How to Optimize Public Spending on Antihypertensive Treatment in Poland - an Example of Rationalization Analysis

• Autorzy: Tomasz Hermanowski , Łukasz Borowiec , Tomasz Faluta
• Języki publikacji: EN

Abstrakty

EN

Background: Approximately 13% of global deaths are assigned to high blood pressure. ACE-Is and ARBs belong to most frequently prescribed classess of antihypertensive treatment. Recent meta-analyses have confirmed lack of evidence for predominance of ARBs over ACE-Is. Nevertheless, in Poland ARBs remain premium priced and better reimbursed compared to ACE-Is. Objective: To assess economic impact of combining existing separate limit groups of the RAAS inhibitors into one group. Presented analysis is an example of rationalization analysis - a new type of analysis introduced by the reimbursement law 2011. Methods: Reimbursement spending in one year horizon was assessed in two scenarios, assuming separate and common limit groups for ACE-Is and ARBs. List of products analysed and their unit prices are based on MoH listing of reimbursed drugs for 1 July 2013. Yearly volume of reimbursed packs was based on the most recent available data ie. NHF reports May 2012 to April 2013. Results: Yearly savings from the public payer perspective is estimated at 155 mln PLN, a significant fraction (2.3%) of the actual spending on drug reimbursement. Average cost of reimbursement of a monthly therapy using ACE-Is and ARBs is estimated at 2.22 and 3.85 PLN respectively, as compared to 2.35 and 10.85 PLN prior to the change. Conclusion: Combining ACE-Is and ARBs into a common limit group could ensure significant savings for the payer without compromising public health. Existing clinical evidence suggests that current practice of financial preference of ARBs over ACE-Is may lead to suboptimal allocation of the public resources.(original abstract)

Słowa kluczowe

EN

Public expenditures; Expenditures on health care; Health care financing

PL

Wydatki publiczne; Wydatki na ochronę zdrowia; Finansowanie służby zdrowia

• Czasopismo: Journal of Health Policy and Outcomes Research
• Rocznik: 2013
• Numer: nr 2
• Strony: 78--87

Twórcy

autor

Tomasz Hermanowski

• Medical University of Warsaw, Warszawa, Poland

autor

Łukasz Borowiec

• Medical Department, Servier Polska, Warszawa, Poland

autor

Tomasz Faluta

• Medical Department, Servier Polska, Warszawa, Poland

Bibliografia

• Ustawa z dnia 12 maja 2011 r. o refundacji leków, środków spożywczych specjalnego przeznaczenia żywieniowego oraz wyrobów medycznych. (Dz. U. z 2011 r. Nr 122, poz. 696, z 2012 r. poz. 95, poz. 742 z późn. zm)
• Godman B., Bucsics A., Burkhardt T., Schmitzer M., Wettermark B., Wieninger P. Initiatives to enhance renin-angiotensin prescribing efficiency in Austria: impact and implications for other countries. Expert Rev. Pharmacoeconomics Outcomes Res 2010; 10 (2): 199-207
• Voncina L., Strizrep T., Godman B. et al. Influence of demand-side measures to enhance renin-angiotensin prescribing efficiency in Europe: implications for the future. Expert Rev. Pharmacoeconomics Outcomes Res 2011; 11(4): 469-479
• Wettermark B., Godman B., Neovius M. Initial effects of a reimbursement restriction to improve the cost-effectiveness of antihypertensive treatment, Health Policy 2010; 94: 221-229
• World Health Organization. The World Health Statistics 2012. World Health Organization. 2012. p.35. Available from: http://apps.who.int/iris/; [Accessed: 10 March 2013]
• Kaplan W., Laing R. Priority Medicines for Europe and the World Project. A public health approach to innovation. WHO, Geneva, Switzerland. 2004. Available from: http://whqlibdoc.who.int/hq/2004/WHO_EDM_PAR_2004.7.pdf; [Accessed 10 March 2013]
• Kochanek KD., Xu JQ., Murphy SL., Miniño AM., Kung HC. Deaths: final data for 2009. National vital statistics reports. 2011; 60(3). Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf; [Accessed 10 March 2013]
• Ezzati M., Hoorn SV., Rodgers A., Lopez AD., Mathers CD., Murray CJ. Estimates of global and regional potential health gains from reducing multiple major risk factors. Lancet 2003; 362: 271-80
• Mancia G., De Backer G., Dominiczak A. et al. Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the EuropeanSociety of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28: 1462.1536
• Cutler JA., Sorlie PD., Wolz M., Thom T., Fields LE., Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension 2008; 52: 818-27
• Widecka K., Grodzicki T., Narkiewicz K., et al. Zasady postępowania w nadciśnieniu tętniczym - 2011 rok. Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego
• NICE clinical guideline 127. Hypertension. Clinical management of primary hypertension in adults. 2011. Available from: http://www.nice.org.uk/nicemedia/live/13561/56008/56008.pdf; [Accessed: 12.03.2013 r.]
• Olafiranye O., Zizi F., Brimah P., Jean-Louis G., Makaryus AN., McFarlane S., Ogedegbe G. Management of Hypertension among Patients with Coronary Heart Disease. Int J Hypertens. 2011; 2011: 653903. doi: 10.4061/2011/653903
• Hedberg N., Jacob J. A review of medicines for lowering blood pressure - summary. Solna: Dental and Pharmaceutical Benefits Agenc. 2008. Available from: http://www.tlv.se/Upload/Genomgangen/review-blood-pressure.pdf; [Accessed April17 2009]
• Atlas SA. The renin-angiotensin aldosterone system: pathophysiological role and pharmacologic inhibition. J Manag Care Pharm. 2007; 13: 9.20
• Israili ZH., Hall WD. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann Intern Med. 1992; 117: 234-42
• The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991; 325: 293-302
• Pfeffer MA., Braunwald E., Moyé LA., et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the Survival and Ventricular Enlargement trial. N Engl J Med. 1992; 327: 669-77
• Jong P., Yusuf S., Rousseau .F., Ahn SA., Bangdiwala SI. Effect of enalapril on 12-year survival and life expectancy in patients with left ventricular systolic dysfunction: a follow-up study. Lancet. 2003; 361: 1843-8
• Flather MD, Yusuf S, Køber L, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. Lancet. 2000; 355: 1575-81
• Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in highrisk patients. N Engl J Med. 2000; 342: 145-53
• Fox KM. EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782-8
• Dagenais GR., Pogue J., Fox K., Simoons ML., Yusuf S. Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials. Lancet 2006; 368: 581-8
• Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253-9
• Matchar DB., McCrory C., Orlando LA., et al. Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension. Ann Intern Med. 2008; 148: 16-29
• Baker WL., Coleman CI., Kluger J., et al. Systematic Review: Comparative Effectiveness of Angiotensin - Converting Enzyme Inhibitors or Angiotensin II-Receptor Blockers for Ischemic Heart Disease. Ann Intern Med. 2009. 15; 151(12): 861-71
• White CM., Greene L. Summary of AHRQ's comparative effectiveness review of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers added to standard medical therapy for treating stable ischemic heart disease. J Manag Care Pharm. 2011; 17(5 Suppl): S1-15
• Strippoli G., Craig M., Schena F., et al. Role of blood pressure targets and specific antihypertensive agents used to prevent diabeteic nephropathy and delay its progression. J. Am. Soc. Nephrol. 2006; 17: S153-S155
• van Vark LC., Bertrand M., Akkerhuis KM., Brugts JJ., Fox K., Mourad JJ., Boersma E. Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of rennin - angiotensin-aldosterone system inhibitors involving 158 998 patients. Eur Heart J. 2012; 33: 2088-2097
• Savarese G., Costanzo P., Cleland JG. et al. A meta-analysis reporting effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients without heart failure. J Am Coll Cardiol. 2013; 61(2): 131-142
• Obwieszczenie Ministra Zdrowia z dnia 24 czerwca 2013 r. w sprawie wykazu refundowanych leków, środków spożywczych specjalnego przeznaczenia żywieniowego oraz wyrobów medycznych. Dziennik Urzedowy Ministra Zdrowia, Warszawa, dnia 24 czerwca 2013 r., Poz. 24
• Komunikat DGL z dnia 26.06.2013 r. Wartość refundacji cen leków według kodów EAN (styczeń-marzec 2013). Available from: http://www.nfz.gov.pl/new/index.php?katnr=0&dzialnr=2&artnr=5505; [Accessed: 29.07.2013]
• Komunikat DGL z dnia 28.05.2013 r. Wartość refundacji cen leków według kodów EAN (styczeń-luty 2013). Available from: http://www.nfz.gov.pl/new/index.php?katnr=0&dzialnr=2&artnr=5465; [Accessed: 29.07.2013]
• Komunikat DGL z dnia 24.07.2013 r. Wartość refundacji cen leków według kodów EAN (styczeń-kwiecień 2013). Available from: http://www.nfz.gov.pl/new/index.php?katnr=0&dzialnr=2&artnr=5553; [Accessed: 29.07.2013]
• Komunikat DGL z dnia 18.07.2013 r. Wartość refundacji cen leków według kodów EAN (styczeń-grudzień 2012). Available from: http://www.nfz.gov.pl/new/index.php?katnr=0&dzialnr=2&artnr=5537; [Accessed: 29.07.2013]
• Komunikat DGL z dnia 16.07.2012 r. Wartość refundacji cen leków według kodów EAN (styczeń-kwiecień 2012). Available from: http://www.nfz.gov.pl/new/index.php?katnr=0&dzialnr=2&artnr=5012; [Accessed: 29.07.2013]
• Available from: http://www.nbp.pl/kursy/archiwum/wagi.xls; [Accessed 07.08.2013]
• NICE clinical guideline 127. Chronic heart failure Management of chronic heart failure in adults in primary and secondary care. Quick reference guide. 2010. Available from: http://www.nice.org.uk/nicemedia/live/13099/50517/50517.pdf; [Accessed 23 March 2013]
• Makani H., Bangalore S., Desouza KA., Shah A., Messerli FH. Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. BMJ. 2013; 346: f360
• National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Reducing risk in heart disease: an expert guide to clinical practice for secondary prevention of coronary heart disease. Melbourne: National Heart Foundation of Australia. 2012
• National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand. Quick reference guide. Diagnosis and management of chronic heart failure. Updated October 2011
• National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand. Quick reference guide. Diagnosis and management of chronic heart failure. Updated October 2011
• Fox K., Garcia MA., Ardissino D., et al. Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology; ESC Committee for Practice Guidelines (CPG). Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J. 2006; 27(11): 1341-81
• Guertin JR., Jackevicius CA., Cox JL., Humphries K., Pilote L., So DY., Tu JV., Wijeysundera H., Rinfret S. Canadian Cardiovascular Outcomes Research Team. The potential economic impact of restricted access to angiotensin-receptor blockers. CMAJ. 2011; 183(3): E180-6
• Fletcher A., Palmer A., Bulpitt C. Coughing with angiotensin converting enzyme inhibitors; how much of a problem? J. Hypertens. 1994; 12: S43-S47
• NHS. PCT prescribing report. November 2009. Prescribing of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-II receptor antagonists (AIIRAs) - prescribing guidance and discussion points
• SPRAWOZDANIE Z DZIAŁALNOŚCI NARODOWEGO FUNDUSZU ZDROWIA ZA 2012 ROK. Warszawa, czerwiec 2012, s. 110
• Available from: www.mp.pl; [Accessed: 07.08.2013]

Identyfikatory

DOI

10.7365/JHPOR.2013.4.9