Medicine cost of chronic disease list (CDL) conditions in the South African private health sector

Abstract

The general research objective of this study was to investigate the prevalence and direct medicine cost of the 27 chronic disease list conditions in a section of the private health sector in South Africa from 2008 until 2012. Globally, it was predicted that deaths from chronic non-communicable diseases would increase by 77.00% between 1990 and 2020 and that most of these deaths would occur in developing countries. Cardiovascular disease will remain the single leading cause of death by 2015, with an estimated 20 million people dying from cardiac diseases and stroke. Estimations show that the prevalence of people with chronic disease list conditions may increase from 11.00% in 2009 to 13.00% in 2025. The proportion of people with co-morbid chronic disease list conditions is estimated to increase from 3.20% in 2009 to 4.00% in 2025. As a result prescribed minimum benefits have been developed to cover treatment, diagnosis and care for 270 medical conditions, including chronic conditions known as the chronic disease list conditions, for all members of medical schemes to be covered fully. Strategies implemented to increase access to quality and affordable medicines include generic substitution (from 2003) and pricing regulations such as the single exit price (from 2004). The results of this study found that the prevalence of patients with at least one chronic disease list condition increased by 25.39% (n = 54 406) and the prevalence of all chronic disease list conditions increased by 41.30% (n = 139 336) between 2008 and 2012. The average number of chronic disease list conditions per patient also increased from 1.57 ± 0.85 (95%Cl:1.57-1.58) in 2008 to 1.77 ± 0.97 (95%Cl:1.77-1.78) in 2012 (p < 0.05). Male and female patients had a chronic disease list condition prevalence increase of 9.38% (n = 8 319) and 12.87% (n = 18 564) respectively between 2008 and 2012 (p < 0.05). Age group: 70 > years had the highest average number of chronic disease list conditions in 2008 and 2012 when compared with the other age groups with 1.85 ± 1.00 (95%CI:1.85-1.86) and 2.07 ± 1.97 (95%CI:2.06-2.07) respectively (p < 0.05). Patients with chronic disease list conditions, when adjusted for of age and gender between 2008 and 2012, had an overall increase of 0.20 chronic disease list conditions (p < 0.05). Patients with a single and co-morbid chronic disease list conditions increased with 4.86% (n = 6 298) and 56.95% (n = 48 108) respectively from 2008 until 2012 (p < 0.05). The prevalence and total cost of all chronic disease list medicine items increased with 20.14% (n = 513 812) and 31.49% (R105 296 602.00) respectively from 2008 to 2012. The average medicine cost per item also increased from R131.08 ± R259.92 (95%CI:R130.77-R131.41) in 2008 to R143.86 ± R483.84 (95%CI:R142.93-R144.01) in 2012. Patient prevalence with the respective medicine items and cost of the top five (5) chronic disease list conditions changed as follows between 2008 and 2012:  Asthma: Patient prevalence increased overall by 26.90% (n = 5 923); medicine items increased by 47.19% (n = 80 353) with a total cost increase of 72.21% (R21 439 217.85);  Diabetes mellitus type 2: Patient prevalence increased overall by 54.33% (n = 17 120); medicine items and total cost increased by 37.45% (n = 149 978) and 62.99% (R37 183 442.32) respectively.  Hyperlipidaemia: Patient prevalence increased overall by 54.74% (n = 35 490), medicine items increased by 24.46% (n = 143 279), with an decrease in total cost of 7.57% (R6 923 676.81);  Hypertension: Patient prevalence increased overall by 38.91% (n = 49 531), with a medicine item increase of 17.46% (n = 288 596) with a total cost increase of 20.73% (R36 574 295.00);  Hypothyroidism: Patient prevalence increased overall by 10.83% (n = 4 288) with decreases in both the number of medicine items and total cost of 87.26% (n = 260 242) and 86.08% (R10 100 155.73) respectively. Strategies implemented to improve access to quality and affordable medicine to treat prescribed minimum conditions and other conditions include generic substitution (from 2003) and pricing regulations such as the single exit price (from 2004). The prevalence of generic medicine items and their associated medicine item cost increased by 33.72% and 46.81% respectively between 2008 and 2012. The average cost per generic medicine item increased constantly from R86.62 ± R65.43 (95%CI:R86.53-R86.73) in 2008 to R95.10 ± R78.06 (95%CI:R95.00-R95.21) in 2012. This average cost per generic medicine item was still lower than for any of the original medicine claimed with the largest practical significant difference between generic medicine items, when compared to all the other generic indicator groups. Overall, the average single exit price per prescription and single exit price per medicine item increased between 2008 and 2012. In contrast, the average dispensing fee per prescription and average dispensing fee per medicine item decreased between 2008 and 2012. Potential cost savings per medicine item from changes in single exit price for all chronic disease list conditions as well as for four of the top 5 chronic disease list medicine items. All of the top 5 chronic disease list conditions had 3.52 times more (n = 306 662) medicine items, with a total cost, 30.26 times higher (R891 414 894.44) in the under-supplied group (not yet paid for by the medical scheme or patient) than the over-supplied group. It can be concluded that there was a noted increase in the number of patients with chronic disease list conditions and their associated medicine treatment cost in this study. Many of these conditions may be cost-effectively treated through adherence education and the possible implementation of certain managed care principles such as generic substitution to reduce medicine treatment cost. The recommendation can be made to conduct a detailed study of the medicine use and treatment cost of the chronic disease list conditions in the public health sector especially regarding the implementation of the National Health Insurance that may involve both the private and public health sectors.