| Abstract: | ABSTRACT: BACKGROUND: Therapeutic reference pricing (TRP) based on the WHO daily defined dose (DDD) is frequently employed method for the cost-containment of pharmaceuticals. Our objective was to compare average drug use in real world to DDD and to evaluate whether TRP based on DDD could result in cost savings in the maintenance medication and the total direct health expenditures for asthma patients treated with Symbicort Turbuhaler (SYT) and Seretide Diskus (SED) in Hungary. METHODS: Real-world data was derived from the NHIF database. Average doses and costs were compared between the high-dose and medium dose SYT and SED groups. Multiple linear regressions were employed to adjust the data for differences in the gender and age distribution of patients. RESULTS: 27,779 patients with asthma were included into the analysis. Average drug use was lower than DDD in all groups, 1.38-1.95 inhalations in both SED groups, 1.28-1.97 and 1.74-2.49 inhalations in the medium and high-dose SYT groups, respectively. Although the cost of SED based on the DDD would be much lower than the cost of SYT in the medium-dose groups, no difference was found in the actual cost of the maintenance therapy. No significant differences were found between the groups in terms of total medical costs. CONCLUSIONS: Cost-containment initiatives by payers may influence clinical decisions. TRP for inhalation asthma drugs raises special concern, because of differences in the therapeutic profile of pharmaceuticals and the lack of proven financial benefits. Our findings indicate that the presented TRP approach of asthma medications based on the daily therapeutic costs according to the WHO DDD do not result in reduced public health care spending in Hungary. Further analysis is required to answer whether TRP generates even additional expenditures by inducing switching costs and reducing patient compliance. Potential confounding factors may limit the generalizability of our conclusions. |
