Overheid verheugd over Uitkomst

Control of drug costs/expenditures is conceived to be of great importance in the Netherlands. The development of these costs is also dependent on regulations concerning the reimbursement system and pricing. For the Dutch situation, a law on drug prices (WGP) and a drug compensation system (GVS) were developed to control drug expenditures and to stimulate the substitution to cheaper drugs (generics). However, it has recently been suggested that this system is insufficient for these purposes. We investigated costing and substitution developments before and after patent expiry and the introduction of generics for three drugs: enalapril, fluoxetine and ranitidine. Drug use - in terms of prevalence, incidence and DDD's - was rather constant during the period or even slightly increasing. Drug costs decreased relevantly after patent expiry for all three drugs. Furthermore, a relevant substitution (up to 8o%) from patented products (specialties and parallel-imported) to generics was observed. In conclusion, decreasing drug costs for enalapril, fluoxetine and ranitidine, after patent expiry in combination with non-decreasing drug use, does not support the suggestion of insufficient control of drug expenditures with the current system

Generating Hypotheses by Discovering Implicit Associations in the Literature: A Case Report of a Search for New Potential Therapeutic Uses for Thalidomide

The availability of scientific bibliographies through online databases provides a rich source of information for scientists to support their research. However, the risk of this pervasive availability is that an individual researcher may fail to find relevant information that is outside the direct scope of interest. Following Swanson’s ABC model of disjoint but complementary structures in the biomedical literature, we have developed a discovery support tool to systematically analyze the scientific literature in order to generate novel and plausible hypotheses. In this case report, we employ the system to find potentially new target diseases for the drug thalidomide. We find solid bibliographic evidence suggesting that thalidomide might be useful for treating acute pancreatitis, chronic hepatitis C, Helicobacter pylori-induced gastritis, and myasthenia gravis. However, experimental and clinical evaluation is needed to validate these hypotheses and to assess the trade-off between therapeutic benefits and toxicities

Adherence of pharmacoeconomic studies to national guidelines in the Netherlands

Objective: This study examines the adherence of Dutch pharmacoeconomic studies to the national guidelines of conducting a pharmacoeconomic evaluation. Methods: Dutch guidelines for pharmacoeconomic research were issued in 1999. All Dutch pharmacoeconomic studies that were published in English during 2000-2002 were selected for our review. Two reviewers examined each study for relevance and compared each study with the nine methodological guidelines selected. Results: It was found that 29 studies satisfied the inclusion criteria. The societal perspective was taken in 13 out of the 29 studies (45%), an adequate time period of analysis was chosen in 21 (72%), effectiveness was explicitly differentiated from efficacy in 17 (59%), an incremental analysis was performed in 23 (79%), costs, benefits and health gains were discounted in 24 (83%), effectiveness was expressed in LYGs or QALYs in 16 (55%), reference prices were used in 8 (28%), subgroup analysis was presented in 13 (45%) and sensitivity analysis was included in 26 (90%). Conclusions: In this review we found that the adherence of studies to some of the Dutch guidelines for pharmacoeconomic studies is fair. However, major improvements are required with respect to the adoption of the societal perspective, presentation of adequate subgroup analyses and application of reference prices

Drug Costs Developments after Patent Expiry of Enalapril, Fluoxetine and Ranitidine: A Study Conducted for the Netherlands

Background: In order to increase price competition, government regulations focus on controlling drug costs. Drug costs after patent expiry are an area of particular interest because the substitution of branded medication with generics represents an opportunity for lowering drug costs. However, drug costs may not decrease after patent expiry, because of a lack of price competition and different national pricing systems. Aim: The aim of this study was to investigate the trends in the use of generics after patent expiry for enalapril, fluoxetine and ranitidine and the subsequent changes, if any, in the costs of these medications. Methods: A drug-utilisation study was performed using data from a large sample of Dutch pharmacies. Both volumes (measured as defined daily doses [DDD] per 1000 population) as well as drug costs (calculated per DDD) prior to and after patent expiry were calculated. Costs per DDD were compared using trend-line analysis. In addition, the relative market shares of the different trade channels (branded, parallel imported and generic) were compared before and after patent expiry. Results: The costs per DDD decreased for all three drugs and, as expected, these costs decrease more rapidly after patent expiry. Significant differences in the trend lines were found for enalapril and fluoxetine. Conclusions: Despite relatively high reimbursement prices for generics in the Netherlands, this example from the Dutch pharmaceutical market demonstrates the benefit of generic substitution for containing pharmaceutical costs, which contrasts with concerns raised by the Dutch government.Cost-analysis, Drug-utilisation, Enalapril, Fluoxetine, Generic-substitution, Ranitidine