The influence of drug use in university hospitals on the pharmaceutical consumption in their surrounding communities

Authors

  • Adeline Gallini,

    Corresponding author
    1. UPS Toulouse 3, Université de Toulouse, Toulouse, France
    2. Service d'Epidémiologie, CHU de Toulouse, Toulouse, France
    • Epidémiologie et analyses en santé publique, INSERM, UMR 1027, Toulouse, France
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  • Renaud Legal,

    1. Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), Ministères chargés de la santé, des solidarités et des comptes publics, Paris, France
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  • Florence Taboulet

    1. Epidémiologie et analyses en santé publique, INSERM, UMR 1027, Toulouse, France
    2. UPS Toulouse 3, Université de Toulouse, Toulouse, France
    3. Laboratoire de droit pharmaceutique et d'économie de la santé, Université de Toulouse, UPS Toulouse 3, Faculté des sciences pharmaceutiques, Toulouse, France
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Correspondence

Dr Adeline Gallini PharmD PhD, INSERM, UMR 1027 Epidémiologie et analyses en santé publique: risques, maladies chroniques, handicaps, Université de Toulouse, UPS Toulouse 3, 37 allées Jules Guesde, 31 073 Toulouse Cedex, France.

Tel: +335 6114 5620

Fax: +335 6114 5623

E-mail: adeline.gallini@cict.fr

Abstract

Aim

To investigate the influence of hospital drug choices on pharmaceutical consumption for nine competitive classes in the surrounding community.

Methods

Ecological study. Data from the national survey on drugs in hospitals were used to extract quantities purchased by 25 French university hospitals for three ‘hospital classes’ (EPOs, LMWHs and setrons) and six ‘ambulatory classes’ (PPIs, ACEIs and ARBs, statins, α-adrenoreceptor antagonists (AAAs) and selective serotonin re-uptake inhibitors SSRIs). Re-imbursed quantities for patients living in the hospital's catchment area were extracted from the national health insurance database. The relationship between the use of a brand in hospitals and their catchment areas was assessed using multivariate linear regressions with instrumental variables.

Results

An increase of 1 day of treatment with one brand in the hospital was associated with a significant increase of 2.8 days of treatment with the same brand in the catchment area. However, results strongly varied according to classes. An increase of 1 day of treatment in the hospital was significantly associated with an increase of 0.21 day for ‘hospital classes’ and 21.8 days for ‘ambulatory classes’ in the catchment area. Strong variations were seen across ‘ambulatory classes’. The effect was maximal for cardiovascular classes and not significant for AAAs and SSRIs. The size of the effect also varied with hospital characteristics: small and proximity university hospitals exerted the greatest influence.

Conclusions

Hospital consumption influences the use of drugs in the community. A significant effect was found, especially for competitive classes used on a long-term basis. The economic consequences of these findings need to be addressed.

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