SWITCHING THE HISTAMINE H-2-RECEPTOR ANTAGONIST FAMOTIDINE TO NONPRESCRIPTION STATUS IN CANADA - AN ECONOMIC-EVALUATION

The aim of this study was to compare the direct medical costs associat ed with the treatment of patients with heartburn/nonulcer dyspepsia un der 2 scenarios: (i) no nonprescription histamine H-2 receptor antagon ist (H(2)RA) is available (the 'status quo scenario'); and (ii) the H( 2)RA famotidine (at a daily dosage of 10mg) is available over-the-coun ter (OTC) at retail pharmacies (the 'OTC scenario'). We employed a dec ision analysis model over a 16-week period that considered direct medi cal costs from 2 alternative perspectives: (i) society, including the cost of self-medication borne by patients; and (ii) a provincial third -party payer for healthcare. Data concerning direct medical costs asso ciated with consumer self-medication and physician prescription of med ication (including pharmacist dispensing fees), tests and procedures, and consultations with general practitioners and specialists were draw n from a clinician panel, published unit costs, and special surveys of institutional databases. All costs are reported in 1993 Canadian doll ars ($Can; $Can1 = $US0.72, October 1995). From a societal perspective , the expected cost per patient over a 16-week period is not substanti ally different between the status quo and the OTC scenarios ($Can98 an d $Can96, respectively). From a provincial third-party payer perspecti ve, the expected costs per patient for the same scenarios are $Can95 a nd $Can89, a saving of $Can6 per patient. These results are sensitive to the proportion of patients who initially choose to see their physic ian rather than self-medicate, and the percentage of patients achievin g successful treatment of symptoms. Changes in the rate or the cost of nonprescription medication, tests/procedures and physician visits do not affect the relative cost rankings. The total number of physician v isits remained constant in both scenarios. From the societal cost pers pective, the availability of famotidine in nonprescription form yields total costs that are similar to the status quo. However, from the per spective of the provincial payer, the expected costs per patient are l ikely to be slightly lower than the status quo if famotidine is availa ble in unrestricted OTC scenario use. To generate significant savings to provincial payers, the number of people choosing immediate physicia n contact would have to be reduced, although not substantially, in the OTC scenario.