背景:在印度,由于缺乏人口层面的金融风险保护机制,医疗支出主要是自付的。通过药品价格管制令(DPCO),印度政府试图控制药品价格。这项研究的目的是使用具有全国代表性的大型药品销售数据来衡量DPCO2013对印度价格控制下抗生素利用的潜在影响。
方法:我们使用中断时间序列分析,准实验研究设计,以评估DPCO2013对印度私营部门抗生素利用的影响。印度药品销售数据集,来自市场研究公司-所有印度起源化学家和分销商有限公司的PharmaTrac被用于研究。数据是从该国23个不同地区的约18,000名库存人员中收集的。主要结果指标是2013年DPCO下抗生素销售量的百分比变化(增加或减少),以标准单位(SU)衡量。
结果:我们的估计表明,干预后(在DPCO2013通知后),根据DPCO2013,抗生素的销售立即减少(水平变化)3.7%(P>0.05),与干预前的分子水平趋势相比,持续下降(趋势变化)0.3%(P>0.05),但这两种变化在统计学上都不显著。然而,就每月平均市场份额而言,与干预前趋势相比,DPCO2013年通知导致抗生素市场份额急剧下降579%(P<0.05)(水平变化),随后持续增加9.5%(P>0.05)(趋势变化)。
结论:2013年DPCO对价格管制下抗生素使用总体增长的影响有限,但从非价格控制的抗生素转变为价格管制的抗生素(根据DPCO2013的通知)。我们认为,价格控制政策需要辅之以对市场行为的持续监控,以产生可衡量的长期影响。
BACKGROUND: In India, due to a lack of population-level financial risk protection mechanisms, the expenditure on healthcare is primarily out-of-pocket in nature. Through Drug Price Control Orders (DPCOs), the Indian Government attempts to keep medicine prices under check. The aim of this study was to measure the potential impact of DPCO 2013 on the utilization of antibiotics under price regulation in India using large nationally representative pharmaceutical sales data.
METHODS: We used interrupted time series analysis, a quasi-experimental research design to estimate the impact of DPCO 2013 on the utilization of antibiotics in the private sector in India. Indian pharmaceutical sales data set, PharmaTrac from a market research company-All Indian Origin Chemists and Distributors Limited-was used for the study. The data are collected from a panel of around 18,000 stockists across 23 different regions of the country. The primary outcome measure is the percentage change (increase or decrease) in the sales volume of the antibiotics under DPCO 2013, measured in standard units (SUs).
RESULTS: Our estimates suggest that post-intervention (after notification of DPCO 2013) there was an immediate reduction (level change) in the sales of antibiotics under DPCO 2013 by 3.7% (P > 0.05), followed by a sustained decline (trend change) of 0.3% (P > 0.05) as compared to the pre-intervention trend at the molecule level, but both changes were statistically insignificant. However, in terms of \'average monthly market share,\' the DPCO 2013 notification resulted in a sharp reduction of 579% (P < 0.05) (level change) followed by a sustained increase of 9.5% (P > 0.05) (trend change) in the \'market share of antibiotics under DPCO\' as compared to pre-intervention trend.
CONCLUSIONS: The impact of DPCO 2013 in terms of the overall increase in the utilization of antibiotics under price regulation was limited but there was a switch from non-price controlled antibiotics to price regulated antibiotics (notified under DPCO 2013). We argue that policies on price control need to be complemented with continuous monitoring of market behavior to have a measurable and long-term impact.