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The report reviews the published and grey literature on international variation in the use of medicines in six areas (osteoporosis, atypical anti-psychotics, dementia, rheumatoid arthritis, cardiovascular disease/lipid-regulating drugs (statins), and hepatitis C). We identify three broad groups of determinants of international variation in medicines use: (1) Macro- or system level factors: Differences in reimbursement policies, and the role of health technology assessment, were highlighted as a likely driving force of international variation in almost all areas of medicines use reviewed. A related aspect is patient co-payment, which is likely to play an important role in the United States in particular. The extent to which cost-sharing policies impact on overall use of medicines in international comparison remains unclear. (2) Service organisation and delivery: Differences in access to specialists are a likely driver of international variation in areas such as atypical anti-psychotics, dementia, and rheumatic arthritis, with for example access to and availability of relevant specialists identified as acting as a crucial bottleneck for accessing treatment for dementia and rheumatoid arthritis. (3) Clinical practice: Studies highlighted the role of variation in the use and ascertainment methods for mental disorders; differences in the use of clinical or practice guidelines; differences in prescribing patterns; and reluctance among clinicians in some countries to take up newer medicines.
Each of these factors is likely to play a role in explaining international variation in medicines use, but their relative importance will vary depending on the disease area in question and the system context.
Table of Contents
Chapter One
Background
Chapter Two
Osteoporosis
Chapter Three
Atypical anti-psychotics
Chapter Four
Dementia
Chapter Five
Rheumatoid arthritis
Chapter Six
Cardiovascular disease lipid-regulating drugs/statins
Chapter Seven
Hepatitis C
Chapter Eight
Summary and conclusions
Research conducted by
The research described in this report was prepared for the Department of Health within the PRP project "An 'On-call' Facility for International Healthcare Comparisons" and was conducted by RAND Europe.
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