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PHP183 - PRICE DIFFERENCE OF MEDICINES DISPENSED IN COMMUNITY PHARMACIES AND IN THE HOSPITAL SECTOR : AN ANALYSIS ON THE MEDICINES FINANCED ON THE BASIS OF HOSPITAL SERVICE TARIFFS

2018; Elsevier BV; Volume: 21; Linguagem: Inglês

10.1016/j.jval.2018.09.1077

1524-4733

A. Laincer, Albane Degrassat-Théas, F. Rouibah, O. Parent de Curzon, Nathalie Poisson, Pascal Paubel,

Health Systems, Economic Evaluations, Quality of Life

In France, medicine prices are set by the national healthcare products pricing committee (CEPS). Hospital medicine intra-diagnosis related group (DRG) prices are an exception to this system because the prices are free and only submitted to competition rules. In the context of search for savings and efficiency and where the hospital buyers' performance is regularly questioned, our study aims to compare medicine prices negotiated by our healthcare establishment (AP-HP), the biggest French university hospital, to the community medicines prices set by the CEPS. From our internal database, we collected the price before tax of January 2018 by common dispensing unit (UCD) for every medicines intra-DRG, excepted medicines for outpatients and hospital use only. For each medicines identified by its presentation (CIP code), the ex-manufacter price is collected from the national health insurance database (AMELI). The price differences (community - APHP) and the price ratio (community/APHP) are calculated and analyzed. Laspeyres indice is set (price ratio weighted by the quantity consumed in 2017 in APHP). Variables that could explain the price differences are analyzed with a khi-2 test or an ANOVA: competition, consumption, therapeutic group, supplier. After consolidation of our database, 888 CIP have been analyzed. APHP prices are lower than community prices for 619 CIP (69.7%). The mean differences is 5.3€ (min -34.9€ ; max 344.6€). The mean price ratio is 32.1 (min 0.4 ; max 7820). Laspeyres indice reaches 2.28. Considering AP-HP medicine consumption in 2017, these differences induce a theoretical gain of 37.8M€ for AP-HP, AP-HP expenditures for those medicines being 30.6M€ out of one billion euros. As expected, competition between generics and patented drugs and between therapeutic substitutes is correlated to better price for AP-HP (p<0.001). When competition exists, public tenders lead to lower prices than administrated prices and offer the potential for significant savings.