000070278 001__ 70278
000070278 005__ 20200103141023.0
000070278 0247_ $$2doi$$a10.3389/fphar.2018.00342
000070278 0248_ $$2sideral$$a105900
000070278 037__ $$aART-2018-105900
000070278 041__ $$aeng
000070278 100__ $$aSanfélix-Gimeno, G.
000070278 245__ $$aVariation in antiosteoporotic drug prescribing and spending across Spain. A population-based ecological cross-sectional study
000070278 260__ $$c2018
000070278 5060_ $$aAccess copy available to the general public$$fUnrestricted
000070278 5203_ $$aIntroduction: Evidence has shown that utilization of antiosteoporotic medications does not correspond with risk, and studies on other therapies have shown that adequacy of pharmaceutical prescribing might vary between regions. Nevertheless, very few studies have addressed the variability in osteoporotic drug consumption. We aimed to describe variations in pharmaceutical utilization and spending on osteoporotic drugs between Health Areas (HA) in Spain.
Methods: Population-based cross-sectional ecological study of expenditure and utilization of the five therapeutic groups marketed for osteoporosis treatment in Spain in 2009. Small area variation analysis (SAVA) methods were used. The units of analysis were the 168 HA of 13 Spanish regions, including 7.2 million women aged 50 years and older. The main outcomes were the defined daily dose (DDD) per 1000 inhabitants and day (DDD/1000/Day) dispensed according to the pharmaceutical claims reimbursed, and the expenditure on antiosteoporotics at retail price per woman =50 years old and per year.
Results: The average osteoporosis drug consumption was 116.8 DDD/1000W/Day, ranging from 78.5 to 158.7 DDD/1000W/Day between the HAs in the 5th and 95th percentiles. Seventy-five percent of the antiosteoporotics consumed was bisphosphonates, followed by raloxifene, strontium ranelate, calcitonins, and parathyroid hormones including teriparatide. Regarding variability by therapeutic groups, biphosphonates showed the lowest variation, while calcitonins and parathyroid hormones showed the highest variation. The annual expenditure on antiosteoporotics was €426.5 million, translating into an expenditure of €59.2 for each woman =50 years old and varying between €38.1 and €83.3 between HAs in the 5th and 95th percentiles. Biphosphonates, despite accounting for 79% of utilization, only represented 63% of total expenditure, while parathyroid hormones with only 1.6% of utilization accounted for 15% of the pharmaceutical spending.
Conclusion: This study highlights a marked geographical variation in the prescription of antiosteoporotics, being more pronounced in the case of costly drugs such as parathyroid hormones. The differences in rates of prescribing explained almost all of the variance in drug spending, suggesting that the difference in prescription volume between territories, and not the price of the drugs, is the main source of variation in this setting. Data on geographical variation of prescription can help guide policy proposals for targeting areas with inadequate antiosteoporotic drug use.
000070278 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000070278 590__ $$a3.845$$b2018
000070278 591__ $$aPHARMACOLOGY & PHARMACY$$b59 / 266 = 0.222$$c2018$$dQ1$$eT1
000070278 592__ $$a1.256$$b2018
000070278 593__ $$aPharmacology (medical)$$c2018$$dQ1
000070278 593__ $$aPharmacology$$c2018$$dQ1
000070278 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000070278 700__ $$aLibrero-López, J.
000070278 700__ $$aModroño-Riaño, G.
000070278 700__ $$aPeiró, S.
000070278 700__ $$aRodríguez-Bernal, C.L.
000070278 700__ $$aCelaya, M.C.
000070278 700__ $$aAza, M.
000070278 700__ $$0(orcid)0000-0002-0961-3298$$aPradas, F.
000070278 700__ $$aBernal-Delgado, E.
000070278 700__ $$aCabañas, A.L.
000070278 700__ $$aMaizal, M.E.
000070278 700__ $$aCalvo, C.B.
000070278 700__ $$aLópez, T.M.
000070278 700__ $$aAlemán, C.S.
000070278 700__ $$aVela, C.
000070278 700__ $$aPacheco, L.P.
000070278 700__ $$aLirola, M.Á.G.
000070278 700__ $$aRuiz, F.R.
000070278 700__ $$aRiaño, G.M.
000070278 700__ $$aMartín, M.V.M.
000070278 700__ $$aCastaño, E.
000070278 700__ $$aPérez, M.D.F.
000070278 700__ $$aBilbao, J.L.A.
000070278 700__ $$aBerenguer, J.A.D.
000070278 700__ $$aFrancés, A.E.
000070278 700__ $$aCabeza, A.
000070278 700__ $$aTrujillo, C.D.
000070278 700__ $$aMartín, N.
000070278 700__ $$aCeruelo, J.
000070278 700__ $$aMagem, D.
000070278 700__ $$aRobles, G.A.S.
000070278 700__ $$aSainz, L.
000070278 700__ $$aFernández, F.
000070278 700__ $$aMontes, G.
000070278 700__ $$aMartos, E.C.
000070278 700__ $$aMataix, Á.
000070278 700__ $$aDelicado, R.H.
000070278 700__ $$aSanz, M.A.
000070278 700__ $$aSitges, L.M.
000070278 700__ $$aAndía, A.A.
000070278 700__ $$aParra, F.J.G.
000070278 700__ $$aGorrichoMendivil, J.
000070278 700__ $$aLópez, J.E.
000070278 700__ $$aBarandiarán, F.A.
000070278 700__ $$aPicado, A.L.
000070278 700__ $$aArtaza, E.R.V.
000070278 700__ $$aIribar, J.
000070278 700__ $$aCuñado, M.A.
000070278 700__ $$aLibrero, S.P.J.
000070278 700__ $$aGarcía-Gil, M.
000070278 773__ $$g9 (2018), 342 [8 pp]$$pFront. pharmacol.$$tFrontiers in pharmacology$$x1663-9812
000070278 8564_ $$s247801$$uhttps://zaguan.unizar.es/record/70278/files/texto_completo.pdf$$yVersión publicada
000070278 8564_ $$s21996$$uhttps://zaguan.unizar.es/record/70278/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
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000070278 951__ $$a2020-01-03-14:03:00
000070278 980__ $$aARTICLE