Impact of pharmaceutical policy interventions on utilization of antipsychotic medicines in Finland and Portugal in times of economic recession: interrupted time series analyses

Objectives: To analyze the impacts of pharmaceutical sector policies implemented to contain country spending during the economic recession – a reference price system in Finland and a mix of policies including changes in reimbursement rates, a generic promotion campaign and discounts granted to the public payer in Portugal – on utilization of, as a proxy for access to, antipsychotic medicines. Methodology We obtained monthly IMS Health sales data in standard units of antipsychotic medicines in Portugal and Finland for the period January 2007 to December 2011. We used an interrupted time series design to estimate changes in overall use and generic market shares by comparing pre-policy and post-policy levels and trends. Results: Both countries’ policy approaches were associated with slight, likely unintended, decreases in overall use of antipsychotic medicines and with increases in generic market shares of major antipsychotic products. In Finland, quetiapine and risperidone generic market shares increased substantially (estimates one year post-policy compared to before, quetiapine: 6.80% [3.92%, 9.68%]; risperidone: 11.13% [6.79%, 15.48%]. The policy interventions in Portugal resulted in a substantially increased generic market share for amisulpride (estimate one year post-policy compared to before: 22.95% [21.01%, 24.90%]; generic risperidone already dominated the market prior to the policy interventions. Conclusions: Different policy approaches to contain pharmaceutical expenditures in times of the economic recession in Finland and Portugal had intended – increased use of generics – and likely unintended – slightly decreased overall sales, possibly consistent with decreased access to needed medicines – impacts. These findings highlight the importance of monitoring and evaluating the effects of pharmaceutical policy interventions on use of medicines and health outcomes

Effect of the economic recession on pharmaceutical policy and medicine sales in eight European countries

Abstract Objective: To identify pharmaceutical policy changes during the economic recession in eight European countries and to determine whether policy measures resulted in lower sales of, and less expenditure on, pharmaceuticals. Methods: Information on pharmaceutical policy changes between 2008 and 2011 in eight European countries was obtained from publications and pharmaceutical policy databases. Data on the volume and value of the quarterly sales of products between 2006 and 2011 in the 10 highest-selling therapeutic classes in each country were obtained from a pharmaceutical market research database. We compared these indicators in economically stable countries; Austria, Estonia and Finland, to those in economically less stable countries, Greece, Ireland, Portugal, Slovakia and Spain. Findings: Economically stable countries implemented two to seven policy changes each, whereas less stable countries implemented 10 to 22 each. Of the 88 policy changes identified, 33 occurred in 2010 and 40 in 2011. They involved changing out-of-pocket payments for patients in 16 cases, price mark-up schemes in 13 and price cuts in 11. Sales volumes increased moderately in all countries except Greece and Portugal, which experienced slight declines after 2009. Sales values decreased in both groups of countries, but fell more in less stable countries. Conclusion: Less economically stable countries implemented more pharmaceutical policy changes during the recession than economically stable countries. Unexpectedly, pharmaceutical sales volumes increased in almost all countries, whereas sales values declined, especially in less stable countries

Pregnant women with suspected Zika virus infection: A claims data analysis

ObjectiveDemonstrate the value of consolidated claims data from communityhealthcare providers in Zika Virus Disease surveillance at local level.IntroductionZika virus disease and Zika virus congenital infection arenationally notifiable conditions that became prominent recently as agrowing number of travel-associated infections have been identifiedin the United States. The Centers for Disease Control and Prevention(CDC) have dedicated significant time and effort on determining andaddressing the risks and impact of Zika on pregnant women and theirbabies who are most vulnerable to the disease. CDC relies on twosources of information, reported voluntarily by healthcare providers,to monitor Zika virus disease: ArboNET and the newly establishedU.S. Zika Pregnancy Registry. A study by IMS Health compared U.S.trends of the Zika virus disease in general and pregnant women withZika virus disease in particular observed in an IMS healthcare claimsdatabase and the CDC ArboNET and the newly established U.S. ZikaPregnancy Registry.MethodsIMS used for this analysis claims for reimbursement from office-based healthcare providers, which are widely accepted standardbusiness practice records throughout the healthcare industry. IMSclaims data is collected daily from office-based providers throughoutthe U.S. and processed, stored and analyzed in a centralized database.The information is available at the patient and visit level, with theability to characterize deidentified patients by age, gender andZIP3 location and to trace a patient’s history of visits, diagnoses,procedures, drugs prescribed and tests performed or ordered.The general IMS study sample captured all patients throughout thecontinental United States covered in claims between October 1, 2016and May 24, 2016 with ICD 10 diagnosis code A92.8, Other SpecifiedMosquito-Borne Viral Fevers. This sample was compared to thesample of laboratory-confirmed Zika virus disease cases reportedto ArboNET by state or territory from the CDC Arboviral DiseaseBranch from January 1, 2015 through May 18, 2016. In addition,IMS compared the subset of patients with both a Zika virus diseasediagnosis and any ICD 10 pregnancy diagnosis to the CDC sampleof patients captured by the U.S. Zika Pregnancy Registry with anylaboratory evidence of possible Zika virus infection in the UnitedStates and territories.ResultsThroughout the continental United States, the IMS claims-basedsample captured 875 patients with a Zika virus disease diagnosiscompared to 548 travel-associated cases reported by CDC. At thestate level, especially in New York, New Jersey, Illinois and Texas,the IMS data captured a much larger number of cases that the CDCreported cases. Most of these possible Zika cases are concentratedin the large metropolitan areas around New York City, Chicagoand Houston. Many of them are diagnosed and treated by the samehealthcare providers.The IMS sample captured 577 pregnant women with a possibleZika virus infection compared to the 168 pregnant women with apossible Zika virus infection reported in the U.S. Zika PregnancyRegistry as of May 24, 2016. Many of the pregnant women in the IMSsample had multiple visits, often in consecutive months, associatedwith the Zika virus disease diagnosis. Pregnant women are morelikely to be tested and diagnosed with a Zika virus infection due tothe risk of fetal malformations from the disease. As many as 250 ofthe 577 pregnant women with a possible Zika virus infection also hada diagnosis of suspected fetal damage due to a viral disease. Of allwomen with a possible Zika virus infection in the IMS sample, 120were in New Jersey, 111 in New York, 93 in Illinois and 74 in Texas,and most were concentrated in the large metropolitan areas aroundNew York City, Chicago and Houston.ConclusionsThese findings suggest that all-payer claims data can be usedsuccesfully to monitor Zika transmission trends at local and statelevel, especially with a focus on pregnant women. Healthcare claimsdata is fast, granular, relevant at local level and can be used tosupplement CDC ArboNET data for local and state level surveillanceand response to the evolving Zika virus infection outbreak. Thisstudy is an example of a novel approach to surveillance for Zika virusdisease and potentially many other infectious diseases

Pregnant women with suspected Zika virus infection: A claims data analysis

ObjectiveDemonstrate the value of consolidated claims data from communityhealthcare providers in Zika Virus Disease surveillance at local level.IntroductionZika virus disease and Zika virus congenital infection arenationally notifiable conditions that became prominent recently as agrowing number of travel-associated infections have been identifiedin the United States. The Centers for Disease Control and Prevention(CDC) have dedicated significant time and effort on determining andaddressing the risks and impact of Zika on pregnant women and theirbabies who are most vulnerable to the disease. CDC relies on twosources of information, reported voluntarily by healthcare providers,to monitor Zika virus disease: ArboNET and the newly establishedU.S. Zika Pregnancy Registry. A study by IMS Health compared U.S.trends of the Zika virus disease in general and pregnant women withZika virus disease in particular observed in an IMS healthcare claimsdatabase and the CDC ArboNET and the newly established U.S. ZikaPregnancy Registry.MethodsIMS used for this analysis claims for reimbursement from office-based healthcare providers, which are widely accepted standardbusiness practice records throughout the healthcare industry. IMSclaims data is collected daily from office-based providers throughoutthe U.S. and processed, stored and analyzed in a centralized database.The information is available at the patient and visit level, with theability to characterize deidentified patients by age, gender andZIP3 location and to trace a patient’s history of visits, diagnoses,procedures, drugs prescribed and tests performed or ordered.The general IMS study sample captured all patients throughout thecontinental United States covered in claims between October 1, 2016and May 24, 2016 with ICD 10 diagnosis code A92.8, Other SpecifiedMosquito-Borne Viral Fevers. This sample was compared to thesample of laboratory-confirmed Zika virus disease cases reportedto ArboNET by state or territory from the CDC Arboviral DiseaseBranch from January 1, 2015 through May 18, 2016. In addition,IMS compared the subset of patients with both a Zika virus diseasediagnosis and any ICD 10 pregnancy diagnosis to the CDC sampleof patients captured by the U.S. Zika Pregnancy Registry with anylaboratory evidence of possible Zika virus infection in the UnitedStates and territories.ResultsThroughout the continental United States, the IMS claims-basedsample captured 875 patients with a Zika virus disease diagnosiscompared to 548 travel-associated cases reported by CDC. At thestate level, especially in New York, New Jersey, Illinois and Texas,the IMS data captured a much larger number of cases that the CDCreported cases. Most of these possible Zika cases are concentratedin the large metropolitan areas around New York City, Chicagoand Houston. Many of them are diagnosed and treated by the samehealthcare providers.The IMS sample captured 577 pregnant women with a possibleZika virus infection compared to the 168 pregnant women with apossible Zika virus infection reported in the U.S. Zika PregnancyRegistry as of May 24, 2016. Many of the pregnant women in the IMSsample had multiple visits, often in consecutive months, associatedwith the Zika virus disease diagnosis. Pregnant women are morelikely to be tested and diagnosed with a Zika virus infection due tothe risk of fetal malformations from the disease. As many as 250 ofthe 577 pregnant women with a possible Zika virus infection also hada diagnosis of suspected fetal damage due to a viral disease. Of allwomen with a possible Zika virus infection in the IMS sample, 120were in New Jersey, 111 in New York, 93 in Illinois and 74 in Texas,and most were concentrated in the large metropolitan areas aroundNew York City, Chicago and Houston.ConclusionsThese findings suggest that all-payer claims data can be usedsuccesfully to monitor Zika transmission trends at local and statelevel, especially with a focus on pregnant women. Healthcare claimsdata is fast, granular, relevant at local level and can be used tosupplement CDC ArboNET data for local and state level surveillanceand response to the evolving Zika virus infection outbreak. Thisstudy is an example of a novel approach to surveillance for Zika virusdisease and potentially many other infectious diseases

Using Big Healthcare Data for ILI Situational Awareness in Georgia

We describe how high-volume electronic healthcare reimbursement claims from providers' offices and retail pharmacies can be used to provide timely and accurate influenza-like illness (ILI) situational awareness at state and CBSA levels. We focused on the 2006-2010 influenza seasons and the 39 CBSAs in the State of GA. A sufficient proportion of claims for services within any 7-day service period can be accumulated from both providers' offices and retail pharmacies to generate useful CBSA-level ILI metrics, dispelling the common perception that claims data accumulate too slowly to be useful for public health decision making in sub-state geographic areas

Documenting the Missed Opportunity Period for Influenza Vaccination in Office-based Settings

Missed opportunities for influenza vaccination in office-based settings occur when patients (who are inclined to accept influenza vaccination if a provider recommends it) remain unvaccinated after a fall/winter healthcare visit. Healthcare providers can be very influential in encouraging patients to obtain influenza vaccination, but little is known in real-time during annual campaigns of how many and what type of providers are actually giving vaccinations in office settings. We propose a new metric derived from electronic healthcare claims that provides a near-real-time estimate of % of providers who are administering influenza vaccines in office-based settings

Using Big Healthcare Data for ILI Situational Awareness in Georgia

We describe how high-volume electronic healthcare reimbursement claims from providers' offices and retail pharmacies can be used to provide timely and accurate influenza-like illness (ILI) situational awareness at state and CBSA levels. We focused on the 2006-2010 influenza seasons and the 39 CBSAs in the State of GA. A sufficient proportion of claims for services within any 7-day service period can be accumulated from both providers' offices and retail pharmacies to generate useful CBSA-level ILI metrics, dispelling the common perception that claims data accumulate too slowly to be useful for public health decision making in sub-state geographic areas

Using Big Healthcare Data to Supplement Chikungunya Surveillance in the U.S.

Chikungunya is not a U.S. nationally notifiable disease and tracking travel-associated and locally acquired cases is currently dependent on voluntary reporting via ArboNET. Electronic healthcare reimbursement claims covering a large proportion of visits to providers' offices may help overcome some of the limitations of ArboNET in documenting timing, occurrence, and spread of Chikungunya in the U.S