Subscribe to RSS
DOI: 10.1055/a-2089-5142
Self-Medication in Europe: Economic and Social Impact on Individuals and Society
Selbstmedikation in Europa: Sozioökonomische Effekte auf den Einzelnen und die GesellschaftAbstract
Objectives To demonstrate the different monetary and time-related costs associated with the treatment of minor ailments (MAs) in the case of a general practitioner (GP) visit or self-medication with non-prescription medicines as an essential part of self-care in European countries. Ultimately, this is also intended to enable health policy statements with regard to an efficient allocation of resources in outpatient care.
Methods A simplified decision-analytical model is applied in which the self-purchase of a non-prescription medicine and a GP visit are considered as partial substitutes from the patient's perspective. In order to compare the decision paths of GP visit and self-medication in the sense of a cost-minimisation approach, the most relevant direct and indirect cost types are identified. Thirty countries are clustered following socioeconomic criteria. The value of self-medication is calculated for an individual MA case per Country Cluster, then the data is extrapolated to the entire population of countries and aggregated to a European value. Status quo and potential scenarios as well as relevant perspectives (patient, GP, healthcare system, national economy) are considered. Sensitivity analyses are conducted.
Results Almost 1.2 billion MA cases are treated by self-medication in Europe p.a., saving EUR 26.31 billion in direct costs and EUR 10.41 billion in indirect costs (status quo). On average, one euro spent on OTC medicines by consumers saves national healthcare systems and economies EUR 6.70. 10–25% of current GP visits could be substituted by self-care, creating an additional savings potential of EUR 17.60 billion.
Conclusion The study results reveal that self-medication in European countries is already associated with a high economic and social value for the individual and society. It is evident that current savings could be further increased by promoting self-care. Through responsible self-medication supported by an adequate health policy, resources and significant efficiency reserves for healthcare systems as well as national economies can be released. The resources freed up through an adequate self-care policy can play a significant role in building more resilient healthcare systems across Europe.
Zusammenfassung
Zielsetzungen Bei der Behandlung leichterer Gesundheitsstörungen führt die Inanspruchnahme eines Hausarztbesuchs zu anderen monetären und zeitlichen Kosten als die Selbstmedikation mit rezeptfreien Arzneimitteln. Die unterschiedlichen Kosten der beiden Behandlungsoptionen sollen auf europäischer Ebene aufgezeigt werden. Dies soll letztlich auch gesundheitspolitische Aussagen im Hinblick auf eine effiziente Ressourcenallokation in der ambulanten Versorgung ermöglichen.
Methodik Es wird ein vereinfachtes entscheidungsanalytisches Modell angewendet, in dem im Fall einer leichteren Gesundheitsstörung der Selbstkauf eines rezeptfreien Arzneimittels und der Besuch des Hausarztes als partielle Substitute aus Sicht des Patienten betrachtet werden. Um die Entscheidungspfade von Hausarztbesuch und Selbstmedikation im Sinne eines Kostenminimierungsansatzes zu vergleichen, werden die wichtigsten direkten und indirekten Kostenarten ermittelt. Dreißig europäische Länder werden nach sozioökonomischen Kriterien geclustert. Der Wert der Selbstmedikation wird zunächst einen einzelnen Behandlungsfall pro Ländercluster berechnet, dann werden die Daten auf die Gesamtpopulation der Länder extrapoliert und zu einem europäischen Wert aggregiert. Status quo und mögliche Szenarien sowie relevante Perspektiven (Patient, Hausarzt, Gesundheitssystem, Volkswirtschaft) werden dabei berücksichtigt sowie Sensitivitätsanalysen durchgeführt.
Ergebnisse In Europa werden jährlich fast 1,2 Milliarden Fälle leichterer Gesundheitsstörungen durch Selbstmedikation behandelt, wodurch 26,31 Milliarden Euro an direkten Kosten und 10,41 Milliarden Euro an indirekten Kosten eingespart werden (Status quo). Im Durchschnitt spart ein Euro, den die Verbraucher für rezeptfreie Arzneimittel ausgeben, den jeweiligen nationalen Gesundheitssystemen und Volkswirtschaften 6,70 EUR. Je nach Land könnten weitere 10–25% der derzeitigen Hausarztbesuche durch Selbstbehandlung substituiert werden, was ein zusätzliches Einsparpotenzial von 17,60 Mrd. EUR bedeuten würde.
Schlussfolgerung Die Studienergebnisse zeigen, dass die Selbstbehandlung leichterer Gesundheitsstörungen mit rezeptfreien Arzneimitteln in Europa bereits heute mit einem hohen ökonomischen und sozialen Nutzen für den Einzelnen und die Gesellschaft verbunden ist. Die gegenwärtigen Einsparungen können durch gesundheitspolitische Maßnahmen zur Förderung einer verantwortungsvollen Selbstmedikation noch weiter gesteigert werden. Hierdurch können weitere Ressourcen und Effizienzreserven für die Gesundheitssysteme und die Volkswirtschaften freigesetzt werden.
Die so zusätzlich freiwerdenden Ressourcen können dazu beitragen, die Gesundheitssysteme in Europa resilienter gegenüber aktuellen und künftigen wirtschaftlichen Herausforderungen auszugestalten.
Key words
self-care - self-medication - non-prescription medicine - public healthcare system - primary healthcare - decision-analytic model - minor ailment - EuropeSchlüsselwörter
Self-care - Selbstmedikation - rezeptfreie Arzneimittel - öffentliches Gesundheitssystem - primäre Gesundheitsversorgung - entscheidungsanalytisches Modell - leichtere Gesundheitsstörung - Europapublished online 2023Publication History
Article published online:
22 May 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Emanuel E, Persad G, Upshur R. et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med 2020; 382: 2049-55
- 2 Noone J, Blanchette C.. The value of self-medication: summary of existing evidence. Journal of Medical Economics 2018; 21: 201-11
- 3 May U, Bauer C.. Pharmacy-based self-care of minor ailments – a health economic analysis focused on the German healthcare system. SelfCare Journal 2018; 9: 27-46
- 4 Ostermann H, Renner A-T, Bobek J. et al A Cost/benefit Analysis of self-care Systems in the European Union. 2015 Available at http://rgdoi.net/10.13140/RG.2.1.3737.6885 Accessed September 09, 2021
- 5 Riegel B, Dunbar SB, Fitzsimons D. et al. Self-care research: Where are we now? Where are we going?. International Journal of Nursing Studies 2021; 116: 103402
- 6 World Health Organization. Self-care interventions for health. Available at https://www.who.int/health-topics/self-care#tab=tab_1 Accessed December 14, 2022
- 7 World Health Organization. The Role of the Pharmacist in Self-Care and Self-Medication. The Hague, Netherlands; 1998 Aug. Available at https://apps.who.int/iris/bitstream/handle/10665/65860/WHO_DAP_98.13.pdf?sequence=1&isAllowed=y Accessed December 14, 2022
- 8 European Commission. Directive 2001/83/EC. 2001 Nov. Report No.: Article 71. Available at https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2001:311:0067:0128:en:PDF Accessed December 14, 2022
- 9 Haramiova Z, Kobliskova Z, Soltysova J. Purchase of prescription and OTC medicines in Slovakia: factors influencing patients’ expectations and satisfaction. Braz J Pharm Sci. 2017 53. Available at http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1984-82502017000100617&lng=en&tlng=en Accessed July 29, 2022
- 10 Klemenc-Ketis Z, Kersnik J.. The Effect of Demographic Characteristics on Self-Medication Patterns: A Cross-Sectional Nationwide Study from Slovenia. Collegium Antropologicum 2011; 35
- 11 Villako P, Volmer D, Raal A.. Factors influencing purchase of and counselling about prescription and OTC medicines at community pharmacies in Tallinn, Estonia. Acta Pol Pharm 2012; 69: 335-40
- 12 Eichenberg C, Auersperg F, Rusch B. et al. Selbstmedikation: Eine bundesdeutsche Repräsentativbefragung zu Motiven, Anlässen und Informationsquellen für den Konsum rezeptfreier Medikamente. Psychother Psych Med 2015; 65: 304-10
- 13 Irish Pharmacy Union, Irish Pharmaceutical Healthcare Association. Self Care. Taking charge of your health. Dublin, Ireland; 2018. Available at: https://www.ipha.ie/IPHA/media/Documents/Self-Care-taking-charge-of-your-health.pdf Accessed January 19, 2021
- 14 Kramer P, Cremers L.. Zelfzorgadvies door huisartsen. PowerPoint Presentation presented at: Meting 2020. 2020
- 15 Proprietary Association of Great Britain. Self Care Nation: Self Care Attitudes and Behaviours in the UK. London, England: Proprietary Association of Great Britain; 2016. Available at: https://www.pagb.co.uk/content/uploads/2016/11/PAGB-SELF-CARE-NATION-REPORT-NOVEMBER-2016-1.pdf Accessed January 19, 2021
- 16 Patiëntenfederatie Nederland. Zelfzorg. 2020. Available at: https://www.patientenfederatie.nl/downloads/monitor/670-patientenmonitor-zelfzorgmiddelen/file Accessed January 19, 2021
- 17 Banks I.. Self Care of Minor Ailments: A Survey of Consumer and Healthcare Professional Beliefs and Behaviour. SelfCare 2010; 1
- 18 Association of the European Self-Care Industry. AESGP Evidence Summary Self-care in times of pandemic and beyond: looking back a year after. 2021 Jun. Available at: https://aesgp.eu/content/uploads/2021/06/AESGP_PP_COVID19_2021.pdf Accessed December 14, 2022
- 19 Milonas C, Milonas A, Kouvelas D. et al. The Economic Health Value from Rx to OTC Switch in Greece. Value in Health 2012; 15
- 20 Pellise L, Serra M.. The economic impact of an hypothetical Rx-to-OTC switch in spain. Value in Health 2015; 18: A341
- 21 Otto MH, Pillarella C, Jommi C.. The Economic Impact of a Switch From Prescription-Only to Non-prescription Drugs in Italy. Front Pharmacol 2018; 9: 1069
- 22 Association of the European Self-Care Industry. The Economic and Public Health Value of Self-Medication. Brussels: AESGP; 2004. Available at: https://aesgp.eu/content/uploads/2019/10/THE-ECONOMIC-AND-PUBLIC-HEALTH-VALUE-OF-SELF-MEDICATION.pdf Accessed December 14, 2022
- 23 IQVIA. IQVIA CH Global Data on non Rx-bound sales. 2020
- 24 Bundesverband der Arzneimittel-Hersteller e.V. Von der Verschreibungs- zur Apotheken-Pflicht. 2018. Available at: https://www.bah-bonn.de/index.php?id=2&type=565&file=redakteur_filesystem/public/20180606_BAH_switches_D_web.pdf Accessed December 14, 2022
- 25 May U, Bauer C, Giulini-Limbach C. et al Improving Influenza Vaccination Rates: Evaluation of Pharmacy Vaccination Model Project during COVID-19 Pandemic in Germany . Available at https://www.ispor.org/docs/default-source/euro2022/ispor-poster-hsd49-pdf.pdf?sfvrsn=66e7ed66_0 Accessed December 14, 2022
- 26 Global Self-Care Federation. Self-Care Readiness Index 2.0. 2022. Available at: https://selfcarepromise.org/wp-content/uploads/2022/12/self-care-readiness-index-report-2022-05122022-v2.pdf Accessed December 14, 2022
- 27 World Health Organization. Self-care in the Context of Primary Health Care. 2009. Available at: https://apps.who.int/iris/bitstream/handle/10665/206352/B4301.pdf Accessed December 14, 2022
- 28 Bundesverband der Arzneimittelhersteller e.V. Ergebnisse aus dem Deutschen Gesundheitsmonitor des BAH. Brennpunktfragen zur Abschätzung von Arztbesuchen aufgrund leichter Gesundheitsstörungen. Bonn; 2015
- 29 Bundesverband der Arzneimittel-Hersteller e.V. OTC/Wahrnehmung der Verbraucher, Ergebnisse aus dem Deutschen Gesundheitsmonitor des BAH. Bonn; 2015
- 30 Association of the European Self-Care Industry. OTC ingredients. 2023 Feb. Available at: https://otc.aesgp.eu/ Accessed February 24, 2023
- 31 Gauld NJ. Analysing the landscape for prescription to non-prescription reclassification (switch) in Germany: an interview study of committee members and stakeholders. BMC Health Services Research 2019; 404 Available at https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4219-6 Accessed December 14, 2022
- 32 Gauld NJ, Bryant LJM, Emmerton LM. et al. Why does increasing public access to medicines differ between developed countries? A qualitative comparison of factors. Journal of Health Services Research & Policy 2015; 20: 231
- 33 Organisation for Economic Co-operation and Development. Health Care Utilisation: Consultations. 2020. (OECD.Stat). Available at: https://stats.oecd.org/Index.aspx?DatasetCode=HEALTH_STAT Accessed February 16, 2023
- 34 European Commission. Improving digital health literacy in Europe. 2020. Available at: https://cordis.europa.eu/project/id/727474 Accessed February 9, 2021
- 35 May U, Bauer C.. Selbstbehandlung und Apotheke. Ein sozio- und gesundheitsökonomisches Gutachten. Bonn: Bundesverbands der Arzneimittel-Hersteller; 2016
- 36 WSMI. Responsible Self-Care and Self-Medication: A Worldwide Review of Consumer Surveys. Ferney-Voltaire; n.d.
- 37 European Commission. Directive 2001/83/EC Article 74 and a guideline for changing the classification for the supply of a medicinal product for human use. Available at: https://ec.europa.eu/health/system/files/2016-11/switchguide_160106_en_0.pdf Accessed December 14, 2022
- 38 Pugh M. Avoid unnecessary GP visits with self-care. NHS West Lancashire. 2017 Available at https://www.westlancashireccg.nhs.uk/2017/09/avoid-unnecessary-gp-visits-with-self-care/ Accessed December 14, 2022
- 39 May U, Bauer C. Pharmacy-based self-care of minor ailments - a health economic analysis focused on the German healthcare system. 2018 Available at https://selfcarejournal.com/article/pharmacy-based-self-care-of-minor-ailments-a-health-economic-analysis-focused-on-the-german-healthcare-system/ Accessed September 26, 2021
- 40 Schneider P, Renner AT, Bobek J. et al. Economic Evaluation of Minor Ailment Schemes (MAS) in the UK. Gesundh ökon Qual manag 2017; 22: S23-9
- 41 Porteous T, Ryan M, Bond C. et al. Preferences for self-care or professional advice for minor illness: a discrete choice experiment. British Journal of General Practice 2007; 57: 917
- 42 Welle-Nilsen LK, Morken T, Hunskaar S. et al. Minor ailments in out-of-hours primary care: An observational study. Scandinavian Journal of Primary Health Care 2011; 29: 39-44
- 43 Fung CY.. Dr. Me project: Teaching children self-care for self-limiting illnesses in primary schools. Future Healthcare. Journal. 2020; 7: 105-8
- 44 O’Cathain A, Simpson R, Phillips M. et al. Tendency to contact general practice instead of self-care: a population vignette study. BJGP Open 2020; 4 bjgpopen20X101024
- 45 World Health Organization. WHO guideline on self-care interventions for health and well-being. 2022 revision. Geneva: World Health Organization; 2022. Available at: https://apps.who.int/iris/handle/10665/357828 Accessed September 13, 2022
- 46 Koch K, Miksch A, Schürmann C. et al. The German Health Care System in International Comparison. Deutsches Ärzteblatt International 2011; 108: 255-61
- 47 McKee S. GPs dealing with ‘unsafe’ work load. PharmaTimes online. 2018 Available at http://www.pharmatimes.com/news/gps_ dealing_with_unsafe_work_load_1217707 Accessed December 14, 2022
- 48 Sandars J, Esmail A.. The frequency and nature of medical error in primary care: understanding the diversity across stud-ies. Family Practice 2003; 20
- 49 European Commission. Medical Errors. Brussels: 2006; (Eurobarometer 64.3 (Nov-Dec 2005))
- 50 Albers R, Gottschling C, Mayer K. et al Albtraum Fehldiagnose. FOCUS Magazin. 2013 (Nr. 8). Available at http://www.focus.de/digital/multimedia/titel-albtraum-fehldiagnose_aid_921147.html Accessed December 14, 2022
- 51 Henley J, Connolly K, Jones S. et al ‘A ticking time bomb’: healthcare under threat across western Europe. The Guardian. 2022 Available at https://www.theguardian.com/society/2022/dec/14/a-ticking-time-bomb-healthcare-under-threat-across-western-europe Accessed December 20, 2022
- 52 Tagesschau. Schlagartig wieder bei Maximal-Belastung. 2022 Oct. Available at: https://www.tagesschau.de/wissen/gesundheit/interview-corona-grippe-doppelwelle-101.html Accessed December 14, 2022
- 53 Macmillan A. Hospitals Overwhelmed by Flu Patients Are Treating Them in Tents. Available at https://time.com/5107984/hospitals-handling-burden-flu-patients/ Accessed December 20, 2022