Price changes of antibiotics and perceived substitutes in the...
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Price changes of antibiotics and perceived substitutes in the context of OTC policy changes in Mexico and Brazil Yared Santa-Ana-Tellez 3 rd international PPRI Conference 13 October 2015
Transcript of Price changes of antibiotics and perceived substitutes in the...
Price changes of antibiotics and perceived substitutes in the context of OTC policy changes in Mexico and Brazil
Yared Santa-Ana-Tellez
3rd international PPRI Conference
13 October 2015
Background
• Lack of regulation for the Over the counter (OTC) sales.
• Self-medication.
• Regulations to control the OTC acquisition of antibiotics.
Mexico2010
Colombia2005
Brazil2010
Chile1999
Venezuela2006
Change in level of consumption
DDD/TID
Chile♦ -5.6
Colombia♦ -1.0
Venezuela♦ -0.1
Mexico♣ -1.2
Brazil♣ -1.4
♦ Wirtz, 2013
♣ Santa-Ana-Tellez, 2013
Effe
ct o
f the p
olic
y
0 2 4 6 8
10
12
2007 Q1
2007 Q3
2008 Q1
2008 Q3
2009 Q1
2009 Q3
2010 Q1
2010 Q3
2011 Q1
2011 Q3
2012 Q1
2012 Q3
2013 Q1
DDD/TID
Mexic
o
Level c
hange
-1.2
**
Slo
pe c
hange
+0.1
**
0 2 4 6 8
10
12
2007 Q1
2007 Q3
2008 Q1
2008 Q3
2009 Q1
2009 Q3
2010 Q1
2010 Q3
2011 Q1
2011 Q3
2012 Q1
2012 Q3
2013 Q1
DDD/TID
Brazil
Level c
hange
-1.4
**
Unintended effects
Antibiotics
Cough and
cold
NSAIDs and
analgesics
0
2
4
6
8
10
12
14
16
18
20
2007 Q
1
2007 Q
3
2008 Q
1
2008 Q
3
2009 Q
1
2009 Q
3
2010 Q
1
2010 Q
3
2011 Q
1
2011 Q
3
2012 Q
1
2012 Q
3
2013 Q
1
DD
D/
TID
Mexico
Slope change+0.2**
Antibiotics
Cough and
cold
NSAIDs and
analgesics
0
5
10
15
20
25
30
2007 Q
1
2007 Q
3
2008 Q
1
2008 Q
3
2009 Q
1
2009 Q
3
2010 Q
1
2010 Q
3
2011 Q
1
2011 Q
3
2012 Q
1
2012 Q
3
2013 Q
1
DD
D/
TID
Brazil
No changes
Level change +1.8**
Level change +0.4**
Price
Quantity
Price
Quantity
Ss
Q1s
Da
S
Q2s
Hypothesis
Q1aQ2a
P1a
P2a
Antibiotics Substitutes
P1s
Da’Ds1
Ds2
P2s
• To study price changes of antibiotics, and medicines to relief symptoms of respiratory infections such as fever and cough after the OTC sales restriction in Mexico and Brazil.
Objective
Methods
• Retail quarterly sales data of trade prices (IMS Health).
• Private sectors Mexico and Brazil.
• January 2007 - March 2013.
• Policy change group:
� Oral and injectable antibiotics.
o Medicines easily available for symptoms relief:
� Cough and cold preparations.
� Analgesics and antipyretics.
� Non-steroidal anti-inflammatory drugs.
Methods
• Trade prices per chemical substance � price per defined
daily dose*.
• Corrected by inflation using 2013 as base year.
• Local currency converted to US Dollars.
• For each therapeutic group:
– Mean price per defined daily dose.
– Median price per defined daily dose.
*WHO ATC classification system
Methods
• Interrupted time series analysis:
o To estimate changes in slope and level of the median price and
mean price of each of the groups after the policy started.
• Stationarity and autocorrelation tested and corrected if any using ARIMA models.
• Dummy variables to assess seasonal variation.
• Measured seasonal variation (reference prices during winter).
Mexic
o A
ntib
iotic
s
20
21
22
23
24
25
26
27
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Mean price per DDD
5 6 7 8 9
10
11
12
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Median price per DDD
Level c
hange
-1.2
*
Slo
pe c
hange
+0.1
**
Seasonal
varia
tion
-0.4
0**
Mexic
o N
SA
ID
s-A
nalg
esic
s
1,8
1,9 2
2,1
2,2
2,3
2,4
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Mean price per DDD
1,2
1,3
1,4
1,5
1,6
1,7
1,8
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Median price per DDD
Slo
pe c
hange
+0.0
1*
No c
hanges
Seasonal
varia
tion
0.0
3**
Mexic
o c
ou
gh
an
d c
old
1,5
1,7
1,9
2,1
2,3
2,5
2,7
2,9
3,1
3,3
3,5
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Mean price per DDD
1,5
1,7
1,9
2,1
2,3
2,5
2,7
2,9
3,1
3,3
3,5
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Median price per DDD
Level c
hange -
0.1
8**
Slo
pe c
hange
-0.0
3**
Level
change -
0.1
1**
Slo
pe c
hange
-0.0
3**
Seasonal
varia
tion
-0.0
7**
Brazil a
ntib
iotic
s
4,5 5
5,5 6
6,5 7
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Mean price per DDD
Seasonal
varia
tion
-0.1
6**
3
3,1
3,2
3,3
3,4
3,5
3,6
3,7
3,8
3,9 4
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Median price per DDD
Level
change -
0.4
3**
Slo
pe c
hange
-0.0
1*
Slo
pe c
hange
-0.0
3**
Seasonal
varia
tion
-0.0
8**
Brazil N
SA
ID
s-A
nalg
esic
s
0,7
0,7
5
0,8
0,8
5
0,9
0,9
5 1
1,0
5
1,1
1,1
5
1,2
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Mean price per DDD
Seasonal
varia
tion
-0.0
1**
0,7
0,7
5
0,8
0,8
5
0,9
0,9
5 1
1,0
5
1,1
1,1
5
1,2
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Median price per DDD
No c
hanges
Slo
pe c
hange
0.0
08*
Seasonal
varia
tion
-0.0
1**
Brazil c
ou
gh
an
d c
old
0 1 2 3 4 5 6 7
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Mean price per DDD
Seasonal
varia
tion
-0.9
0**
0
0,5 1
1,5 2
2,5 3
01_2007
03_2007
01_2008
03_2008
01_2009
03_2009
01_2010
03_2010
01_2011
03_2011
01_2012
03_2012
01_2013
Median price per DDD
Level change +
0.45*
Slo
pe c
hange
+0.1
8**
Seasonal
varia
tion
-0.1
6**
Discussion
• Antibiotics: Price decreased in both countries.
• NSAIDs-analgesics: increased in Mexico and decreased in Brazil
• Cough and cold medicines: decreased in Mexico and increased in Brazil.
• Prices of medicines are constantly fluctuating and some of these fluctuations are related to seasons.
Implications
• The implementation an OTC sales restriction of antibiotics is a good initiative to improve their use.
• However, this type of policies should:
� be comprehensive,
� take into account the potential substitution effects in the
use of other medicines, and
� consider the potential changes in the existent
pharmaceutical market.
Acknowledgments
IMS Health for providing the data.
Funded by
The National Council for Science and Technology in Mexico.
