Kockaya, G.

Ufuktepe, B.

Value in Health

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PHP45 Health Transformation Program Impact on Import and Local Pharmaceutical Consumption in Turkey 

 VA L U E  I N  H E A LT H  1 6  ( 2 0 1 3 )  A 3 2 3 – A 6 3 6  A461
the 646 records found, 108 studies met the inclusion criteria (29 cost-effectiveness 
studies (CES) and 81 systematic reviews on effectiveness (SRE)). The majority of 
CES addressed adherence (55%), followed by inappropriate prescribing (31%) and 
prescribing errors (28%). No studies addressed the full medicines pathway. A simi-
lar picture emerged for SRE at 67%, 15 and 11 respectively. Among the 15 types of 
outcomes used in CES, the top three were clinical (31%) measures of adherence 
(21%) and quality-adjusted life years (17%). In SRE, hospitalisations (43%), measures 
of adherence (23%) and mortality (21%) were the most frequent. ConClusions: 
Interventions to improve suboptimal use of medicines tend to be specific to a par-
ticular aspect of the pathway and/or to a particular disease area. Little considera-
tion is made on how to improve medicines use in patients with co-morbidities and 
poly-medication. The medicines pathway is rarely examined holistically but in a 
fragmented manner, making it difficult to draw conclusions on which aspect of 
suboptimal use of medicines should be prioritised for investment.
PHP48
THe effecT of Reduced oR Removed coPaymenTs foR PRescRiPTion 
medicines on adHeRence – a sysTemaTic Review
Sinnott S.J., Sinnott C.M., Whelton H.
University College Cork, Cork, Ireland
objeCtives: To examine the effect of removal or reduction in prescription copay-
ments, in the absence of disease management plans, on adherence to prescription 
medications. Methods: Six electronic databases were systematically searched 
for relevant articles, along with hand searches of references in review articles and 
the included studies. Studies were included if they involved an intervention which 
reduced or removed copayments and if the outcome was objectively measured 
adherence. Study designs permitted were randomised controlled trials, time series 
analyses, controlled before/after studies and cohort studies. Studies were excluded 
if the intervention was part of a disease management plan. Study exclusion, data 
extraction and quality appraisal were carried out by two independent reviewers. 
Data were qualitatively synthesised. Results: Nine out of 40 studies were included. 
One study was an RCT; the remainder were all controlled before/after studies. 
There were 144,991 cases and 125,057 controls in this review. The mean age was 
54.39yrs and 55.21yrs for the cases and controls respectively. 44.79% of the cases 
were female, whereas 49.54% of the controls were female. Four studies analysed the 
effect of reduced copayment, 4 studies analysed the effect of a removed copayment 
and 1 study analysed both. Only one study received a strong quality assessment, 
one study was rated as moderate, and the remainder were rated as weak. Seven 
studies showed a significant improvement in adherence. Two studies did not show 
an improvement in adherence. ConClusions: This review concludes that there 
is some evidence of small increases in adherence on the removal or reduction of 
copayments. However, confounders and biases between the included studies were 
variable. Future studies should concentrate on establishing associations between 
reduced cost-sharing and clinical and economic outcomes.
PHP49
PRevalence of PHysicians causing PoTenTial dRug inTeRacTions in 
ambulaToRy caRe in swiTzeRland: a RePResenTaTive naTional suRvey
Bucher H.C.
Basel Institute for Clinical Epidemiology & Biostatistics, Basel, Switzerland
objeCtives: No representative data on the quality of drug prescription exist in 
Switzerland. We analysed potential drug interactions (PDI) in primary care based 
on prescription data from 2010 from three large health insurers. Methods: In our 
study population we identified based on the national drug formulary 494 drug-
drug interactions (DDI) classes. Of those, 41 were from drug interaction severity 
classes I (contraindicated) and II (potentially contraindicated) and classified as PDI. 
PDI were calculated for two indicators with different denominators, 1) the total 
number of DDI and 2) the total number of patients potentially exposed to a PDI. 
For each physician we calculated the probability that the number of caused PDI 
was unlikely (p-value between 0.05 and 0.01; ‘problematic prescription behaviour’) 
and very unlikely (p-value < 0.01; ‘likely problematic prescription behaviour’) to be 
explained by chance. Results: Of 3.13 million individuals 1.34% were exposed to 
at least one PDI; figures increased to 3.78% and 4.40% in females and males aged 
≥ 70 years. Of 20,710 physicians 42% caused at least one PDI. With DDI being the 
denominator 6.2% und 3.4% of general practitioners and 0.9% und 0.5% of specialists 
were classified with a ‘problematic’ and ‘likely problematic prescription behaviour’. 
With the patient population being the denominator between 0.96% and 6.22% of 
physicians from all specialty groups had caused a PDI that was classified as ‘likely 
problematic’ (p-value < 0.01). When combining both indicators 457 of 20‘720 physi-
cians (2.2%) had a prescription behaviour causing a PDI that in comparison to peers 
was highly unlikely to be explained by chance (p-value < 0.01). ConClusions: A 
total of 2.2% of physicians in primary care prescribe during one year at least one 
drug combination that is classified as PDI. A linkage to other data sources would 
be needed to further classify PDI that put patients at serious risk for adverse drug 
reactions.
PHP50
a sysTemaTic evaluaTion of dRug-dRug inTeRacTions in 
PRescRiPTions; facTs and comPaRisons
Ahmad M., Arshad W., Usman Minhas M.
The Islamia University of Bahawalpur, Bahawalpur, Pakistan
objeCtives: The study focus was to evaluate and compare the prescriptions for 
the encountered potential drug-drug interactions (pDDIs) and their different levels 
on the basis of onset, severity and documentation status, in a tertiary care hos-
pital and community pharmacies in Bahawalpur, Pakistan. Methods: Total 800 
prescriptions, 400 from a tertiary care teaching hospital and 400 from community 
pharmacies, fulfilling inclusion criteria were collected thrice a week during a period 
of three months and were analyzed for potential drug-drug interactions using dug 
digest database, drug interaction checker of www.drugs.com and reference text 
prescribed those drugs from DPC/PDPS data collected between 1st April 2010 and 
31st March 2012 at 1139 of acute care hospitals in Japan. Hospitals were classified 
into five categories (university, private, publi, social insurance group, and others). 
SQL Server 2008 R2 was used for data handling, R for data analysis, and ArcGIS for 
statistical analysis of geography. Results: Generic drugs were least used amongst 
almost all types of drugs in university hospital and social insurance group. For 
prescription of generic drugs, private hospital was the most proactive, followed 
by public hospital. It was revealed, thorough comparison between 20% of medical 
care institutions that are the most proactive towards introduction of generic drugs 
and 20% of the least proactive, that the shifting progress was slower in bigger size 
medical care institutions. ConClusions: This study indicated that for effective 
promotion of generic drugs, it is important to establish plans for changing the policy 
of medical care institutes, which are amongst the bottom 20% of introduction rate, 
where a policy maker does not shift to generic drugs even in the area of expensive 
drugs such as anti anticancer agents and radio contrast agents.
PHP45
HealTH TRansfoRmaTion PRogRam imPacT on imPoRT and local 
PHaRmaceuTical consumPTion in TuRkey
Ufuktepe B.1, Kockaya G.2
1Istanbul University, Istanbul, Turkey, 2Health Economics and Policy Association, Ankara, Turkey
objeCtives: Health Transformation Program(HTP) started in year 2003 by MoH of 
Turkey. All health system changed dramatically. It had impact on all health con-
sumptions and expenditures. The aim of this study is to show the impact of HTP 
on the imported pharmaceuticals(IP) and local manufactured pharmaceutical(LMS) 
sales in Turkey. Methods: Pharmaceutical retail sales data in units and 
volume(US$) from year 1998 to 2012 were retrieved from IMS Dataview. Local and 
import consumption trends were reviewed. The data was analyzed with Microsoft 
Excel 2010. Results: Total unit sales were 689M in 1998, 698M in 2002 and 1768 M 
in 2012; after 10 years of HTP. Total sales were 1937M, 2526M and 8000 M USD for 
the same years, respectively. Between 1998 and 2012, CAGR(Cumulative Annual 
Growth Rate) of unit sales was 7%, while the majority of this growth came from 
HTP(9,7% after HTP vs 0,3% before HTP). There was no significant change in unit 
sales between 1998 and 2002; total CAGR was 0,3%. Sales between 1998 and 2012 in 
USD had an average growth rate of 10,7%. Comparing CAGR for before and after HTP; 
LMP was 1,5% before and 7% after while IP showed an inverse ratio with the total 
and LMP values and was 23,5% and 13,1% before and after. In the beginning of the 
15 years period market share for local manufacturing 92,6% in units and 80,8% in 
USD; in 2002 dropped down to 88,8% in units and 65,7% in USD, and finally in 2012 to 
75,2% in units and 49,8% in USD. ConClusions: The percentage of IP both in units 
and volume increased in years. This increase may be caused by different reasons, 
particularly new oncology and biotechnology molecules. It was observed that the 
volume increase in IP or decrease in LMP was limited by the HTP.
PHP46
undeRsTanding PaTTeRns of moniToRing of aPPRoPRiaTe PRescRibing 
in euRoPe
Schroeder C.1, Keja J.2, Hughes B.2, Toussi M.3
1IMS Health, Munich, Germany, 2IMS Health, London, UK, 3IMS Health, Paris La Défense, France
objeCtives: To analyse the current requirements and patterns for drug use moni-
toring in Europe and highlight new ways for pharmaceutical companies to meet 
these requirements Methods: We combined three methods of data collection to 
characterise current requirements and patterns for drug use monitoring: 1) review of 
official reports by European agencies; 2) analysis of data elements on the European 
Medicines Agency (EMA) website; and 3) interviews with experts from pharma-
ceutical companies, facing requirements for conducting drug utilisation studies 
(DUS). Results: The recent Good Vigilance Practice (GVP) established a clear regula-
tory framework for drug safety monitoring and calls for the assessment of the effec-
tiveness of risk minimisation measures (RMMs). This should include the evaluation 
of their implementation and outcome. DUS provide simple metrics for monitoring 
of appropriate drug use, and thus the implementation of RMMs. We identified 28 
drugs with DUS in their risk management plan and an additional 23 DUS requested 
by EMA. We observed a top total number of requests for DUS in the fields of contra-
ception (n= 10), infectious diseases (mainly HIV and hepatitis) (n= 8) and diseases 
of the metabolism (mainly diabetes) (n= 6) and less for other therapeutic areas. The 
main reasons for DUS requests were monitoring of off-label use (n= 30) and new 
safety concerns (n= 27). Experts confirmed an increasing demand for DUS. In order 
to optimise the RMMs, repetitive DUS in different points in time are necessary. This 
study analyses DUS’ critical data elements allowing for the automation of such 
measurements. ConClusions: Current and future EMA practice for DUS seems 
to focus on new active substances, particularly in diseases of high public health 
relevance and infectious diseases. To meet this demand, pharmaceutical compa-
nies are required to propose more repetitive measurements of the drug use. This 
study identifies data elements allowing for the automation of such measurements.
PHP47
caTcHing THe low-Hanging fRuiT in medicines oPTimisaTion
Faria R., Sculpher M.J.
Centre for Health Economics, York, UK
objeCtives: The medicines bill in high income countries accounts for approxi-
mately 17% of total health care expenditure. However, around $500 million could 
be saved a year worldwide by optimising medicines use. This study aims to scope 
the evidence on the effectiveness and cost-effectiveness of interventions to 
address suboptimal use of medicines and pinpoint the evidence gaps to prioritise 
future research. Methods: Systematic searches (up to February 2013) of the NHS 
Economic Evaluation Database, the Cochrane Database of Systematic Reviews and 
the Database of Abstracts of Reviews of Effects for systematic reviews on effec-
tiveness or cost-effectiveness and for primary research on cost-effectiveness of 
interventions. Studies in English set in any country were included. Results: Of 


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HEALTH TRANSFORMATION PROGRAM IMPACT ON IMPORT AND LOCAL PHARMACEUTICAL CONSUMPTION IN TURKEY

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PHP45 Health Transformation Program Impact on Import and Local Pharmaceutical Consumption in Turkey

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