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This paper investigates the effects of changes in drug therapy on drug expenditure in Sweden between 1990 and 1995. Analyses have been carried out for both the aggregate drug expenditure and for drug expenditure according to the main groups of the Anatomical Therapeutic Chemical (ATC) classification system. Changes in expenditure can be divided into 3 components: the price of drugs, the quantity of drugs consumed and a residual. The size of the residual is a measure of the effect of changes in drug treatment patterns on drug expenditure. The aggregate real drug expenditure increased by 50% between 1990 and 1995. The relative retail price index of drugs decreased by 9% and the quantity index measured in terms of defined daily doses increased by 27%. The remaining residual increased by 30%. This implies that, if the residual had been unchanged during the study period, the aggregate expenditure would have increased by only 15%. The results also show that the size of the residual varies substantially across different ATC groups. The increase in the residual was largest for drugs that affect the nervous system (ATC group N); the residual increased by 86%. From the observed changes in residual values, it can be concluded that the underlying factor responsible for the increase in drug expenditure in Sweden is changes in drug therapy from less expensive to more expensive drugs.

Ihe occurrence of pharmaceuticals in surfacewater is an mqhg p d m in dcvdoped counirics. If mdr polhdim is imnsjhd to drinking watw the d t i a g invosmtay aorr* dosc mcdiccIfion of large ppukiim pwps may cmpmnise public heuhh. k Ihc pRgmna will be evailfated by a n d aquatic life mcly be compromised. 3he stodrofphmmacarticals in regional surface hdm County Cosmcil, the provider of p&ic lvater and sewage treatment plant t$hents. In hcalthcme in the Stodahdm, Sweden ngion, thefirst dassijkution, I2 of22 antibiotics and has intrOmtced a dassijicatim of pkmmacattivirus inhibitom w m Considered to pose little d d n r g s accodiw to thcirpotmtialfaraccuris&toputrlich&viamrfacewateracmula-mulation in surfhcc water and interfcr#rct with tion ar to aqclatic ife. Detectable lev& of aquatic life. The dassification utilizes pmduce~ qI&&"S, d w -e , trimethcpim, and supplied data on bidegmdation, b i -hrt~&~~idazdc mfimnd in all sewer treatment tion, and eco-taricity. nte purpose ofthe cla98i-plant effluents investigated. In the surface water ficat'on is to inmuse the awarcn~ss of patients, samples phannacattid m*dues were observed doctors, and producers that pharmaceuticals ~occasiondy. may have side effeds outside the patient. Hence, doctors mrd patients may make a mure m U t t i --f d d i d s$cction of drug in cases where d thmp&i+equivdent alternatives tuvawihdk

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