gms | German Medical Science

Background: Demographic changes in general and the aging of our society in particular are well known problems concerning public economy. The expenses for prescribed drugs represent the second largest part of the costs of statutory health insurances and grow constantly. The reason of growing costs is predominantly induced by innovative and expensive drugs than by demography. Thus, we examined price classes as well as the ATC (anatomic- therapeutic-clinical) classification structural changes.

Materials and Methods: Drug prescription data of a regional representative sample of statutory health insurances from 2006 to 2013 were analyzed in detail.

Results: 10% of the most expensive drugs in total expenses had prices above 1,100 Euro in 2006, in the year 2013 it was more than 4,700 Euro. The 1% cost high end was 5,500 Euro in 2006 and 12,100 Euro in 2013. The top positions in the ATC-7-code in the price group of 1,000 – 1,999 Euro are interferon beta-1a (L03AB07, 301% increase from 2012 to 2013), glatiramer acetate (L03AX13, 270% increase from 2012 to 2013) and cytostatic preparations (ATC pseudo code, 301% ). In the price group of 2,000 till 4,999 Euro the top positions were parenteral solutions individually prepared with monoclonal antibodies (ATC pseudo code, 333%), infliximab (L04AB02, 303%) and fingolimod (L04AA27, 423%). The next higher price group from 5,000 to 9,999 Euro included adalimumab (L04AB04, 326%), etanercept (L04AB01, 301%) and abiraterone (L02BX03, 755%). In the group from 10,000 Euro till 19,999 Euro there are the top positions imatinib (L01XE01, 307%), imiglucerase (A16AB02, 341%) and telaprevir (J05AE11, 64%). The range of prices above 20,000 Euro was represented by agalsidase alfa (A16AB03, 341%), by again parenteral solutions individually prepared with monoclonal antibodies (ATC pseudo code, 208%) and by ivacaftor (R07AX02, 1000%).

In 2012 and 2013 the age depending drug prices in the group under 1,000 Euro are unimodal distributions with modal value between 70 and 75 years. We used a 5-year smoothing in order to reduce statistical noise. In the price group between 1,000 and 2,000 Euro as well as between 2,000 Euro and 5,000 Euro we have a bimodal distribution, where the first and larger distribution summit is from 45 to 50 years. Between 2006 and 2013 we have an increasing age shift of approximately 5 years within each group, but the type of distribution remains unchanged with some exceptions for children and the price group 2,000 to 5,000 Euro. Caused by increasing portions of higher price groups an overall shift to the modal value of 45 to 50 aged patients is resulting.

Conclusion: The aging of society seems not to be the major reason regarding the increase of costs of drugs. The growing number of highly expensive innovative drugs already has high impact on expenses and will increase in influence.