Abstract
Background
Little information exists on how constantly growing pharmaceutical expenditures are distributed in large representative samples of national populations in Western countries.
Objective
This study analyzes the distribution of pharmaceutical expenditures in ambulatory care and explores the basic characteristics of the high-cost drug users.
Method
Reimbursed prescription drug purchases in 2009 were derived from the National Prescription Register for a 50 % sample of the adult Finnish population. The high-cost users who were among the top 5 % in terms of drug expenditures were identified based on annual drug costs.
Results
The distribution of pharmaceutical costs is strongly skewed in Finland; only 5 % of the population accounts for about half of the costs. These high-cost drug users were older than the low-cost drug users, with more than one-fourth of them being over 75 years old. The high-cost drug users used, on average, more drugs than the low-cost drug users, but approximately 15 % of them used only 1–5 drugs. Almost 50 % of the high-cost drug users used more than 10 drugs per year. They had chronic diseases more often than the low-cost drug users, especially uremia requiring dialysis, post-transplant conditions, severe anemia associated with chronic renal failure and multiple sclerosis were common among the high-cost users.
Conclusion
The skewness of the cost distribution indicates a need for more patient-specific cost-containment methods, and the high number of drugs in the high-cost group calls for exploring the possibilities of disease management and patient monitoring techniques in cost containment.
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Notes
The randomization was based on the insured population living in Finland in 2006, and those in long-term institutional care in 2009 were excluded from the sample. Because individual characteristics were observed at the end of 2008, it means that the data were representative for the 2009 population except for those who had immigrated to Finland in 2007–2009. However, the number of new immigrants in Finland is low, annually around 0.5 % of the population, and this limitation should have had only a negligible impact on the results.
References
Aaserud, M., Austvoll-Dalgren, A., Kösters, J.P., Oxman, A.D., Ramsay, C., Sturm, H.: Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD005979. (2006). doi:10.1002/14651858.CD005979
Ess, S.M., Schneeweiss, S., Szucs, T.D.: European healthcare policies for controlling drug expenditure. Pharmacoeconomics 21, 89–102 (2003)
OECD: Health at a glance. http://ec.europa.eu/health/reports/docs/health_glance_en.pdf Accessed 11 May 2011
OECD: Health at a glance 2009. http://www.oecd.org/dataoecd/55/2/44117530.pdf. Accessed 5 December 2011
Finnish Statistics on Medicines 2009. Finnish Medicines Agency Fimea and The Social Insurance Institution, Helsinki, Finland (2010)
Berk, M.L., Monheit, A.C.: The concentration on health care expenditures. Revisit. Health Affairs 20, 9–18 (2001)
Snellman, E., Pekurinen, M.: Particularly Expensive and Demanding Treatments. [in Finnish] Reports of the Ministry of Social Affairs and Health, Helsinki, Finland (2005)
Kapiainen, S., Seppälä, T.T., Häkkinen, U., Lauharanta, J., Roine, R.P., Korppi-Tommola, M.: Extremely Expensive Patients in the Capital Area [In Finnish]. National Institute for Health and Welfare, Helsinki, Finland (2010)
Isacson, D., Haglund, B.: Heavy users of prescription drugs—mortality and stability in use patterns. Scand. J. Prim. Health Care 7, 149–155 (1989)
Hallas, J., Nissen, A.: Individualized drug utilization statistics. Analyzing a population’s drug use from the perspective of individual users. Eur. J. Clin.Pharmacol. 47, 367–372 (1994)
Kozyrskyj, A., Lix, L., Dahl, M., Soodeen, R-A.: High-cost users of pharmaceuticals: who are they? Manitoba Centre for Health Policy. Winnipeg (2005). http://mchp-appserv.cpe.umanitoba.ca/reference/high-cost.pdf Accessed 21 December 2011
Zuvekas, S.H., Cohen, J.W.: Prescription drugs and the changing concentration of health care expenditures. Health Aff. 26, 249–257 (2007)
Thomas, C., Ritter, G., Wallack, S.: Growth in prescription drug spending among insured elders. Health Aff. 20(5), 265–277 (2001)
Daniel, G., Malone, D.: Characteristics of older adults who meet the annual prescription drug expenditure threshold for Medicare medication therapy management programs. J. Manag. Care Pharm. 13, 142–154 (2007)
Hovstadius, B., Åstrand, B., Persson, U., Pettersson, G.: Acquisition cost of dispensed drugs in individuals with multiple medications—a register-based study in Sweden. Health Policy 101(2), 153–161 (2011)
WHO. ATC/DDD Index 2011. (2011). http://www.whocc.no/atc_ddd_index/ Accessed 11 May 2011
Austvoll-Dahlgren, A., Aaserud, M., Vist, G.E., Ramsay, C., Oxman, A.D., Sturm, H., Kösters, J.P., Vernby, Å.: Pharmaceutical policies: Effects of cap and co-payment on rational drug use. Cochrane database of systematic reviews 2008, Issue 1. Art. No.: CD007017
Chang, C.-B., Chen, J.-H., Wen, C.-J., Kuo, H.-K., Lu, I.-S., Chiu, L.-S., Wu, S.-C., Chan, D.-C.: Potentially inappropriate medications in geriatric outpatients with polypharmacy: application of six sets of published explicit criteria. Br. J. Clin. Pharmacol. 72(3), 482–489 (2011)
Linjakumpu, T.: Drug use among the home-dwelling elderly. Trends, polypharmacy and sedation. Oulu University, Oulu, Finland 2003, http://herkules.oulu.fi/isbn9514271025/isbn9514271025.pdf Accessed 21 December 2011
Dwyer, L.L., Han, B., Woodwell, D.A., Rechtsteiner, E.A.: Polypharmacy in nursing home residents in the United States: results of the 2004 national nursing home survey. Am. J. Ger. Pharmacother. 8, 63–72 (2010)
Jyrkkä, J., Enlund, H., Korhonen, M.J., Sulkava, R., Hartikainen, S.: Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons. Results of the Kuopio 75 + study: a cross sectional analysis. Drugs Aging 26(6), 493–503 (2011)
Jyrkkä, J., Enlund, H., Korhonen, M.J., Sulkava, R., Hartikainen, S.: Polypharmacy status as an indicator of mortality in an elderly population. Drugs Aging 26(12), 1039–1048 (2009)
Kuzuya, M., Masuda, Y., Hirakawa, Y., Iwata, M., Enoki, H., Hasegawa, J., Cheng, X.W., Iguchi, A.: Underuse of medications for chronic diseases in the oldest community-dwelling older frail Japanese. J. Am. Geriatr. Soc. 54, 598–605 (2006)
Martikainen, J.E., Enlund, H.: New chemical entities and their market penetration in Finland during the years 1996 through 2005. Clin. Ther. 31(3), 668–676 (2009)
Koskinen, H., Martikainen, J.E., Maljanen, T.: Antipsychotics and antidepressants. An analysis of cost growth in Finland from 1999 to 2005. Clin. Ther. 31, 1469–1477 (2009)
Furu, K., Wettermark, B., Andersen, M., Martikainen, J.E., Almarsdottir, A.B., Toft Sørensen, H.: The Nordic countries as a cohort for pharmacoepidemiological research. Basic Clin. Pharmacol. Toxicol. 106(2), 86–94 (2010)
Rikala, M., Hartikainen, S., Sulkava, R., Korhonen, M.J.: Validity of the finnish prescription register for measuring psychotropic drug exposures among elderly Finns: a population-based intervention study. Drugs Aging 27(4), 337–349 (2010)
Haukka, J., Suvisaari, J., Tuulio-Henriksson, A., Lönnqvist, J.: High concordance between self-reported medication and official prescription database information. Eur. J. Clin. Pharmacol. 63(11), 1069–1074 (2007)
Cole, A., Norman, H., Weatherby, L., Walker, A.: Drug copayment and adherence in chronic heart failure: effect on cost and outcomes. Pharmacotherapy 26(8), 1157–1164 (2006)
Krähenbühl, J.-M., Decollogny, A., Bugnon, O.: Using the costs of drug therapy to screen patients for a community pharmacy-based medication review program. Pharm. World Sci. 30, 816–822 (2008)
Saastamoinen, L.K., Enlund, H., Klaukka, T.: Repeat prescribing processes in primary care: a qualitative study. Int. J. Pharm. Pract. 16(3), 155–167 (2008)
Sakshaug, S., Furu, K., Karlstad, O., Ronning, M., Skurtveit, S.: Switching statins in Norway after new reimbursement policy: a nationwide prescription study. Br. J. Clin. Pharmacol. 64(4), 476–481 (2007)
Schneeweiss, S., Maclure, M., Carleton, B., Glynn, R.J., Avorn, J.: Clinical and economic consequences of a reimbursement restriction of nebulised respiratory therapy in adults: direct comparison of randomised and observational evaluations. BMJ 328, 560 (2004)
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Both authors work as salaried researchers for the Social Insurance Institution.
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Saastamoinen, L.K., Verho, J. Drug expenditure of high-cost patients and their characteristics in Finland. Eur J Health Econ 14, 495–502 (2013). https://doi.org/10.1007/s10198-012-0393-8
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DOI: https://doi.org/10.1007/s10198-012-0393-8