The influences of Taiwan's generic grouping price policy on drug prices and expenditures: Evidence from analysing the consumption of the three most-used classes of cardiovascular drugs

<p>Abstract</p> <p>Background</p> <p>Controlling the growth of pharmaceutical expenditures is a major global challenge. Promotion of generic drug prescriptions or use is gaining increased support. There are substantial contextual differences in international experiences of implementing pharmaceutical policies related to generic drugs. Reporting these experiences from varied perspectives can inform future policy making. This study describes an experience of Taiwan, where patients with chronic (long-term) conditions are usually managed in hospitals and drugs are provided in this setting with costs reimbursed through the National Health Insurance (NHI). It investigates the effects of Taiwan's reimbursement rate adjustment based on chemical generic grouping in 2001. This research also demonstrates the use of micro-level longitudinal data to generate policy-relevant information. The research can be used to improve efficiency of health care resource use.</p> <p>Methods</p> <p>We chose the three most-used classes of cardiovascular drugs for this investigation: beta blocking agents, calcium channel blockers mainly with vascular effects, and plain ACE inhibitors. For each drug class, we investigated changes in daily expense, consumption volume, and total expenditures from a pre-action period to a corresponding post-action period. We compared an exposure or "intervention" group of patients targeted by the action with a comparisonor "control" group of patients not targeted by the action. The data sources are a longitudinal database for 200,000 NHI enrolees, corresponding NHI registration data of health care facilities, and an archive recording all historical data on the reimbursement rates of drugs covered by the NHI. We adopted a fixed effects linear regression model to control for unobserved heterogeneity among patient-hospital groups. Additional descriptive statistics were applied to examine whether any inappropriate consumption of drugs in the three classes existed.</p> <p>Results</p> <p>The daily drug expense significantly decreased from the pre-action period to the post-action period for the exposure group. The average magnitudes of the decreases for the three classes of drugs mentioned above were 14.8%, 5.8% and 5.8%, respectively. In contrast, there was no reduction for the comparison group. The number of days of the prescription increased significantly from the pre- to the post-action period for both exposure and comparison groups. The total expense also significantly increased for both patient groups. For the exposure group, the average magnitudes of the growth in the total expenditure for the three classes of drugs were 47.7%, 60.0% and 55.3%, respectively. For the comparison group, they were 91.6%, 91.6% and 63.2%, respectively. After the action, approximately 50% of patients obtained more than 180 days of prescription drugs for a six-month period.</p> <p>Conclusion</p> <p>The 2001 price adjustment action, based on generic grouping, significantly reduced the daily expense of each of the three classes of cardiovascular drugs. However, in response to this policy change, hospitals in Taiwan tended to greatly expand the volume of drugs prescribed for their regular patients. Consequently, the total expenditures for the three classes of drugs grew substantially after the action. These knock-on effects weakened the capability of the price adjustment action to control total pharmaceutical expenditures. This means that no saved resources were available for other health care uses. Such expansion of pharmaceutical consumption might also lead to inefficient use of the three drug classes: a large proportion of patients obtained more than one day of drugs per day in the post-action period, suggesting manipulation to increase reimbursement and offset price controls. We recommend that Taiwan's government use the NHI data to establish a monitoring system to detect inappropriate prescription patterns before implementing future policy changes. Such a monitoring system could then be used to deter hospitals from abusing their prescription volumes, making it possible to more effectively save health care resources by reducing drug reimbursement rates.</p

An integrated assessment of INDCs under Shared Socioeconomic Pathways: an implementation of C(3)IAM

A series of global actions have been made to address climate change. As a recent developed climate policy, Intended Nationally Determined Contributions (INDC) have renewed attention to the importance of exploring temperature rise levels lower than 2 °C, in particular a long-term limit of 1.5 °C, compared to the preindustrial level. Nonetheless, achieving the 2 °C target under the current INDCs depends on dynamic socioeconomic development pathways. Therefore, this study conducts an integrated assessment of INDCs by taking into account different Shared Socioeconomic Pathways (SSPs). To that end, the CEEP-BIT research community develops the China’s Climate Change Integrated Assessment Model (C3IAM) to assess the climate change under SSPs in the context of with and without INDCs. Three SSPs, including “a green growth strategy” (SSP1), “a more middle-of-the-road development pattern” (SSP2) and “further fragmentation between regions” (SSP3) form the focus of this study. Results show that after considering INDCs, mitigation costs become very low and they have no evident positive changes in three SSPs. In 2100, a temperature rise would occur in SSP1-3, which is 3.20, 3.48 and 3.59 °C, respectively. There are long-term difficulties to keep warming well below 2 °C and pursue efforts toward 1.5 °C target even under INDCs. A drastic reduction in greenhouse gas emissions is needed in order to mitigate potentially catastrophic climate change impacts. This work contributes on realizing the hard link between the earth and socioeconomic systems, as well as extending the economic models by coupling the global CGE model with the economic optimum growth model. In C3IAM, China’s energy consumption and emissions pattern are investigated and refined. This study can provide policy makers and the public a better understanding about pathways through which different scenarios could unfold toward 2100, highlights the real mitigation and adaption challenges faced by climate change and can lead to formulating effective policies

An Updated Search of Steady TeV γ−\gamma-Ray Point Sources in Northern Hemisphere Using the Tibet Air Shower Array

Using the data taken from Tibet II High Density (HD) Array (1997 February-1999 September) and Tibet-III array (1999 November-2005 November), our previous northern sky survey for TeV $\gamma-$ray point sources has now been updated by a factor of 2.8 improved statistics. From $0.0^{\circ}$ to $60.0^{\circ}$ in declination (Dec) range, no new TeV $\gamma-$ray point sources with sufficiently high significance were identified while the well-known Crab Nebula and Mrk421 remain to be the brightest TeV $\gamma-$ray sources within the field of view of the Tibet air shower array. Based on the currently available data and at the 90% confidence level (C.L.), the flux upper limits for different power law index assumption are re-derived, which are approximately improved by 1.7 times as compared with our previous reported limits.Comment: This paper has been accepted by hepn

Search for psi(3770)\ra\rho\pi at the BESII detector at the Beijing Electron-Positron Collider

Non-$D\bar{D}$ decay \psppto \rhopi is searched for using a data sample of $(17.3\pm 0.5) pb^{-1}$ taken at the center-of-mass energy of 3.773 GeV by the BESII detector at the BEPC. No \rhopi signal is observed, and the upper limit of the cross section is measured to be \sigma(\EETO \rhopi)<6.0 pb at 90% C. L. Considering the interference between the continuum amplitude and the \pspp resonance amplitude, the branching fraction of \pspp decays to $\rho\pi$ is determined to be \BR(\pspp\ra\rho\pi)\in(6.0\times10^{-6}, 2.4\times10^{-3}) at 90% C. L. This is in agreement with the prediction of the $S$- and $D$-wave mixing scheme of the charmonium states for solving the ``\rhopi puzzle'' between \jpsi and \psp decays.Comment: 15 pages, 5 figure

Measurement of the cross section for e^+e^- -> ppbar at center-of-mass energies from 2.0 to 3.07 GeV

Cross sections for e^+e^- -> ppbar have been measured at 10 center-of-mass energies from 2.0 to 3.07 GeV by the BESII experiment at the BEPC, and proton electromagnetic form factors in the time-like region have been determined.Comment: 6 pages, 3 figure

Partial Wave Analysis of χc0→π+π−K+K−\chi_{c0}\to\pi^+\pi^-K^+K^-

A partial wave analysis of $\chi_{c0}\to\pi^+\pi^-K^+K^-$ in $\psi(2S)\to\gamma\chi_{c0}$ decay is presented using a sample of 14 million $\psi(2S)$ events accumulated by the BES II detector. The data are fitted to the sum of relativistic covariant tensor amplitudes for intermediate resonant decay modes. From the fit, significant contributions to $\chi_{c0}$ decays from the channels $f_0(980)f_0(980)$, $f_0(980)f_0(2200)$, $f_0(1370)f_0(1710)$, $K^*(892)^0\bar K^*(892)^0$, $K^*_0(1430)\bar K^*_0(1430)$, $K^*_0(1430)\bar K^*_2(1430) + c.c.$, and $K_1(1270)K$ are found. Flavor-SU(3)-violating $K_1(1270)-K_1(1400)$ asymmetry is observed. Values obtained for the masses and widths of the resonances $f_0(1710)$, $f_0(2200)$, $f_0(1370)$, and $K^*_0(1430)$ are presented.Comment: 16 pages, 9 figures, and 4 table

Measurements of the continuum RudsR_{\rm uds} and RR values in e+e−e^+e^- annihilation in the energy region between 3.650 and 3.872 GeV

We report measurents of the continuum $R_{\rm uds}$ near the center-of-mass energy of 3.70 GeV, the $R_{{\rm uds(c)}+\psi(3770)}(s)$ and the $R_{\rm had}(s)$ values in $e^+e^-$ annihilation at 68 energy points in the energy region between 3.650 and 3.872 GeV with the BES-II detector at the BEPC Collodier. We obtain the $R_{\rm uds}$ for the continuum light hadron (containing u, d and s quarks) production near the $D\bar D$ threshold to be $R_{\rm uds}=2.141 \pm 0.025 \pm 0.085$.Comment: 5 pages, 3 figure

Measurements of the braching fractions for psi(3770)--> D0D0-bar,D+D-,DD-bar$ and the resonance parameters of psi(3770) and psi(2S)

We report measurements of the branching fractions for $\psi(3770)\to D^0 \bar D^0, D^+D^-, D\bar D$ and resonance parameters of $\psi(3770)$ and $\psi(2S)$. By analyzing the line-shapes of the cross sections for inclusive hadron, $D^0 \bar D^0$ and $D^+D^-$ event production in the range from 3.660 GeV to 3.872 GeV covering both $\psi(2S)$ and $\psi(3770)$ resonances, we extract the branching fractions for $\psi(3770)$ decay into $D^0\bar D^0 {\rm and} D^+D^-$ respectively to be $B(\psi(3770)\to D^0 \bar D^0)=(46.7 \pm 4.7 \pm 2.3)$ and $B(\psi(3770)\to D^+ D^-)=(36.9 \pm 3.7 \pm 2.8)$, which give $B(\psi(3770)\to D \bar D)=(83.6 \pm 7.3 \pm 4.2)$ and non-$D\bar D$ branching fraction of $\psi(3770)$ to be $B(\psi(3770)\to non-D \bar D)=(16.4 \pm 7.3 \pm 4.2)$. We meanwhile obtain the resonance parameters of $\psi(3770)$ and $\psi(2S)$ to be $M_{\psi(3770)}=3772.2 \pm 0.7 \pm 0.3$ MeV, $\Gamma^{\rm tot}_{\psi(3770)}=26.9 \pm 2.4 \pm 0.3$ MeV and $\Gamma^{ee}_{\psi(3770)}=251 \pm 26 \pm 11$ eV; $M_{\psi(2S)}=3685.5 \pm 0.0 \pm 0.3$ MeV, $\Gamma^{\rm tot}_{\psi(2S)}=331 \pm 58 \pm 2$ keV and $\Gamma^{ee}_{\psi(2S)}=2.330 \pm 0.036 \pm 0.110$ keV; as well as the $R$ value for the light hadron production directly through one photon annihilation to be $R_{uds}=2.262\pm 0.054\pm 0.109$ in this energy region.Comment: 7 pages, 4 figure

Experimental study of ψ(2S)\psi(2S) decays to \K^+ K^- \pi^+ \pi^- \pi^0 final states

$K^+K^-\pi^+\pi^-\pi^0$ final states are studied using a sample of $14\times10^6$ $\psi(2S)$ decays collected with the Beijing Spectrometer (BESII) at the Beijing Electron-Position Collider. The branching fractions of $\psi(2S)$ decays to $K^+K^-\pi^+\pi^-\pi^0$, $\omega K^+ K^-$, $\omega f_0(1710)$, $K^{\ast}(892)^0 K^- \pi^+\pi^0+c.c.$, $K^{\ast}(892)^{+} K^- \pi^+\pi^- +c.c.$, $K^{\ast}(892)^{+} K^- \rho^0+c.c.$ and $K^{\ast}(892)^0 K^-\rho^+ + c.c.$ are determined. The first two agree with previous measurements, and the last five are first measurements.Comment: 19 pages, 9 figure