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Reimbursement restriction moderately decreases Benzodiazepine use in general practice.

Hoebert, J.M., Souverein, P.C., Mantel-Teeuwisse, A.K., Leufkens, H.G.M., Dijk, L. van. Reimbursement restriction moderately decreases Benzodiazepine use in general practice. Abstract. In: Abstract Book PPRI Conference 2011. 29-30 september 2011, Vienna. 10
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Problem Statement: On January 1st 2009, benzodiazepines were excluded from the Dutch positive reimbursement list when used as anxiolytic, hypnotic or sedative, to limit misuse and for cost savings. Thus far, the (un)intended effects of this reimbursement restriction are unknown. Objective(s): To assess the impact of the reimbursement restriction on benzodiazepine use in patients newly diagnosed with anxiety or sleeping disorder. Policy/ies targeted: Reimbursement restriction and general practice. Stakeholder(s) involved: General practitioners. Region covered: The Netherlands Study design: Drug utilization study Time period: January 2007 - July 2009. Setting: Netherlands Information Network of General Practice, a network of general practices across the Netherlands Intervention(s): Reimbursement restriction Result(s): In the first two to three quarters after the policy change, the incidence of anxiety and sleeping disorders decreased by almost 10% and 12%, respectively. The proportion of patients being prescribed a benzodiazepine following a diagnosis was lower in 2009 compared to 2008 for both anxiety (33.7% vs. 30.0%, p<0.05) and sleeping disorder (67.0% vs. 59.1%, p<0.05) as was the proportion of patients with more than 1 benzodiazepine prescription for both anxiety (42.6% vs. 36.4%, p<0.05) and sleeping disorder (42.6% vs 35.0%, p<0.05). A shift to or an increase in initiation of alternative treatment for anxiety with SSRIs was not found. Patients with sleeping disorder had a lower risk of discontinuation in 2009 compared to 2008 (HR 0.63 95%CI 0.52-0.76), this was not observed for patients with anxiety. Conclusions: The reimbursement restriction has resulted in a moderately positive effect on the use of benzodiazepines, as initiation of benzodiazepine use slightly decreased in patients newly diagnosed with anxiety or sleeping disorder. Besides, no unwanted negative effects, such as shifts to alternative treatment with SSRIs, have been observed. Lesson(s) learned and success factor(s): Careful attention is needed before implementing a new policy and afterwards, when determining the effects of regulatory changes. The outcomes of policy changes should be seen in broader perspective. A regulatory change may lead to public cost savings, but may increase private expenditures or may lead to under-treatment of certain populations.
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