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Expenditures for Treatment of Cardiovascular Disease
Use of cardiovascular medications in England
S shaped temporal increasing of drug prescriptions?
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Dr. David Rosen
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rosend{at}rogers.com Dr. David Rosen
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The findings of Jackevicius et al do not surprise me. It would be interesting to know , along with the disparity of spending among the provinces,their respective prevalences of cardiovascular disease.Isn't it time for our society and our medical schools to wake up and take a hard look at non-medicinal preventive measures? That would include having knowledgeable researchers and physician-teachers who understand nutrition (none in my day)and other lifestyle issues. This may mean physicians' organizations getting out of the closet in order to influence public policy,education,and paediatric care. In the end that may reduce expenditures. Conflict of Interest:None declared |
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Azeem Majeed Imperial College London, UK
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a.majeed{at}imperial.ac.uk Azeem Majeed
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Cynthia Jackevicius and colleagues' findings on trends in the use of cardiovascular medications in Canada have many similarities to trends in the use of these medications in England, albeit with a few differences that probably reflect the way in which health services are funded and managed in England. [1] Almost all prescribing for chronic diseases in England is carried out by general practitioners. [2] Data on prescriptions dispensed by community pharmacists show that in 2007, 251 million prescriptions for cardiovascular medications were issued in England at an annual cost of $3.43 billion. [3] In England, 75% of cardiovascular medications were dispensed generically, compared to only 29% in Canada. This may account for the lower cost per prescription in England($13.66 in England v. $47.79 in Canada) and the lower overall total costs of cardiovascular medication in the two countries ($3.43 billion in England v. around $5 billion in Canada), even though England has a much larger population than Canada. Despite the lower costs of cardiovascular prescribing in England, reviews of the quality of care show high use of medications such as statins in people with cardiovascular disease. [4] In England, general practitioners receive regular feedback on their prescribing patterns, including data on cost, quality and generic prescribing, and comparisons with other general practitioners. This feedback, coupled with incentive schemes to encourage generic prescribing, seems to have been successful in limiting the growth in spending by England's NHS on cardiovascular drugs without any adverse impact on quality of care. Azeem Majeed, Professor of Primary Care, Imperial Colege London, UK Mariam Molokhia, Senior Lecturer in Epidemiology, London School of Hygiene & Tropical Medicine, UK References 1. Jackevicius CA, Cox JL, Carreon D, et al. Long-term trends in use of and expenditures for cardiovascular medications in Canada. CMAJ 2009;181:45–51. 2. Majeed A, Evans N, Head P. What can PACT tell us about prescribing in general practice? BMJ 1997;315:1515-1519. 3. Prescriptions Dispensed in the Community. Statistics for 1997 to 2007: England. NHS Information Centre, Leeds, England. 2009. 4. Millett C, Gray J, Wall M, Majeed A. Ethnic Disparities in Coronary Heart Disease Management and Pay-for-Performance in the UK. Journal of General Internal Medicine 2009;24:8-13. Conflict of Interest:None declared |
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oscar mota internal medicine retired coimbra university hospital portugal
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filomsousa{at}netvisao.pt oscar mota
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The paper demonstrated that “Prescriptions and expenditures for cardiovascular medications escalated over the period 1996 to 2006 in Canada”. It was “observed a sharp and steady increase in the use of and expenditures for cardiovascular medications in Canada, with expenditures increasing more than 200% over the decade of study”. As it was stated, “overall, demographic, population and economic factors potentially explain 136% or two-thirds of the increase in cardiovascular medication expenditures”. Of the other one third of the increase in costs, I presume that 40% would be by not explained increasing numbers of prescriptions, since 60% was caused by the greater use of patented medications. It was sated that “Projected increases may reach potentially unsustainable levels”, and that there was “no plateau in spending on cardiovascular medications in Canada during the study period”. Contrary to the stated absence of plateau, it was my impression, by observing figures 1 to 3, that temporal increasing was not linear but S shaped. From figure 2, it seems that the peak of annual increase rate was attained in year 2001. In figure 1, the peaks of annual increases of individual drug prescriptions was, apparently, also situated around 2001, a little early to ACEI (1999) and a little later to Statins (around 2003). I would like to know if those are only subjective impressions or if, by analysis of crude numbers, they may be translated to reality. If that hypothesis proved true, it will be interesting to know if attenuation in the increase of prescriptions was explained by administrative or economic constraints, saturation of markets or reflected more critical and conscientious prescription mode, the result of remarkable papers like this one. Conflict of Interest:None declared |
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