TY - JOUR
T1 - Prescribing efficiency of proton pump inhibitors in china
T2 - Influence and future directions
AU - Zeng, Wenjie
AU - Finlayson, Alexander E.
AU - Shankar, Sushma
AU - De Bruyn, Winnie
AU - Godman, Brian
N1 - Funding Information:
China has also seen considerable increases in pharmaceutical expenditure, growing at over 16% per annum during the past decade and over 35% per annum in recent years [18-21]. This growth is attributable to several factors including urbanization, ageing populations, expansion in medical insurance, improvements in living standards and the irrational use of drugs [18]. China’s healthcare system has also experienced a transition from a planned economy to a market economy in recent years. Alongside this, the Chinese government has introduced different types of health insurance in recent years targeting different populations, with coverage reaching over 90% of the population by 2011 [20,22-24] although large disparities still exist [25]. The ultimate goal of the authorities in China is universal coverage by 2020 [22-24,26]. As a result of increased coverage, healthcare expenditure increased from 3.5% to 5% of GDP between 1995 and 2010, equating to a ten-fold increase in yearly per capita spending from US $ 21 to 220 [24]. This further increased to US$350 per year in 2011 [21]. Alongside this, the financial support from the Chinese government to public hospitals declined steadily in recent years from approximately 60% of hospital revenues in 1980s to 8.2% by 2003. As a result, pharmaceutical expenditure in hospitals now accounts for approximately 40% to 50% of their total income [18,21,27-30], with hospitals necessarily using the revenue from drug dispensing for their sustainability [20,24,28,31]. This has caused much concern in China regarding difficulties with obtaining medical services and their high cost.
Publisher Copyright:
© 2015 Zeng et al.; licensee BioMed Central.
PY - 2015/1/22
Y1 - 2015/1/22
N2 - Background: Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables. Methods: Observational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China. Results: Appreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (-34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (-19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral PPIs as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%. Conclusions: Encouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.
AB - Background: Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables. Methods: Observational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China. Results: Appreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (-34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (-19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral PPIs as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%. Conclusions: Encouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.
KW - China
KW - Drug utilisation
KW - Europe
KW - Generics
KW - Health policies
KW - Prices
KW - Proton pump inhibitors
UR - http://www.scopus.com/inward/record.url?scp=84928033828&partnerID=8YFLogxK
U2 - 10.1186/s12913-014-0638-6
DO - 10.1186/s12913-014-0638-6
M3 - Article
C2 - 25609265
AN - SCOPUS:84928033828
SN - 1472-6963
VL - 15
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 11
ER -