price changes of antibiotics and perceived substitutes in the...
TRANSCRIPT
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.