There is increasing focus on drug expenditure across Europe as this is now the largest or equalling the largest component in ambulatory care, with costs continuing to rise driven by ageing populations, rising patient expectations and the continual launch of new premium priced drugs.
This has resulted in multiple supply and demand side reforms across Europe to help contain costs. However, countries need to continually learn from each other to help maintain the European ideals of comprehensive and equitable healthcare. This can be achieved by undertaking cross national studies analysing DU consumption data alongside expenditure and health care policies in high volume classes in ambulatory care. CNC studies have been undertaken for the statins, proton pump inhibitors and ACEIs/ ARBs in collaboration with EuroDURG and health authorities/ health insurance companies from across Europe.
Utilisation data (in DDDs — defined daily doses) was typically collected from 2001 to 2007/ 2008. Demand-side measures were categorised under the ‘4Es’ — education, engineering, economics and enforcement. The findings show that multiple and intensive supply and demand side measures appreciably enhanced prescribing efficiency, with the demand side measures appearing additive mirroring other studies.
In addition in the case of enforcement (prescribing restrictions), their nature and follow-up also appreciably influenced subsequent utilisation patterns and overall prescribing efficiency. More studies are planned to add to the knowledge base including the influence of demand side measures with enhancing the utilisation of losartan among the ARBs following its availability as a generic.
The aim of this project was to create a central web site with access to a multi-country minimal data set on national therapeutic arsenals and their link to the ATC/DDD system.
Progress on this project has been slow. In the ATC/DDD guidelines, details of the structure of a minimal data set are now made explicit. In addition, a proposal was formulated for a multilingual medical terminology system to manage translations of the ATC under the ISO standard for multilingual terminologies. Moreover, a datamodel was proposed to analyse differences between therapeutic pharmaceutical arsenals of different countries (in the framework of a Belgian PhD). A proof of concept website with Belgian, Italian, and Swedish data is yet to be constructed.
The ARITMO project claims to analyse the arrhythmic potential of drugs in the following classes of study drugs (> 250 compounds): antipsychotics, anti-infectives (antibacterials, antimycotics and antivirals ) and H1-antihistamines, globally and in specific subgroups (age, co-morbidity, genetically). Click here to go to the ARITMO website.