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Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the 'Farmacia Popular' programme in Brazil.

ABSTRACT: OBJECTIVES:'Farmácia Popular' (FP) programme was launched in 2004, expanded in 2006 and changed the cost sharing for oral hypoglycaemic (OH) and antihypertensive (AH) medicines in 2009 and in 2011. This paper describes patterns of usage and continuity of coverage for OH and AH medicines following changes in patient cost sharing in the FP. STUDY DESIGN:Interrupted time series study using retrospective administrative data. METHODS:Monthly programme participation (PP) and proportion of days covered (PDC) were the two outcome measures. The open cohort included all patients with two or more dispensings for a given study medicine in 2008-2012. The interventions were an increase in patient cost sharing in 2009 and zero patient cost sharing for key medicines in 2011. RESULTS:A total of 3.6 and 9.5?million patients receiving treatment for diabetes and hypertension, respectively, qualified for the study. Before the interventions, PP was growing by 7.3% per month; median PDC varied by medicine from 50% to 75%. After patient cost sharing increased in 2009, PP reduced by 56.5% and PDC decreased for most medicines (median 60.3%). After the 2011 free medicine programme, PP surged by 121?000 new dispensings per month and PDC increased for all covered medicines (80.7%). CONCLUSION:Cost sharing was found to be a barrier to continuity of treatment in Brazil's private sector FP programme. Making essential medicines free to patients appear to increase participation and continuity of treatment to clinically beneficial levels (PDC >80%).

SUBMITTER: Emmerick ICM

PROVIDER: S-EPMC5695305 | biostudies-other | 2017 Nov

REPOSITORIES: biostudies-other

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Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the 'Farmácia Popular' programme in Brazil.

Emmerick Isabel Cristina Martins ICM Campos Monica Rodrigues MR Luiza Vera Lucia VL Chaves Luisa Arueira LA Bertoldi Andrea Dâmaso AD Ross-Degnan Dennis D

BMJ open 20171103 11

<h4>Objectives</h4>'Farmácia Popular' (FP) programme was launched in 2004, expanded in 2006 and changed the cost sharing for oral hypoglycaemic (OH) and antihypertensive (AH) medicines in 2009 and in 2011. This paper describes patterns of usage and continuity of coverage for OH and AH medicines following changes in patient cost sharing in the FP.<h4>Study design</h4>Interrupted time series study using retrospective administrative data.<h4>Methods</h4>Monthly programme participation (PP) and prop ...[more]

PMID: 29101135

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Project description:BACKGROUND:Increasing medicines availability and affordability is a key goal of Brazilian health policies. "Farmácia Popular" (FP) Program is one of the government's key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability. METHODS:Longitudinal, retrospective study using interrupted time series to analyze: HTN and DM treatment coverage; total and per capita expenditure; percentage paid by MoH; and patient cost sharing. Analyzes were conducted in the dispensing database of the FP program (from 2006 to 2012). RESULTS:FP has increased its coverage over time; by December 2012 FP covered on average 13% of DM and 11.5% of HTN utilization, a growth of over 600 and 1500%, respectively. The overall cost per treatment to the MoH declined from R$36.43 (R$?= reais, the Brazilian currency) to 18.74 for HTN and from R$33.07to R$15.05 for DM over the period analyzed, representing a reduction in per capita cost greater than 50%. The amount paid by patients for the medicines covered increased over time until 2011, but then declined to zero. We estimate that to treat all patients in need for HTN and DM in 2012 under FP, the Government would need to expend 97% of the total medicines budget. CONCLUSIONS:FP rapidly increased its coverage in terms of both program reach and proportion of cost subsidized during the period analyzed. Costs of individual HTN and DM treatments in FP were reduced after 2011 for both patients (free) and government (better negotiated prices). However, overall FP expenditures by MoH increased due to markedly increased utilization. The FP is sustainable as a complementary policy but cannot feasibly substitute for the distribution of medicines by the SUS.

Project description:BackgroundChina implemented the national drug price negotiation (NDPN) policy to include 17 innovative anticancer medicines in the national reimbursement drug list in 2018. We aimed to assess the impact of this policy on the utilization, cost, and accessibility of anticancer medicines.MethodsWe obtained monthly medicine procurement data from 1039 hospitals from October 2017 to December 2019. We examined changes in availability, utilization, defined daily dose cost (DDDc), and affordability of the medicines using descriptive statistics and controlled interrupted time series analysis, measuring utilization by defined daily doses (DDDs). Cetuximab and raltitrexed were compared separately for the same indication.ResultsThe mean availability of 17 negotiated anticancer medicines was 28.78% after the NDPN, amounting to an increase of 25.22%. The availability increased by 7.88% (95% confidence interval (CI) = 4.31%, 11.45%, P < 0.001) immediately and by 1.23% (95% CI = 0.81%, 1.64%, P < 0.001) per month after policy implementation. Compared with the control group, the utilization of the medicines increased by 11.44 DDDs (95% CI = 2.42, 20.46, P = 0.014) immediately and by 3.54 DDDs (95% CI = 2.47, 4.60, P < 0.001) per month after policy implementation, while the DDDc decreased by US$109.09 (95% CI = 68.14, 150.05, P < 0.001) immediately and remained stable thereafter. The results on cetuximab and raltitrexed were similar. Availability and utilization differed among regions in east, middle, and west China. Out-of-pocket costs decreased by 17.35 times the catastrophic health expenditures to 1.99 times, but the affordability ratio for 14 negotiated medicines was still greater than 1.ConclusionsThe NDPN policy improved the availability, utilization, and affordability of anticancer medicines. China's experience in NDPN provides a reference for other countries. However, the availability and affordability of anticancer medicines still need further improvement.

Project description:BackgroundEvidence suggests that the media can influence societal attitudes and beliefs to various social issues. This influence is especially strong for mental health issues, particularly suicide. As such, the aim of this study is to systematically examine Canadian newspaper coverage of the popular fictional Netflix series 13 Reasons Why, wherein the lead character dies by suicide in the final episode.MethodsArticles mentioning the series were systematically collected from best-selling Canadian newspapers in the three-month period following series release (April-June 2017). Articles were coded for adherence to key best practice recommendations on how to sensitively report suicide. Frequency counts and proportions were produced. An inductive qualitative thematic analysis was then undertaken to identify common themes within the articles.ResultsA total of 71 articles met study inclusion criteria. The majority of articles did not mention the suicide method (88.7%) and did not use stigmatizing language such as 'commit suicide' (84.5%). Almost half of the articles linked suicide to wider social issues (43.7%) or quoted a mental health professional (45.1%). 25% included information telling others considering suicide where to get help. Our qualitative analysis indicated that articles simultaneously praised and criticized the series. It was praised for (i) promoting dialogue and discussion about youth suicide; (ii) raising awareness of youth suicide issues; (iii) shining a spotlight on wider social issues that may affect suicide. It was criticized for (i) glorifying suicide, (ii) harmfully impacting young viewers; (iii) prompting pushback from educators and schools.ConclusionsNewspaper coverage of '13 Reasons Why' generally adhered to core best practice media recommendations, and sensitively discussed suicide from various angles, prompting productive discussion and dialogue about youth suicide. These findings suggest that the media can be an ally in promoting dialogue and raising awareness of important public health issues such as suicide.

Project description:OBJECTIVES:To identify whether the abolition of prescription fees in Scotland resulted in: (1) Increase in the number (cost to NHS) of medicines prescribed for which there had been a fee (inhaled corticosteroids). (2) Reduction in hospital admissions for conditions related to those medications for which there had been a fee (asthma or chronic obstructive pulmonary disease (COPD))-when both are compared with prescribed medicines and admissions for a condition (diabetes mellitus) for which prescriptions were historically free. DESIGN:Natural experimental retrospective general practice level interrupted time series (ITS) analysis using administrative data. SETTING:General practices, Scotland, UK. PARTICIPANTS:732 (73.6%) general practices across Scotland with valid dispensed medicines and hospital admissions data during the study period (July 2005-December 2013). INTERVENTION:Reduction in fees per dispensed item from April 2008 leading to the abolition of the fee in April 2011, resulting in universal free prescriptions. PRIMARY AND SECONDARY OUTCOMES:Hospital admissions recorded in the Scottish Morbidity Record - 01 Inpatient (SMR01) and dispensed medicines recorded in the Prescribing Information System (PIS). RESULTS:The ITS analysis identified marked step reductions in adult (19-59 years) admissions related to asthma or COPD (the intervention group), compared with older or young people with the same conditions or adults with diabetes mellitus (the counterfactual groups). The prescription findings were less coherent and subsequent sensitivity analyses found that both the admissions and prescriptions data were highly variable above the annual or seasonal level, limiting the ability to interpret the findings of the ITS analysis. CONCLUSIONS:This study did not find sufficient evidence that universal free prescriptions was a demonstrably effective or ineffective policy, in terms of reducing hospital admissions or reducing socioeconomic inequality in hospital admissions, in the context of a universal, publicly administered medical care system, the National Health Service of Scotland.

Project description:BackgroundTo fight against the rising incidence of syphilis, the Brazilian Ministry of Health (MoH) launched the "Syphilis No!" Project (SNP), with specific resources funded by a parliamentary amendment. Then, in 2018, a national rapid response started to be implemented on the Brazilian Unified Health System (SUS, Sistema Único de Saúde) in two strategic lines (1) to reinforce SUS's universal actions and (2) to implement specific ones to 100 municipalities chosen by the MoH as priorities for syphilis congenital response. In 2015, such localities represented 6895% of congenital syphilis cases in Brazil. In this context, SNP has implemented actions to strengthen epidemiological surveillance of acquired syphilis and congenital syphilis by instituting an integrated and collaborative response through health services networks and reinforcing interstate relations.MethodsA quasi-experimental study using time series analysis was conducted to assess immediate impacts and changes to the trend in national congenital syphilis before and after the project, from September 2016 to December 2019. Data were assessed considering rates of congenital syphilis per 1,000 live births in all priority municipalities (n=100) covered by the project and in non-priority municipalities (n=5,470) from all five macro-regions of Brazil.FindingsPriority municipalities showed a greater reduction (change in trend) in comparison to non-priority. The linear regression model revealed trend changes after the intervention, with both groups of municipalities showing a drop in the average monthly number of cases per 1,000 live births, with a reduction of -0·21 (CI 95% -0·33 to -0·09; p=0·0011) in priority municipalities and of -0·10 (CI 95% -0.19 to -0.02; p=0·0216) in non-priority municipalities.InterpretationThe study using ITS provides important evidence on the direction, timing, and magnitude of the effects of interventions introduced as part of the SNP on congenital syphilis in Brazil. Our results suggest that the Syphilis No! Project influenced the trends of congenital syphilis in Brazil from 2018, with higher reductions achieved in the priority municipalities.FundingThe research is funded by a grant to the Syphilis No! Project from Brazilian Ministry of Health (Project Number: 54/2017). The funders had no role in study design, analysis, decision to publish, or preparation of the manuscript.

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Dataset Information

Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the 'Farmacia Popular' programme in Brazil.

Publications

Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the 'Farmácia Popular' programme in Brazil.

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