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Australian Statistics on Medicines 2003

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Australian Statistics on Medicines 2003 Australian Statistics on Medicines 2003 Acknowledgments Prepared by John Dudley, Maxine Robinson and Penny Main, of the Drug Utilization Sub-Committee Secretariat. We would like to thank the following people for their help in the access and provision of data and information used in this report: • Peter Marlton and Mick Turner, Department of Health and Ageing • Kerri Mackay, TGA • Rebecca Bennetts, Australian Institute of Health and Welfare © Commonwealth of Australia 2005 ISBN 0 642 82748 6 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the: Commonwealth Copyright Administration, Attorney General’s Department, Robert Garran Offices, National Circuit, Canberra ACT 2600 or posted at http://www.ag.gov.au/cca Also published on http://www.health.gov.au/internet/wcms/publishing.nsf/ Content/health-pbs-general-pubs-asm.htm Publications Approval Number: 3712/JN8772 FOREWORD Comprehensive and valid statistics on use of medicines by Australians in the public domain should be accessible to all interested parties. From the first edition in 1992 until 1999 the Drug Utilization Sub-Committee (DUSC) produced the Australian Statistics on Medicines (ASM) for each calendar year to 1998. In 2002 we presented the annual statistics for 1999 and 2000 and in 2003 we presented the annual statistics for 2001 and 2002. This edition presents the annual statistics for 2003. A continuous data set representing estimates of the aggregate community use (non public hospital) of prescription medicines in Australia is a key tool for Australia’s National Medicines Policy. The ASM presents dispensing data on most drugs marketed in Australia and is the only current source of data in Australia to cover all prescription medicines dispensed in the community. Drug utilisation data can assist the targeting and evaluation of quality use of medicines initiatives, and the evaluation of changes to the availability of medicines. It is also needed for pharmacosurveillance by regulatory and financing authorities and by the pharmaceutical industry. Publication of the Australian data also facilitates international comparisons of drug utilisation profiles and encourages international collaboration on drug utilisation research particularly in relation to enhancing the quality use of medicines and health outcomes. Andrea Mant MBBS, MD, MA, FRACGP Chairman Drug Utilization Sub-Committee iii CONTENTS FOREWORD iii INTRODUCTION 1 INFORMATION ON THE AUSTRALIAN STATISTICS ON MEDICINES 3 Pharmaceutical Benefits Advisory Committee 4 Drug Utilization Sub-Committee 5 National Medicines Policy 5 Drug classification 6 Measurement unit 8 Health Insurance Commission processing 9 Pharmacy Guild survey data 10 Combined database 11 ADVERSE DRUG EVENT REPORTING IN AUSTRALIA 13 HIGHLY SPECIALISED DRUGS PROGRAM 16 Program overview 16 Highly Specialised Drugs Working Party 16 Criteria for selection of Highly Specialised Drugs 17 Supply of pharmaceutical benefits to remote Aboriginal Health Services 19 Expenditure 20 HEALTH EXPENDITURE TRENDS 21 DRUG UTILISATION TRENDS 23 TABLES IN THE AUSTRALIAN STATISTICS ON MEDICINES 28 References 28 CAVEATS 29 GLOSSARY OF TERMS 30 Weights and measures 31 v ANATOMICAL THERAPEUTIC CHEMICAL INDEX (ATC) 32 AND DEFINED DAILY DOSE (DDD) CHANGES 2003 Table 1 Estimates of 2003 community prescription numbers and, 35 for PBS listed drugs, cost (government and patient) Table 2 Community prescription drug use, in defined daily doses 171 (DDDs) per 1000 population/day, for 2001 to 2003 INDEX BY ATC CODE 255 List of Tables Table A: Prescription numbers by ATC groups 23 Table B: Top 10 drugs by defined daily dose/1000 population/day, 2003 25 Table C: Top 10 drugs by prescription counts, 2003 26 Table D: Top 10 drugs by cost to Government, 2003 26 List of Figures Figure A: Community utilisation of fluoxetine 11 Figure B: Community utilisation of amitriptyline 11 Figure C: Number of prescriptions by type of service 24 Figure D: Top 10 subsidised drugs dispensed in 2003 27 Figure E: Top 10 non-subsidised drugs dispensed in 2003 27 vi INTRODUCTION The data contained in the 2003 ASM are drawn from two sources. The first is the Health Insurance Commission records of prescriptions submitted for payment of a subsidy under the Pharmaceutical Benefits and Repatriation Pharmaceutical Benefits Schemes (PBS/RPBS). The second is an ongoing survey of a representative sample of community pharmacies, which provides an estimate of the non-subsidised use of prescription medicines in the Australian community. The usage of prescription medicines dispensed to in-patients in public hospitals is generally not available in this report. The usage of prescription medicines to out-patients and discharged patients in one state of Australia is included. It is planned that all out-patients and discharged patients will receive PBS subsidised prescriptions in the future. The units of measurement are the prescription and the defined daily dose per 1000 population per day (DDD/1000 population/day). The defined daily dose is established by the WHO Collaborating Centre for Drug Statistics Methodology on the basis of the assumed average dose per day of the drug, used for its main indication by adults. The drugs presented in this publication are arranged using the Anatomical Therapeutic Chemical (ATC) classification system. For more detail on this classification and the unit of measurement, please read the chapter ‘Information on the Australian Statistics on Medicines’. The data are presented in two major tables. Table 1 includes 2003 community (i.e. subsidised and non-subsidised) prescription numbers, together with the government and patient costs for drugs PBS listed and subsidised by the Australian Government only. Cost information on the dispensing of drugs not listed on the PBS and drugs that are PBS-listed but for which no subsidy is claimed from the Australian Government is not available. Table 2 includes community prescription drug use, in DDDs/1000 population/day, for the year 2003. 1 INFORMATION ON THE AUSTRALIAN STATISTICS ON MEDICINES In order to work towards the more rational and cost-effective use of medication in society, it is essential to have accurate information on patterns of drug prescription and use. Where this use is found to be inappropriate, drug utilisation data can monitor the impact of educational or regulatory interventions and can guide the interpretation of pharmacoeconomic analysis.(1) In Australia community prescriptions (i.e. non public hospital) are dispensed either as private prescriptions or under one of two subsidisation schemes—the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS). These schemes were established to provide the general community (PBS) and returned servicemen and women (RPBS) with access to necessary medicinal products, which are affordable, available and of acceptable standards. In 2003 the RPBS was 7.4% of the size of the PBS. However over 90% of the RPBS prescriptions involved PBS listed drugs. In Australia, a new medicinal drug must gain approval for supply in accord with the requirements of the Therapeutic Goods Act 1989. Approval is also required to extend the indications of an established drug. Applications are dealt with by the Therapeutic Goods Administration (TGA) and, for prescription drugs, advice is sought from an expert committee, the Australian Drug Evaluation Committee (ADEC). Once a prescription drug is approved for marketing, the company concerned usually applies to have the drug listed on the PBS. This is the national scheme available to the Australian community, for subsidising the cost of pharmaceuticals. Because of the attraction of the scheme to consumers, it is usually necessary for the company to have the drug listed on the scheme for viable marketing to occur. The Pharmaceutical Benefits Advisory Committee (PBAC) makes recommendations to the Australian Government about what drugs should be listed on the PBS. Whereas the pre-market evaluation addresses the issues of quality, safety and efficacy, the PBAC considers effectiveness and cost-effectiveness of the product relative to other alternatives. Once a drug has been recommended for listing on the PBS by the PBAC, the Pharmaceutical Benefits Pricing Authority (PBPA) negotiates the price paid with the company. The PBPA consists of government, industry and consumer representatives. After agreement is reached, the Australian Government considers the advice of both the PBAC and the PBPA and makes a decision on whether the drug should be listed on the PBS. 3 Under the PBS, general patients paid the cost of a prescription up to a maximum of $22.40 from February 2002 to February 2003 rising to $23.10 until February 2004. Pensioner and concessional patients paid $3.60 per prescription from February 2002 to February 2003 rising to $3.70 to February 2004. In addition, there is a safety net to protect people with high medication needs. Once general patients (and their immediate family) incurred $708.40 in 2003 of PBS expenditure (indexed), prescriptions for the remainder of 2003 cost only the concessional copayment amount. Once pensioners and concessionals incurred $192.40 in 2003 of expenditure (indexed) they receive all remaining prescriptions free of charge for the remainder of the calendar year. Patients may also be required to pay a surcharge where the doctor prescribes a more expensive brand of an item, when there are cheaper, equivalent brands of that item listed on the PBS. As the general patient copayment rises, the dispensed price of many of the cheaper medications falls under this level. In such cases the patient pays the full price and no claim for payment is transmitted under the PBS. In 2003, under copayment general prescriptions represented around 15% of all community prescribing. There are also many drugs that are not listed on the PBS or RPBS and are available only on private prescription with the patient paying the full cost (7.3% of community prescriptions in 2003).
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