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ENDEP : A virtual network to provide evidence on pharmaceutical policies

ENDEP : A virtual network to provide evidence on pharmaceutical policies CHANG MAI ICIUM APRIL 2004. Professor Christine Huttin Health scientist and research professor Endep research group coordinator and Endep US research inc IAE Aix en Provence and CNRS Paris. ENDEP : What is it ?.

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ENDEP : A virtual network to provide evidence on pharmaceutical policies

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  1. ENDEP : A virtual network to provide evidence on pharmaceutical policies CHANG MAI ICIUM APRIL 2004 Professor Christine Huttin Health scientist and research professor Endep research group coordinator and Endep US research inc IAE Aix en Provence and CNRS Paris

  2. ENDEP : What is it ? • A virtual think tank created in december 1994, as a research activity discussed with EU representatives. • Aim: to provide evidence to decision makers on the impact of pharmaceutical policies • Evaluation research based on different methodologies • Combine different policy levels: national and European levels • A multi country, interdisciplinary team, variable according to projects • Building partnerships with commercial consulting firms (SKIM) • Centralisation of data sets and institutionalisation of the research consortium in the European research area. • Internationalisation and links with global networks

  3. Examples of drug policy areas researchedby the Endep research group • Pricing policies: price controls, reference pricing • Deregulation policies: switching policies • Copayments and user fees : use of scenario analysis, economic and pharmacoepidemiological step models, adaptation of reversed conjoint designs • Incentives mechanisms to physicians (positive and negative, use of experimental designs) • Referral system analysis and rational drug prescribing (link with the DURG group) • Comparison of subjective and objective measures of risk perceptions cardio vascular diseases (link with Ghent/Brussels research consortium), comparison of theoretical and practical knowledge par sex

  4. OBJECTIVES OF THE BIOMED PROJECT • To examine whether and how cost to the patient through different reimbursement systems in Europe influence physicians treatment choices and patient behaviours • To disentangle prescribing decisions and consumer decisions • To generate potential primary data on primary care services for insertion in health information systems of the EU monitoring framework (e.g. with the fourth group on health systems of the ECHI 36 indicators)

  5. Prevalent copayment systems in Europe

  6. Patient charges and patients and physicians’decision making process(METHODS) • In-depth analysis of the influence of various reimbursement systems on decision making process of physicians and patients • Disease specific approach on chronic and acute conditions (hypertension, hay fever, dyspepsia and hormone replacement therapy) • Combination of qualitative focus groups) and surveys (adapted conjoint designs and patient surveys) • Internationalisation process (e.g. consensus building)

  7. Patient charges and physicians’decision making process The conceptual basis: an adaptation of the Lens model (Brunswick, 52; Cooksey, 90), Hammond,95:theoretical background of probability functionalism) Patient cues Economic cues True State Judged State Clinical cues Judged weights Corrected weights

  8. Cost sensitivity analysis of European primary care physicians 2. Final design administered by SKIM Analytical (market survey company) Given a patient profile: Q1: How would you treat this patient ? Q2: To what extent did you take patient cost into account when you decided how to treat this Patient ? (scale 1-7) Patient characteristics: patient affordability,patientrequestfor cheaper treatment, severity of disease(hay fever) or risk factors (hypertension), patients’expenses on other diseases

  9. PATIENT CHARGE AND PHYSICIANS’COST SENSITIVITY MAIN RESULTS

  10. Results country A: average utility values

  11. Results country B : average utility values

  12. Results country C: average utility values

  13. Results country D : average utility values

  14. LINKING COST SENSITIVTY INDEX FOR EACH INDIVIDUAL PHYSICIAN WITH PRESCRIBING INTENTION SHIFTS

  15. PRESCRIBING INTENTION SHIFTSFOR HYPERTENSION IN COUNTRY A

  16. PRESCRIBING INTENTION SHIFTSFOR HYPERTENSION IN COUNTRY B

  17. PRESCRIBING INTENTION SHIFTSFOR HAY FEVER IN COUNTRY A

  18. PRESCRIBING INTENTION SHIFTSFOR HAY FEVER IN COUNTRY B

  19. The type of copayment or user fee has also greatly influenced other clinical strategies’ dimensions • Cost reduction strategies have been classified in three categories: the 3 « P » P: Patient cost related strategies P: Physician cost related strategies P: Pharmacist cost related strategies • According to health care systems, decision points where cost issues are discussed differ

  20. THIS NEW METHOD CAN BE USED AS A DECISION AID FOR POLICYMAKERS TO TAILOR USER FEES AND CONTROL FOR POTENTIAL EFFECTS ON INAPPROPRIATE PRESCRIBING OR MOST COST EFFECTIVE DRUGS CHANG MAI ICIUM APRIL 2004 Professor Huttin www.marquiswhoswho/christinehuttin.net Email: chris.huttin@comcast.net Endep asbl coordinator and Endep US research inc Director

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