Antidepressant utilization in primary care in a Spanish region

Úbeda, Amalia; Cardo, Encarna; Sellés, Noelia; Broseta, Rocio; Trillo, J.L.; Fernández-Llimós, Fernando

doi:10.1007/s00127-006-0149-9

Cited by 19 publications

(11 citation statements)

References 22 publications

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“…In fact, by inducing some patients to switch from their The literature seems to provide heterogeneous evidence on the effects of RP on the prices of drugs covered by the policy. Of the 22 studies addressing the effects of RP on prices, 14 found a decrease in drug prices under RP, [7,12,13,15,17,[27][28][29][30]32,[34][35][36][37] Belgium (GRP) Ambiguous [23] Value of RP for generic drugs reduced from 84% to 74% of prices of original drugs 2 y after introduction [23] Canada (TRP) No change [18,[24][25][26] Decrease [15,17,[27][28][29] Larger reductions for high-priced drugs. In the case of NSAIDs, no reduction of prices under GRP, while significant drop of prices under TRP [28] After GRP, small but sustained decrease in the prices of fully reimbursed drugs used to set RP.…”

Section: Pricesmentioning

confidence: 99%

“…[13] Value of RP decreased five times in a decade [13] Significant increase in prices of drugs not under RP [13,30] Hungary (TRP) Ambiguous [31] Only off-patent drugs already facing generic competition reduced prices Italy (GRP) Decrease [32] Reduction of prices larger for drugs with more generic competitors. Only drugs already facing generic competition reduced prices Norway (GRP) Decrease [7] Brand-named drugs reduced prices more than generics South Africa (GRP) Ambiguous [33] Prices increased, but inflation was lower after introduction of RP Spain (GRP) Decrease [34] Ambiguous [14] Only drugs with original prices above RP reduced prices to RP values. Prices of new generic entrants are lower after RP than before…”

Section: Pricesmentioning

confidence: 99%

“…[14,30,37] Second, the savings, although relevant at the level of chemical molecules, are not always significant in the context of the pharmaceutical expenditure as a whole. [14,34] The effect of RP on the demand for pharmaceuticals should also be evaluated within the regulatory framework. With regard to TRP systems, no real effect on the overall number of prescriptions in a therapeutic group can be expected ex ante.…”

Section: Quantities and Expendituresmentioning

confidence: 99%

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Effects of Reference Pricing in Pharmaceutical Markets

2011

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This work aims to provide a systematic and updated survey of original scientific studies on the effect of the introduction of reference pricing (RP) policies in Organisation for Economic Co-operation and Development (OECD) countries. We searched PubMed, EconLit and Web of Knowledge for articles on RP. We reviewed studies that met the inclusion criteria established in the search strategy. From a total of 468 references, we selected the 35 that met all of the inclusion criteria. Some common themes emerged in the literature. The first was that RP was generally associated with a decrease in the prices of the drugs subject to the policy. In particular, price drops seem to have been experienced in virtually every country that implemented a generic RP (GRP) policy. A GRP policy applies only to products with expired patents and generic competition, and clusters drugs according to chemical equivalence (same form and active compound). More significant price decreases were observed in the sub-markets in which drugs were already facing generic competition prior to RP. Price drops varied widely according to the amount of generic competition and industrial strategies: brand-named drugs originally priced above RP values decreased their prices to a greater extent. A second common theme was that both therapeutic RP (TRP) and GRP have been associated with significant and consistent savings in the first years of application. A third general result is that generic market shares significantly increased whenever the firms producing brand-named drugs did not adopt one of the following strategies: lowering prices to RP values; launching new dosages and/or formulations; or marketing substitute drugs still under patent protection. Finally, concerning TRP, although more evidence is needed, studies based on a large number of patient-level observations showed no association between the RP policy and health outcomes.

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Section: Pricesmentioning

confidence: 99%

Section: Pricesmentioning

confidence: 99%

Section: Quantities and Expendituresmentioning

confidence: 99%

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Effects of Reference Pricing in Pharmaceutical Markets

2011

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“…Evidence shows that generics have contributed to increased utilization of medicines [101,110]. In contrast to other policies described above, generics polices describe an area for which evidence on their effectiveness to ensure affordable access is available.…”

Section: Generic Policiesmentioning

confidence: 99%

How Can Pricing and Reimbursement Policies Improve Affordable Access to Medicines? Lessons Learned from European Countries

Vogler

Paris

Ferrario

et al. 2017

Appl Health Econ Health Policy

147

118

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Key points for Decision Makers: European countries apply different pharmaceutical pricing and reimbursement policies. These policies are frequently assessed against their financial consequences and their ability to contain costs but less so in terms of access to medicines. Policies should be accompanied by regular evaluations, facilitated by the use of the appropriate methodology and access to the relevant data. There appears to be a need for additional changes beyond traditional pharmaceutical pricing and reimbursement policies. Collaborative approaches (e.g. between countries or between regulatory authorities, pricing and reimbursement agencies) and more transparency in terms of real medicine prices, R+D costs and medicines in the pipeline are considered as possible pathways for the future. AbstractThe paper discusses pharmaceutical pricing and reimbursement policies in European countries with regard to their ability to ensure affordable access to medicines. A frequently applied pricing policy is external price referencing. While it provides some benchmark for policy-makers and has shown to be able to generate savings, it may also contribute to delay in product launch in countries where medicine prices are low. Value-based pricing has been proposed as a policy that promotes access while rewarding useful innovation, however implementing it has proven quite challenging. For high-priced medicines, managed-entry agreements are increasingly used. These agreements allow policy-makers to manage uncertainty and obtain lower prices. They can also facilitate earlier market access in case of limited evidence about added therapeutic value of the medicine. However, these agreements raise transparency concerns due to the confidentiality clause. Tendering as used in the 2 hospital and offpatent outpatient sectors has proven to reduce medicine prices but it requires a robust framework and appropriate design with clear strategic goals in order to prevent shortages. These pricing and reimbursement policies are supplemented by the widespread use of Health Technology Assessment to inform decision-making, and by strategies to improve the uptake of generics, and also biosimilars. While European countries have been implementing a set of policy options, there is a lack of thorough impact assessments of several pricing and reimbursement policies on affordable access. Increased cooperation between authorities, experience sharing, and improving transparency on price information, including the disclosure of confidential discounts, are opportunities to address current challenges.3

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“…SSRI is the most commonly utilized group among antidepressant drugs, and fluoxetine is the most common to be prescribed among (Ubeda et al, 2007;Mohanta et al, 2008). Neuromuscular blockers are used during surgical procedures, mechanical ventilation in the intensive care unit and during electroconvulsive therapy (ECT) to produce muscle relaxation.…”

Section: Introductionmentioning

confidence: 99%

Neuromuscular blocking effect of fluoxetine and its interaction with rocuronium

Patel

Barvaliya

Patel³

et al. 2013

Auton Autocoid Pharmacol

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As selective serotonin reuptake inhibitors have an inhibitory effect on nicotinic acetylcholine receptors, they may affect the neuromuscular transmission and interact with neuromuscular blockers. This study was designed to observe the effect of fluoxetine on neuromuscular transmission and its interaction with rocuronium using the rat phrenic nerve hemidiaphragm and rabbit head drop methods. Rat phrenic nerve hemidiaphragms were mounted and stimulated using a train of four pulses (TOF). The effect of fluoxetine was studied on both indirectly and directly stimulated basal twitch responses by plotting cumulative dose response curves (DRCs). DRCs of rocuronium were obtained in the absence, and presence of 5 μm and 20 μm fluoxetine to study its interaction. ED5 , ED50 and ED95 values of rocuronium DRCs in absence and presence of fluoxetine were calculated. Fluoxetine significantly inhibited twitch responses in both indirect and directly stimulated preparations. Fluoxetine (20 μm) caused an increase in the potency of rocuronium such that the ED50 and ED95 values of rocuronium DRCs were significantly decreased. Partially inhibited twitch responses by fluoxetine (100 μm) were not reversed by neostigmine (3.3 μm) or 3,4 diaminopyridine (0.25 μm). Rabbits were given fluoxetine 0.25 mg kg(-1) and 1 mg kg(-1) orally for 15 days, and on 15th day, rocuronium infusion was given, and time for head drop was recorded. The time of head drop was significantly reduced in fluoxetine pretreated as compared to control group. Fluoxetine blocks the neuromuscular transmission and increases the potency of rocuronium-induced neuromuscular block.

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Antidepressant utilization in primary care in a Spanish region

Cited by 19 publications

References 22 publications

Effects of Reference Pricing in Pharmaceutical Markets

Effects of Reference Pricing in Pharmaceutical Markets

How Can Pricing and Reimbursement Policies Improve Affordable Access to Medicines? Lessons Learned from European Countries

Neuromuscular blocking effect of fluoxetine and its interaction with rocuronium

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