Drug usage by outpatients in Croatia during an 8-year period: Influence of changes in pricing policy

Vitezić, Dinko; Madjarevic, T; Gantumur, Monja; Buble, Tonći; Vitezić, Miomira; Kovačević, Miljenko; Mršić-Pelčić, Jasenka; Šestan, Branko

doi:10.5414/cp201686

Cited by 3 publications

(4 citation statements)

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“…CHIF provides the mandatory health insurance in Croatia, with the obligatory health insurance contributions of employed citizens as the major source of its revenue [32]. This public fund is responsible for health policy implementation, funding and control of health services [33]. There are two reimbursement lists compiled by the CHIF, the Croatian National Medicine Basic Reimbursement List, with both hospital and retail prescription drugs, fully covered by mandatory insurance, and the Croatian National Medicine Supplementary Reimbursement List, where patients have to pay the fraction of the cost, from 10 to 90%.…”

Section: Main Outcome Measuresmentioning

confidence: 99%

Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia

et al. 2019

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Background: Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socioeconomic standard, and access to medical services and public pharmacies in urban, rural and island environments (city of Split vs. Dalmatian Hinterland vs. islands in Southern Croatia). Methods: A historical cohort study included 213 patients diagnosed from 2008 to 2014 with essential arterial hypertension (AH) and without related complications or diabetes mellitus. Each patient was followed up for 365 days from the visit when the diagnosis of hypertension was ascertained. Normotension was defined as arterial pressure < 140/90 mmHg. The annual cost of drugs prescribed for treating newly diagnosed hypertensive patient and the total price for defined daily dose per patient were also evaluated. Results: More than half patients achieved normotension within a year from the initial diagnosis in all family medicine practices (57.3%), without significant differences among the three geographic regions (P = 0.981). Higher initial systolic blood pressure was a positive predictive prognostic factor on achieveing normotension (odds ratio (OR) 0.96, 95% confidence interval 0.95-0.98). ACE inhibitors were the most commonly prescribed antihypertensive agents in monotherapy (35.1%), as well as considering overall prescriptions (25.2%). Calcium channel blockers were the most commonly prescribed initial BP-lowering single agents in urban areas (28.6%), whereas angiotensin-converting enzyme inhibitors were more common in rural (28.0%) and island areas (22.7%) (P = 0.037). The median annual antihypertensive drug cost was 169.4 (95% CI 151.5-201.8) Croatian kunas and was similar across the study sites. Conclusion: Multiple antihypertensive drugs, prescribed in accordance with the guidelines, lead to similar pharmacological effects. Primary care physicians seem to be able to overcome potential interfering socioeconomic factors and successfully achieve normotension in newly diagnosed patients with uncomplicated AH after 1 year of treatment.

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Section: Main Outcome Measuresmentioning

confidence: 99%

Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia

et al. 2019

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“…We could not make the full assessment of the cost-effectiveness of medicines included in the CIHI Basic List because we could not obtain the full dataset for the spending and expenditures for individual medicines of 9 ATC classes included in the analysis. Pragmatically, the process of pricing is rather complex, so that the price listed in the CIHI Basic List may differ from the actual price paid but the CIHI because of complex rebate and bundling arrangements with the pharmaceutical companies [11] . We could obtained expenditure data only for medicines on the CIHI list which were deleted from the WHO EML, for which Croatia spent about 40 million Euros over the time when the CIHI Basic List from this study was in effect.…”

Section: Discussionmentioning

confidence: 99%

“…Just like the WHO EML, CIHI considers comparative effectiveness for medicines on the list [12] , so that EML-deleted or rejected medicines should probably not have been included on the Croatian national medicines list. Expenditure for such medicines is a significant problem for the system of health care that is burdened by over-utilization of and over-expenditures for medicines [11] and subjected to constant reforms to achieve financial sustainability and efficiency with limited resources [11] .…”

Section: Discussionmentioning

confidence: 99%

“…CIHI is the public insurance fund that dominates both the mandatory and supplementary health insurance in the Croatian health care system, where the impact of the private health insurance on the market is minimal at the moment [11] . CIHI was established in 1993, based on the Health Care Law, and is responsible for the implementation of health policies and financing and control of health services, including all medicines prescribed by primary health care doctors and those dispensed in pharmacies [11] . CIHI compiles two lists of medicines – the Basic List, where medicines are fully reimbursed by the CIHI, and the Supplementary List, for which the patients have to pay a fraction of the cost.…”

Section: Introductionmentioning

confidence: 99%

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Using the WHO Essential Medicines List to Assess the Appropriateness of Insurance Coverage Decisions: A Case Study of the Croatian National Medicine Reimbursement List

et al. 2014

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PurposeTo investigate the use of the WHO EML as a tool with which to evaluate the evidence base for the medicines on the national insurance coverage list of the Croatian Institute of Health Insurance (CIHI).MethodsMedicines from 9 ATC categories with highest expenditures from 2012 CIHI Basic List (n = 509) were compared with 2011 WHO EML for adults (n = 359). For medicines with specific indication listed only in CIHI Basic List we assessed whether there was evidence in Cochrane Database of Systematic Reviews questioning their efficacy and safety.ResultsThe two lists shared 188 medicines (52.4% of WHO EML and 32.0% of CIHI list). CIHI Basic List had 254 medicines and 33 combinations of these medicines which were not on the WHO EML, plus 14 medicines rejected and 20 deleted from WHO EML by its Evaluation Committee. For deleted medicines, we could obtain data that showed 2,965,378 prescriptions issued to 617,684 insured patients, and the cost of approximately € 41.2 million for 2012 and the first half of 2013, when the CIHI Basic List was in effect. For CIHI List-only medicines with a specific indication (n = 164 or 57.1% of the analyzed set), fewer benefits or more serious side-effects than other medicines were found for 17 (10.4%) and not enough evidence for recommendations for specific indication for 21 (12.8%) medicines in Cochrane systematic reviews.ConclusionsNational health care policy should use high-quality evidence in deciding on adding new medicines and reassessing those already present on national medicines lists, in order to rationalize expenditures and ensure wider and better access to medicines. The WHO EML and recommendations from its Evaluation Committee may be useful tools in this quality assurance process.

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Antihypertensive Drugs in Croatia: What Changes the Drug Usage Patterns?

Kučan

Mršić-Pelčić

Vitezić

2018

Clinical Therapeutics

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Drug usage by outpatients in Croatia during an 8-year period: Influence of changes in pricing policy

Cited by 3 publications

References 0 publications

Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia

Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia

Using the WHO Essential Medicines List to Assess the Appropriateness of Insurance Coverage Decisions: A Case Study of the Croatian National Medicine Reimbursement List

Antihypertensive Drugs in Croatia: What Changes the Drug Usage Patterns?

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