Leena K Saastamoinen1, Jouko Verho. 1. Research Department, The Social Insurance Institution, Helsinki, Finland. leena.k.saastamoinen@kela.fi
Abstract
BACKGROUND: Little information exists on how constantly growing pharmaceutical expenditures are distributed in large representative samples of national populations in Western countries. OBJECTIVE: This study analyzes the distribution of pharmaceutical expenditures in ambulatory care and explores the basic characteristics of the high-cost drug users. METHOD: Reimbursed prescription drug purchases in 2009 were derived from the National Prescription Register for a 50% sample of the adult Finnish population. The high-cost users who were among the top 5% in terms of drug expenditures were identified based on annual drug costs. RESULTS: The distribution of pharmaceutical costs is strongly skewed in Finland; only 5% of the population accounts for about half of the costs. These high-cost drug users were older than the low-cost drug users, with more than one-fourth of them being over 75 years old. The high-cost drug users used, on average, more drugs than the low-cost drug users, but approximately 15% of them used only 1-5 drugs. Almost 50% of the high-cost drug users used more than 10 drugs per year. They had chronic diseases more often than the low-cost drug users, especially uremia requiring dialysis, post-transplant conditions, severe anemia associated with chronic renal failure and multiple sclerosis were common among the high-cost users. CONCLUSION: The skewness of the cost distribution indicates a need for more patient-specific cost-containment methods, and the high number of drugs in the high-cost group calls for exploring the possibilities of disease management and patient monitoring techniques in cost containment.
BACKGROUND: Little information exists on how constantly growing pharmaceutical expenditures are distributed in large representative samples of national populations in Western countries. OBJECTIVE: This study analyzes the distribution of pharmaceutical expenditures in ambulatory care and explores the basic characteristics of the high-cost drug users. METHOD: Reimbursed prescription drug purchases in 2009 were derived from the National Prescription Register for a 50% sample of the adult Finnish population. The high-cost users who were among the top 5% in terms of drug expenditures were identified based on annual drug costs. RESULTS: The distribution of pharmaceutical costs is strongly skewed in Finland; only 5% of the population accounts for about half of the costs. These high-cost drug users were older than the low-cost drug users, with more than one-fourth of them being over 75 years old. The high-cost drug users used, on average, more drugs than the low-cost drug users, but approximately 15% of them used only 1-5 drugs. Almost 50% of the high-cost drug users used more than 10 drugs per year. They had chronic diseases more often than the low-cost drug users, especially uremia requiring dialysis, post-transplant conditions, severe anemia associated with chronic renal failure and multiple sclerosis were common among the high-cost users. CONCLUSION: The skewness of the cost distribution indicates a need for more patient-specific cost-containment methods, and the high number of drugs in the high-cost group calls for exploring the possibilities of disease management and patient monitoring techniques in cost containment.
Authors: A Austvoll-Dahlgren; M Aaserud; G Vist; C Ramsay; A D Oxman; H Sturm; J P Kösters; A Vernby Journal: Cochrane Database Syst Rev Date: 2008-01-23