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Acquisition cost of dispensed drugs for individuals with multiple medications – a register-based study
Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.ORCID iD: 0000-0002-6648-8702
Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. (eHälsoinstitutet ; eHealth Institute)ORCID iD: 0000-0002-4295-7201
Institute of Economic Research, School of Economics and Management, University of Lund.
2011 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 101, no 2, p. 153-161Article in journal (Refereed) Published
Abstract [en]

Background:

The total drug sales has increased substantially during the last decades. The increase is assumed to be associated with the observed increase in the individual use of several different drugs, the so-called multiple medications.

 

Objective:

To analyse the acquisition cost of dispensed prescription drugs for individuals with multiple medications in a national population.

 

Study design, setting and participants:

An individual based register study of all dispensed prescription drugs (DP) in Sweden in 2006, including 6.2 million individuals. As an indicator of multiple medications, five or more dispensed prescription drugs (DP≥5) during a 12-month period was applied. For comparison, ten or more (DP≥10) and fifteen and more (DP≥15) dispensed drugs during a 12-month period were used.

 

Results:

The total acquisition cost of dispensed drugs in Sweden in 2006 was SEK 23.2 billion, (corresponding to EUR 2.5 billion 2006). Individuals with DP≥5 (24.5% of total population) accounted for 78.8% of the total drug cost, and individuals with DP≥10 (8.6% of population) and DP≥15 (3.0% of population) accounted for 46.3% and 23.2% respectively.

 

Individuals with DP>5 younger than 70 years of age (corresponding to 64.9% all individuals with DP>5) accounted for 64.7% of the total acquisition cost for all with DP>5.The highest total drug cost for individuals with DP>5 was displayed in the age group 60-69 followed by 70-79 and 50-59 years, 21.5%, 19.8%, and 17.4%, respectively.

 

The average acquisition cost per daily defined dosage (DDD) generally decreased with increasing age. For individuals with DP≥5, the average cost per DDD decreased from SEK 8.04 to SEK 2.27 (-72%) for the age group 10-19 to 90 years and above. The highest average cost per DDD was observed for individuals with DP≥10.

 

The drug cost for women with DP≥5 (corresponding to 60.9% all individuals with DP>5) represented 56.0% of the total cost. Men with DP≥5 (corresponding to 39.1% all individuals with DP>5) represented 44.0% of the total cost.

 

For individuals with DP≥5, the average cost per DDD was SEK 4.31 (corresponding to EUR 0.46 2006), for women 4.08, and for men 4.62.

 

Conclusion:

Individuals with ten or more drugs accounted for almost half of the acquisition costs of dispensed drugs. In order to reduce the risks for adverse drug reactions, interactions and inappropriate drug us, interventions with focus on reduction of the number of prescription drugs for the small group of patients with many different drugs, may therefore also give a substantial reduction of the total drug costs.

Place, publisher, year, edition, pages
2011. Vol. 101, no 2, p. 153-161
National Category
Natural Sciences
Research subject
Natural Science, Biomedical Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-2185DOI: 10.1016/j.healthpol.2011.03.003Scopus ID: 2-s2.0-79957992695OAI: oai:DiVA.org:lnu-2185DiVA, id: diva2:309339
Available from: 2010-04-07 Created: 2010-04-07 Last updated: 2017-12-12Bibliographically approved
In thesis
1. On drug use, multiple medication and polypharmacy in a national population
Open this publication in new window or tab >>On drug use, multiple medication and polypharmacy in a national population
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The application of multiple medications has successively increased during a number of years and has thereby increased the potential risks of adverse drug reactions, interactions and non-adherence to drug therapy. This may result in unnecessary health expenditure, directly due to redundant drug sales, and indirectly due to the increased hospitalization caused by drug-related problems. The overall aim of this thesis was to investigate the occurrence and development of drug use, multiple medication, and polypharmacy in an entire national population by using individual-based data on dispensed drugs. The studies (I-V) in the thesis are based on data of dispensed prescription drugs for up to 6.2 million individuals obtained from the Swedish Prescribed Drug Register. The data in the studies cover different periods of time between July 2005-Sept 2008, and the data have been analyzed on the basis of epidemiological measures and statistical methods. The major conclusions of the studies are: the prevalence of dispensed drugs and multiple medications was extensive in all age groups and was higher for females than for males. Multiple medications should be regarded as a risk in terms of potential drug-drug interactions and adverse drug reactions in all age groups (I). Regional differences in the prevalence of polypharmacy were observed and partly explained by the regional age distribution in Sweden. The use of a novel weighted polypharmacy index indicated regional differences in drug therapy for individuals with polypharmacy (II). The number of drugs used by an individual not only increased the potential risks associated with multiple drug use, but also the potential burden of an increased therapeutic intensity, especially for elderly (III). Individuals with ten or more drugs accounted for almost fifty percent of the total acquisition costs of dispensed drugs. Therefore, interventions with a focus on the reduction of the number of prescription drugs for the small group of patients with a large number of different drugs may also result in a substantial reduction in the total drug costs (IV). In spite of national and regional efforts to reduce polypharmacy, the prevalence of polypharmacy and excessive polypharmacy and the mean number of drugs per individual continued to increase in Sweden 2005-2008 (V). The observed year-by-year increase in polypharmacy underlines the importance of monitoring the development of drug use in all ages. Individual-based registers studies of dispensed drugs provide high quality data and could serve as the basis for further research and also in terms of training health care personnel. It can also be used as a base for interventions and the evaluation of drug use. To enable better comparisons on drug use and its consequences, there is a need for standards concerning measurements, classification and criteria which encompass all types of medications. For clinicians, there is a need for information concerning the patient’s actual use of all different types of medications.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2010. p. 66
Series
Linnaeus University Dissertations ; 15
Keyword
drug use, multiple medication, polypharmacy, register, prevalence, therapeutic intensity, acquisition cost.
National Category
Natural Sciences
Research subject
Natural Science, Biomedical Sciences
Identifiers
urn:nbn:se:lnu:diva-2336 (URN)978-91-86491-20-8 (ISBN)
Public defence
2010-05-18, Sal N 2007, Smålandsgatan 26 B, Kalmar, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-04-09 Created: 2010-04-07 Last updated: 2017-05-30Bibliographically approved

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Hovstadius, BoÅstrand, BengtPetersson, Göran

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