Sandra De Coster

Sustaining Generic Medicines Markets in Europe

The size of generic medicines retail markets varies widely among European countries, owing to differences in the policy environment surrounding generic medicines. This study aims to provide a comparative analysis of policy tools that European countries have used to develop their generic medicines market and to formulate recommendations for sustaining generic medicines markets. The European experience indicates that there is no single approach towards developing a generic medicines market. Penetration of generic medicines is more successful in countries that permit (relatively) free medicine pricing. Reference-pricing systems do not aid generic medicine use if the price of originator medicines falls to the reference price level. Physician budgets stimulate generic medicine use if accompanied by rewards/sanctions for budget surpluses/deficits, respectively. Generic substitution aids generic medicine use if it is financially attractive to pharmacists to substitute generic for originator medicines. Patient co-payment seems to affect demand for generic medicines. This study shows that coordinated government policies are critically needed in many European countries. To sustain the development of a generic medicines market, countries need to supplement supply-side policies, such as pricing reductions, by demand-side policies that create incentives for physicians, pharmacists and patients to use generic medicines.

Potential Savings from Increased Substitution of Generic for Originator Medicines in Europe

This study aims to estimate annual savings from increased generic substitution in the retail market of 11 European countries in 2004. Savings from generic substitution were calculated for the top ten active substances by public expenditure on originator medicines in each country. For each active substance, average price levels weighted by volume of sales of medicines belonging to the group of originator medicines and to the group of generic medicines were calculated. The price difference between originator and generic medicines was multiplied by the volume of originator medicines to be substituted. The analysis considered that, following generic substitution, 5 per cent of market volume for each active substance would be made up by originator medicines and 95 per cent by generic medicines. Increased generic substitution for the top ten active substances generated total potential savings of around €3 bn, with country savings ranging from €1 lm in Poland to €1 bn in Germany. Increased generic substitution would be expected to reduce public expenditure on originator medicines containing these active substances by at least 20 per cent in each country. Countries that pursue the development of their domestic generic medicines market, therefore, can expect to gain substantial savings from increased generic substitution.

Reforming the Belgian market for orthotic braces: What can we learn from the international experience?

OBJECTIVES This article aims to review regulation governing outpatient orthotic braces (neck, wrist and knee braces) in France, the Netherlands and Sweden with a view to reforming the Belgian market. METHODS Information about the regulatory framework was derived from an analysis of legal texts and a survey completed by national experts. RESULTS Strategies to keep down prices include public procurement in Sweden, maximum prices in France, and exclusion of expensive braces from reimbursement in the Netherlands. Reimbursement is linked to a medical indication or a chronic condition in France, the Netherlands and Sweden. To gain reimbursement, the cost-effectiveness of orthotic braces needs to be demonstrated in France and the Netherlands. Orthotic braces tend to be initially prescribed by a specialist physician and distributed by orthotists, medical equipment shops and/or community pharmacies. CONCLUSIONS Extensive government intervention exists in the outpatient orthotic brace market in the countries studied. Our recommendations to reform the Belgian market for prefabricated orthotic braces are to separate reimbursement for service provision from reimbursement for braces; to set prices by means of a tendering process or an international price comparison; and to make reimbursement conditional on effectiveness and cost-effectiveness of braces.

Cardiovascular drug use prior to diagnosis of diabetes: a pilot study in community pharmacy.

Objectives The literature indicates that cardiovascular drug use is higher during the years prior to diagnosis of type 2 diabetes mellitus. As there are pharmaco‐epidemiological and economic consequences of enhanced medication use prior to diagnosis of diabetes, there is a need for a comparative analysis of the drug‐use pattern by patients with a subsequent diagnosis of diabetes and control patients. This pilot study aimed to investigate cardiovascular drug use in patients with a subsequent diagnosis of diabetes using data extracted from 200 community pharmacies in the Belgian township of Hasselt.

Do tariffs and prices correspond with costs? A case study of orthotic braces.

Abstract Objectives: The Belgian third-party payer wishes to set reimbursement tariffs at a level that reflects the costs of orthotic braces. This article aims to calculate production and distribution costs of a prefabricated hard neck and knee brace and to explore whether Belgian tariffs and actual retail prices correspond with estimated costs of these two braces. Methods: The cost model considered manufacturing costs, general overheads, research and development costs, warehousing costs, profit and distribution margins. Data were gathered from manufacturers, a production site visit, desk research, a decomposition of finished products and stakeholder interviews. The price year was 2007. Results: The cost model estimated a retail price of €55–€150 for the neck brace, depending on assumptions. The estimated retail price for the neck brace was lower than the reimbursement tariff of €194 and the actual retail price of €241. The estimated retail price of €331–€694 for the knee brace was lower than the actual retail price of €948. Conclusions: Actual retail prices and reimbursement tariffs for a neck brace and a knee brace exceeded prices based on estimated costs. Therefore, there appears to be scope for reducing tariffs.

Information on antidepressants for psychiatric inpatients: the divide between patient needs and professional practice

Background Medicine information is an integral part of patient care and a patient right. In particular, patients with a mental health diagnosis have a need for information on medicines. Objective This study aims to describe the current practice on information provision on antidepressants to inpatients in psychiatric hospitals. Methods A qualitative study was conducted consisting of semi-structured interviews with health care professionals (n=46) and patients (n=17) in 11 Flemish psychiatric hospitals. Two topic guides were designed for conducting the interviews with these respective stakeholders. The issues addressed in the topic guides related to: organization of information provision in the hospital, information on demand of the patient, information provision by health care professionals, information for relatives, evaluation of provided information, interdisciplinary contacts on information provision and satisfaction on current practice of information provision. The interviews were analysed according to the five stages of the framework analysis. Results Psychiatrists and nurses are the key players to provide information on antidepressants. Their approach depends on patient characteristics and mental state. Information is provided mainly orally. Health care professionals consider non-verbal cues of patients to verify if information has been understood. Health care professionals reported lack of time and lack of interdisciplinary contacts as negative aspects. Patients indicated that health care professionals take too little initiative to provide medicine information. Conclusions Patients are informed about their antidepressants through various pathways. Although the awareness is present of the importance of the individual approach and efforts are done to tailor information to the individual patient, improvement is still possible. Tailoring communication; assessing patient needs and preferences; matching of health care professional style and patient needs; and achieving concordance, is a complex and challenging task for health care professionals in mental health care.

Detecting pre-diabetes and the role of the pharmacist

Objective This study aims to use a pharmacoepidemiological approach to study the drug use of patients during the year prior to diabetes diagnosis (i.e. pre-diabetic patients) and control patients. Drug use might reveal cardiovascular, metabolic and/or endocrinological changes and help to identify indicators for active monitoring of Type 2 diabetes mellitus. Methods A retrospective case-control study compared drug use of patients with a future diagnosis of diabetes (experimental patients) with patients without a diabetes diagnosis (control patients) based on community pharmacy records. An experimental patient had used oral hypoglycaemic drugs during 2005 or 2006. Experimental and control patients were matched in terms of age, gender and quarter of index date. Drugs were selected based on possible co-morbidities of diabetes. Drug use was expressed as a binary variable, indicating whether or not a patient took specific drugs. Drug use was compared between experimental patients during the year prior to diagnosis and control patients using the chi-squared test. Results Our dataset covered 5,064 patients (1,688 experimental and 3,376 control patients). A higher probability of taking cardiovascular drugs was observed for specific subgroups of patients with pre-diabetes as compared to control patients: this trend was observed for men as well as for women, for various cardiovascular drug classes, and for different age groups (p<0.05), although it was not always statistically significant for the 29-38 age group. For each selected age and gender group, patients with pre-diabetes had a higher probability of taking a combination of a lipid-modifying agent and an antihypertensive drug than control patients (p<0.005). Conclusions Using community pharmacy data, this study demonstrated that age and a characteristic drug use pattern could contribute to detecting pre-diabetes. There is a potential role for community pharmacists to follow up drug indicators of patients with a view to refer high-risk people for screening by a physician.