Drug Utilisation

Drug Utilisation of BRAF inhibitors for melanoma in Ireland

Collaborators:
Primary Care Reimbursement Service, National Centre for Pharmacoeconomics

Status: Complete

Summary:
The aim of this study is to review the utilisation of the BRAF inhibitors vemurafenib (Zelboraf®) and dabrafenib (Tafinlar®) in Ireland. Vemurafenib was first reimbursed in March 2013 through the Primary Care Reimbursement Service (PRCS). Dabrafenib became available in October 2014. The National Centre for Pharmacoeconomics conducted an economic evaluation of both of these drugs, and found that vemurafenib was not cost-effective relative to dacarbazine, and that dabrafenib was cost-effective relative to vemurafenib. We will investigate the use of both vemurafenib and dabrafenib by interrogating the PCRS claims database from March 2013 to December 2015.

Publications: ‘Drug utilisation of BRAF inhibitors for melanoma in Ireland’ Gorry, C, McCullagh, L and Barry, M. Value in Health, 19 (7); A347-A930 Abstract presented at the 20th European ISPOR conference, Vienna, Austria, November 2016

Real world high-tech drug utilisation and budget impact

Collaborators:
National Centre for Pharmacoeconomics, Materials and Surface Science Institute (MSSI) University of Limerick, Royal College of Surgeons Ireland, National Cancer Registry of Ireland

Status: Ongoing

Summary:
Awarding Body: Health Research Board – Applied Partnership Award 2016. (Part of the Utility of High-Tech Drug Analysis to the Decision Maker project) The aim of this project is to analyse anonymised prescribing data for drugs reimbursed on the High-Tech drugs scheme from 2010 to 2015 to determine drug utilisation (including duration of treatment and expenditure); to compare actual drug utilisation to predicted utilisation; to compare actual drug displacement to predicted displacement; to compare total budget impact to predicted budget impact at the time of the decision to reimburse.

Perspectives on Generic Substitution in Ireland

Collaborators:
National Centre for Pharmacoeconomics, School of Pharmacy Royal College of Surgeons in Ireland

Status: Ongoing

Summary:
The aim of this study was to assess the knowledge and perceptions of patients, pharmacists and prescribers (specifically medical doctors) in early 2013 towards generic medicines and substitution, prior to the introduction and implementation of the Health (Pricing and Supply of Medical Goods) Act 2013 (July 2013), which provided a mechanism for the introduction of generic substitution of medicinal products based on interchangeability at active substance level, and for a system of internal reference pricing. Three stakeholder specific questionnaires were developed to assess knowledge of and perceptions to generic medicines and generic substitution. A total of 762 healthcare professionals and 353 patients were recruited. The study highlighted that over 84% of patients were familiar with generic medicines and are supportive of the concept of generic substitution. Approximately 74 % of prescribers and 84 % of pharmacists were supportive of generic substitution in most cases. The concerns of the main stakeholders were also highlighted and provided a valuable insight into the potential difficulties that may arise in its implementation, and the need for on-going reassurance and proactive dissemination of the impact of the generic substitution policy.

Publications: O’Leary A, Usher C, Lynch M, Hall M, Hemeryk L, Spillane S, Gallagher P, Barry M. Generic medicines and generic substitution: contrasting perspectives of stakeholders in Ireland. BMC research notes. 2015 Dec 15;8(1):790.

Cost containment interventions

Collaborators:
National Centre for Pharmacoeconomics

Status: Complete

Summary:
The aim of this study was to examine trends in expenditure of pharmaceuticals on the Community Drugs Schemes from 2005 to 2010, and to examine the impact of cost-containment interventions on expenditures that were introduced at this time and affected the pricing mechanism for pharmaceuticals in Ireland. Prescription data were analyzed using an Irish national prescription claims database according to drug category, that is, generic, patent, and off patent for the 2 largest schemes; the publicly funded General Medical Services (GMS) Scheme and copayment Drugs Payment (DP) Scheme. An increase in expenditure was noted across all schemes up to 2009 and declined thereafter to the end of the study period (October 2010). Results from this study, based on a section of the total population of Ireland during a 6-year period, indicated that reductions in the wholesale margin and pharmacy markup had the largest impact on reducing pharmaceutical expenditure during the study period.

Publications: C Usher, K Bennett, L Tilson & M Barry. Cost containment interventions introduced on the community drug schemes in Ireland – evaluation of expenditure trends using a national prescription claims database. Clinical Therapeutics 2012 34(3); 636-39.

Prescribing trends for dabigatran etexilate in primary care

Collaborators:
National Centre for Pharmacoeconomics

Status: Complete

Summary:
At the time of the analysis, dabigatran etexilate was licensed, in Ireland, for thromboprophylaxis in adults after elective total hip- and total knee-replacement only. A retrospective review (January 2010 to June 2011) of the National General Medical Services Prescription Database showed that 1929 patients had received prescriptions for dabigatran etexilate. Of these, 42% had received it for longer than the licensed maximum duration (at that time) of 35 days. The Eastern Health board cohort (n=510) was analysed further. Here 64.5% had received the drug for longer than 35 days. Patients on rate/rhythm control therapy were significantly more likely to receive more than 90 days of dabigatran etexilate compared to patients not receiving rate/rhythm control therapy (OR= 17.9; 95%CI 13.6, 23.5).Likewise, patients on rate/rhythm control therapy were significantly more likely to receive more than 180 days of dabigatran etexilate compared to patients not receiving rate/rhythm control therapy (OR= 16.3; 95%CI 11.5, 23.0). It is possible that dabigatran etexilate had been prescribed for stroke prevention in atrial fibrillation.

Publications: McCullagh L and Barry M. Prescribing trends for dabigatran etexilate in primary care. Irish Medical Journal 2012; 105 (5): 34-136

Other Related Publications

C Usher & M Barry. A Reference Pricing System for Ireland. Editorial. Exp Rev Pharmacoecon Outcomes Res 2012 12(6), 675-77.
Grimes RT, Bennett K, Tilson L, Usher C, Smith SM, Henman MC. Initial therapy, persistence and regimen change in a cohort of newly treated type 2 diabetes patients. Br J Clin Pharmacol. 2014 Dec 17. doi: 10.1111/bcp.12573. PMID: 25521800