Browsing by Subject "drug expenditure"

Over the past few years antidiabetic agents have contributed significantly to the total drug expenditure. The increased prevalence of type 2 diabetes and market entry of new and more expensive antidiabetic agents have led to increases in the diabetes drug expenditure. On the other hand, several cost containment policies have been implemented over the years to curb the increasing expenditures. The aim of this study is to decompose and quantify the increase in the diabetes drug expenditure in Finland between 2003 and 2015. Understanding the specific cost dynamics underlying the total diabetes drug expenditure is important for policymakers. All reimbursed outpatient diabetes drug purchases in Finland between 2003 and 2015 were extracted from the national Prescription Register, which is maintained by the Social Insurance Institution of Finland (Kela). Purchases of antidiabetic agents were identified from the register based on the Anatomical Therapeutic Chemical (ATC) classification system. Using Fisher’s ideal indexes, the change in the per capita diabetes drug expenditure was decomposed into six different determinants: (1) purchase volume; (2) purchase size; (3) therapeutic choices between drug classes; (4) drug choices between different active ingredients; (5) unit costs; and (6) changes between packages. The decomposition was conducted separately for insulins and non-insulin antidiabetic drugs. From 2003 to 2015, the per capita diabetes drug expenditure increased by10.38 euros for insulins and by 14.83 euros for non-insulins. The expenditure growth for insulins was mainly driven by volume effects: the increase of the number of purchases increased the per capita expenditure by €4.30 and the increase in the size of purchases by €3.98. Changes in therapeutic choices increased the per capita expenditure by €3.74. For non-insulins, the main components of the expenditure increase were changes in therapeutic choices and changes in purchase volume, which increased the per capita expenditure by €9.59 and €9.48, respectively. Changes in purchase size increased the non-insulin per capita expenditure by €1.38. Price effects, measured as changes in cost per Defined Daily Dose (DDD), as well as changes in product mix, i.e. substitutions between different packages within the same active ingredient, had decreasing effects on the expenditure of both insulins and non-insulins. For insulins, the decreasing effect of price changes was €0.95, and the substitutions to cheaper alternatives at the package level decreased the expenditure by €1.07. For non-insulins, the decreases were €4.18 and €0.97, respectively. For both insulins and non-insulins, the main component of the expenditure increase were volume effects. The increase expenditure resulting from increases in volume effects is likely explained by the increased incidence of type 2 diabetes. The increased incidence of type 2 diabetes is also reflected in the consumption of insulins since as the disease progresses type 2 diabetes is also treated with insulin. Therapeutic choices from older to newer drugs and more expensive drugs have increased expenditures in both drug classes. Given the impact of therapeutic choices on drug expenditure, further research is required to ensure that investments in the use of newer drugs result in proportionate improvements in treatment outcomes. Price effects had a decreasing effect on expenditures, but their impact was modest in comparison to increases from other components. In conclusion, the main determinants of expenditure increase are similar for both insulins and non-insulins. However, the relative impact of the determinants varied between them. Therefore, from the cost containment perspective, different policy measures may be considered. For insulins, due to their relatively high unit cost, the introduction and uptake of biosimilar products is a key measure to influence expenditure growth. For non-insulins, concentrating on the non-price components of the drug expenditure is encouraged.