Evaluation of the impact of terminating the reimbursement of a therapeutic class of drugs on the French health system: The example of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs)

The French social security has had a balanced budget as a recurring objective for several decades, with a specific target on the National Health Insurance (NHI) branch. Over the past several years, efforts have intensified, with a continuing policy on decreasing drug prices, developing ambulatory care to limit hospitalizations or reducing the reimbursement of some specialists. Decreasing the reimbursement rate of drugs reduces, as a direct effect, the prescription and delivery of the targeted drugs. However, the substitution effect in favor of still reimbursed drugs should not be forgotten, because it could minimize the intended effect in economic terms as well as in terms of public health. The recent French decision to terminate the reimbursement of Symptomatic Slow-Acting Drugs for Osteoarthritis (SYSADOAs) is an interesting case study for the impact of terminating the reimbursement a drug from a collective perspective. The aim of the present study was to investigate prescription substitutions in favor of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), both in terms of volumes and costs, as well as the occurrence of their potentially associated adverse effects (AEs) using a methodology based on access to national administrative databases.