A time-series analysis of the effect of increased copayments on the prescription of antidepressants, anxiolytics, and sedatives in Sweden from 1990 to 1999

University of California, San Francisco, Division of General Internal Medicine, Ambulatory Care Center, 400 Parnassus Avenue, Box 0320, San Francisco, CA 94143-0320, USA.
Clinical Therapeutics (Impact Factor: 2.73). 05/2003; 25(4):1262-75. DOI: 10.1016/S0149-2918(03)80082-6
Source: PubMed


Outpatient prescription medication spending in Sweden has increased sharply since 1974. The Swedish government has raised copayments to reduce medication consumption and limit the growth of medication spending.
The aim of this study was to examine the effect of the 1995 and 1997 copayment increases on Swedish consumption of antidepressants, anxiolytics, sedatives.
Monthly drug-use data for July 1990 through December 1999 for these 3 pharmaceutical classes were obtained from Apoteket AB (Stockholm, Sweden). Data were provided for both sexes in units of defined daily doses per 1000 inhabitants. These series were analyzed with the use of Box-Jenkins autoregressive, integrated, moving-average time-series modeling methods.
Dispensing of all 3 drugs classes increased immediately before copayment changes, with the exception of male sedative use at the time of the 1997 reform. Permanent increases in male antidepressant and sedative use occurred before the 1995 copayment reform. Only female antidepressant use was permanently reduced following the 1997 copayment reform.
Our findings suggest that Swedish patients' valuation of mental health medications exceeds the enacted price increases. The permanent increases in male antidepressant and sedative use, beginning in 1995, may have been the result of previous undertreatment. The permanent reduction in female antidepressant use, beginning in 1997, suggests that the price levels reached a threshold that matched or exceeded Swedish women's valuation of these modific

Download full-text


Available from: Michael K Ong, Jan 04, 2014
  • Source
    • "In some cases this was due to study design. For example, studies found that cost sharing had a positive or no effect on the use of prescription drugs among groups of older people [56,57], among nursing home residents [58], among patients with chronic conditions [30,59,60], where user charges were low [59-62], or when patients were able to switch to cheaper alternatives. Older people are more likely to suffer from life-threatening and/or chronic conditions and may therefore be less sensitive to price. "
    [Show abstract] [Hide abstract]
    ABSTRACT: As pharmaceutical expenditure continues to rise, third-party payers in most high-income countries have increasingly shifted the burden of payment for prescription drugs to patients. A large body of literature has examined the relationship between prescription charges and outcomes such as expenditure, use, and health, but few reviews explicitly link cost sharing for prescription drugs to efficiency and equity. This article reviews 173 studies from 15 high-income countries and discusses their implications for important issues sometimes ignored in the literature; in particular, the extent to which prescription charges contain health care costs and enhance efficiency without lowering equity of access to care.
    Full-text · Article · Feb 2008 · International Journal for Equity in Health
  • Source
    • "Some report associations between increased co-payment for pharmaceuticals and decreased utilization [13] and costs as well as reduced rate of increase of costs and reduced cost per prescription [5] [6] [8] [15]. Other report no effect on drug utilization by increased co-payments [11] [12] [16]. Johnson et al. found that a large co-payment increase reduced the use of essential drugs and had a negative impact on health status although cost was not reduced [12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The last decades increasing pharmaceutical expenditures in Sweden and other western countries have created a need for reforms to reduce the trend. The aim was to analyse if reforms concerning the pharmaceutical reimbursement scheme in Sweden during the years 1986-2002 were associated with changes in cost, volume and cost per volume of pharmaceuticals. Effects of changes in the reimbursement schedule during the study period were evaluated for all registered pharmaceuticals in Sweden and for five indicator drug groups. Five policy changes during the study period were assessed. Three concerned increased patient co-payment (January 1, 1991; January 1, 1995 and June 1, 1999), one the introduction of reference based pricing and increased co-payment (January 1, 1993) and one a new structure of the reimbursement schedule (January 1, 1997). The National Corporation of Swedish Pharmacies provided pharmaceutical delivery data for all Swedish pharmacies. Possible breaks in the trend associated with the investigated reforms were analysed with linear segmented regression analysis. This showed that increased co-payments were not associated with changed level or slope of cost and volume. The new reimbursement schedule was associated with a decreased level of cost and volume, both for all drugs combined and for several of the indicator drug groups. It was also associated with an increased slope for both volume and cost in some indicator drug groups and for all drugs. Introduction of reference based pricing was associated with a reduced slope of cost/defined daily doses (DDD) in all of the indicator drug groups and for all drugs. The analysis showed that major changes in the reimbursement system such as the introduction of a new reimbursement schedule and reference based pricing were associated with reductions in cost and volume for the new reimbursement schedule and cost per volume for reference based pricing.
    Full-text · Article · Jan 2007 · Health Policy
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this paper a new calibration technique working at cryogenic temperatures over the broad frequency range from 0.16 to 20 GHz for the measurement of the complex input impedance of a one-port device is presented. The impedance is extracted from complex reflection coefficient measurements of the a thin film performed by a vector network analyser. The method has been validated by measuring metallic samples with a known temperature behaviour. Its broadband nature makes it particularly powerful when exploring a region of the magnetic field-temperature-frequency parameter space of superconductors that was previously inaccessible with a comparable precision.
    No preview · Article · Oct 1999
Show more