title: Systematic review of factors affecting pharmaceutical expenditures.
abstract: OBJECTIVE
  To systematically identify the main factors contributing to the increase in pharmaceutical expenditures.
  
  
  METHODS
  A systematic search of published studies was conducted utilising major widely used electronic databases using the search terms 'factors,' 'financing,' 'pharmaceutical,' and 'expenditures.' To be included, the studies needed to: (1) measure at least one of the following outcomes: total growth in pharmaceutical expenditures, price growth or quantity growth; (2) mention a clear method for analysing the impact of factors affecting the increases in drug expenditures; (3) be written in English. Nonprimary articles that were published only as an abstract, a review, a commentary or a letter were excluded.
  
  
  RESULTS
  From a total of 2039 studies, only 25 were included in the full review. The main determinant categories that were identified in the review were factors related to price, utilisation, therapeutic choice, demand and health care system.
  
  
  CONCLUSIONS
  The major cost drivers were found to be changes in drug quantities and therapies as well as new drugs. It is important for policymakers to understand pharmaceutical spending trends and the factors that influence them in order to formulate effective cost containment strategies and design optimum drug policy.
authors.affiliation: Senior Specialist of Pharmacoeconomics & Pharmacoepidemiology, National Health Insurance Fund, Khartoum, Sudan. Electronic address: m_abdalaziz@yahoo.com.
authors.forename: Mohamed Awad
authors.initials: MA
authors.lastname: Mousnad
authors.affiliation: Assoc. Professor, Programme Chair, Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia.
authors.forename: Asrul Akmal
authors.initials: AA
authors.lastname: Shafie
authors.affiliation: Professor of Social & Administrative Pharmacy, College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: Mohamed Izham
authors.initials: MI
authors.lastname: Ibrahim
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D016527:Drug Costs / Q000706:statistics & numerical data; D004358:Drug Therapy / Q000191:economics / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006291:Health Policy; D006801:Humans; D004364:Pharmaceutical Preparations / Q000191:economics*
chemical_list: D004364:Pharmaceutical Preparations
keywords: Drug financing; Drug quantities changes; Drug therapies changes; New drugs; Pharmaceutical expenditures; Spending determinants