Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies

摘要: Background Pharmaceuticals are important interventions that could improve people's health. Pharmaceutical pricing and purchasing policies used as cost-containment measures to determine or affect the prices paid for drugs. Internal reference establishes a benchmark price within country which is maximum level of reimbursement group Other include controls, prices, index pricing, negotiations volume-based pricing. Objectives To effects pharmaceutical on health outcomes, healthcare utilisation, drug expenditures use. Search methods We searched Cochrane Central Register Controlled Trials (CENTRAL), part The Library (including Effective Practice Organisation Care Group Register) (searched 22/10/2012); MEDLINE In-Process & Non-Indexed Citations MEDLINE, Ovid EconLit, ProQuest PAIS International, World Wide Political Science Abstracts, INRUD Bibliography Embase, 14/12/2010); NHSEED, 08/12/2010); LILACS, VHL International Abstracts (IPSA), Ebsco (17/12/2010); OpenSIGLE 21/12/10); WHOLIS, WHO 17/12/2010); Bank (Documents Reports) 21/12/2010); Jolis 09/10/2011); Global 09/10/2011) ; OECD 30/08/2005); iLibrary eLibrary - Essential Drugs Medicines web site (browsed 21/12/2010). Selection criteria Policies in this review were defined laws; rules; financial administrative orders made by governments, non-government organisations private insurers. To be included study had an objective measure at least one following outcomes: use, utilisation outcomes costs (expenditures); randomised trial, non-randomised interrupted time series (ITS), repeated (RM) controlled before-after policy large jurisdiction system care. Data collection analysis Two authors independently extracted data assessed risk bias. Results summarised tables. There too few comparisons with similar across studies allow meta-analysis meaningful exploration heterogeneity. Main results We 18 (seven identified update): 17 also pricing. None trials. All ITS RM analyses. quality evidence was low very all outcomes. Three reported cumulative year after transition period. Two median relative insurer's expenditures, both drugs cost share drugs, -18%, ranging from -36% 3%. third total market -1.5%. Four -10%, -53% 4% change 15% prescriptions (range -14% 166%). -39% -87% -17%). One 55% (95% CI 11% 98%) use generic -43% -67% -18%) brand six months same -5.3% -1.1% respectively start policy. monthly sales volume statins 21% 19% 24%) introduction mortality however they excluded because design limitations. Authors' conclusions The majority met our inclusion criteria evaluated We found internal may reduce short term shifting Reference related but effect uncertain. increase analysis reporting patients' limited administration not reported. uncertain due lack evidence. other until now sparse However, slightly when compared no intervention.