Effect of reimbursement restriction policy on the use of benzodiazepines in the Netherlands: an interrupted time series analysis

Abstract

ObjectivesUse of benzodiazepines has health risks. Reimbursement was restricted in the Netherlands from January 2009 onwards with the goal to reduce chronic use and healthcare expenditures. The aim of this study is to assess the initial and long-term effects of this policy on benzodiazepine use.DesignInterrupted time series analysis, segmented regression models, Kaplan-Meier survival analysis and Cox proportional hazards analysis.SettingA 10% random sample of benzodiazepine dispensings by outpatient pharmacies between January 2002 and August 2015 were obtained from the PHARMO database. This database covered a catchment area representing about 3.6 million residents in 2015.Participants2 500 800 benzodiazepine prescriptions from 128 603 patients were included.InterventionReimbursement restriction policy from January 2009 onwards.Outcome measuresChanges in: the volume of dispensed prescriptions and doses, the incidence, prevalence of incidental, regular and chronic use and discontinuation rates of benzodiazepines.ResultsThe volume of dispensed prescriptions and doses decreased by 12.5% (95% CI 9.0% to 15.9%) and 15.1% (95% CI 11.4% to 17.3%) respectively in January 2009 compared with December 2008. A clear initial effect on the overall incidence (−14.7%; 95% CI −19.8% to 9.6%) and the prevalence of incidental (−17.8%; 95% CI −23.9% to 11.7%), regular (−20.0%; 95% CI −26.1% to 13.9%) and chronic (−16.0%; 95% CI −23.1% to 8.9%) use was observed. A statistically significant reduction in the monthly trend per 1000 medication users was observed for the overall incidence (−0.017; 95% CI −0.031 to 0.003) and the prevalence of incidental (−3.624; 95% CI −4.996 to 2.252) but not for regular (−0.304; 95% CI −1.204 to 0.596) and chronic (0.136; 95% CI −0.858 to 1.130) use. Patients who started treatment before policy had a slightly higher probability of discontinuation (HR=1.013; 95% CI 1.004 to 1.022).ConclusionsThe reimbursement policy had a significant initial effect on the volume, incidence and prevalence of benzodiazepine use. In addition, there is a statistically significant reduction in the monthly trend of overall incidence and of the prevalence of incidental use. No statistically significant reduction in the monthly trend of chronic use, the main purpose of the reimbursement restriction, could be demonstrated.

Optimising the secondary use of primary care prescribing data to improve quality of care: a qualitative analysis

“…Datasets which can be combined and supplemented with other information are available, specifically: the Institute for Drug Outcomes Research Database,39 Nivel Primary Care Database15 35 40 and various research-specific datasets of academic networks of GPs (eg, Registration Network Groningen41). These datasets have the advantage of more complete information (diagnosis and dispensed medicines) though are limited to the voluntary participation GP practices.…”

Effectiveness of peer‐supervision on pediatric fever illness treatment among registered private drug sellers in East‐Central Uganda: An interrupted time series analysis

“…30 In addition, we wanted to cater for policy shifts if they occurred during the study period-a major strength of using interrupted time series. 31 Consideration was made in using interrupted time series since the study had six data points before and six data points after introduction of peer supervision, which are considered a minimum for reliable results. 32,33 The mean with the corresponding SD and the median number of visits by DDIs and peer supervisors was computed.…”

“…The ITSA method was the preferred choice for this study because it was not possible to randomize peer supervision (the intervention) 30 . In addition, we wanted to cater for policy shifts if they occurred during the study period‐a major strength of using interrupted time series 31 . Consideration was made in using interrupted time series since the study had six data points before and six data points after introduction of peer supervision, which are considered a minimum for reliable results 32,33 …”

Effectiveness of Peer-Supervision on Paediatric Fever Treatment Among Registered Private Drug Sellers in East-Central Uganda: An Interrupted Time Series Analysis

“…The ITSA method was the preferred choice for this this study because it was not possible to randomise peer supervision (the intervention) [30]. In addition we wanted to cater for policy shifts if they occurred during the study period-a major strength of using interrupted time series [31]. Consideration was made in using interrupted time series since the study had six data points before and six data points after introduction of peer supervision which are considered a minimum for reliable results [32,33].…”