http://hdl.handle.net/10468/326 2017-10-18T19:53:40Z http://hdl.handle.net/10468/3366 The continuing evolution of official statistics: some challenges and opportunities MacFeely, Steve As economies, societies, and environments change, official statistics evolve and develop to reflect those changes. In reaction to disruptive innovations arising from globalisation, technological advances, and cultural changes, the pace of change of official statistics will accelerate in the future. The motivation for change may also be more existential than that of the past as official statisticians consider the survival of their discipline. This article examines some of the emerging developments and questions whether they present threats or offer opportunities. 2016-11-01T00:00:00Z http://hdl.handle.net/10468/2448 Irish GMS cost projections and its implications between 2016 and 2026 Conway Lenihan, Aisling; Woods, Noel Introduction: Ireland had one of the highest pharmaceutical spends per capita in the EU in 2012. The General Medical Services (GMS) scheme is the largest community drug scheme in Ireland with approximately 40% of the population eligible for free drugs and appliances in 2012. The total cost of GMS prescriptions increased by 414% between 1998 and 2012. This paper projects Irish GMS cost from 2016 to 2026 and examines the implications of the estimated impact on GMS expenditure. Method: Central Statistics Office (CSO) population projections (2013) and HSE-PCRS GMS population prescription data (2012) were used to develop four variables; population, GMS coverage, average cost per claimant and claims rate. A Monte Carlo Simulation (MCS) model simulated the effect of these four variables on GMS costs, by health board region, age cohort and sex. Results: Irish population is projected to grow by approximately 10% between 2012 and 2026. The over 70s population is estimated to grow by 64% with the proportion of males growing by 72%. GMS expenditure is estimated to increase by 64%, from €1.1 billion in 2016 to €1.8 billion by 2026. Age is a key driver of GMS expenditure, specifically those aged under 11 and over 70. The MCS results project that males, the Mid-Western and South Eastern regions are driving GMS costs in the under 11s. Females, Midlands and Southern regions are driving GMS costs in the over 70s. Conclusion: Population growth coupled with an aging population will impact future GMS costs. Targeted GMS policy changes such as co-payment charges, reference pricing, and generic substitution can help to contain future GMS expenditure. 2015-11-07T00:00:00Z http://hdl.handle.net/10468/2622 Drug prescribing patterns in the General Medical Services Scheme in Ireland and projected costs to 2026 Conway Lenihan, Aisling The primary objective is to investigate the main factors contributing to GMS expenditure on pharmaceutical prescribing and projecting this expenditure to 2026. This study is located in the area of pharmacoeconomic cost containment and projections literature. The thesis has five main aims: 1. To determine the main factors contributing to GMS expenditure on pharmaceutical prescribing. 2. To develop a model to project GMS prescribing expenditure in five year intervals to 2026, using 2006 Central Statistics Office (CSO) Census data and 2007 Health Service Executive{Primary Care Reimbursement Service (HSE{PCRS) sample data. 3. To develop a model to project GMS prescribing expenditure in five year intervals to 2026, using 2012 HSE{PCRS population data, incorporating cost containment measures, and 2011 CSO Census data. 4. To investigate the impact of demographic factors and the pharmacology of drugs (Anatomical Therapeutic Chemical (ATC)) on GMS expenditure. 5. To explore the consequences of GMS policy changes on prescribing expenditure and behaviour between 2008 and 2014. The thesis is centered around three published articles and is located between the end of a booming Irish economy in 2007, a recession from 2008{2013, to the beginning of a recovery in 2014. The literature identified a number of factors influencing pharmaceutical expenditure, including population growth, population aging, changes in drug utilisation and drug therapies, age, gender and location. The literature identified the methods previously used in predictive modelling and consequently, the Monte Carlo Simulation (MCS) model was used to simulate projected expenditures to 2026. Also, the literature guided the use of Ordinary Least Squares (OLS) regression in determining demographic and pharmacology factors influencing prescribing expenditure. The study commences against a backdrop of growing GMS prescribing costs, which has risen from e250 million in 1998 to over e1 billion by 2007. Using a sample 2007 HSE{PCRS prescribing data (n=192,000) and CSO population data from 2008, (Conway et al., 2014) estimated GMS prescribing expenditure could rise to e2 billion by2026. The cogency of these findings was impacted by the global economic crisis of 2008, which resulted in a sharp contraction in the Irish economy, mounting fiscal deficits resulting in Ireland's entry to a bailout programme. The sustainability of funding community drug schemes, such as the GMS, came under the spotlight of the EU, IMF, ECB (Trioka), who set stringent targets for reducing drug costs, as conditions of the bailout programme. Cost containment measures included: the introduction of income eligibility limits for GP visit cards and medical cards for those aged 70 and over, introduction of co{payments for prescription items, reductions in wholesale mark{up and pharmacy dispensing fees. Projections for GMS expenditure were reevaluated using 2012 HSE{PCRS prescribing population data and CSO population data based on Census 2011. Taking into account both cost containment measures and revised population predictions, GMS expenditure is estimated to increase by 64%, from e1.1 billion in 2016 to e1.8 billion by 2026, (ConwayLenihan and Woods, 2015). In the final paper, a cross{sectional study was carried out on HSE{PCRS population prescribing database (n=1.63 million claimants) to investigate the impact of demographic factors, and the pharmacology of the drugs, on GMS prescribing expenditure. Those aged over 75 (ẞ = 1:195) and cardiovascular prescribing (ẞ = 1:193) were the greatest contributors to annual GMS prescribing costs. Respiratory drugs (Montelukast) recorded the highest proportion and expenditure for GMS claimants under the age of 15. Drugs prescribed for the nervous system (Escitalopram, Olanzapine and Pregabalin) were highest for those between 16 and 64 years with cardiovascular drugs (Statins) were highest for those aged over 65. Females are more expensive than males and are prescribed more items across the four ATC groups, except among children under 11, (ConwayLenihan et al., 2016). This research indicates that growth in the proportion of the elderly claimants and associated levels of cardiovascular prescribing, particularly for statins, will present difficulties for Ireland in terms of cost containment. Whilst policies aimed at cost containment (co{payment charges, generic substitution, reference pricing, adjustments to GMS eligibility) can be used to curtail expenditure, health promotional programs and educational interventions should be given equal emphasis. Also policies intended to affect physicians prescribing behaviour include guidelines, information (about price and less expensive alternatives) and feedback, and the use of budgetary restrictions could yield savings. 2015-01-01T00:00:00Z http://hdl.handle.net/10468/2203 The implications of regional and national demographic projections for future GMS costs in Ireland through to 2026 Conway Lenihan, Aisling; Kenneally, Martin; Woods, Noel; Thummel, Andreas; Ryan, Marie BACKGROUND: As the health services in Ireland have become more resource-constrained, pressure has increased to reduce public spending on community drug schemes such as General Medical Services (GMS) drug prescribing and to understand current and future trends in prescribing. The GMS scheme covers approximately 37% of the Irish population in 2011 and entitles them, inter alia, to free prescription drugs and appliances. This paper projects the effects of future changes in population, coverage, claims rates and average claims cost on GMS costs in Ireland. METHODS: Data on GMS coverage, claims rates and average cost per claim are drawn from the Primary Care Reimbursement Service (PCRS) and combined with Central Statistics Office (CSO) (Regional and National Population Projections through to 2026). A Monte Carlo Model is used to simulate the effects of demographic change (by region, age, gender, coverage, claims rates and average claims cost) will have on GMS prescribing costs in 2016, 2021 and 2026 under different scenarios. RESULTS: The Population of Ireland is projected to grow by 32% between 2007 and 2026 and by 96% for the over 70s. The Eastern region is estimated to grow by 3% over the lifetime of the projections at the expense of most other regions. The Monte Carlo simulations project that females will be a bigger driver of GMS costs than males. Midlands region will be the most expensive of the eight old health board regions. Those aged 70 and over and children under 11 will be significant drivers of GMS costs with the impending demographic changes. Overall GMS medicines costs are projected to rise to €1.9bn by 2026. CONCLUSIONS: Ireland’s population will experience rapid growth over the next decade. Population growth coupled with an aging population will result in an increase in coverage rates, thus the projected increase in overall prescribing costs. Our projections and simulations map the likely evolution of GMS cost, given existing policies and demographic trends. These costs can be contained by government policy initiatives. 2014-10-21T00:00:00Z