G. Van Hal

Potential impact of policy regulation and generic competition on sales of cholesterol lowering medication, antidepressants and acid blocking agents in Belgium

Abstract Background: Pharmaceutical expenditures are increasing as a proportion of health expenditures in most rich countries. Antidepressants, acid blocking agents and cholesterol lowering medication are major contributors to medicine sales around the globe. Methods: We aimed to document the possible impact of policy regulations and generic market penetration on the evolution of sales volume and average cost per unit (Defined Daily Doses and packages) of antidepressants, acid blocking agents and cholesterol lowering medication. We extracted data from the IMS health database regarding the public price and sales volume of the antidepressants (selective serotonin reuptake inhibitors (SSRI’s), monoamine oxidase inhibitors (MAOI’s) and tricyclic and remaining antidepressants (TCA’s)), acid blocking agents (proton pump inhibitors (PPI’s) and H2 receptor antagonists) and cholesterol lowering medication (statins and fibrates) in Belgium between 1995 and 2009. We describe these sales data in relation to various national policy measures which were systematically searched in official records. Results: Our analysis suggests that particular policy regulations have had immediate impact on sales figures and expenditures on pharmaceuticals in Belgium: changes in reimbursement conditions, a public tender and entry of generic competitors in a reference pricing system. However, possible sustainable effects seem to be counteracted by other mechanisms such as marketing strategies, prescribing behaviour, brand loyalty and the entry of pseudogenerics. It is likely that demand-side measures have a more sustainable impact on expenditure. Conclusion: Compared with other European countries, generic penetration in Belgium remains low. Alternative policy regulations aimed at enlarging the generic market and influencing pharmaceutical expenditures deserve consideration. This should include policies aiming to influence physicians’ prescribing and a shared responsibility of pharmacists, physicians and patients towards expenditures.

Knowledge of and attitude towards human papillomavirus infection and vaccines among nurses at a tertiary hospital in South Africa.

The purpose of this cross-sectional study was to determine factors contributing to recommending vaccination to patients, using a self-administered anonymous questionnaire given to 345 nurses working at a tertiary hospital in South Africa. The average age of the participants was 37.2 years. About three-quarters (73.3%) of the nurses were aware of HPV and among them, 38.3% knew that HPV is the most common sexually transmitted virus. Nurses had poor knowledge regarding HPV infection and the HPV vaccine. The majority (90.9%) of the nurses intended to recommend the vaccine to their patients. The nurses who mentioned that adolescents and young adults would accept HPV vaccination were more likely to recommend HPV vaccination to their patients (OR = 57.78, p = 0.031). Nurses had a low level of knowledge regarding HPV infection and vaccines but they were willing to recommend the vaccines to their patients. Nurses need to be educated before implementing HPV vaccinations nationwide.

A comparison between wastewater-based drug data and an illicit drug use survey in a selected community.

BACKGROUND Estimations of drug use are mostly based on population surveys that can suffer from response biases. The current study evaluates using wastewater-based epidemiology (WBE) for assessing illicit drug use by comparing wastewater data with that from a population survey. METHODS Introductory letters (29,083) were sent to inhabitants of Lier, Belgium, asking them to participate in an online survey study. Participants were asked to indicate their drug use in the past week for a 12-week period (September-November 2014). Concomitant wastewater samples were collected from the associated wastewater treatment plant in four bi-weekly periods. Samples were analyzed using solid-phase extraction and liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). RESULTS On average, 263 (1%) inhabitants filled out the questionnaire each week. According to the survey results, cannabis was the most used drug, followed by amphetamine, cocaine and methylenedioxymethamphetamine (MDMA). Wastewater data corroborated these results. Cocaine, amphetamine and MDMA showed a significant difference between days of the week. The four sampling periods differed significantly from each other for cocaine, amphetamine and methadone. CONCLUSION Observed drug consumption patterns from survey and wastewater data match national and international data. Wastewater analyses confirm that WBE can be reliably used to confirm patterns and trends in drug use. Future studies should focus on identifying the most opportune sampling period giving the most reliable estimates of drug use and use smaller, contained communities such as festivals or prisons if methodology allows.

Quantifying independent risk factors for failing to rescreen in a breast cancer screening program in Flanders, Belgium

BACKGROUND Mammographic screening may reduce breast cancer mortality by about 20%, provided participation is high and women screen regularly. We quantified independent risk factors for failing to rescreen and built a model to predict how rescreening rates change if these risk factors would be modified. METHODS Multivariate analysis was used to analyze data from a prospective study which included a self-administered questionnaire and rescreening status 30months after a t0 mammogram, using a random sample of women 50-67years (Belgium 2010-2013). RESULTS A false positive result at the most recent past mammogram (Odds Ratio=5.0, 95% Confidence Interval 3.6-6.8), an interval until new invitation greater than 25months (Odds Ratio=4.8 for >29months, 95% Confidence Interval 2.9-8.1), waiting times in the mammography unit >1h (Odds Ratio=2.1, 95% Confidence Interval 1.2-3.7) and difficulties in reaching the unit (Odds Ratio=2.5, 95% Confidence Interval 1.4-4.4) were the strongest independent predictors for failing to rescreen. The area under the curve of the receiver operating characteristic analysis was 0.705 for the model development stage and 0.717 for the validation stage and goodness-of-fit was good. CONCLUSIONS Maintaining an invitation cycle of maximum 25months, limiting waiting time in the mammography unit and lowering the number of false positives could increase breast cancer screening compliance.

A pivotal role for the general practitioner in a mixed mammographic screening model

BACKGROUND A mixed mammographic screening model presents a country or region with a complex problem. Promoting a significant shift within the target population from opportunistic breast cancer screening to participation in an organised screening programme offers many advantages. The objective was to explore the role of GPs as potential mediators by assessing their specific knowledge, attitudes, and experience on breast cancer and mammographic screening. METHODS A detailed questionnaire was mailed in 2007 to 1500 GPs randomly sampled from the GP population in the province of Antwerp, Belgium. Levels of knowledge on epidemiology and screening, opinions and attitudes on systematic mammographic screening, and experience with breast cancer and mammography were evaluated. RESULTS We received 317 completed questionnaires, 21.1% of the contacted GPs. General knowledge on basic concepts of mammographic screening was average, while the response to an open question on the differences between screening and opportunistic mammography was very limited. More than half of the participants had a positive or realistic attitude towards many aspects of systematic screening, and had satisfactory experience with breast cancer patients in their daily practice (about 82% saw one to four new cases a year). Many (72%) were favourably disposed towards systematic screening organised by the government. CONCLUSION The answers of the GPs suggest a promising potential with regard to the official breast cancer screening programme. Many participants presented qualifications, which could contribute to a change from the mixed model in favour of the official screening system. A number of gaps, however, need to be filled and there is a continuing need to educate physicians on principles and risks and benefits of systematic screening of the target group.

Evidence-based prevention of cannabis use in flanders is there a role for health economic evaluation?

ObjectivesCannabis is a popular drug in Flanders, in spite of the fact that the prevention of its use lists high on the Flemish political agenda. The Flemish Government aims to prevent cannabis use efficiently and in achieving this, a health economic analysis could be helpful. The possibilities and limitations of applying economic evaluation techniques to the prevention of substance (ab)use, are discussed in this paper.MethodsA thorough literature search, interviews with key persons, an internet search and an analysis of unpublished reports and documents was performed.ResultsThe interrelation between various forms of substance use, and of the array of strategies to prevent this (including the costs thereof), seems to demand a joint evaluation of multiple substances.ConclusionsMore than methodological difficulties, the general lack of knowledge on age- and time-specific health and income effects caused by various forms of substance (ab)use, currently makes the evidence-based evaluation of prevention of cannabis use in Flanders a virtually impossible undertaking.

The Belgian Association of Public Health (BAPH) A closer acquaintance

Public health is a very broad domain. Yet, it can encroach deeply in individual lives. The recent and more chronic examples are manifold: swine flu outbreak, obesity, illicit drug use, BSE, dioxin crisis, and so on. However, Belgian scientific research on public health does not seem to be in the right proportion to the importance of the subject. Since many years, the Belgian Association of Public Health (BAPH) tries to bring together Belgian public health research and researchers. The BAPH is a scientific organisation of research groups and institutions, health workers and policy makers who are active in the field of public health. The aims of the association are to increase the knowledge in different domains of public health, to stimulate public health research and to improve public health practices by bringing together researchers and field workers. To achieve these aims, the association organises thematic scientific meetings, often in collaboration with a university. Every two years the association organises a national symposium. For spreading research results and information, the BAPH can count on the Archives of Public Health, which is the official Journal of the BAPH.