title: Determinants of utilisation differences for cancer medicines in Belgium, Scotland and Sweden.
abstract: BACKGROUND
  Little comparative evidence is available on utilisation of cancer medicines in different countries and its determinants. The aim of this study was to develop a statistical model to test the correlation between utilisation and possible determinants in selected European countries.
  
  
  METHODS
  A sample of 31 medicines for cancer treatment that obtained EU-wide marketing authorisation between 2000 and 2012 was selected. Annual data on medicines' utilisation covering the in- and out-patient public sectors were obtained from national authorities between 2008 and 2013. Possible determinants of utilisation were extracted from HTA reports and complemented by contacts with key informants. A longitudinal mixed effect model was fitted to test possible determinants of medicines utilisation in Belgium, Scotland and Sweden.
  
  
  RESULTS
  In the all-country model, the number of indications reimbursed positively correlated with increased consumption of medicines [one indication 2.6, 95% CI (1.8-3.6); two indications 2.4, 95% CI (1.4-4.3); three indications 4.9, 95% CI (2.2-10.9); all P < 0.01], years since EU-wide marketing authorisation [1.2, 95% CI (1.02-1.4); p < 0.05], price per DDD [0.9, 95% CI (0.998-0.999), P < 0.01], and Prescrire rating [0.5, 95% CI (0.3-0.9), P < 0.05] after adjusting for time and other covariates.
  
  
  CONCLUSIONS
  In this study, the most important correlates of increased utilisation in a sample of cancer medicines introduced in the past 15 years were: medicines coverage and time since marketing authorisation. Prices had a negative effect on consumption in Belgium and Sweden. The positive impact of financial MEAs in Scotland suggests that the latter may remove the regressive effect of list prices on consumption.
authors.affiliation: Department of Social Policy, London School of Economics and Political Science, London, UK. a.ferrario@lse.ac.uk.|LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. a.ferrario@lse.ac.uk.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferrario
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D001530:Belgium; D003132:Commerce; D058110:Counterfeit Drugs; D005060:Europe; D006801:Humans; D012606:Scotland; D013548:Sweden
chemical_list: D000970:Antineoplastic Agents; D058110:Counterfeit Drugs
keywords: Managed entry agreements; Medicines utilisation; Multilevel mixed-effects data models; Oncology; Pharmaceutical policy