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Reimbursement Decision-Making and Prescription Patterns of Glitazones in Treatment of Type 2 Diabetes Mellitus Patients in Denmark

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Abstract

There are marked differences between countries with regard to reimbursement decision-making, yet few studies have tried to understand this process and its consequences by a detailed analysis of the local context and decision-making structure. This article describes reimbursement decision-making and subsequent prescribing patterns of new pharmaceuticals by means of a case study on glitazones in treatment of type 2 diabetes mellitus patients in Denmark. The study shows that institutional arrangements, providing the context in which evidence is used, are highly important for understanding the reimbursement decision-making process. In particular the Danish Medicines Agency (DMA) has shaped the decision to reimburse glitazones on the basis of physician-mediated requests of individual patients. Relatively few patients have been prescribed glitazones since their introduction in 2000, suggesting that individual reimbursement may be an effective instrument in controlling overall expenditure of selected pharmaceuticals, although in the case of glitazones this has likely been achieved at the expense of equality in access to the products. The discussion focuses on the generalizability of the findings to both other pharmaceuticals in the individual reimbursement scheme in Denmark, and to other countries that are trying to balance the need to control overall pharmaceutical care expenditure with the need to secure equality in access to new drugs with therapeutic added value.

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Abbreviations

BMI:

Body Mass Index

CEMTV:

Centre for Evaluation and Health Technology Assessment

CPMP:

Committee for Proprietary Medicinal Products

DMA:

Danish Medicines Agency

EMEA:

European Medicines Agency

GP:

General Practitioner

HbA1c:

Glycosilated haemoglobin (%)

NICE:

National Institute for Health and Clinical Excellence

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Acknowledgements

We would like to thank Prof. Kjeld Møller Pedersen for his comments on an earlier version of this article.

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Authors and Affiliations

  1. Institute of Public Health, Department of Health Economics, University of Southern Denmark, J.B. Winsløws Vej 9B,1, DK, 5000, Odense C, Denmark

    P. B. Iversen & H. Vondeling

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  1. P. B. Iversen
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  2. H. Vondeling
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Correspondence to H. Vondeling.

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Iversen, P.B., Vondeling, H. Reimbursement Decision-Making and Prescription Patterns of Glitazones in Treatment of Type 2 Diabetes Mellitus Patients in Denmark. Health Care Anal 14, 79–89 (2006). https://doi.org/10.1007/s10728-006-0017-5

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