Pharmacoepidemiology and costs of medications dispensed during pregnancy: A retrospective population‐based study

Abstract

ObjectiveTo describe the pharmacoepidemiology and costs associated with medications dispensed during pregnancy.DesignPharmacoepidemiological study and cost analysis.SettingQueensland, Australia.PopulationAll women who gave birth in Queensland between January 2013 and June 2018.MethodsWe used a whole‐of‐population linked administrative dataset, Maternity1000, to describe medications approved for public subsidy that were dispensed to 255 408 pregnant women. We describe the volume of medications dispensed and their associated costs from a Government and patient perspective.Main outcome measuresPrevalence of medication use; proportion of total dispensings; total medication costs in AUD 2020/21 ($1AUD = $0.67USD/£0.55GBP in December 2022).ResultsDuring pregnancy, 61% (95% CI 60.96–61.29%) of women were dispensed at least one medication approved for public subsidy. The mean number of items dispensed per pregnancy increased from 2.14 (95% CI 2.11–2.17) in 2013 to 2.47 (95% CI 2.44–2.51) in 2017; an increase of 15%. Furthermore, mean Government cost per dispensing increased by 41% from $21.60 (95% CI $20.99–$22.20) in 2013 to $30.44 (95% CI $29.38–$31.49) in 2017. These factors influenced the 53% increase in total Government expenditure observed for medication use during pregnancy between 2013 and 2017 ($2,834,227 versus $4,324,377); a disproportionate rise compared with the 17% rise in women's total out‐of‐pocket expenses observed over the same timeframe ($1,880,961 versus $2,204,415).ConclusionsPrevalence of medication use in pregnancy is rising and is associated with disproportionate and rapidly escalating cost implications for the Government.

Use of privacy‐preserving record linkage to examine the dispensing of pharmaceutical benefits scheme medicines to pregnant women in Western Australia

“…Use of medicine exposure information from a national prescribing scheme may imply that our results are generalizable to other Australian states. In fitting with this, results from our study were consistent with other Australian research 19 . However, it is not clear how generalizable these results are internationally.…”

“…In fitting with this, results from our study were consistent with other Australian research. 19 However, it is not clear how generalizable these results are internationally.…”

“…This is consistent with other studies in Australia and internationally using both administrative and self-reported medication use, although a wide range in prevalence has been observed. [18][19][20][21][22] In a 2011 systematic review of prescription medication use during pregnancy in developed countries, prevalence estimates ranged from 27% to 93%, 23 with the large variation between studies attributed to differences in study design, and the availability and scheduling of medications.…”

How the structural determinants of health inequities impact access to prescription medication for pregnant women in Australia: a narrative review

“…Prior research indicates >80% of women take at least one medication during pregnancy, 1 , 2 , 3 , 4 with an increasing need for medication use observed as more women enter pregnancy with chronic medical conditions and/or develop pregnancy related complications. 5 , 6 Despite increased demand, data to support safe, effective, and efficient medication use during pregnancy remains scarce. Between 2000 and 2010, only 26.7% of new drugs approved in the United States provided any human safety data for use during pregnancy, with sufficient data to determine teratogenic risk (i.e., probability of a substance causing fetal developmental abnormalities) being available for only four of those medications (2.3%).…”

The fatigue after infusion or transfusion pilot trial and feasibility study: A three‐armed randomized pilot trial of intravenous iron and blood transfusion for the treatment of postpartum anemia

“…27 In the last decade, third-generation high-single-dose IV-iron formulations have been increasingly used 28,29 as an alternative to, or alongside, RBC-T for the treatment of more severe PPA, 5 and associated with escalating healthcare costs. 30 Despite the increasing popularity of IV-iron, and Patient Blood Management recommendations supporting its use as an alternative to RBC-T for hemodynamically stable women with PPA, 27,31,32 there is a lack of evidence on the comparative safety and effectiveness of IV-iron and/or RBC-T for both woman-centered and laboratorybased outcomes (Caljé et al 2023). 33 This lack of evidence likely contributes to treatment variation.…”