Mills, F.

Shum, D.

Siu, E.

Wyatt, G.

Elsevier - Publisher Connector 

PHP64 A 10-Year Review of the Canadian Common Drug Review: Pharmaceutical Manufacturers’ Success Rate 

A464  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  
(100%), Abbott (100%), Bayer (83%), Gilead (80%), and Boehringer-Ingelheim (80%). 
The average time to receive a CDR recommendation varied from 170 days to 248 
days. The manufacturers with the fastest time to recommendation are GSK, Abbott, 
Roche, Boehringer-Ingelheim, and Watson. Time to reimbursement / formulary list-
ings in all provinces ranged from 123 days to 593 days. ConClusions: This is the 
first analysis to describe the success rate of pharmaceutical manufacturers through 
the CDR. There appears to high variability in all the metrics that were measured and 
further research into the determinants of variability is warranted.
HealtH Care Use & PoliCy stUdies – Health Care Costs & Management
PHP65
iMPaCt of MediCare Part d on PresCriPtion Use, HealtH Care 
exPenditUres, and HealtH serviCes Utilization: national estiMates 
for MediCare BenefiCiaries, 2002 to 2009
Cheng L.I.1, Rascati K.L.2
1Amgen, Thousand Oaks, CA, USA, 2The University of Texas at Austin, Austin, TX, USA
objeCtives: To investigate the impact of Medicare Part D on prescription utilization, 
health services utilization, and health care expenditures in the general Medicare 
population. Methods: A retrospective analysis of Medicare beneficiaries (N= 32,228) 
was conducted using the Medical Expenditure Panel Survey 2002 to 2009 data. 
Multivariable quantile regression was used to estimate the following outcomes at 
the 25th, 50th, 75th, and 90th percentiles, adjusting for socio-demographic charac-
teristics: 1) number of prescription fills; 2) out-of-pocket (OOP) drug expenditures; 3) 
total drug expenditures; 4) OOP health care expenditures; 5) total health care expen-
ditures; 6) number of hospitalizations; and 7) number of emergency department 
(ED) visits between the pre-Part D (2002-2005) and post-Part D (2006-2009) periods. 
All expenditures were inflation-adjusted to 2009 dollars. Results: In the general 
Medicare population, Part D was associated with decreases in OOP drug expenditures 
(-25.7% to -33.6%; p< 0.0001) and OOP health care expenditures (-22.1% to -24.3%; 
p< 0.0001) across all percentiles. Part D was associated with increases in the number 
of prescription fills across all percentiles (5.8% to 8.4%; p< 0.0001) but only at the 
75th and 90th percentiles for increases in total drug expenditures (75th percentile: 
5.5%; 90th percentile: 10.2%; p< 0.0001). Part D was not associated with changes in 
total health care expenditures, hospitalizations, or ED visits in the general Medicare 
population. ConClusions: Part D resulted in increases in medication utilization 
and reductions in OOP drug and OOP health care expenditures among Medicare 
beneficiaries, but was not associated with differences in total health care spending, 
hospitalizations, or ED visits.
PHP66
tHe iMPliCations of deMograPHiC CHanges for gMs Costs in ireland 
tHroUgH to 2026
Conway A.1, Kenneally M.1, Thummel A.2, Woods N.1, Ryan M.1
1University College Cork, Cork, Ireland, 2Darmstadt University, Darmstadt, Germany
objeCtives: The General Medical Services (GMS) scheme presently covers around 
40% of the Irish population and entitles them, inter alia, to free prescription drugs and 
appliances. This paper projects the effects of future changes in population, coverage, 
claims rates and average claims cost on GMS costs in Ireland. Methods: Data on 
GMS coverage, claims rates and average cost per claim are drawn from the Primary 
Care Reimbursement Service (PCRS) and combined with Central Statistics Office (CSO) 
(Regional and National Population Projections through to 2026). A Monte Carlo Model 
is used to simulate the effects demographic change (by region, age, gender, coverage, 
claims rates and average claims cost) will have on GMS prescribing costs in 2016, 
2021 and 2026 under different scenarios. Results: A total of 100,000 Monte Carlo 
simulations indicate that GMS medicines costs could rise to € 1.9bn by 2026 and will 
likely fall in the € 1.7bn to € 2.3bn region. Population is projected to grow by 32% by 
2026 and by 96% for the over 70s. The Eastern region is estimated to grow by 3% over 
the lifetime of the projections at the expense of most other regions. The Monte Carlo 
simulations project that females will be a bigger driver of GMS costs than males. Those 
aged 70 and over and children under 12 will be significant drivers of GMS costs with 
the impending demographic changes. ConClusions: GMS coverage is increasing 
in tandem with falling public health budgets and poses a threat going forward to the 
sustainability and funding of the GMS scheme. Our projections and simulations map 
the likely evolution of GMS cost, given existing policies and demographic trends.
PHP68
variaBility in PUBliCally-PresCriBed drUg Costs: tHe role of region, 
age and gender
O Céilleachair A.J., Woods N., O’Sullivan K., Kenneally M.
University College Cork, Cork, Ireland
objeCtives: Ireland currently has one of the highest levels of public drug spending 
per capita in Europe. As budget retrenchment efforts continue, publically-funded 
drug schemes such as the General Medical Scheme have been the subject of several 
initiatives to reduce costs in recent years. However, little is known about the regional 
and socio-demographic factors that may influence variations in prescribing across 
the state. The objective of this study was to identify these factors. Methods: Using 
a 192,000-strong sample of PCRS data drawn from monthly GMS returns for 2007, 
we constructed an ANOVA model that included the main effects of age, gender and 
region together with their second order and third order interactive terms in an 
interactive effects regression model examining the role of gender, age category and 
region of residence in explaining variation in prescribing costs for Ireland. Results: 
Mean cost per person per month was € 102. Men were on average more expensive 
than women (€ 109 vs. € 94) and cost increased with age group (€ 34 for those 0-12yrs 
and € 169 for those over 75). The most expensive region was the Midlands HSE region 
(€ 103) while the North West (€ 90) was the least costly. Most of the variation in pre-
scribing costs was explained by age, though the relationship between prescribing 
cost and age category was not constant. A significant three-way interaction was 
found between age category, gender and region. ConClusions: The regional and 
Hungarian Forint (HUF) or 234 Euro (EUR) / patient. We found the highest reimburse-
ment per patient in county Nógrád (87879 HUF, 315 EUR), Fejér (80851 HUF, 290 EUR) 
and Békés (77643 HUF, 278 EUR), while the lowest reimbursement county Budapest 
(58859 HUF, 211 EUR), Jász-Nagykun-Szolnok (55757 HUF, 200 EUR) and Zala (54924 HUF, 
197 EUR). ConClusions: We found significant differences measured by all the three 
indicators in home care (nursing) services in Hungary. Our results revealed that there 
are important inequalities both in the access to and utilization of home care services.
PHP62
self-rePorted PoPUlation HealtH: an international PersPeCtive 
Based on eQ-5d
Szende A.1, Janssen M.B.2, Cabasés J.M.3, Ramos Goñi J.M.2
1Covance, Leeds, UK, 2EuroQol Group, Rotterdam, The Netherlands, 3Public University of Navarra, 
Pamplona, Spain
objeCtives: General population EQ-5D health surveys have been accumulated 
in the EuroQol Group’s archive over the past two decades. Using the database as a 
source of standardized measure of self-reported health, the objective was to esti-
mate the level of health (EQ-5D population norms) and the distribution of health 
within populations along socio-demographic characteristics. Methods: Analyses 
captured EQ-5D data on 163,838 individuals from 18 countries with nationally repre-
sentative population surveys. Descriptive statistics were used to provide EQ-5D-3L 
population norms by age and gender categories for EQ VAS, EQ-5D index values, 
and for the 5 dimensions for each country. Odds ratios and the health concentra-
tion index methodology were used in the socio-demographic analysis of EQ-5D 
data. Results: The mean EQ-VAS rating varied from 71.1 to 83.7 and from 70.4 to 
83.3 across countries without and with age standardization, respectively. Statistically 
significant inequalities existed in all samples (p< 0.01) with the EQ-VAS based health 
concentration index varying from 0.090 to 0.157 across countries. Among the soci-
odemographic factors, age had generally the largest contributing share, while edu-
cation also had a consistent role in explaining lower levels of self-reported health. 
Among the 5 dimensions, usual activities and pain/discomfort were the highest 
contributors to overall inequalities in most countries. ConClusions: EQ-5D norms 
can be used as reference data to compare patients with specific conditions and to 
assess the burden of the disease in question. Inequalities in self-assessed health 
exist in all countries with different social and cultural backgrounds, deserving the 
attention of policy makers within each country.
HealtH Care Use & PoliCy stUdies – formulary development
PHP63
analysis of adverse reaCtions of MediCine in Ukraine
Zalis’ka O., Maksymovych N., Zaliskyy O.
Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
objeCtives: In Ukraine the pharmacovigilance system for adverse reactions is 
working. In 2008 was received 7,115, 2009 – 8291, 2010 – 8673, 2012- 11674 card-
reports of adverse reactions (AR) drugs. MoH conducted a detailed analysis of these 
reports found that 13% of them experienced serious adverse events, and 0.7% of the 
cards with the unexpected AR. Methods: We analyzed the side effects depending 
on the ATC-group drugs. Results: We found that antimicrobial agents for sys-
temic use the largest number of reports received on AR (75.4%), which in most 
cases manifested anaphylactic AR. Further analysis showed that AR often were 
drugs (by INN): ceftriaxone (12.6%), amoxicillin in combination with clavulanic 
acid (8.0%), levofloxacin (6.3%). Among the cardiovascular drugs, reports AR often 
came on enalapril (10.0%), pentoxifylline (9.7%) and amlodipine (8.1%).Among the 
drugs affecting the nervous system, haloperidol (7.4%), metamizol sodium (7.4%) 
and paracetamol (7.0%). The analysis showed that the ratio of serious not serious 
AR under anti-neoplastic drugs and antiretroviral drugs is 1:2, anti-TB drugs - 1:3, 
and those affecting the cardiovascular system, gastrointestinal tract, respiratory 
system - under 1:9, 1 : 6, 1:6. Thus, the frequency of serious AR is much higher in 
the application of anti-neoplastic, anti-HIV and anti-TB drugs.The greatest risk 
AR was for children aged 28 days - 11 years, especially boys, and adults, especially 
women aged 46-60 years. ConClusions: Results of the analysis of AR indicate 
that needed pharmaceutical care when dispensing antiretrovirals, anti-tuberculosis, 
anti-neoplastic drugs that meet the requirements of Good pharmacy practice in 
Ukraine. Implementation of training courses and programs for pharmacists on the 
subject of safe use of drugs to treat infectious diseases, tuberculosis and HIV / 
AIDS is essential. As well as acquiring skills pharmaceutical care and prevent AR 
in dispensing drugs to children and women 45-60 years.
PHP64
a 10-year review of tHe Canadian CoMMon drUg review: 
PHarMaCeUtiCal ManUfaCtUrers’ sUCCess rate
Shum D.1, Wyatt G.2, Siu E.2, Mills F.2
1Hoffmann-La Roche Limited, Mississauga, ON, Canada, 2Wyatt Health Management, Oakville, 
ON, Canada
objeCtives: The Canadian Common Drug Review (CDR) is a national HTA agency 
that has been in existence for 10 years. During this, the CDR has reviewed the 
clinical and cost-effectiveness of 188 drugs and provided 269 recommendations to 
the publically funded drug plans. Of all the drugs reviewed over the past 10 years, 
50.4% have received a positive recommendation and 49.6% have received a negative 
recommendation. The objective of this analysis was to describe the success rate of 
each pharmaceutical manufacturer in terms of type of recommendation, time to 
recommendation, and time to listing in the provincial formularies. Methods: The 
CDR Tracker database was used to analyze all CDR drug reviews from 2003 to the end 
of 2012. There were a total of 189 reviews during this 10 year period. All manufactur-
ers that had three or more submissions with CDR were included in the analysis; 
29 companies met this criterion. Results: Of the 189 reviews and 29 companies 
analyzed, the positive recommendation rates ranged from 100% to 17%. The top 5 
most successful manufactures in terms of positive recommendations were Roche 


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PHP64 A 10-Year Review of the Canadian Common Drug Review: Pharmaceutical Manufacturers’ Success Rate

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