Impacts of drug reimbursement reductions on utilization and expenditures of oral antidiabetic medications in Taiwan: An interrupted time series study
Resource
Health Policy, 116(2-3), 196-205
Journal
Health Policy
Journal Volume
116
Journal Issue
2-3
Pages
196-205
Date Issued
2014
Author(s)
Hsu, Jason C.
Lu, Christine Y.
Lu, Christine Y.
Wagner, Anita K.
Chan, K. Arnold
Lai, Mei-Shu
Ross-Degnan, Dennis
Abstract
Objectives: To control increasing pharmaceutical expenditures, Taiwan's National Health Insurance has implemented a series of drug reimbursement price reductions since 2000. This study examined changes in use and expenditures of oral antidiabetic medications following the price regulation in November 2006. Methods: We obtained claims data between January 2006 and August 2007 from Taiwan's National Health Insurance Research Database. We categorized oral antidiabetic products as affected by the reimbursement reduction ("targeted") or not ("non-targeted"), by level of relative price reduction, and by manufacturer type (international vs. local manufacturers). We used an interrupted time series design and segmented regression models to estimate changes in monthly per capita prescribing rate, volume, and insurance reimbursement expenditures following the policy. Results: The majority (129/178; 72.5%) of oral antidiabetic products were targeted by this round of price reductions. There was a relative reduction of 9.5% [95%CI: -12.68, -6.32] in total expenditures at ten months post-policy compared to expected rates. For targeted products, there were 2.04% [95%CI: -4.15, 0.07] and 13.26% [95%CI: -16.64, -9.87] relative reductions in prescribing rate and expenditures, respectively, at ten months post-policy. Non-targeted products increased significantly (22% [95%CI: 10.49, 33.51] and 22.85% [95%CI: 11.69, 34.01] relative increases in prescribing rate and expenditures respectively). Larger reimbursement cuts led to greater reductions in prescribing rate, volume, and insurance reimbursement expenditures of targeted products. Prescribing rates of both targeted and non-targeted products by international manufacturers declined after the policy while rates of prescribing non-targeted products by local manufacturers increased. Conclusions: While total government expenditures for oral antidiabetic medications were contained by the policy, our results indicate that prescribing shifted at the margin from targeted to non-targeted products and from international to local products. Further research is warranted to understand how changes in medication use due to price regulation policies affect medication adherence and patient health outcomes. ? 2013 Elsevier Ireland Ltd.
Subjects
Drug reimbursement reduction; Interrupted time series; Oral hypoglycemic medications
SDGs
Other Subjects
2,4 thiazolidinedione derivative; alpha glucosidase inhibitor; biguanide derivative; dipeptidyl peptidase IV; oral antidiabetic agent; sulfonylurea derivative; antidiabetic agent; ambulatory care; article; diabetes mellitus; government; health care cost; health care policy; health care utilization; health insurance; human; major clinical study; medication compliance; national health insurance; prescription; reimbursement; time series analysis; drug cost; economics; epidemiology; organization and management; public health; reimbursement; statistics and numerical data; Taiwan; Drug Costs; Humans; Hypoglycemic Agents; Interrupted Time Series Analysis; National Health Programs; Reimbursement Mechanisms; Taiwan
Type
journal article