Exploring the impact of the national tender system on the use of costly drugs treating rheumatoid arthritis patients in ten rheumatology centers in Norway (2010-2019).

Autor: Brkic A; Research Department, Sorlandet Hospital, Service box 416, Kristiansand, Norway. 107alen@gmail.com.; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. 107alen@gmail.com., Diamantopoulos AP; Division of internal medicine, Section for Rheumatology, Akershus University Hospital, Lørenskog, 1478, Norway., Hoff M; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.; Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway., Haavardsholm EA; Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Fevang BTS; Department of Rheumatology, Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Haukeland University Hospital, Bergen, Norway., Brekke LK; Haugesund Hospital for Rheumatic Diseases, Haugesund, Norway., Loli L; Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway., Zettel C; Department of Rheumatology, Betanien Hospital, Skien, Norway., Bakland G; Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway., Mielnik P; Department for Neurology, Section for Rheumatology, Rheumatology and Physical Medicine, , District General Hospital of Førde, Førde, Norway., Haugeberg G; Research Department, Sorlandet Hospital, Service box 416, Kristiansand, Norway.; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.; Division of Rheumatology, Department of Medicine, Sorlandet Hospital, Kristiansand, Norway.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2023 Sep 07; Vol. 23 (1), pp. 968. Date of Electronic Publication: 2023 Sep 07.
DOI: 10.1186/s12913-023-09975-7
Abstrakt: Background: Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) are highly effective in treating rheumatoid arthritis (RA), albeit high drug cost has restricted their use in many countries. As a countermeasure, Norway implemented pharmaceutical tendering as a cost-reducing strategy. The aim of this study was to assess the annual proportion of different b/tsDMARDs registered to treat RA patients under the influence of a Norwegian pharmaceutical tendering between 2010 and 2019.
Method: The data is collected from ten Norwegian outpatient centers. The included patients are categorized as naïve, non-naïve, and current b/tsDMARD users. 13 individual b/tsDMARDs are assessed and compared with the tender rankings from each year. Overview of subcutaneous (sc) with per oral vs. intravenous (iv) and biosimilars vs. non-biosimilar are also described.
Result: The tender-winning b/tsDMARD was the most or second most used drug in nine out of ten years for naïve users, seven for non-naïve users, and twice for current users. The average sum of the highest and second highest proportion among naïve, non-naïve, and current b/tsDMARD users were 75%, 53%, and 50% during the ten years, respectively. The tender-winning drug was iv in eight out of ten years. However, the average total proportion of sc and per oral b/tsDMARDs was about 70% for naïve b/tsDMARD users, 50% for non-naïve b/tsDMARD users, and 60% for current b/tsDMARD users. The main contributors to sc and per oral b/tsDMARD were etanercept (reference and biosimilar) and certolizumab pegol. The main contributors to iv b/tsDMARD were rituximab reference and infliximab biosimilar. Despite low-ranking offers, rituximab reference (offered as a second-line drug) often achieved a high proportion among non-naïve and current b/tsDMARD users. After the introduction of biosimilars, their average proportion was about 40%, 40%, and 20% for naïve, non-naïve, and current b/tsDMARD users, respectively.
Conclusion: Based on observed data, a higher tender rank was associated with a higher proportion among naïve and non-naïve b/tsDMARD users. However, in most cases, sc b/tsDMARDs achieved a higher proportion with lower tender ranks than iv b/tsDMARDs with higher tender ranks.
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
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