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The impact of the reformed pricing system and new guideline for antihypertensive drugs on utilization and expenditures in Korea

Other Titles
 약가 인하와 고혈압 약제 급여 및 처방 기준이 의료 사용행태와 지출에 미친 영향 
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Dept. of Public Health/박사
Background: Increases in pharmaceutical expenditures constitute a major issue, and in response, the Korean government has reformed the drug pricing system and adopted new guideline for prescription and reimbursement. These policies were intended to reduce drug prices and restrict reimbursement from inappropriate prescriptions.Objectives: The present study was conducted to identify the effects of the new pricing system and new guideline for antihypertensive drugs on utilization and expenditures in Korea.Methods: Decomposition analysis was conducted for the macro perspective and segmented regression analysis was for stochastic analysis with 54,295 subjects which were only with primary hypertension in the data. National patient sample data of Health Insurance Review & Assessment Service was used in both analyses. The study period was from March 2011 to December 2013. The dependent variables were daily drug utilization, prescribing days, average number of drugs per month, percentage of original drugs per prescription, drug overutilization and prohibited combinations for antihypertensive drug utilization, and antihypertensive drug costs, antihypertensive drug cost per prescribing day, outpatient medical costs whose primary diagnosis was primary hypertension(I10-I13) for expenditures.Results: The results of decomposition analysis indicated that total pharmaceutical expenditures decreased by 9.8% after implementation of the pricing policy, and by an additional 5.9% after the guideline was adopted. Following the implementation of the new pricing policy, the quantity index (-3%) and expenditures (-25%) of price-reduced drugs decreased, but the quantity (2%) and expenditures(5%) of not price-reduced drugs increased. The expenditures in both groups (price-reduced: -7%; not price-reduced: -5%) decreased without increasing quantities after the new guideline was implemented. The indexes of therapeutic choice in both groups increased slightly following both policies. These policies could not control expensive drugs such as angiotensin receptor blockers and calcium channel blockers.From the results of segmented regression, these policies saved approximately USD 5.47 (29.1%) of sum of antihypertensive drug costs and outpatient medical cost, and USD 4.22 (28%) of antihypertensive drug costs in December 2013 compared to March 2012. The effect of the new guideline reduced expenditures more than the new drug pricing system in a segmented regression analysis. Original drug utilization rates did not change significantly as a function of the policies. Drug overutilization and prohibited combinations increased after the new pricing system, and decreased after the new guideline.Conclusions: Policymakers must consider the side effects and the comprehensive effects when controlling drug price directly. The policies saved money, but there were some side effects caused by the new pricing system. The guideline which is a kind of soft regulations was more effective, more reliable, less side effects than the direct cost control.
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