A Cost-Effectiveness Approach To Drug Subsidy And Pricing In Australia

Birkett, Donald; Mitchell, Anne; McManus, Peter

doi:10.1377/hlthaff.20.3.104

Cited by 69 publications

(67 citation statements)

References 2 publications

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“…19 All this exists despite numerous initiatives to improve rational prescription including the use of clinical practice guidelines, electronic decision support tools, formularies, copayments, therapeutic and generic substitution policies, and education of doctors and pharmacists. 24,[34][35][36][37] Of particular concern is the continuing use of long-acting benzodiazepines that are contraindicated in the elderly. 8,9 Our results from Australia and Canada confirm findings from the United States that benzodiazepines with longer half-lives such as diazepam and nitrazepam are some of the most common compounds prescribed.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Benzodiazepine and Related Drug Use in Nova Scotia and Australia

et al. 2008

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Objective: Benzodiazepines can be a problem if used for long periods, or in at-risk populations, such as the elderly. We compared the use of benzodiazepine and related prescription medicines in Nova Scotia and Australia. Methods: The Nova Scotia Pharmacare Program and the Pharmaceutical Benefits Scheme in Australia were used to obtain dispensing data in comparable populations for all publicly subsidized benzodiazepines and related compounds. Usage was compared from 2000 to 2003, using the World Health Organization anatomical therapeutic chemical and defined daily dosage (DDD) system. We also determined differences in the types of benzodiazepines prescribed. Results: The use of benzodiazepines increased at a steady but comparable rate in both areas. However, the use of benzodiazepines in Nova Scotia was more than double that of Australia in 2000 (123 and 48 DDD/1000 beneficiaries per day, respectively) through 2003 (138 and 57 DDD/1000 beneficiaries per day, respectively). Eight different benzodiazepines made up 90% of the drug use in Nova Scotia by contrast to only 4 different benzodiazepines in Australia. Conclusions: Large differences exist between the type and rate of benzodiazepine prescribing in Nova Scotia and Australia, with Nova Scotia reporting more than twice as much use. Benzodiazepine use in both jurisdictions is increasing. The Canadian findings are especially concerning as benzodiazepine use in the Atlantic provinces has been reported to be less than other provinces. The variations between the 2 jurisdictions may be due to factors such as fewer benzodiazepines available in Australia, differences in prescriber, patient attitudes and behaviours, or different initiatives to influence benzodiazepine use.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Benzodiazepine and Related Drug Use in Nova Scotia and Australia

et al. 2008

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“…If manufacturers can reach a pricing agreement with a single purchaser, they are guaranteed a large share of the market, and enjoy the potential of high-volume drug sales that offset the effects of lower prices. This is one of the factors that has allowed countries such as Australia and New Zealand to secure among the world' s lowest prices for pharmaceuticals (Birkett et al 2001;Davis 2004).…”

Section: Discussionmentioning

confidence: 99%

Income-Based Drug Coverage in British Columbia: Lessons for BC and the Rest of Canada

Morgan¹,

Evans²,

Hanley³

et al. 2006

hcpol

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Background: In May 2003, the government of British Columbia adopted incomebased pharmacare, replacing an age-based drug benefits program. Stated policy goals included reducing government spending, maintaining or enhancing access to medicines and improving financial equity. The province' s experience on these policy dimensions can inform policy making in other jurisdictions and offers insight into priorities for Canada' s National Pharmaceuticals Strategy. Method: The research team created an anonymized database with information about drug use, private and public expenditure and household income for all residents of British Columbia from 1996 to 2004. This database was used to evaluate the impact of the policy on trends in drug expenditures, utilization and sources of payment for seniors and non-seniors of different income levels. Results: In the immediate term, Fair PharmaCare appears to have met many of its policy goals. Government spending was reduced. Access to medicines was maintained (though not enhanced). And the distributions of private and public expenditures were brought more closely in line with distribution of income. Long-run impacts depend largely on how a reduced role for government affects trends in costs, access and equity. Early indications suggest that a larger role for government may be needed to maintain performance on desired policy objectives over time. Conclusion: In the long run, there is reason for setting a new national standard for pharmacare that increases, not decreases, the share of publicly covered spending in every province. The federal government could play a key role by helping provinces increase public funding for prescription drugs and thereby facilitate cost control, maintain access to medicines and enhance financial equity.

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“…In Australia reimbursement is decided first, followed by price negotiations with a separate committee, where these price negotiations are always based on the price that was used in the cost-effectiveness analysis submitted to the reimbursement committee [4]. In Finland the same committee assesses both reimbursement and price and also negotiates with manufacturers before a final decision is reached [5].…”

Section: Pricing and Reimbursementmentioning

confidence: 99%

“…Previous attempts in Australia and the provinces of Canada to exclude pharmaceutical treatment for Gaucher's disease from reimbursement failed as patient representatives and other interest groups protested [4,31]. The high political (and administrative!)…”

Section: Outcome Of Decision Makingmentioning

confidence: 99%

“…Studies in both Australia and British Columbia have shown that a large proportion of health economic evaluations in submissions for reimbursement use sickness-specific outcome measures or only compares the cost of therapies [18,33]. Only 4% of the total number of submissions for reimbursement in Australia between 1993 and 1996 included estimates of the incremental cost per QALY gained [4].…”

Section: Use Of Health Economic Evidencementioning

confidence: 99%

See 1 more Smart Citation

Priority setting for pharmaceuticals

Anell

2004

The European Journal of Health Economics

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Authorities in a number of countries rely increasingly on cost-effectiveness analysis to determine reimbursement status or clinical guidance for pharmaceuticals. This study compared the use of health economic evidence across five reimbursement committees (Australia, Ontario and British Columbia in Canada, Finland, and France) and one clinical guidance committee (England and Wales). Health economic evidence was found to support decision making, although cost-effectiveness is less important in some identifiable situations. Since the relative importance of cost-effectiveness varies, it will be difficult to implement a single explicit threshold. Further research may make patterns of decision making, distributional concerns, and the importance of different criteria more transparent, which would help to narrow the gap between the theory and practice of health economic evaluations. While the use of health economic evidence and the outcome of decision making are similar across committees, there is presently only limited knowledge to what extent prescribing patterns are influenced by decisions.

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A Cost-Effectiveness Approach To Drug Subsidy And Pricing In Australia

Cited by 69 publications

References 2 publications

A Comparison of Benzodiazepine and Related Drug Use in Nova Scotia and Australia

A Comparison of Benzodiazepine and Related Drug Use in Nova Scotia and Australia

Income-Based Drug Coverage in British Columbia: Lessons for BC and the Rest of Canada

Priority setting for pharmaceuticals

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