title: Pharmaceutical cost management in an ambulatory setting using a risk adjustment tool.
abstract: BACKGROUND
  Pharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending.
  
  
  METHODS
  Descriptive study, cross-sectional. The study used a database of 4,700,000 population, with the following information: age, gender, assigned CRG group, chronic conditions and pharmaceutical expenditure. The predictive model for pharmaceutical expenditure was developed using CRG with 9 core groups and estimated by means of ordinary least squares (OLS). The weights obtained in the regression model were used to establish a case mix system to assign a prospective budget to health districts.
  
  
  RESULTS
  The risk adjustment tool proved to have an acceptable level of prediction (R2 ≥ 0.55) to explain pharmaceutical expenditure. Significant differences were observed between the predictive budget using the model developed and real spending in some health districts. For evaluation of pharmaceutical spending of pediatricians, other models have to be established.
  
  
  CONCLUSIONS
  The model is a valid tool to implement rational measures of cost containment in pharmaceutical expenditure, though it requires specific weights to adjust and forecast budgets.
authors.affiliation: Research Centre for Health Economics and Management, Universitat Politècnica de València, Edificio 7 J, Campus de Vera s/n, 46022 Valencia, Spain. dvivas@upvnet.upv.es.
authors.forename: David
authors.initials: D
authors.lastname: Vivas-Consuelo
authors.forename: Ruth
authors.initials: R
authors.lastname: Usó-Talamantes
authors.forename: Natividad
authors.initials: N
authors.lastname: Guadalajara-Olmeda
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Trillo-Mata
authors.forename: Carla
authors.initials: C
authors.lastname: Sancho-Mestre
authors.forename: Laia
authors.initials: L
authors.lastname: Buigues-Pastor
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D003363:Cost Control / Q000191:economics*; D003430:Cross-Sectional Studies; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D018803:Models, Economic; D020379:Risk Adjustment / Q000379:methods*; D013030:Spain