Determinants of new drugs prescription in the Swiss healthcare market

Abstract

BackgroundDrug markets are very complex and, while many new drugs are registered each year, little is known about what drives the prescription of these new drugs. This study attempts to lift the veil from this important subject by analyzing simultaneously the impact of several variables on the prescription of novelty.MethodsData provided by four Swiss sickness funds were analyzed. These data included information about more than 470,000 insured, notably their drug intake. Outcome variable that captured novelty was the age of the drug prescribed. The overall variance in novelty was partitioned across five levels (substitutable drug market, patient, physician, region, and prescription) and the influence of several variables measured at each of these levels was assessed using a non-hierarchical multilevel model estimated by Bayesian Markov Chain Monte Carlo methods.ResultsMore than 92% of the variation in novelty was explained at the substitutable drug market-level and at the prescription-level. Newer drugs were prescribed in markets that were costlier, less concentrated, included more insured, provided more drugs and included more active substances. Over-the-counter drugs were on average 12.5 years older while generic drugs were more than 15 years older than non-generics. Regional disparities in terms of age of prescribed drugs could reach 2.8 years.ConclusionsRegulation of the demand has low impact, with little variation explained at the patient-level and physician-level. In contrary, the market structure (e.g. end of patent with generic apparition, concurrence among producers) had a strong contribution to the variation of drugs ages.

Newer long-acting insulin prescriptions for patients with type 2 diabetes: prevalence and practice variation in a retrospective cohort study

“…The factors associated with the use of new medicines may vary between therapeutic areas (1). In line with our findings, a recent analysis of the use of new medicines, irrespective of therapeutic area, in Switzerland found that male sex and younger age enhanced the probability of using new medicines, while the number of comorbidities had little impact (12). In contrast to our findings, the practice location and proportion of elderly people in general practice have also been associated with the use of new medicines (11).…”

“…Still, little is known about patterns of newer insulin use in T2DM patients and especially information on practice variation and practice and patient-related characteristics associated with the prescription of newer long-acting insulins is lacking. In previous research, a number of patient and practice characteristics have been positively associated with the prescription of new medicines, including male sex, younger age and practice location (11,12). Whether these factors also apply for the prescription of newer insulins is unknown.…”

Determinants of drug expenditure in the Swiss healthcare market in 2006

“…Our source population came from four sickness funds and consisted in 473,886 insured living in Switzerland in 2006. Those data were already used to study the determinants of new drugs prescription in Switzerland [15], where it was shown that they were remarkably representative of the demographic structure of the population. In 2006, pharmacists already had a more neutral role in the choice of products, because they did no longer receive a percentage of the selling price but an administrative tax.…”

“…What is more, in Switzerland it is difficult to obtain representative drug data from insurers because such data could reveal the risk structure of insured and harm their risk financial compensation interests. Our study is based on 2006 data that four major insurance companies accepted to provide, anonymously, thanks to the support of the Federal Office of Public Health [15]. Although these data are arguably old, they provide a valuable and very rare source to understand the functioning of the Swiss drugs' market, while presenting some important advantages: they are highly representative of the Swiss population and they describe a drug market offering a significant choice among multiple products (18 per specific market in average) at a time when the generics were significantly gaining importance.…”

Adoption of new medicines in primary care: A comparison between the uptake of new oral anticoagulants and diabetes medicines

“…2,3 Therefore, monitoring and understanding the uptake patterns of new medicines is important, to maintain quality of care and to prevent unnecessary prescriptions and healthcare costs. 4 The uptake of new medicines in primary care is often not equally distributed among physicians. 5 For example, in studies among British general practitioners, 42% of prescriptions for new medicines were initiated by 10% of the physicians.…”