhibitor and angiotensin II antagonist use increased and remained higher among patients with diabetes. More than half of men and women with diabetes used ACE inhibitors and one out of five used angiotensin II antagonists in 2002. Lipid-lowering medication use increased, especially among women. In 1997-98 it was lower in lower socioeconomic groups; among men with diabetes the use remained lower than among others.
beta-blocker use was constant and ACE inhibitor and angiotensin II antagonist use increased. Lipid-lowering medication use increased considerably after a health insurance reform in 2000, in which elevated reimbursement of drug costs (75%) was extended to include all CHD patients with hyperlipidaemia.Socioeconomic differences in medication use disappeared after the reform. However, lipid-lowering medication use remained at a lower level among men with diabetes, suggesting that their treatment did not follow guidelines.
Previous research has shown that a small proportion of the population accounts for a substantial proportion of spending on physician and hospital services. Much less is known about the high-cost users of ambulatory prescription medicines. We investigate the concentration and sustained nature of ambulatory prescription drug expenditures among residents of British Columbia, Canada in 2001 and 2004. Linking person-specific administrative data from several sources, we examine the demographics, socio-economic status, and health status of high-cost ambulatory pharmaceutical users and the extent that high-cost pharmaceutical use was sustained, at the individual level, from 2001 to 2004. The top 5% of users were responsible for 48% of ambulatory prescription expenditures in the province. A significant burden of morbidity, as well as sustained high expenditures, characterized these users. They were older, more likely to be female, more likely to be of low income, and more likely to be hospitalized and die within the year of study than other pharmaceutical users and non-users. Our results suggest that careful consideration should be given to the long-term financial burdens and access barriers created by pharmaceutical insurance policies that rely heavily on private payments by individuals. Our focus is on costs associated with ambulatory prescription drug use, however, had we included information on the cost of prescription drugs used in hospitals, we would likely have detected an even stronger relationship between high-cost pharmaceutical use and poor health status.
The two-part estimation technique has been advocated for estimating models using individual level health care utilization data characterised by a large proportion of non-consumption and small proportions of heavy users. This paper compares the two-part model to several other estimators, including the Poisson, negative binomial and 'zero altered' negative binomial models on the basis of within-sample forecasting accuracy and non-nested model selection tests. The empirical model estimates the differential effect of the removal of copayments for prescription medicines on the prescription drug utilization by older adults with differing levels of health status. The two-part estimator of this model is found to dominate the competitors. Results from this model indicate that utilization increases appear to be higher among individuals with lower levels of health status.
To determine whether (a) ceftizoxime can replace cefoxitin in the prevention and treatment of various infections in a major teaching hospital, (b) a previously applied two-stage intervention program is an effective method of instituting a therapeutic interchange of ceftizoxime for cefoxitin and (c) the replacement of cefoxitin with ceftizoxime results in a more cost-effective therapy.
Two-phase, open, sequential study.
Tertiary care teaching hospital.
One hundred patients who received cefoxitin during the 6 months immediately before the start of the interchange program (phase 1) and 100 who received ceftizoxime during the 6 months immediately after the start of the program (phase 2) were randomly selected.
The demographic characteristics of the two patient groups were similar except for sex (p
During recent decades consumption of antiglaucoma drugs has shown a steady increase in the Nordic countries. The cost increase can partly be explained by the use of newer, more expensive drugs. The increase in daily doses, however, is relatively much larger than the corresponding ageing of the population. There are large national and regional differences. Measured in daily defined doses (DDD) the consumption of glaucoma medication is almost three times as high in Sweden as in Denmark. Within all the Nordic countries there exists up to more than two-fold regional differences between high- and low-consuming counties. The new classes of IOP-lowering drugs have been very quickly adopted. Statistical data indicate that adding new drugs is more common than switching to a new therapy.