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Utilization and Costs of Glucose‐ lowering Therapies following Health Technology Assessment for the new reimbursement scheme in Sweden
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
The NEPI Foundation – The Swedish Network for Pharmaco-epidemiology, 581 91 Linköping, Sweden.
Center for Family and Community Medicine, Karolinska Institute, 141 83 Huddinge, Sweden.
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
2012 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 108, no 2-3, 207-215 p.Article in journal (Other academic) Published
Abstract [en]

Objectives: A new reimbursement scheme (RS) for glucose lowering therapies (GLT) was implemented in Sweden on March 1, 2010. Products on the market were retained, restricted, excluded or excluded for new courses in the new RS. The aim of this study was to compare utilization and costs of GLT for type 2 diabetes Mellitus (T2DM) before and after the implementation of the changed RS.

Methods: This was a quasi-experimental study using data on dispensed GLT and costs from adatabase on dispensed individual based prescriptions in Sweden.  Segmentedregression analyses were used to assess utilization and costs.

Results: Following the changed reimbursement status, there was an accelerated increasing trend in number of patients treated with restricted (P=0.0007) or retained (P=0.0021) insulins, as well as in costs for insulin based GLT (P=0.0014). No impact was detected in the total number of patients treated with oral GLT, but a slightly negative trend in total costs for oral GLT was detected following the intervention (P=0.0177).

Conclusions: The new reimbursement scheme had a minor impact on utilization and costs of oral GLT. Despite restricted reimbursement for patients with T2DM, the utilization of insulin based GLT and related costs increased faster following the intervention.

Place, publisher, year, edition, pages
Elsevier , 2012. Vol. 108, no 2-3, 207-215 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-75538DOI: 10.1016/j.healthpol.2012.10.008ISI: 000313535300012OAI: oai:DiVA.org:liu-75538DiVA: diva2:508083
Available from: 2012-03-07 Created: 2012-03-07 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Lipid‐modifying and glucose-lowering therapies in clinical practice: The impact of guidelines and changing reimbursement schemes
Open this publication in new window or tab >>Lipid‐modifying and glucose-lowering therapies in clinical practice: The impact of guidelines and changing reimbursement schemes
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

cardiovascular disease, which is still a major cause of death that creates large burdens to society in terms of costs and morbidity. Dyslipidemia and type 2 diabetes mellitus are the main risk factors for cardiovascular disease, and national and international guidelines recommend lipid-modifying and glucose-lowering treatments for prevention. In 2010, about 836,000 (9% of the population) and 372,000 patients respectively were treated with these therapies in Sweden.

Various pharmaceutical policies aimed at improving the efficiency of drug use have been introduced over the years. Health technology assessment (HTA) was introduced in Sweden in 2002 as a foundation for informing pricing and reimbursement decisions by the Dental and Pharmaceutical Benefits Agency (TLV). Following HTA reviews, new reimbursement schemes for lipid-modifying and glucose-lowering therapies were introduced in 2009 and 2010 respectively. To assess the impact of the changing reimbursement schemes on the use and costs of these therapies, we analyzed data from the Swedish drug registry, using a quasi-experimental design and interrupted time series analyses.

Our results showed that the new reimbursement scheme for lipid-modifying treatment had a major effect on use; following the implementation of this scheme, there was a substantial increase in both discontinuation and switching to higher doses. Conversely, the new reimbursement scheme for glucose-lowering therapies had overall only a minor effect on use. Larger savings in the lipid market were anticipated but not fully realized, while even the minor anticipated changes in costs in the glucose-lowering market were not realized due to increased costs for insulins. We found that changes in reimbursement schemes might lead to unintended effects, which should be considered before implementation. Softer demand-side policies, such as recommendations and guidelines, might be a better option under some circumstances.

Clinical and national guidelines are other policies aimed at improving quality of care and drug use. We assessed the impact of guidelines on the quality of lipid-modifying therapies, defined as proportions of patients attaining goal/normal levels according to guidelines for lipid management. A longitudinal retrospective observational study was carried out, covering time periods before and after initiation of lipid-modifying treatment. The findings show that about 40% of the patients attained the recommended low-density lipoprotein cholesterol goals following treatment, but only 18% attained goals/normal levels in all lipid parameters. Improvement in triglycerides was moderate, and low levels of high-density lipoprotein cholesterol persisted, showing only modest improvement following therapy. Treatment patterns were found to have a better degree of adherence to guidelines regarding low-density lipoprotein cholesterol as compared to other lipid parameters.

The overall objective of treatment of type 2 diabetes mellitus is to improve glycemic control without negatively affecting quality of life. Hypoglycemia is a common side effect of intensive blood glucose control, mostly seen in patients treated with insulins. Earlier studies have suggested that hypoglycemia has a negative impact on quality of life, even in patients treated with oral glucose-lowering therapies. We carried out a cross-sectional retrospective study to assess the impact of self-reported experience of hypoglycemia on quality of life in Swedish adult patients with type 2 diabetes mellitus treated with a combination of metformin and sulfonylureas. The results showed that about 40% of the patients achieved the goal of glycemic control. About 19% reported experience of moderate or more severe hypoglycemia, and these patients were found to have lower quality of life than those patients reporting no or mild hypoglycemia, as measured by EQ-5D, a generic quality of life instrument. This could be important to consider in clinical practice.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 96 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1285
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75545 (URN)978-91-7519-998-6 (ISBN)
Public defence
2012-03-30, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
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Available from: 2012-03-07 Created: 2012-03-07 Last updated: 2017-06-30Bibliographically approved

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Pettersson, BillieLevin, Lars‐Åke

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