A pilot study to determine the cost of pharmaceutical drug treatment for chronic conditions prescribed in relation to patients' age

Objective: To determine the age distribution of patients and the total drug cost. To establish the average cost per age group and identify factors that may influence cost. Method: A pilot study was conducted by selecting by convenience sampling a number of patients over 18 years who were registered in the Pharmacy of Your Choice scheme with a community pharmacy where the study was carried out. For each patient, type, frequency and cost of medication supplied were identified from treatment cards and from Government Health Procurement Services (GHPS). Key findings: Data was collected for 491 patients (aged between18-98 years) were 272 (55%) were females and 10% (n = 47) were institutionalised. Eight percent (n=395) were prescribed drugs for cardiovascular diseases which constituted 50% of the total drug expenditure. Daily cost per patient was one euro. Pearson correlation value (p<0.05) revealed a significant relationship between the increase in cost, unit doses and number of diseases with increasing age, between gender and different settings. Gender variation between drug categories was not significant (p>0.05). Conclusions: Cost of drug treatment is vital information that financing providers and policy makers require for the allocation of budgets. Findings suggest that populations are ageing, cost increases with age and that gender and setting influence the treatment being provided.peer-reviewe

Reference pricing for pharmaceuticals : a policy perspective

Objective: To analyse the introduction of reference pricing systems for pharmaceuticals in Malta, their effectiveness and adequacy to-date, and to propose possible improvements. Method: A study on 18 interviewees associated with pharmaceutical and economical pricing policies was performed. A literature review analysis of the local published media regarding the subject was also undertaken to confirm personal interpretations given and to bridge information gaps. Key Findings: There are two separate reference pricing systems in place; one for the private and another for the public health sector, operating via different economic mechanisms. Reasons for resorting to such systems centred around the lack of access and affordability of medicines. This situation had emanated from an inefficient business environment, lack of proper government regulation and management and an imbalance of power between medicines’ suppliers, consumers and patients. A total of 18 respondents participated in the study. Two out of the 18 respondents considered the system successful, 6 deemed it unsuccessful and 7 thought the system had limited success. Results show that reference pricing may be regarded as a fair and simple means of monitoring and comparing local medicine prices with those of other countries. Reference pricing systems do not cater for many of the problems associated with such pricing. Conclusions: Reference pricing cannot be taken out of context in an integrated pharmaceutical system. The situation must be tackled holistically to address the real issues hindering the establishment of fair prices of medicines for Maltese consumers. Policy systems should be constructed in accordance with Malta’s particular political, economic and cultural requirements in line with local and European Union (EU) legislation.peer-reviewe

Applying quality systems to computerised stock management systems

OBJECTIVES: To investigate the impact of applying quality systems to an established computerised stock management system of a local pharmaceutical wholesale dealer. METHOD: An established computerised stock management system was analysed to determine the compliance of recorded data with actual stock. A risk assessment of all the steps for each parameter was carried out and a risk management plan was established as necessary following risk evaluation. After a one-year period, the same parameters were re-evaluated using the same methodology and compared with baseline. KEY FINDINGS: All parameters showed an improvement from baseline at the end of the study. CONCLUSION: The application of quality systems to computerised stock management systems should be a mandatory requirement to ensure data reliability in line with Good Distribution Practice (GDP)1 ensuring batch traceability and reconciliation throughout the storage, distribution and recall procedures and other GDP-related activities.peer-reviewe

Cost analysis of standard operating procedures in community pharmacies

Objective: The objectives were to compile Standard Operating Procedures (SOPs) for processes undertaken in community pharmacies and to assess and compare the financial implications of implementing these SOPs. Method: Two community pharmacies of different sizes were identified using purposive sampling. Eighty hours of non-participant and participant observation were conducted in both pharmacies and 5 SOPs were compiled. The 5 SOPs compiled were: Temperature Monitoring and Control, Inward Order: Specified Drugs for Dangerous Drugs (DDA), Inward Order: Cold Chain Product, Housekeeping and Pest Control. The SOPs were psychometrically evaluated for content validity by a focus group. Readability of the SOPs was tested by means of the Gunning Fog Index. The capital, recurrent and total expenditure involved for implementing each SOP in the two pharmacies were calculated and compared. Key findings: The average Gunning Fog Index was 14.73 years. This index gives an indication of number of years of education that a person needs to be able to understand the text easily on the first reading. Total expenditure for implementing the SOPs was expected to be higher in the larger pharmacy (pharmacy B) than in the smaller pharmacy (pharmacy A). This was confirmed for 3 of the 5 SOPs compiled. Conclusion: The cost for implementing the majority of the SOPs for both pharmacies was negligible and most probably their implementation would have a minimal financial impact on the profit of pharmacy.peer-reviewe

Cost evaluation of collagenase clostridium histolyticum versus surgery for dupuytren's contracture

Objective: To evaluate whether collagenase injections would be a cost-effective alternative to surgery for Dupuytren’s contracture in Malta. Method: An average of fifty patients per year requires surgery to correct Dupuytren’s contracture in Malta. The price of collagenase injections was obtained from published pharmacoeconomic studies in Spain, United Kingdom and United States. The cost to treat multiple affected joints using collagenase injections at the different prices was compared to the costs associated with surgery in both the government and private hospital setting. A proposed price at which collagenase injections would be more costeffective than surgery to treat two affected joints in Malta was calculated. Key findings: The cost of surgery in the private hospital setting is significantly higher than that in the government hospital setting. The price of collagenase in the United States is significantly higher than in Europe. At the prices available in Europe, collagenase use in Malta would not confer significantly increased costs when treating one, two or three affected joints, both in the government and private hospital setting. Treating two affected joints rather than one affected joint does not significantly increase costs, however treating three affected joints significantly increases costs, in both hospital settings. For collagenase injections to be cost-effective in Malta, they would need to be priced at 77 Euro per vial or less. Conclusion: If all patients were to be administered the injection instead of undergoing surgery, the hospital would be able to accommodate 20 additional total knee replacements each year. With surgery costs in Malta being much less than in other European countries, there could be a possibility for Malta to attract patients from other countries. Collagenase injections would offer a less invasive treatment for the patients, and if priced at 77 Euro per vial or less, would provide a more cost-effective option to the government hospital.peer-reviewe

The financial impact of the Pharmacy of Your Choice scheme on community pharmacies

Objective: To give an insight into the financial impact of the Pharmacy Of Your Choice (POYC ) scheme on community pharmacies. Method: A time and motion study was carried out in three community pharmacies that are enrolled in the POYC scheme to provide information on the time allocated to the various activities pertaining to the scheme. Two different methods were used to calculate the costs incurred to implement the system in the three pharmacies. Key findings: The direct costs that are related to the implementation of the POYC scheme are reasonably close to the government’s remuneration. Conclusion: Expenses incurred due to the POYC scheme run into thousands of Euro every year. Consequently, the POYC scheme does not seem to be very profitable for the community pharmacies where it has been implemented. It is highly recommended that the remuneration by the government ought to be revised.peer-reviewe

Generic medicine prices and their distribution in Malta

Objectives: To analyse the composition of the private pharmaceutical retail market in Malta on the basis of the originator or generic status of available medicines and to observe the change in prices of generics and originators over time. Method: The prices of a sample (n=435) of medicines in Malta were analysed for an eight year period (2002 to 2009). The variation in price in the generic and originator segments was calculated. Thirty-one active ingredients with generics available were identified and the Average Retail Price Per Unit (ARPPU) and the Lowest Retail Price Per Unit (LRPPU) were calculated. The average discount from the originator price was calculated, per compound and also by drug class. Key Findings: The sample population contained 17.2% generic products. The mean drop in the ARPPU was of 10.87% and for the LRPPU of 21.42% for the LRPU. The average discount was 14.59% in 2002 and 37.19% in 2009. Conclusion: The number of generic medicines in Malta has increased in the last eight years, with a consequent decrease in the lowest prices available for the set of medicinal compounds.peer-reviewe

Generic medicine prices and their distribution in Malta

Objectives: To analyse the composition of the private pharmaceutical retail market in Malta on the basis of the originator or generic status of available medicines and to observe the change in prices of generics and originators over time. Method: The prices of a sample (n=435) of medicines in Malta were analysed for an eight year period (2002 to 2009). The variation in price in the generic and originator segments was calculated. Thirty-one active ingredients with generics available were identified and the Average Retail Price Per Unit (ARPPU) and the Lowest Retail Price Per Unit (LRPPU) were calculated. The average discount from the originator price was calculated, per compound and also by drug class. Key Findings: The sample population contained 17.2% generic products. The mean drop in the ARPPU was of 10.87% and for the LRPPU of 21.42% for the LRPU. The average discount was 14.59% in 2002 and 37.19% in 2009. Conclusion: The number of generic medicines in Malta has increased in the last eight years, with a consequent decrease in the lowest prices available for the set of medicinal compounds.peer-reviewe

Public perception of generic pharmaceuticals in Malta

Objective: To evaluate the perception of the Maltese general public on generic medicinal products. Method: A self-administered questionnaire was compiled and distributed to a sample of the general public. Data collected from the questionnaires was analysed using SPSS ® version 19. Key findings: Five hundred and forty four questionnaires were completed. Fifty one percent of the respondents did not know the meaning of the term ‘generic medicinal product’ and 47% of the respondents became familiar with the term through the questionnaire. Conclusion: Improved communication amongst patients and healthcare professionals on the correct meaning of generic medicinal products and their medical and financial implications is required.peer-reviewe

Reference pricing for pharmaceuticals : a policy perspective

Objective: To analyse the introduction of reference pricing systems for pharmaceuticals in Malta, their effectiveness and adequacy to-date, and to propose possible improvements. Method: A study on 18 interviewees associated with pharmaceutical and economical pricing policies was performed. A literature review analysis of the local published media regarding the subject was also undertaken to confirm personal interpretations given and to bridge information gaps. Key Findings: There are two separate reference pricing systems in place; one for the private and another for the public health sector, operating via different economic mechanisms. Reasons for resorting to such systems centred around the lack of access and affordability of medicines. This situation had emanated from an inefficient business environment, lack of proper government regulation and management and an imbalance of power between medicines’ suppliers, consumers and patients. A total of 18 respondents participated in the study. Two out of the 18 respondents considered the system successful, 6 deemed it unsuccessful and 7 thought the system had limited success. Results show that reference pricing may be regarded as a fair and simple means of monitoring and comparing local medicine prices with those of other countries. Reference pricing systems do not cater for many of the problems associated with such pricing. Conclusions: Reference pricing cannot be taken out of context in an integrated pharmaceutical system. The situation must be tackled holistically to address the real issues hindering the establishment of fair prices of medicines for Maltese consumers. Policy systems should be constructed in accordance with Malta’s particular political, economic and cultural requirements in line with local and European Union (EU) legislation.peer-reviewe