Long-Term Effects of the Global Budget Program and Periodic Price Adjustment on Antibacterial Agents: A Nationwide Decomposition Analysis between 2001 and 2016

BACKGROUND:Previous studies have shown that financial strategies are beneficial for improving the appropriate use of antibiotics within a limited period of time. Long-term effects have rarely been explored. METHODS:This study evaluated the changes in expenditure and prescription patterns of antibacterial agents under the global budget (GB) program and drug price adjustment of a National Health Insurance scheme. Two structural methods, i.e., the Laspeyres method and Fisher's Ideal Index decomposition method, were used to illustrate the impacts of price, volume and drug change. RESULTS:During the first 5 years of the GB program (i.e., 2001-2006), the expenses of antibacterial agents increased by 54.1%, while the volume decreased by 11-21.3%. Therapeutic choice was the predominant cause of expense growth. In the second and third 5-year periods (i.e., 2006-2011 and 2011-2016), the driving force of therapeutic choice gradually decreased. The antibacterial expense remained stable with a slight increase in prescription volume. Periodic price adjustment contributed steadily to cost containment, by 21.9 to 39.9%. CONCLUSION:The GB program led to a remarkable increase in antibacterial expenses, which was mainly attributed to therapeutic choice, especially in the early stage. Periodic price adjustment, in contrast, provided steady benefits to pharmaceutical budget control without a noticeable increase in drug volume.