title: Are pharmacological properties of anticoagulants reflected in pharmaceutical pricing and reimbursement policy? Out-patient treatment of venous thromboembolism and utilization of anticoagulants in Poland.
abstract: OBJECTIVE
  Pharmacotherapy with vitamin K antagonists (VKA) and low-molecular-weight heparins (LMWH) is a major cost driver in the treatment of venous thromboembolism (VTE). Major representatives of anticoagulants in Europe include: acenocoumarol and warfarin (VKA), enoxaparin, dalteparin, nadroparin, reviparin, parnaparin and bemiparin (LMWH). Aim of this report is to measure and critically assess the utilization of anticoagulants and other resources used in the out-patient treatment of VTE in Poland. To confront the findings with available scientific evidence on pharmacological and clinical properties of anticoagulants.
  
  
  METHODS
  The perspectives of the National Health Fund (NHF) and the patients were adopted, descriptive statistics methods were used. The data were gathered at the NHF and the clinic specialized in treatment of coagulation disorders.
  
  
  RESULTS
  Non-pharmacological costs of treatment were for the NHF 1.6 times higher with VKA than with LMWH. Daily cost of pharmacotherapy with LMWH turned out higher than with VKA (234 times for the NHF, 42 times per patient). Within both LMWH and VKA the reimbursement due for the daily doses of a particular medication altered in the manner inversely proportional to the level of patient co-payment. Utilization of long-marketed and cheap VKA was dominated by LMWH, when assessed both through the monetary measures and by the actual volume of sales. Pharmaceutical reimbursement policy favored the more expensive equivalents among VKA and LMWH, whereas in the financial terms the patients were far better off when remaining on a more expensive alternative.
  
  
  CONCLUSIONS
  The pharmaceutical pricing and reimbursement policy of the state should be more closely related to the pharmacological properties of anticoagulants.
authors.affiliation: Department of Drug Management, Institute of Public Health, Collegium Medicum, Jagiellonian University, Krakow, Poland. mxbochen@cyf-kr.edu.pl.
authors.forename: T
authors.initials: T
authors.lastname: Bochenek
authors.forename: M
authors.initials: M
authors.lastname: Czarnogorski
authors.forename: R
authors.initials: R
authors.lastname: Nizankowski
authors.forename: A
authors.initials: A
authors.lastname: Pilc
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000494:pharmacology*; D016527:Drug Costs; D004358:Drug Therapy / Q000706:statistics & numerical data; D006291:Health Policy / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007356:Insurance, Pharmaceutical Services; D011044:Poland; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000191:economics*
chemical_list: D000925:Anticoagulants