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Is the level of patient co-payment for medicines associated with refill adherence in Sweden?
Nordic School Public Heatlh, Sweden Nordic Health Econ AB, Sweden .
Nordic School Public Heatlh, Sweden University of Gothenburg, Sweden .
Medical Prod Agency, Sweden .
University of Gothenburg, Sweden Sahlgrens University Hospital, Sweden .
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2014 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 1, 85-90 p.Article in journal (Refereed) Published
Abstract [en]

Background: In the Swedish reimbursement scheme, the co-payment is based on the price of the product and decreases in a stepwise manner as the total accumulated co-payment increases. The aim of this study was to analyse how refill adherence in Sweden varies according to patients co-payment level for medicines, with antiepileptic drug (AED) use as an example. Methods: Prevalent AED users aged 18-85 years who purchased an AED between 1 January and 30 June 2007 were identified in the Swedish Prescribed Drug Register and followed for a maximum of 2 years. Patient time was categorized based on patients accumulated co-payment for all drugs per reimbursement period. The continuous measure of medication acquisition (CMA) was used to estimate refill adherence in relation to the patients co-payment level. Associations between patients co-payment for all medicines and refill adherence were assessed with multilevel mixed-effects linear regression, accounting for clustering within patients. Results: The study population included 2210 patients (mean age: 56 years; 54% men). CMA for AED was 91% for patients where the co-payment corresponded to 100% of the price. Compared with these patients, refill adherence for AED was 2-4% higher (P less than 0.001) for patients with reduced co-payment (co-payment of 50% of the price). Higher age, higher income and fenytoin use were also associated with a higher refill adherence for AED. Conclusions: Using AED as an example, a higher level of reimbursement was associated with a higher refill adherence compared with full co-payment in Sweden.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy B - Oxford Open Option D , 2014. Vol. 24, no 1, 85-90 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-105245DOI: 10.1093/eurpub/ckt062ISI: 000330838200019OAI: diva2:705038
Available from: 2014-03-14 Created: 2014-03-14 Last updated: 2015-03-31

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Jönsson, Anna K.
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Division of Drug ResearchFaculty of Health SciencesDepartment of Clinical Pharmacology
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