title: No need to tax the sick: clinical guidelines for rofecoxib as an alternative effective method to the copayment policy in the advent of increasing pharmaceutical expenditures.
abstract: BACKGROUND
  Over the last few years, major health care systems have been trying to control increasing pharmaceutical expenditures by a variety of methods, such as the controversial copayment policy, as essential health expenditures were being jeopardized.
  
  
  OBJECTIVE
  To analyze the regulatory intervention of preauthorization on a rofecoxib model in the medical corps of the Israeli Defense Forces (IDF) in terms of indications for prescription, consumption, and cost.
  
  
  METHODS
  Guidelines established by the medical services branch based on current literature and communication with diverse specialists and hospitals were implemented by a general practitioner who checked each rofecoxib prescription that was written for IDF personnel by a specialist. The intervention was initiated in November 2000 and continued until August 2001 and after the study.
  
  
  METHODS
  The study was divided into two parts. The first part was a retrospective monthly, preintervention analysis of computerized medical records of IDF personnel (N = 247) for whom rofecoxib was prescribed. The second was a prospective monthly, postintervention analysis of filled-out guideline forms (N = 250) of approved rofecoxib prescriptions.
  
  
  METHODS
  Patients, were IDF personnel, age 18 to 45, treated in military and civilian outpatient clinics for whom rofecoxib was prescribed.
  
  
  METHODS
  The study took place at the Medical Service Branch of the IDF between August 2000 and August 2001.
  
  
  RESULTS
  We demonstrated a significant decrease in average monthly consumption (43.0%) and estimated monthly expenditures (40.84%) of rofecoxib, as well as significant shifts (p < 0.001) in indications for whom rofecoxib was approved. These shifts (from pre- to postintervention) include the following: others/nonspecified (80 to 12%), known peptic disorder (7 to 32%), peptic complaints (4 to 22%), and rheumatic (8 to 19%).
  
  
  CONCLUSIONS
  This type of intervention can be cost-effective, can provide quality care, and may be a viable alternative to the controversial and problematic copayment policy.
authors.affiliation: Medical Services Branch, IDF Medical Services and Supply Center, 16 Doley Street, Neve Savyon, Or Yehuda, Israel.
authors.forename: Yitzhak
authors.initials: Y
authors.lastname: Rosen
authors.forename: Naomi
authors.initials: N
authors.lastname: Yachelevich
authors.forename: Paul
authors.initials: P
authors.lastname: Benedek
authors.forename: Itamar
authors.initials: I
authors.lastname: Grotto
authors.forename: Avishy
authors.initials: A
authors.lastname: Goldberg
authors.forename: Yair
authors.initials: Y
authors.lastname: Morad
authors.forename: Hadar
authors.initials: H
authors.lastname: Marom
authors.forename: Nissim
authors.initials: N
authors.lastname: Ohana
authors.forename: Yaron
authors.initials: Y
authors.lastname: Bar-Dayan
mesh_terms: D000293:Adolescent; D000328:Adult; D017047:Cost Sharing; D004363:Drug Utilization / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D007557:Israel; D007783:Lactones / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D008887:Military Medicine / Q000191:economics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012189:Retrospective Studies; D013450:Sulfones / Q000191:economics / Q000627:therapeutic use*
chemical_list: D007783:Lactones; D013450:Sulfones; C116926:rofecoxib