(039) Use of Drug Use Evaluations by Australia’s National Reimbursement Agency to Assess Quality of Medicines Use: A Document Analysis Study

Background: Subsidised access to cost-effective medicines is a fundamental component of Australia’s health system and National Medicines Policy. Drug use evaluations conducted by the Pharmaceutical Benefits Scheme (PBS), Australia’s national funding agency are an ongoing component to ensure the program’s viability and quality use of medicines for individuals and populations.

Objectives: To determine how the findings of drug utilisation reviews for medicines subsidised on Australia’s Pharmaceutical Benefits Scheme are used in identifying, assessing and addressing inappropriate use of subsidised medicines and promoting better quality medicine use.

Methods: We conducted a document analysis study retrieving all publicly available drug utilisation reviews and comprehensive post-market review documents published on the PBS website between 2012 and 2022. We developed a standardised tool to extract information on: review type, medicines reviewed, patterns of drug use, and characterised policy responses recommended to the funding agency.

Results: We identified 119 reports: 111 standard and 8 comprehensive whole-of-drug class or disease management reviews. Among the standard reviews 51 examined single drugs or a combination product, 60 multiple drugs or drug classes, 73 assessed the predicted versus actual use of a medicine and 60 a general utilisation review. The most frequent reviews of single drugs were for eculizumab and testosterone, and most frequent drug classes were antipsychotics, immunosuppressants, diabetes drugs, protein kinase inhibitors, monoclonal antibodies and antibody drug conjugates. The 8 comprehensive reviews examined drugs in smoking cessation, pulmonary arterial hypertension, chronic obstructive pulmonary disease, dementia, childhood asthma, type 2 diabetes, biologics in psoriasis and ezetimibe. Decisions of the Advisory Committee were available for 103 of the standard reviews. Among a wide range of policy recommendations the most frequent were: nil intervention required (55%), further analysis (17%), review/change listing (8%), educate prescribers (5%) and consult on findings (6%). A case study of multiple reviews of pregabalin use illustrates how these reviews were used to monitor uptake after listing, and identify and reduce inappropriate use.

Conclusions: This study shows how evaluation using drug use evaluations is embedded into the complex decision making, governance, and implementation of the medicines access scheme to ensure program goals are met and the scheme is sustainable.