Projecting future drug expenditures--2008.

PURPOSE: Drug expenditure trends in 2006 and 2007, projected drug expenditures by setting for 2008, and factors likely to influence drug expenditures are discussed. SUMMARY: Various factors are likely to influence drug expenditures in 2008, including drugs in development, the diffusion of new drugs, drug safety concerns, generic drugs, Medicare Part D, and changes in the drug supply chain. The increasing availability of important generic drugs and drug safety concerns continue to moderate growth in drug expenditures. The drug supply chain remains dynamic and may influence drug expenditures, particularly in specialized therapeutic areas. Initial data suggest the Medicare Part D benefit has influenced drug expenditures, but the ultimate impact of the benefit on drug expenditures remains unclear. From 2005 to 2006, total drug expenditures increased by 8.7% to $275 billion. Drug expenditures in clinics continue to grow more rapidly than in other settings, with a 20.9% increase from 2005 to 2006, and drug expenditures in clinics are now greater than the amount spent in hospitals. Hospital drug expenditures increased at a moderate rate of only 3.8% from 2005 to 2006; through the first nine months of 2007, hospital drug expenditures increased by only 2.2% compared with the same period in 2006. CONCLUSION: In 2008, we project a 5-7% increase in drug expenditures in outpatient settings, a 12-14% increase in clinics, and a 4-6% increase in hospitals.     

Projecting future drug expenditures--2003.

Drug expenditure projections for 2003 and factors likely to influence drug costs are discussed. The United States continues to face the challenge of increased growth in health expenditures, and drug expenditures are continuing to increase faster than the growth in total health care expenditures. These increases can be largely attributed to an increase in the average age of the U.S. population and technological advancement. On the basis of price inflation and non-price inflationary factors, including increases in volume, shifts in patient and therapeutic intensity, and expected approval of new drugs, a 10-12% increase in drug expenditures in 2003 for the inpatient setting and a 13.5-15.5% increase for ambulatory care settings are forecasted. While few new drugs are expected to greatly influence expenditures in 2003, the continued diffusion of recently approved drugs such as drotrecogin alfa and nesiritide will have a dramatic impact on total drug expenditures and must be carefully considered in the budgeting process. An agent likely to have a significant impact on HIV treatment is enfuvirtide, the first in a new class of antiretrovirals (fusion inhibitors), but its high cost ($10,000-$15,000 per year) may limit patients' access to this medication. An expanded user's guide is provided to assist the reader in appropriate application of this information in the drug budgeting process. Technological, demographic, and market-based changes and changes in public policy will continue to influence pharmaceutical expenditures in the coming year. An understanding of the overall drivers of medication expenditures and vigilance in monitoring pharmaceutical innovation are critical in the effective management of these resources.     

Projecting future drug expenditures--2002.

Drug-cost projections for 2002 and factors likely to influence drug costs are discussed. The United States continues to face the challenge of increased growth in health expenditures, and pharmaceutical expenditures continue to increase significantly faster than the growth in total health care expenditures. These increases can be largely attributed to a combination of general inflation, an increase in the average age of the U.S. population, and the increased use of new technologies. On the basis of price inflation and nonprice inflationary factors, including increases in volume, shifts in patient and therapeutic intensity, and the expected approval of new drugs, we forecast a 15.5% increase in drug expenditures in 2002 for hospitals and clinics and an 18.5% increase for ambulatory care settings. One of the most substantial contributors to the rise in pharmaceutical expenditures over the past decade is the successful introduction and rapid diffusion of new pharmaceuticals. Data about many new drugs on the horizon are provided. One agent likely to have the highest impact on hospitals in the next year is drotrecogin alfa for the treatment of sepsis. The cost of this agent is expected to range from $3,000 to $10,000 per patient per course of therapy. Other factors influencing medication costs, including generic medications, legislative initiatives, and the recent acts of terrorism committed against the United States, are also discussed. Technological, demographic, and market-based changes, and possibly public policy changes, will have a dramatic influence on pharmaceutical expenditures in the coming year. An understanding of what is driving the changes is critical to the effective management of these resources.     

Projecting future drug expenditures--1995.

Use of information on inflation, pharmacoeconomics, market introduction of new drug entities, practice-site-specific drug-use patterns, federal legislation, and the changing structure of health care delivery to project drug expenditures is discussed. Drug price inflation has been declining over the past several years, from 6.9% in 1991 to 2.2% for part of 1994. This can be attributed to both the growth of managed care and the industry's fear of government price controls. Pharmaceutical industry analysts project the overall price increase for pharmaceuticals in the next 12-24 months to be 2-5%. Pharmacoeconomic research is likely to become increasingly important; pharmacists will need to understand and critically evaluate this research. Drug budget projections should include a complete review of new drugs and biotechnology agents pending FDA approval, drugs pending approval for new indications, and common unlabeled uses of expensive existing agents. Various methods are available for tracking practice-site-specific drug-use patterns; those that categorize expenditures by diagnosis-related group may underestimate total expenditures associated with treating a given condition. State and federal legislation may affect drug rebates, prices, and ultimately drug expenditures. Although health care reform legislation did not pass in 1994, changes are occurring in both the pharmaceutical industry and in health care delivery, shifting the control of drug selection, utilization, and expenditures from individual prescribers to large purchasers. The accuracy of projections of drug expenditures can be improved by examining inflation, pharmacoeconomic research, the introduction of new drug entities, practice-site-specific drug-use patterns, federal legislation, and the changing structure of health care delivery.     

Projecting future drug expenditures--2004.

PURPOSE: Drug expenditure trends since 2002 and projected drug expenditures for 2004 are discussed. SUMMARY: In 2002 there was a moderation in the trend of increasing drug expenditures. Drug expenditures increased by 12.3% between 2001 and 2002. This trend continued in the first half of 2003, with expenditures increasing by only 10% compared with 2002. This moderation in the drug expenditures trend can be attributed to many factors, especially patent expirations and decreases in new drug approvals. Higher cost sharing for consumers and a general economic slowdown in the United States affecting employment and insurance coverage have resulted in a smaller increase in drug utilization. In 2004, there should be a 10-12% increase in drug expenditures for outpatient settings, a 19-21% increase for clinics, and a 6-8% increase for hospitals. CONCLUSION: Drug expenditure growth should continue to outpace the growth in overall health care expenditures and the growth in the U.S. economy.     

Projecting future drug expenditures--1992.

The effects of inflation, generic competition, and the introduction of new drug entities on future drug expenditures are discussed. The impact of inflation can be predicted by analyzing trends in historical data and determining factors that may affect drug use. Useful sources include U.S. Bureau of Labor Statistics Producer Price Index figures for pharmaceuticals, commercially available data on drug product pricing, and market basket indices compiled by the Health Care Financing Administration (HCFA) and the American Hospital Association. HCFA predicts that quarterly increases in pharmaceutical prices in 1992-93 will range from 6.4% to 8.1%. Pharmaceutical industry analysts predict overall annual inflation rates for pharmaceuticals in 1991-92 ranging from 8% to 10%. To evaluate generic competition, information on the expiration of patents and market exclusivity can be used. Decreases of 30-70% in the list price of a drug product can be expected after the introduction of a generic product, and the price usually stabilizes at approximately 50% of the list price of the innovator product at the time the first generic product was marketed. Predicting when new drug entities will be introduced is difficult; analysts say the usual time from filing of a new drug application to FDA approval is two years. The FDA says approval usually follows within a few weeks after an advisory panel's recommendation for approval, and marketing can be expected within a few months after final FDA approval. Assumptions about future drug expenditures should take into account historical and predicted rates of inflation, the status of generic competition for existing products, and the prospects for introduction of new drug entities.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cancer research 2001: drug resistance, new targets and drug combinations.

The development of new anticancer drugs and the identification of novel targets represent major focus areas for pharmaceutical and biotech companies, universities and research institutes worldwide. The 92nd Annual Meeting of the American Association for Cancer Research (AACR) provided a glimpse of the latest developments in the cancer field. We highlight here presentations on resistance mechanisms (efflux, target modulation), new targets and drugs in development (topoisomerase, angiogenesis, cell cycle inhibitors) and new molecular technologies. The emergence of technologies for concurrently screening for expression of thousands of genes, has provided a new approach for the identification of molecular targets and mechanisms of both action and resistance of new compounds. The importance of inhibiting multiple targets simultaneously was brought up in several presentations.     

Infectious disease 2001: drug resistance, new drugs.

The 41st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) was held in Chicago on 16-19 December 2001, rescheduled following the tragic events of 11th September. Nonetheless, it attracted thousands of delegates from industry and academia and covered, in over 2200 oral and poster presentations, topics ranging from bioterrorism, microbial pathogenesis and emerging pathogens, to infection control, vaccines, antibiotic resistance and new antimicrobial agents and treatment strategies. Summarized here are highlights on bacterial and fungal drug resistance and on new agents in preclinical and clinical development.