title: Expanding access to high-cost medicines through the E2 access program in Thailand: effects on utilisation, health outcomes and cost using an interrupted time-series analysis.
abstract: OBJECTIVE
  In 2008, the Thai government introduced the 'high-cost medicines E2 access program' as a part of the National List of Essential Medicines to increase patient access to medicines, improve clinical outcomes and make medicines more affordable. Our objective was to examine whether the 'high-cost medicines E2 access program' achieved its goals.
  
  
  METHODS
  Interrupted time-series design study.
  
  
  METHODS
  3 tertiary hospitals in different regions of Thailand, January 2006 to December 2012.
  
  
  METHODS
  Patients with target acute and chronic disease diagnoses who newly met E2 program criteria for selected study medicines.
  
  
  METHODS
  High-cost medicines E2 access program.
  
  
  METHODS
  Level and trend changes over time in the proportions of eligible patients who received the indicated E2 medicines and who improved clinically, as well as in costs of treatment.
  
  
  RESULTS
  A total of 2024 patients were included in utilisation analyses and 1375 patients with selected acute diseases contributed to analyses of clinical outcome. After 1 year of the E2 program implementation, the percentage of eligible patients receiving the indicated E2 program medicines increased significantly (relative change 12.7% (95% CI 4.4% to 21.0%), especially among those insured by the government's universal coverage scheme (relative change 19.9% (95% CI 9.5% to 30.5%)). The increase in the proportion of clinically improved patients with acute conditions was not significant (relative change 6.2% (95% CI -1.9% to 15.1%)). Quarterly healthcare costs per patient dropped significantly (relative change -13.5% (95% CI -26.9% to -1.7%)).
  
  
  CONCLUSIONS
  In the study hospitals, the E2 access program seems to have facilitated patient access to specialty medicines, may have contributed to improved health outcomes, and decreased treatment costs. Routine monitoring is needed to assess effects of expanding the programme, including effects on quality of care and financial sustainability.
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
authors.forename: Rosarin
authors.initials: R
authors.lastname: Sruamsiri
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
authors.forename: Anita K
authors.initials: AK
authors.lastname: Wagner
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
authors.forename: Christine Y
authors.initials: CY
authors.lastname: Lu
authors.affiliation: Pharmaceutical Care Research Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
authors.forename: Teerapon
authors.initials: T
authors.lastname: Dhippayom
authors.affiliation: College of Pharmacy, South Dakota State University, Brookings, South Dakota, USA.
authors.forename: Surachat
authors.initials: S
authors.lastname: Ngorsuraches
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand School of Pharmacy, Monash University Malaysia, Selangor, Malaysia School of Population Health, University of Queensland, Brisbane, Australia School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA.
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
mesh_terms: D000208:Acute Disease / Q000191:economics*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics*; D016208:Databases, Factual; D016527:Drug Costs / Q000639:trends*; D018954:Drugs, Essential; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation / Q000592:standards*; D012044:Regression Analysis; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013785:Thailand; D055815:Young Adult
chemical_list: D018954:Drugs, Essential
keywords: Access; Clinical outcome; Health care cost; High-cost medicines; Interrupted time series; policy evaluation