title: Analysis of the impact of removing mucolytics and expectorants from the list of reimbursable drugs on prescription rates: a time-series analysis for France 1998-2010.
abstract: OBJECTIVE
  After a comprehensive review of the therapeutic advantage of all drugs reimbursed by the French Public Health Insurance, a large number of drugs were removed from the list of reimbursable drugs, among them mucolytics and expectorants (ATC Class R05C) in March 2006. The aim of this study is to evaluate the impact of this measure on the mucolytic and expectorant class, on the prescription of possible substitute drugs (other bronchodilators, antitussives and antibacterials) and on the costs for Public Health Insurance.
  
  
  METHODS
  Prescription data were taken from a 850 French physicians sample surveyed by the IMS-Health Permanent Survey on Medical Prescription from 1998 to 2010. We performed linear segmented regression to determine changes in the level and slope of the prescription rates and to estimate the budget impact.
  
  
  RESULTS
  Following their removal from the list of reimbursable drugs, the prescription rate for mucolytics declined significantly and we recorded an increase in the prescription rates for antitussives and bronchodilators. The medically unexpected increase in antitussives can be viewed as a negative side-effect of the policy. Four years after the reform, total savings for Public Health Insurance were estimated at EUR 32.1 million.
  
  
  CONCLUSIONS
  Further removals from the list of reimbursable drugs should take into account the possibility of negative impact on public health and potential savings.
authors.affiliation: Institut de Recherche et de Documentation en Economie de la Santé, Irdes, 10 rue Vauvenargues, 75018 Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Pichetti
authors.forename: Christine
authors.initials: C
authors.lastname: Sorasith
authors.forename: Catherine
authors.initials: C
authors.lastname: Sermet
mesh_terms: D000996:Antitussive Agents / Q000191:economics; D001993:Bronchodilator Agents / Q000191:economics; D017046:Cost Savings; D016527:Drug Costs; D005100:Expectorants / Q000191:economics*; D005602:France; D018166:Health Care Reform; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D016014:Linear Models; D055553:Prescription Drugs / Q000191:economics*; D011634:Public Health / Q000191:economics
chemical_list: D000996:Antitussive Agents; D001993:Bronchodilator Agents; D005100:Expectorants; D055553:Prescription Drugs