Increasing health care costs is an international problem from which South
Africa is not excluded. Prescription medication contributes most to these high health care costs,
and methods to reduce their costs to society are implemented worldwide. In South Africa, such
a method is a managed care reference medicine price list, as introduced by a PBM (pharmacy
benefit management) company. This step had some cost implications in the private health
sector in South Africa, and these implications were investigated in this study. Central nervous
system (CNS) medicine items are among the top ten medicine items claimed and represent a
substantial amount of the costs of all medicine items claimed during the study period.
Antidepressants, a subdivision of the CNS agents, comprise the largest share of CNS agents
claimed and CNS costs, and were therefore investigated more closely.
The objective of this study was to analyse the usage patterns and costs of central
nervous system medicine items, and more specifically, the antidepressants, against the
background of the implementation of a managed care reference medicine price list in the private
sector of South Africa.
This study was conducted as a retrospective, non-experimental quantitative research
project. The study population consisted of all medicine items claimed as observed on the
database over the two-year study period of May 2001 to April 2002 (pre-MPL) and May 2002 to
April 2003 (post-MPL). Data were provided by MedschemeTM/lnterpharm, and the Statistical
Analysis System® SAS 8.2® was used to extract the data from the database.
The central nervous system agents had a prevalence of 8.10% (N=49098736) and a
total cost of R757576976.72 over the two-year study period. The cost per CNS item increased
by 5.98% or R11.50 per CNS item in the year after MPL implementation, and the cost per
prescription containing CNS medicine items increased by 4.09% or R9.07 per prescription. CNS
agents are classified into ten sub-pharmacological groups, according to the MIMSC3 (Snyman,
2003:13a). One of these sub-pharmacological groups, antidepressants, comprised 33.97% of all
CNS medicine items claimed (N=3978364) and 45.53% of all costs associated with CNS
medicine items (N=R757576976.72) over the study period. The number one antidepressant
claimed was amitriptyline, a tricyclic antidepressant. Of the antidepressants with generic
substitutes, all with the exception of clomipramine, were prescribed at generic substitution rates
of more than 50%. After the MPL implementation, generic antidepressant products were more
frequently prescribed (16.48% increase, N=617190), although patient co-payments did not
decrease immediately. Some innovator products had price reductions after the implementation
of the MPL.
This study indicates that cost minimisation analyses and retrospective drug utilisation reviews
are valuable tools in the evaluation of managed care medicine price lists. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:nwu/oai:dspace.nwu.ac.za:10394/607 |
| Date | January 2004 |
| Creators | Joubert, Janine Mari |
| Publisher | North-West University |
| Source Sets | South African National ETD Portal |
| Detected Language | English |
| Type | Thesis |
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