An analysis of the usage of antibiotics in the private health care sector : a managed health care approach / Renier Coetzee
The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamentalrole in the effectiveness, efficiency and responsiveness of health care systems. However,health care expenditure is a great cause for concern and many nations around the worldstruggle to contain rising health care costs.Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisationreview (DUR) and disease management have emerged as control tools to ensure cost effectiveselection and use of medicine. These managed care instruments are often used to determinewhether new strategies or interventions, such as the implementation of a managed medicinereference price list, are appropriate and have "value".The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in theprivate health care sector of South Africa.The research design used in this study was retrospective, non-experimental and quantitative.The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31April 2003) from the central medicine claims database of Medschem&. Data was analysedaccording to prevalence, cost and original (innovator) or generic medicine items. For thepurpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and"others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations,quinolones, chloramphenicol and aminoglycosides.The results of the empirical investigation showed the total number of medicine items claimedduring the study period amounted to 49098736 medicine items having a total expenditure ofR7150344897.00. There was a decrease in the prevalence of original (innovator) productsduring the two-year period. The prevalence of generic products increased from 25.87% to32.47%.A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during thetwo-year period. Original antibiotics had a prevalence of 42.32%, while generic antibioticsconstituted 57.68% of all antibiotic products claimed (n = 4092495). However, original(innovator) products contributed 62.32% and generic products 37.68% to the total cost of allantibiotics claimed.It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed(n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43)for the two-year period. The average cost of beta-lactam items ranged between R112.88 *69.95 and R122.18 + 81.42.The Medschema Price List (MPL) was implemented in May 2001. The aim of this referencepricing system was to allocate a ceiling price to a group of drugs, which are similar in terms ofcomposition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicineexpenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibioticsclaimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost ofall beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursedR61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed atthe ceiling price set by the MPL, a cost saving of 2.79% could have been achieved.Cost analysis indicated that it is possible to reduce health care costs by implementing strategieswith the aim to reduce medicine cost. Further research, however, is necessary and in thisregard recommendations for further research were formulated.
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