PMID- 18823069 OWN - NLM STAT- MEDLINE DCOM- 20081211 LR - 20151119 IS - 1099-1557 (Electronic) IS - 1053-8569 (Linking) VI - 17 IP - 11 DP - 2008 Nov TI - Effects of an evidence report and policies lifting reimbursement restrictions for acid suppressants: analysis of the Belgian national database. PG - 1113-22 LID - 10.1002/pds.1664 [doi] AB - PURPOSE: To explore the effect on prescribing of policies that lift reimbursement restrictions on selected H2-antihistamines and proton pump inhibitors (PPI) and of practice recommendations. METHODS: Monthly claims based data for proton pump inhibitors (PPIs) and H2-antihistamines were obtained from the national health insurance database (Farmanet 1997-2005). Two policies were issued. In March 2001 two H2-antihistamines and in March 2003 two PPIs became available without restrictions. An evidence report was distributed in September 2004. Periods before and after implementation of the interventions were compared. Interrupted time series with segmented regression analysis was used to assess and compare time trends. RESULTS: The first policy resulted in an increase of volume (1.6 million DDDs; 95% CI 1.4-1.8 million; p < .001) and expenditure (euro 637,744; 95% CI 177 052-1 098 437; p = .026) for H2-antihistamines, but consumption of PPIs continued to grow. After the second policy use of selected PPIs also increased (4.7 million DDDs increase; 95% CI 3.9-5.5 million; p < .001), but more than the desired shift toward selected PPIs. Although total expenditure stabilized at a lower level, there was no significant change of trend. Publication of the evidence report did not have any impact on prescribing. CONCLUSIONS: Policies that lift reimbursement restrictions did not result in meaningful changes in utilization or cost saving. They may even have unintended effects. Collaboration between policymakers and guideline developers and linking policies to evidence-based guidelines could be a more effective way to pursue cost-containment and better quality of care. CI - Copyright (c) 2008 John Wiley & Sons, Ltd. FAU - van Driel, Mieke L AU - van Driel ML AD - Department of General Practice and Primary Health Care, Ghent University, Belgium. mvandrie@bond.edu.au FAU - Vander Stichele, Robert AU - Vander Stichele R FAU - Elseviers, Monique AU - Elseviers M FAU - De Sutter, An AU - De Sutter A FAU - De Maeseneer, Jan AU - De Maeseneer J FAU - Christiaens, Thierry AU - Christiaens T LA - eng PT - Comparative Study PT - Journal Article PL - England TA - Pharmacoepidemiol Drug Saf JT - Pharmacoepidemiology and drug safety JID - 9208369 RN - 0 (Histamine H2 Antagonists) RN - 0 (Proton Pump Inhibitors) SB - IM MH - Belgium MH - Cost Savings MH - *Drug Costs MH - Drug Utilization MH - *Financing, Government MH - Guideline Adherence MH - *Health Policy MH - Histamine H2 Antagonists/*economics MH - Humans MH - Insurance, Health, Reimbursement/*legislation & jurisprudence MH - Insurance, Pharmaceutical Services/*economics/legislation & jurisprudence MH - Practice Guidelines as Topic MH - Practice Patterns, Physicians' MH - *Prescription Fees MH - Proton Pump Inhibitors/*economics MH - Time Factors EDAT- 2008/10/01 09:00 MHDA- 2008/12/17 09:00 CRDT- 2008/10/01 09:00 PHST- 2008/10/01 09:00 [pubmed] PHST- 2008/12/17 09:00 [medline] PHST- 2008/10/01 09:00 [entrez] AID - 10.1002/pds.1664 [doi] PST - ppublish SO - Pharmacoepidemiol Drug Saf. 2008 Nov;17(11):1113-22. doi: 10.1002/pds.1664.