Impact of regional copayment policy on selective serotonin reuptake inhibitor (SSRI) consumption and expenditure in Italy

Damiani, Gianfranco; Federico, Bruno; Silvestrini, Giulia; Bianchi, Cristina; Anselmi, Angela; Iodice, Lanfranco; Ronconi, Alessandra; Navarra, Pierluigi; Da, Roberto; Raschetti, Roberto; Ricciardi, Walter

doi:10.1007/s00228-012-1422-3

Cited by 8 publications

(5 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regional differences were also observed in Italy, with a lower percentage of females receiving a prescription for an SSRI in Emilia Romagna than in Tuscany; however, this appears to be in line with regional SSRI prescribing differences observed for the general population. 45 The popularity of paroxetine in Italy and the Netherlands and the absence of a reduction in its prescribing over the study period are surprising, given the number of studies that have demonstrated an increase in the risk of congenital heart defects associated with paroxetine exposure during the early stages of pregnancy. 9,12,46 In the Netherlands, new guidelines on the prescribing of SSRIs during pregnancy were issued in 2012, after the end of our study period; these do not specify a preferred SSRI, but do recommend that, if paroxetine is taken during the periconceptional period, the dose should not exceed 20 mg/day.…”

Section: Discussionmentioning

confidence: 99%

Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population‐based study in six European regions

Charlton

Jordan

Pierini

et al. 2014

BJOG

103

View full text Add to dashboard Cite

Objective To explore the prescribing patterns of selective serotonin reuptake inhibitors (SSRIs) before, during and after pregnancy in six European population-based databases.Design Descriptive drug utilisation study.Setting Six electronic healthcare databases in Denmark, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK.Population All women with a pregnancy ending in a live or stillbirth starting and ending between 2004 and 2010.Methods A common protocol was implemented across databases to identify SSRI prescriptions issued (UK) or dispensed (non-UK) in the year before, during or in the year following pregnancy.Main outcome measures The percentage of deliveries in which the woman received an SSRI prescription in the year before, during or in the year following pregnancy. We also compared the choice of SSRIs and changes in prescribing over the study period.Results In total, 721 632 women and 862 943 deliveries were identified. In the year preceding pregnancy, the prevalence of SSRI prescribing was highest in Wales [9.6%; 95% confidence interval (CI 95 ), 9.4-9.8%] and lowest in Emilia Romagna (3.3%; CI 95 , 3.2-3.4%). During pregnancy, SSRI prescribing had dropped to between 1.2% (CI 95 , 1.1-1.3%) in Emilia Romagna and 4.5% (CI 95 , 4.3-4.6%) in Wales. The higher UK prepregnancy prescribing rates resulted in higher first trimester exposures. After pregnancy, SSRI prescribing increased most rapidly in the UK. Paroxetine was more commonly prescribed in the Netherlands and Italian regions than in Denmark and the UK.Conclusions The higher SSRI prescribing rates in the UK, compared with other European regions, raise questions about differences in the prevalence and severity of depression and its management in pregnancy across Europe.

show abstract

Section: Discussionmentioning

confidence: 99%

Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population‐based study in six European regions

Charlton

Jordan

Pierini

et al. 2014

BJOG

103

View full text Add to dashboard Cite

show abstract

“…The data are weighted by gender and age, allowing us to overcome differences in the demographic structure among regions. Furthermore, the interrupted time series regression analysis allowed us to obtain more valid estimates of the impact of co-payment and national reimbursement criteria on the utilization of statins compared to a pre-post design [1,34,46]. …”

Section: Discussionmentioning

confidence: 99%

The impact of Regional co-payment and National reimbursement criteria on statins use in Italy: an interrupted time-series analysis

Damiani

Federico

Anselmi

et al. 2014

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

BackgroundStatins are among the most commonly prescribed drugs worldwide in the prevention of cardiovascular diseases and their effectiveness is largely acknowledged. The consumption of statins increased four-fold during the 2000–2010 decade in Italy and national and regional control policies were developed. Restrictions to reimbursement were fixed at the national level, whereas co-payment was introduced in some, but not all, regions. The aim of the present study is to assess the impact of such policies on the consumption of statins in Italy between 2001–2007 among outpatients.MethodsThe statin use was measured in terms of defined daily doses per 1,000 inhabitants per day (DDD/1000 inh. day) from May 2001 to December 2007. The study was conducted in 17 out of 21 regions, nine of which had implemented a co-payment policy. Time trends in consumption before and after the introduction of co-payment policies and reimbursement criteria were examined using segmented regression analysis of interrupted time-series, adjusting for seasonal components.ResultsThe consumption of statins increased by 22.9 DDD/1000 inh. day in May 2001 to 54.7 DDD/1000 inh. day in December 2007. On average, there was a 1.7% increase in statin use each month before the national guideline changed while the increase was about 0.5% afterwards. The revision of the reimbursement criteria was associated with a significant decrease in level (coefficient = −2.80, 95% CI −3.70 to −1.90 p-value <0.001) and trend (coefficient = −0.33, 95% CI −0.37 to −0.29 p-value <0.001). The introduction of co-payment was associated with a significant change in trend of consumption so that the overall use of the drug increased by 0.04 (95% CI 0.02 to 0.07, p-value < 0.001) DDD/1000 inh. day per month in the post-intervention period, but there was no evidence of a change in level of consumption (p-value = 0.163).ConclusionsConsumption of statins in Italy increased almost three-fold during the study period. The restriction to reimbursement Interventions was associated with an immediate drop and a decrease in trend of statin use, while the regional copayment was associated with a small increase in trend of statin use.

show abstract

“…In the last 20 years, pharmaceutical policies have been mostly driven by the cost-containment imperative. Therefore, a primary research target has been the impact of pharmaceutical policies on public expenditures [ 1 – 5 ], prices [ 3 , 6 , 7 ] and demand/quantities [ 4 , 5 , 8 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Literature on the impact of pharmaceutical policies has some limitations. First, most studies focused either on a single therapeutic class [ 8 , 10 – 12 ] or on the effects of a single policy [ 1 , 3 , 9 ]. Second, the simultaneous impact of different policies [ 11 ] and their effects over time [ 2 ] have not been investigated.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, despite evidence that pharmaceutical policies impact more than one variable, little is known about how these effects are interdependent, such as how much the reduction in public expenditures is caused by a fall in the demand for pharmaceuticals. The literature has investigated the effects of reference pricing [ 2 , 7 , 13 , 14 ] and copayment [ 5 , 11 , 12 , 15 ]. However, research has not considered regional policies together with the combined effects of different policies over time.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The simultaneous effects of pharmaceutical policies from payers’ and patients’ perspectives: Italy as a case study

2015

View full text Add to dashboard Cite

ObjectivesThis paper aims at covering a literature gap on the effects of copayments, prescription quotas and therapeutic reference pricing on public and private expenditures and volumes (1) When these policies are implemented in different areas at different times, (2) estimating their impact in the short and long run, (3) assessing the extent to which these impacts are interdependent, (4) scrutinising the extent to which the effects are mediated by prescribers’ and patients’ behaviours.MethodsMonthly regional data on pharmaceutical expenditures, volumes and policies in Italy from 2000 to 2014 are analysed using a difference-in-differences model enriched to capture short- versus long-term effects and simultaneous and interactive effects. Sobel–Goodman test and bootstrap analyses were used to test for mediation.ResultsThe three policies have different short- and long-run effects. Interactions support the hypothesis of reinforcing effects. Behavioural reactions to policies such as reducing the demand or total per capita expenditures mediate the impact of policies, thus explaining the different effects between the short and long term.ConclusionsEvidence on the impact over time of regional policies diversely introduced in different times have important policy implications. First, pharmaceutical policies interact with each other, and the combined effect may be different from what we would expect from the sum of each single policy. Hence, policymakers should be very careful in designing mixed policies for their unexpected combined effects. Second, the impact of policies tends to reduce over time. If longer-term impact is desired, it would be appropriate to introduce some adjustments over time. Third, policies have multiple effects, and this should be considered when they are designed. Finally, pharmaceutical policies may have an unintended impact on health and health care.

show abstract

Impact of regional copayment policy on selective serotonin reuptake inhibitor (SSRI) consumption and expenditure in Italy

Abstract: The implementation of copayment policies in Italy affected both the use and expenditure of SSRIs between 2001 and 2007 to only to a minor extent.

Cited by 8 publications

References 24 publications

Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population‐based study in six European regions

Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population‐based study in six European regions

The impact of Regional co-payment and National reimbursement criteria on statins use in Italy: an interrupted time-series analysis

The simultaneous effects of pharmaceutical policies from payers’ and patients’ perspectives: Italy as a case study

Contact Info

Product

Resources

About