Impact on In- and Out-of-Hospital Drug Prescriptions of Including a More Expensive Me-Too Antidepressant in a Hospital Drug Formulary: a Controlled Longitudinal Study
Corresponding Author
Eduardo Carracedo-Martínez
Santiago de Compostela Health Area, Galician Health Service (Servizo Galego de Saúde - SERGAS). Spanish National Health System, Santiago de Compostela, Spain
Correspondence
Eduardo Carracedo-Martínez, Santiago de Compostela Health Area, Galician Health Service (Servizo Galego de Saúde - SERGAS). Spanish National Health System, Santiago de Compostela, Spain.
Email: [email protected]
Search for more papers by this authorRaquel Vázquez-Mourelle
Deputy Directorate-General. Galician Health Service (Servicio Gallego de Salud SERGAS), Spanish National Health System, Santiago de Compostela, Galicia, Spain
Search for more papers by this authorAdolfo Figueiras
Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública – CIBERESP), Santiago de Compostela, Spain
Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
Search for more papers by this authorMaría Piñeiro-Lamas
Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública – CIBERESP), Santiago de Compostela, Spain
Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
Search for more papers by this authorCorresponding Author
Eduardo Carracedo-Martínez
Santiago de Compostela Health Area, Galician Health Service (Servizo Galego de Saúde - SERGAS). Spanish National Health System, Santiago de Compostela, Spain
Correspondence
Eduardo Carracedo-Martínez, Santiago de Compostela Health Area, Galician Health Service (Servizo Galego de Saúde - SERGAS). Spanish National Health System, Santiago de Compostela, Spain.
Email: [email protected]
Search for more papers by this authorRaquel Vázquez-Mourelle
Deputy Directorate-General. Galician Health Service (Servicio Gallego de Salud SERGAS), Spanish National Health System, Santiago de Compostela, Galicia, Spain
Search for more papers by this authorAdolfo Figueiras
Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública – CIBERESP), Santiago de Compostela, Spain
Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
Search for more papers by this authorMaría Piñeiro-Lamas
Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública – CIBERESP), Santiago de Compostela, Spain
Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
Search for more papers by this authorAbstract
Background
The effect of the inclusion of a more expensive me-too medicine in a hospital drug formulary (HDF) on both in- and out-of-hospital utilization, and the contextual factors which influence this type of induction is rarely studied. Accordingly, this work aimed to quantify the effect of the decision of a hospital of including a more expensive me-too antidepressant in its HDF.
Methods
A controlled longitudinal study was carried out in a Regional Health Service of Spain. We performed a segmented regression analysis with control group. We used the following dependent variables: defined daily doses (DDD) per 1000 inhabitants per day, DDD per 100 bed days, and cost per DDD.
Results
At a hospital level, the modification in the formulary led to utilization changes: (1) an increase in immediate consumption of the newly included me-too drug; and, (2) an annual 25.96% [95% CI: 2.96%–48.95%] decrease in the adjusted trend of the already existing parent antidepressant. The adjusted trend of the cost per DDD of the sum of all medications in the therapeutic group increased by 20.03% annually [95% CI: 3.24%–36.82%]. In the out-of-hospital setting utilization changes were: (1) the adjusted trend of the newly included me-too drug rose by 12.14% annually [95% CI: 4.97%–19.30%]; and, (2) that of the parent drug underwent a negative change in trend of 4.18% annually [95% CI: 0.00%–8.36%].
Conclusions
The inclusion of a more expensive me-too drug in the HDF led to increased consumption of this more expensive me-too drug both in- and out-of-hospital.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
Data for this study will be available from the corresponding author on a reasonable request.
REFERENCES
- 1 World Health Organization. The world health report: health systems financing: the path to universal coverage; 2010 https://apps.who.int/iris/handle/10665/44371, Accessed July 14, 2020.
- 2Vázquez-Mourelle R, Durán-Parrondo C, López-Pardo E, Carracedo-Martínez E. Eficiencia del programa de seguimiento farmacoterapéutico de antipsicóticos parenterales de acción prolongada en el área sanitaria de Santiago de Compostela. Gac Sanit. 2016; 30(1): 73-76. doi:10.1016/j.gaceta.2015.09.006
- 3Spurling GK, Mansfield PR, Montgomery BD, et al. Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review. PLoS Med. 2010; 7(10):e1000352. doi:10.1371/journal.pmed.1000352
- 4Pearce MJ, Begg EJ. A review of limited lists and formularies: are they cost-effective? Pharmacoeconomics. 1992; 1(3): 191-202. doi:10.2165/00019053-199201030-00006
- 5Mousnad MA, Shafie AA, Ibrahim MI. Systematic review of factors affecting pharmaceutical expenditures. Health Policy. 2014; 116(2–3): 137-146. doi:10.1016/j.healthpol.2014.03.010
- 6Gourzoulidis G, Kourlaba G, Stafylas P, Giamouzis G, Parissis J, Maniadakis N. Association between copayment, medication adherence and outcomes in the management of patients with diabetes and heart failure. Health Policy. 2017; 121(4): 363-377.
- 7Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. BMJ. 2013; 347:f6753. doi:10.1136/bmj.f6753
- 8Peters DH, Tran NT, Adam T. Implementation Research in Health: a Practical Guide; 2013. https://www.who.int/alliance-hpsr/alliancehpsr_irpguide.pdf, Accessed July 9, 2020.
- 9Vazquez-Mourelle R, Carracedo-Martinez E, Figueiras A. Impact of a change of bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions: interrupted time series design with comparison group. Implement Sci. 2020; 15(1): 33. doi:10.1186/s13012-020-00996-y
- 10Vazquez-Mourelle R, Carracedo-Martinez E, Figueiras A. Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group. Implement Sci. 2019; 14(1): 75. doi:10.1186/s13012-019-0924-0
- 11Vazquez-Mourelle R, Carracedo-Martinez E. The influence of changes in hospital drug formulary on the prescription of proton pump inhibitors. Farm Hosp. 2017; 41(1): 49-67. doi:10.7399/fh.2017.41.1.10559
- 12Larsen MD, Schou M, Kristiansen AS, Hallas J. The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care. Eur J Clin Pharmacol. 2014; 70(7): 859-865. doi:10.1007/s00228-014-1681-2
- 13Gallini A, Legal R, Taboulet F. The influence of drug use in university hospitals on the pharmaceutical consumption in their surrounding communities. Br J Clin Pharmacol. 2013; 75(4): 1142-1148. doi:10.1111/j.1365-2125.2012.04455.x
- 14Hernandez I, Zhang Y. Comparing adoption of breakthrough and “me-too” drugs among medicare beneficiaries: a case study of dipeptidyl peptidase-4 inhibitors. J Pharm Innov. 2017; 12(2): 105-109.
- 15 Management Sciences for Health. MDS-3: Managing Access to Medicines and Health Technologies; 2012. https://www.msh.org/sites/default/files/mds3-jan2014.pdf, Accessed July 14, 2020.
- 16Burke N, Bowen JM, Troyan S, et al. Management of Hospital Formularies in Ontario: challenges within a local health integration network. Can J Hosp Pharm. 2016; 69(3): 187-193. doi:10.4212/cjhp.v69i3.1554
- 17Vogler S, Zimmermann N, Habl C, Mazag J. The role of discounts and loss leaders in medicine procurement in Austrian hospitals—a primary survey of official and actual medicine prices. Cost Eff Resour Alloc. 2013; 11(1): 15. doi:10.1186/1478-7547-11-15
- 18 Instituto Galego de Estatística. Padrón municipal de habitantes; 2019. https://www.ige.eu/web/mostrar_actividade_estatistica.jsp?idioma=gl&codigo=0201001002, Accessed July 14, 2020.
- 19 Consellería de Facenda. Proxecto de orzamentos da comunidade autónoma galega. Ano. 2019; 2019: 346–355. http://www.conselleriadefacenda.es/orzamentos/2019/PR/LEI_III_FR08.PDF#view=Fit&toolbar=0&navpanes=0, Accessed July 14, 2020
- 20 Administración General del Estado. Orden SSI/1225/2014, de 10 de julio, por la que se procede a la actualización del sistema de precios de referencia de medicamentos en el Sistema Nacional de Salud; 2014. https://www.saludcastillayleon.es/institucion/es/recopilacion-normativa/ordenacion-sistema-sanitario/medicamentos-productos-sanitarios/orden-ssi-1225-2014-10-julio-procede-actualizacion-sistema-.ficheros/421011-OSSI-1225-2014-10-7-2014.pdf, Accessed July 14, 2020.
- 21Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002; 27(4): 299-309. doi:10.1046/j.1365-2710.2002.00430.x
- 22Linden A. Conducting interrupted time-series analysis for single- and aultiple-group comparisons. Stata J. 2015; 15(2): 480-500.
- 23Kontopantelis E, Doran T, Springate DA, Buchan I, Reeves D. Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis. BMJ. 2015; 350:h2750. doi:10.1136/bmj.h2750
- 24Jandoc R, Burden AM, Mamdani M, Levesque LE, Cadarette SM. Interrupted time series analysis in drug utilization research is increasing: systematic review and recommendations. J Clin Epidemiol. 2015; 68(8): 950-956. doi:10.1016/j.jclinepi.2014.12.018
- 25Sopko MA Jr, Ehret MJ, Grgas M. Desvenlafaxine: another "me too" drug? Ann Pharmacother. 2008; 42(10): 1439-1446. doi:10.1345/aph.1K563
- 26Calabozo Freile B, Viñuela ÁD. Desvenlafaxina: el viejo truco del metabolito activo y la autorización nacional. El Ojo de Markov. 2014; 29: 1-2. https://www.saludcastillayleon.es/portalmedicamento/fr/terapeutica/ojo-markov/desvenlafaxina-viejo-truco-metabolito-activo-autorizacion-n.fichiers/429050-Ojo%20de%20Markov%20n%C2%BA29_Desvenlafaxina_el%20viejo%20truco%20del%20metabolito%20activo%20y%20la%20autorizaci%C3%B3n%20nacional.pdf, Accessed July 14, 2020
- 27 WHO Collaborating Centre for Drug Statistics Methodology. International language for drug utilization research; 2019. https://www.whocc.no/, Accessed July 14, 2020.
- 28 WHO Collaborating Centre for Drug Statistics Methodology. Definition and general considerations; 2018; https://www.whocc.no/ddd/definition_and_general_considera/, Accessed July 14, 2020.
- 29Laporte JR, Tognoni G. Principios de epidemiología del medicamento. 2nd ed. Masson Salvat Medicina; 2007 https://www.icf.uab.cat/assets/pdf/productes/llibres/pem.pdf
- 30Capellá D, Laporte JR. Métodos aplicados en estudios descriptivos de utilización de los medicamentos. In: JR Laporte, G Tognoni, eds. Principios de epidemiología del medicamento. 2nd ed. Ediciones Científicas y Técnicas; 1993.
- 31 World Health Organization. Methods to analyse medicine utilization and expenditure to support pharmaceutical policy implementation. 2018; https://apps.who.int/iris/bitstream/handle/10665/274282/9789241514040-eng.pdf, Accessed July 14, 2020.
- 32Taljaard M, McKenzie JE, Ramsay CR, Grimshaw JM. The use of segmented regression in analysing interrupted time series studies: an example in pre-hospital ambulance care. Implement Sci. 2014; 9: 77. doi:10.1186/1748-5908-9-77
- 33Bernal JL, Cummins S, Gasparrini A. The use of controls in interrupted time series studies of public health interventions. Int J Epidemiol. 2018; 47(6): 2082-2093. doi:10.1093/ije/dyy135
- 34Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017; 46(1): 348-355. doi:10.1093/ije/dyw098
- 35Sruamsiri R, Wagner AK, Ross-Degnan D, et al. Expanding access to high-cost medicines through the E2 access program in Thailand: effects on utilisation, health outcomes and cost using an interrupted time-series analysis. BMJ Open. 2016; 6(3):e008671. doi:10.1136/bmjopen-2015-008671
- 36Fijn R, Brouwers JR, Knaap RJ, Van Den Berg DJ. Drug and Therapeutics (D & T) committees in Dutch hospitals: a nation-wide survey of structure, activities, and drug selection procedures. Br J Clin Pharmacol. 1999; 48(2): 239-246. doi:10.1046/j.1365-2125.1999.00001.x
- 37Fijn R, Lenderink AW, Egberts AC, Brouwers JR, De Jong-Van DenBerg LT. Assessment of indicators for hospital drug formulary non-adherence. Eur J Clin Pharmacol. 2001; 57(9): 677-684. doi:10.1007/s002280100358
- 38Gallini A, Juillard-Condat B, Saux MC, Taboulet F. Drug selection in French university hospitals: analysis of formularies for nine competitive pharmacological classes. Br J Clin Pharmacol. 2011; 72(5): 823-831. doi:10.1111/j.1365-2125.2011.03997.x
- 39Plet HT, Kjeldsen LJ, Christensen Rde P, Nielsen GS, Hallas J. Do educational meetings and group detailing change adherence to drug formularies in hospitals? A cluster randomized controlled trial. Eur J Clin Pharmacol. 2014; 70(1): 109-116. doi:10.1007/s00228-013-1589-2
- 40Lapointe-Shaw L, Fischer HD, Newman A, et al. Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital. PLoS One. 2012; 7(6):e39737. doi:10.1371/journal.pone.0039737
- 41Viktil KK, Blix HS, Eek AK, Davies MN, Moger TA, Reikvam A. How are drug regimen changes during hospitalisation handled after discharge: a cohort study. BMJ Open. 2012; 2(6):e001461.
- 42Grimmsmann T, Schwabe U, Himmel W. The influence of hospitalisation on drug prescription in primary care—a large-scale follow-up study. Eur J Clin Pharmacol. 2007; 63: 783-790.
- 43Pruckner GJ, Schober T. Hospitals and the generic versus brand-name prescription decision in the outpatient sector. Health Econ. 2018; 27(8): 1264-1283.
- 44Acosta-Jaramillo CM, Martínez-Tobo LZ, Rodríguez-Márceles MA. Diagnosis of the structure and operating processes of the pharmacy and therapeutics committees in two health institutions of the special regime in Bogotá. Rev Colomb Cienc Quím Farm. 2012; 41(1): 21-35.
- 45Fijn R, van Epenhuysen LS, Peijnenburg AJ, Brouwers JR, de Jong-van den Berg LT. Is there a need for critical ethical and philosophical evaluation of hospital drugs and therapeutics (D&T) committees? Pharmacoepidemiol Drug Saf. 2002; 11(3): 247-252. doi:10.1002/pds.719
