Helsana Drug Report 2020: Spitex patients exposed to significant medication risks

The latest Helsana Drug Report shows that the medication costs borne by basic insurance amounted to CHF 7.6 billion in 2019, remaining stable in relation to 2018. Few new medications were launched on the market, and patent expiries and the price review carried out by the Federal Office of Public Health (FOPH) resulted in lower costs, despite only one-third of medications being reviewed each year. Costs, however, continue to remain stable overall. New, highly priced medications result in huge and rapid cost growth, as demonstrated by the development in cancer drugs (+9.5%). The largest increase in sales (CHF +37.0 million) was seen for a medication used in cancer treatment (Keytruda). While the product has received several indication extensions since its approval in 2017, these have so far not resulted in a significant price reduction.

Only 13 new active substances – cancer drugs and immunosuppressants – were launched on the market in 2019, of which just two are seen as potential innovations. There is great savings potential where generic preparations of biological pharmaceuticals are concerned. Even ten years after the first introduction of a biosimilar, the huge savings potential in the Swiss healthcare system remains almost completely unexploited. This potential increases every year as patent expiries result in ever cheaper generics arriving on the market. Significant reforms such as the introduction of price-independent margins (fixed margins) or equivalence between biosimilars and generics would create an incentive to prescribe them. 

Driven by the wish of many to spend their old age at home, more and more people are taking advantage of Spitex services. While data on the medication of vulnerable patient groups in Switzerland are not widely available, an analysis has been carried out using Helsana data. Since 2013, the use of medication by Spitex patients has increased dramatically (+ 47.7%). On average, 16 preparations are purchased in parallel (nursing home residents: nine preparations), despite the concomitant use of five or more active substances being considered problematic (polypharmacy). In 2019, half of Spitex patients (47.8%) had a long-term use of a potentially inappropriate medication (PIM). This involved sleep-inducing agents such as benzodiazepines. PIMs have been shown to be associated with adverse drug reactions, an increased hospitalisation risk and, in turn, additional costs and increased mortality.

It is vital that a periodic and systematic review of the medicines prescribed by doctors be carried out, and that those involved professionals communicate clearly. Billing data from health insurers can help in this regard and provide medical professionals with support. Spitex could potentially take on a supporting role in this context in the future.