Sinnott, Sarah-Jo; Normand, Charles; Byrne, Stephen; Woods, Noel; Whelton, Helen; (2015) Copayments for prescription medicines on a public health insurance scheme in Ireland. Pharmacoepidemiology and drug safety, 25 (6). pp. 695-704. ISSN 1053-8569 DOI: https://doi.org/10.1002/pds.3917
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Abstract
PURPOSE: We assessed the impact of the introduction of a €0.50 prescription copayment, and its increase to €1.50, on adherence to essential and less-essential medicines in a publicly insured population in Ireland. METHODS: We used a pre-post longitudinal repeated measures design. We included new users of essential medicines: blood pressure lowering, lipid lowering and oral diabetic agents, thyroid hormone, anti-depressants, and less-essential medicines: non-steroidal anti-inflammatory drugs (NSAIDs), Proton Pump Inhibitors/H2 antagonists (PPIs/H2 ), and anxiolytics/hypnotics. The outcome was change in adherence, measured using Proportion of Days Covered. We used segmented regression with generalised estimating equations to allow for repeated measurements. RESULTS: Sample sizes ranged from 7145 (thyroid hormone users) to 136 111 (NSAID users). The €0.50 copayment was associated with reductions in adherence ranging from -2.1%[95% CI, -2.8 to -1.5] (thyroid hormone) to -8.3%[95% CI, -8.7 to -7.9] (anti-depressants) for essential medicines and reductions in adherence of -2%[95% CI, -2.3 to -1.7] (anxiolytics/hypnotics) to -9.5%[95% CI, -9.8 to -9.1] (PPIs/H2 ) for less-essential medicines. The €1.50 copayment generally resulted in smaller reductions in adherence to essential medicines. Anti-depressant medications were the exception with a decrease of -10.0% [95% CI, -10.4 to -9.6] after the copayment increase. Larger decreases in adherence were seen for most less-essential medicines; the largest was for PPIs/H2 at -13.5% [95% CI, -13.9 to -13.2] after the €1.50 copayment. CONCLUSION: Both copayments had a greater impact on adherence to less-essential medicines than essential medicines. The major exception was for anti-depressant medicines. Further research is required to explore heterogeneity across different socio-economic strata and to elicit the impact on clinical outcomes. Copyright © 2015 John Wiley & Sons, Ltd.
Item Type | Article |
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Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology |
Research Centre | EHR Research Group |
PubMed ID | 26696242 |
ISI | 378548800011 |
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