Prescribing efficiency of proton pump inhibitors in China: influence and future directions

Wenjie Zeng, Alexander E Finlayson, Sushma Shankar, Winnie de Bruyn, Brian Godman

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables.MethodsObservational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China.ResultsAppreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (?34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (?19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral forms as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%.ConclusionsEncouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.
LanguageEnglish
Number of pages23
JournalBMC Health Services Research
Volume15
Issue number11
DOIs
Publication statusPublished - 22 Jan 2015

Fingerprint

Proton Pump Inhibitors
China
Health Expenditures
Injections
Omeprazole
Direction compound
Pharmaceutical Preparations
Lansoprazole
Drug and Narcotic Control
Teaching Hospitals
Motivation
Retrospective Studies
Physicians
Costs and Cost Analysis

Keywords

  • proton pump inhibitors
  • China
  • drug utilisation
  • generics
  • health policies
  • drug prices

Cite this

Zeng, Wenjie ; Finlayson, Alexander E ; Shankar, Sushma ; de Bruyn, Winnie ; Godman, Brian. / Prescribing efficiency of proton pump inhibitors in China : influence and future directions. In: BMC Health Services Research . 2015 ; Vol. 15, No. 11.
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title = "Prescribing efficiency of proton pump inhibitors in China: influence and future directions",
abstract = "Pharmaceutical expenditure is currently rising by 16{\%} per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80{\%} of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables.MethodsObservational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China.ResultsAppreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84{\%} of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93{\%} of total injectables by 2013. Injectables accounted for 42{\%} of total PPI utilisations in 2008 and 2009 before falling to below 30{\%}. Procured prices for oral preparations reduced over time (?34{\%}). Generic oral omeprazole in 2010 was 87{\%} below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (?19{\%}). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral forms as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84{\%}.ConclusionsEncouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.",
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Prescribing efficiency of proton pump inhibitors in China : influence and future directions. / Zeng, Wenjie; Finlayson, Alexander E; Shankar, Sushma; de Bruyn, Winnie; Godman, Brian.

In: BMC Health Services Research , Vol. 15, No. 11, 22.01.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prescribing efficiency of proton pump inhibitors in China

T2 - BMC Health Services Research

AU - Zeng, Wenjie

AU - Finlayson, Alexander E

AU - Shankar, Sushma

AU - de Bruyn, Winnie

AU - Godman, Brian

PY - 2015/1/22

Y1 - 2015/1/22

N2 - Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables.MethodsObservational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China.ResultsAppreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (?34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (?19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral forms as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%.ConclusionsEncouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.

AB - Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables.MethodsObservational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China.ResultsAppreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (?34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (?19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral forms as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%.ConclusionsEncouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.

KW - proton pump inhibitors

KW - China

KW - drug utilisation

KW - generics

KW - health policies

KW - drug prices

U2 - 10.1186/s12913-014-0638-6

DO - 10.1186/s12913-014-0638-6

M3 - Article

VL - 15

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 11

ER -