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Pharmaceutical penetration of new drug and pharmaceutical market structure in Taiwan: hospital-level prescription of thiazolidinediones for diabetes

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Abstract

This study used Taiwan’s National Health Insurance claim database (years 2000–2005) to examine how thiazolidinediones (TZD), a new class of drugs for diabetes, penetrated into Taiwan’s hospitals, and its association with the concentration of all diabetes drugs at the hospital level. We collected 72 monthly summaries of diabetes prescriptions from all hospitals in Taiwan. Hospital-level pharmaceutical concentration was measured by penetration of TZD, defined as monthly market share of TZD in each hospital. Concentration of diabetes drugs was measured by Herfindahl–Hirschman indices. We found a negative association (coefficient = −0.3610) between TZD penetration and concentration of diabetes drug but a positive association between penetration of TZD and the volume of prescribed diabetes drugs (coefficient = 0.4088). In conclusion, hospital characteristics and volume of services determined the concentration of pharmaceuticals at the institution level, reflecting the heterogeneous competition between pharmaceutical companies within each hospital. Institution-level pharmaceutical concentration influences the adoption and penetration of new drugs.

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References

  1. Cutler, D.M., McClellan, M., Newhouse, J.P., Remler, D.: Are medical prices declining? Evidence from heart attack treatments. Q. J. Econ. 113, 991 (1998)

    Article  Google Scholar 

  2. Dozet, A., Lyttkens, C.H., Nystedt, P.: Health care for the elderly: two cases of technology diffusion. Soc. Sci. Med. 54, 49 (2002)

    Article  Google Scholar 

  3. Baker, L.C.: Managed care and technology adoption in health care: evidence from magnetic resonance imaging. J. Health Econ. 20, 395 (2001)

    Article  Google Scholar 

  4. Baker, L.C., Phibbs, C.S.: Managed care, technology adoption and health care: the adoption of neonatal intensive care. Rand J. Econ. 33, 524 (2002)

    Article  Google Scholar 

  5. Burke, M.A., Fournier, G.M., Prasad, K.: The diffusion of a medical innovation: is success in the stars? South. Econ. J. 73, 588 (2007)

    Google Scholar 

  6. Poulsen, P.B., Vondeling, H., Dirksen, C.D., Adamsen, S., Go, P.M.N.Y.H., Ament, A.J.H.: Timing of adoption of laparoscopic cholecystectomy in Denmark and in The Netherlands: a comparative study. Health Policy 55, 85 (2001)

    Article  Google Scholar 

  7. Moloney, T.W., Rogers, D.E.: Medical technology—a different view of the contentious debate over costs. N. Engl. J. Med. 301, 1413 (1979)

    Article  Google Scholar 

  8. Rudholm, N.: Competition and substitutability in the Swedish pharmaceuticals market. Appl. Econ. 35, 1609 (2003)

    Article  Google Scholar 

  9. Bae, J.P.: Drug patent expirations and speed of generic entry. Health Serv. Res. 32, 87 (1997)

    Google Scholar 

  10. Berndt, E.R., Bui, L., Reiley, D.R., Urban, G.L.: Information, marketing, and pricing in the US antiulcer drug market. Am. Econ. Rev. 85, 100 (1995)

    Google Scholar 

  11. Ellison, S.F., Cockburn, I., Griliches, Z., Hausman, J.: Characteristics of demand for pharmaceutical products: an examination of four cephalosporins. Rand J. Econ. 28, 426 (1997)

    Article  Google Scholar 

  12. Grabowski, H.G., Vernon, J.M.: Brand loyalty, entry and price competition in pharmaceuticals after the 1984 Drug Act. J. Law Econ. 35, 331 (1992)

    Article  Google Scholar 

  13. Rudholm, N.: Entry and the number of firms in the Swedish pharmaceuticals market. Rev. Ind. Org. 19, 351 (2001)

    Article  Google Scholar 

  14. Acemoglu, D., Linn, J.: Market size in innovation: theory and evidence from the pharmaceutical industry. Q. J. Econ. 119, 1049 (2004)

    Article  Google Scholar 

  15. Morton, F.M.S.: Entry decisions in the generic pharmaceutical industry. Rand J. Econ. 30, 421 (1999)

    Article  Google Scholar 

  16. Aronsson, T., Bergman, M.A., Rudholm, N.: The impact of generic drug competition on brand name market shares—evidence from micro data. Rev. Ind. Org. 19, 423 (2001)

    Article  Google Scholar 

  17. Frank, R.G., Salkever, D.S.: Generic entry and the pricing of pharmaceuticals. J. Econ. Manag. Strategy 6, 75 (1997)

    Article  Google Scholar 

  18. Hudson, J.: Pricing dynamics in the pharmaceutical industry. Appl. Econ. 24, 103 (1992)

    Article  Google Scholar 

  19. Caves, R.E., Whinston, M.D., Hurwitz, M.A.: Patent expiration, entry, and competition in the US pharmaceutical industry. Brookings Pap. Econ. Act. 1991, 1 (1991)

    Google Scholar 

  20. Frank, R., Salkever, D.S.: Pricing, patent loss and the market for pharmaceuticals. South. Econ. J. 59, 165 (1992)

    Article  Google Scholar 

  21. Frank, R.G.: Prescription drug prices: why do some pay more than others do? Health Aff. 20, 115 (2001)

    Article  Google Scholar 

  22. Saha, A., Grabowski, H., Birnbaum, H., Greenberg, P., Bizan, O.: Generic competition in the US pharmaceutical industry. Int. J. Econ. Bus. 13, 15 (2006)

    Article  Google Scholar 

  23. Rogers, E.M.: Diffusion of innovations. Simon and Schuster, New York (2003)

    Google Scholar 

  24. Hellerstein, J.K.: The importance of the physician in the generic versus trade-name prescription decision. Rand J. Econ. 29, 108 (1998)

    Article  Google Scholar 

  25. Pauly, M.V.: Monopsony power in health insurance: thinking straight while standing on your head. J. Health Econ. 6, 73 (1987)

    Article  Google Scholar 

  26. Snyder, C.M.: Why do larger buyers pay lower prices? Intense supplier competition. Econ. Lett. 58, 205 (1998)

    Article  Google Scholar 

  27. Dusing, M.L., Guo, J.J., Kelton, C.M., Pasquale, M.K.: Competition and price discounts for a hospital buyer in the anti-infective pharmaceutical market. J. Pharm. Finan. Econ. Pol. 14, 59 (2005)

    Article  Google Scholar 

  28. Martin, S.: Market power and/or efficiency? Rev. Econ. Stat. 70, 331 (1988)

    Article  Google Scholar 

  29. Staten, M., Umbeck, J., Dunkelberg, W.: Market share/market power revisited : a new test for an old theory. J. Health Econ. 7, 73 (1988)

    Article  Google Scholar 

  30. Hsieh, C.-R., Sloan, F.A.: Adoption of pharmaceutical innovation and the growth of drug expenditure in Taiwan: is it cost effective? Value Health. 11, 334 (2008)

    Article  Google Scholar 

  31. BNHI: National Health Insurance Statistics Report. Bureau of National Health Insurance, Taipei (2008)

    Google Scholar 

  32. BNHI. National Health Insurance Act. Available at: http://www.nhi.gov.tw/english. Accessed 5 May 2009

  33. BNHI. Drug Formulary of National Health Insurance. 2009. Available at: http://www.nhi.gov.tw/webdata/webdata.asp?menu=3&menu_id=56&webdata_id=1099&WD_ID=. Accessed 6 May 2009

  34. Lee, Y.-C., Yang, M.-C., Huang, Y.-T., Liu, C.-H., Chen, S.-B.: Impacts of cost containment strategies on pharmaceutical expenditures of the National Health Insurance in Taiwan, 1996–2003. Pharmacoeconomics 24, 891 (2006)

    Article  Google Scholar 

  35. Diamant, M., Heine, R.J.: Thiazolidinediones in type 2 diabetes mellitus: current clinical evidence. Drugs. 63, 1373 (2003)

    Article  Google Scholar 

  36. Cohen, F.J., Neslusan, C.A., Conklin, J.E., Song, X.: Recent antihyperglycemic prescribing trends for US privately insured patients with type 2 diabetes. Diabetes Care 26, 1847 (2003)

    Article  Google Scholar 

  37. Laird, N.M., Ware, J.H.: Random-effects models for longitudinal data. Biometrics 38, 963 (1982)

    Article  Google Scholar 

  38. Liang, K.-Y., Zeger, S.L.: Longitudinal data analysis using generalized linear models. Biometrika 73, 13 (1986)

    Article  Google Scholar 

  39. Zeger, S.L., Liang, K.-Y.: Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42, 121 (1986)

    Article  Google Scholar 

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Acknowledgment

This research was supported by one grant from the intramural grant of National Health Research Institutes (grant number: HP-097-PP-04). We would also like to thank Mr. James Steed for his assistance in editing this manuscript.

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Authors and Affiliations

  1. Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli 350, Taiwan

    Yi-Wen Tsai, Yu-Wen Wen, Ken N. Kuo & Pei-Fen Chen

  2. Institute of Health and Welfare Policy, National Yang-Ming University, No. 155, Sec. 2, Linong St., Taipei, 112, Taiwan

    Yi-Wen Tsai, Weng-Foung Huang & Yue-Chune Lee

  3. Bureau of Medical Affairs, Department of Health, The Executive Yuan, 6F, No. 36, Tacheng St., Taipei, 10341, Taiwan

    Hsin-Wei Shih

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  1. Yi-Wen Tsai
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  2. Yu-Wen Wen
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  4. Ken N. Kuo
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  5. Pei-Fen Chen
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  7. Yue-Chune Lee
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Correspondence to Yue-Chune Lee.

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Tsai, YW., Wen, YW., Huang, WF. et al. Pharmaceutical penetration of new drug and pharmaceutical market structure in Taiwan: hospital-level prescription of thiazolidinediones for diabetes. Eur J Health Econ 11, 279–290 (2010). https://doi.org/10.1007/s10198-009-0174-1

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  • DOI: https://doi.org/10.1007/s10198-009-0174-1

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