In the previous three articles by Vogler and co-authors price and volume components of pharmaceutical expenditure were discussed. In the final article of the series, some of the methodological challenges that can be faced in interpreting and analysing expenditure data are addressed and the challenges faced by the authors’ own survey of pharmaceutical expenditure data across European Union Member States are discussed [1].
Total pharmaceutical expenditure and sub-markets
Pharmaceutical expenditure can refer to the total market or specific sub-markets. Other distinctions include outpatient and inpatient pharmaceutical expenditure. Sub-markets include the generics market, prescription medicines market, over-the-counter market and the self-medication market.
Expenditure data may not be available for all sub-markets, making it difficult to interpret and analyse data, as is the case for genetics expenditure data. Data gaps are also found in public and private pharmaceutical expenditure data and outpatient and inpatient pharmaceutical expenditure.
Inpatient (hospital) pharmaceutical expenditure data is particularly difficult to collect, attributable mainly to the financing system in European countries. Total pharmaceutical expenditure on standard hospital databases often comprise only outpatient department expenditure and therefore may be misleading.
Survey
In 2009, Vogler and co-authors conducted a survey of European Union Member States to obtain data on total pharmaceutical expenditure. Health data from the Organisation for Economic Co-operation and Development (OECD) were used to obtain outpatient pharmaceutical expenditure and if unavailable, Eurostat (the statistical office of the European Union) was referred to.
A separate survey was conducted among competent authorities to obtain actual or estimated hospital pharmaceutical expenditure. Not all countries found it easy to provide the full data set; most countries found the data inaccessible and required extra effort to obtain it; and some failed to provide the data despite their best efforts.
For outpatient pharmaceutical expenditure per inhabitant, a higher number of countries were able to provide data, and information on outpatient pharmaceutical expenditure was misinterpreted as total pharmaceutical expenditure.
It was also found that national pharmaceutical expenditure data covered expenditure for pharmaceuticals and medical devices.
For further information on methodology and results of the survey, please refer to the full-text manuscript published in GaBI Journal, 2013, Issue 4.
Other methodological challenges
Inter-country comparisons of pharmaceutical expenditure pose methodological challenges. These include exchange rates and a possible weighting for the different economic situations of the countries. The effects of these differences in price levels between countries can be achieved by using power purchasing parities, as this will reflect the relative price level in relation to the purchasing power of a country.
The method of data collection and storage may have changed at a particular time point, which might explain breaks in the data series.
Finally, it is common for some countries to publish preliminary expenditure data, based on estimates, with the aim of correcting the estimate once all the data are available.
Conclusion
In this series of articles, Vogler and co-authors have taken a top-down approach to exploring pharmaceutical data as an indicator in health-expenditure accounting. Their aim has been to highlight limitations of the concept for consideration when interpreting the data. As a minimum requirement, they advise checking the detailed notes accompanying the data set, which can greatly assist in understanding the coverage, quality and limitations of the data set. Policymakers are also advised to consider all approaches rather than opt for a single policy for pharmaceutical expenditure containment.
Conflict of interest
The authors of this paper [1] declared that there were no conflicts of interest.
Editor’s comment
Dr Sabine Vogler, Member of International Editorial Advisory Board of GaBI Journal, published the full manuscript in GaBI Journal, 2013, Issue 4, readers are invited to view the paper:
Understanding the components of pharmaceutical expenditure—overview of pharmaceutical policies influencing expenditure across European countries
If you are interested in contributing a research paper in generics policies of your country to GaBI Journal, please send us your submission here.
Related articles
Volume components of pharmaceutical expenditure
Price components of pharmaceutical expenditure
Pharmaceutical expenditure as a health-expenditure indicator
Reference
1. Vogler S, et al. Understanding the components of pharmaceutical expenditure—overview of pharmaceutical policies influencing expenditure across European countries. Generics and Biosimilars Initiative Journal (GaBI Journal). 2013;2(4). doi: 10.5639/gabij.2013.0204.051
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