The value of self-medication: summary of existing evidence

Figures & data

Figure 1. CHWP self-reported treatment rates for conditions with FDA-approved non-prescription medications in the US workforce¹⁸. Abbreviations. CHWP, Center for Workforce Health and Performance; FDA, US Food and Drug Administration; GERD, gastroesophageal reflux disease.

Table 1. Estimated absenteeism and presenteeism costs by chronic condition in the US workforce in 2016¹.

Condition or symptom	People with condition (%)^a	Average number of other conditions^a	Net lost workdays through absence and presenteeism (millions)^b	Net lost-productivity costs (USD billions)^b
Allergies/hay fever	39.5	3.0	130.9	44.9
Chronic back/neck pain	14.3	4.9	128.1	42.4
Heartburn/GERD	13.6	4.6	92.6	30.5
Obesity	11.1	4.6	92.1	31.6
Chronic sleeping problems	6.5	5.7	89.8	30.0
Chronic pain	5.6	6.1	60.6	20.0
Arthritis	13.5	4.6	57.4	19.7
Irritable bowel disorder	6.0	5.3	56.7	18.9
Headaches	8.9	5.1	53.3	19.1
Migraine	8.9	4.8	48.8	16.7
Urinary/bladder problems	4.0	5.4	33.8	11.2
Ulcer	2.0	6.0	9.9	3.4

^a Among workers with condition.

^b Compared with employees with condition.

Abbrevation. GERD, gastroesophageal reflux disease.

Figure 2. Estimated increases in cost to the Australian healthcare system associated with eight categories of non-prescription medications being switched to prescription only status (2014)¹⁹.

Figure 3. Estimated annual cost savings from a switch in the triptan class of migraine medication from prescription only to non-prescription status across six EU member states (France, UK, Spain, Italy, Germany, and Poland)²⁸.

Figure 4. Predicted number of cardiovascular events that could be avoided over a 10-year period if a non-prescription statin drug was available³¹.

Figure 5. Predicted cost savings (EUR billions) if all residents in the European Union aged 55 years and older took a 1,000 mg/day supplement of omega-3 eicosapentaenoic acid + docosahexaenoic acid³². Abbreviation. CVD, cardiovascular disease.

Figure 6. The impact of non-prescription pain medications on activity and work impairment in the US (data from the National Health and Welfare Survey 2013 data)³⁶.

Table

Terms used	Databases used	Search round^a
Self-medication AND Cost OR Benefit OR Economic	PubMed, Ebscohost, Google Scholar	1
OTC AND Cost OR Benefit OR Economic	PubMed, Ebscohost, Google Scholar	1
OTC and Cost OR Benefit OR Economic	PubMed, Ebscohost, Google Scholar	1
Prescription to OTC switch	PubMed, Ebscohost, Google Scholar	1
Self-medication AND Research	PubMed, Ebscohost, Google Scholar	1
Over the counter AND Research	PubMed, Ebscohost, Google Scholar	1
OTC AND Research	PubMed, Ebscohost, Google Scholar	1
Self-medication AND Economic model	PubMed, Ebscohost, Google Scholar	1
Over the counter AND Economic model	PubMed, Ebscohost, Google Scholar	1
OTC AND Economic model	PubMed, Ebscohost, Google Scholar	1
Self-medication AND Antihistamine OR Orlistat OR Statin OR Nicotine	PubMed, Ebscohost, Google Scholar	2
OTC AND Antihistamine OR Orlistat OR Statin OR Nicotine	PubMed, Ebscohost, Google Scholar	2
OTC AND Antihistamine OR Orlistat OR Statin OR Nicotine	PubMed, Ebscohost, Google Scholar	2

^a In round one we were looking for specific countries; then we expanded to any country. In round two we began looking for specific treatment areas where prescriptions have been transitioned previously. This excludes articles found in the references of other articles as well as information sent from member countries.

Abbreviation. OTC, over the counter.

Table

Reference (year)	Design	Condition suitable for self-medication	Main finding
MUCHE^19 (2014)	Model	Grouped	Moving 8 categories of non-prescription medications back to prescription status would cost the Australian healthcare system an additional AUD 2.5 billion.
Shanahan and de Lorimier^20 (2014)	Model	Grouped	Adoptions of complementary medicine treating osteoporosis, osteopenia, cardiovascular disease, age-related macular degeneration and moderate major depression resulted in notable reductions in healthcare costs and improvements in productivity.
Center for Workforce Health and Performance^18 (2016)	Model	Grouped	Chronic conditions account for ∼ USD 165 billion annually in lost productivity costs in the US, and only 28%, of employee’s conditions, on average, are treated overall.
Anderson et al.^21 (1995)	Model	Allergic rhinitis/Chronic uticaria	Canada benefits CAD 1.13–1.24 for every CAD 1 spent on non-sedating anti-histamines.
Tasch et al.^25 (1996)	Model	Heartburn/Non-ulcer dyspepsia	Cost savings of CAD 6 per user would be made if Famotidine became available as a non-prescription product.
Sullivan et al.^23 (2003)	Model	Allergic Rhinitis/Chronic uticaria	Second-generation anti-histamines save USD 4 billion and prevent 449 deaths.
Rankin et al.^26 (2016)	Model	Cold	In a hypothetical scenario, wherein dextromethorphan is moved to prescription status only, access would cost an additional USD 22–31 billion during 2016–2025.
Millier et al.^28 (2013)	Model	Migraine	Across six EU-member countries, moving two triptans to non-prescription availability would save EUR 75 million.
Stomberg et al.^31 (2016)	Model	Cardiovascular disease	If statins were non-prescription in the US, it would save USD 10.8 billion.
Shanahan^32 (2016)	Model	Cardiovascular disease	Non-prescription omega-3 acids save EUR 2.29 per EUR 1 spent on the compounds.
Mansfield and Callahan^24 (2008)	Model	Heartburn	If heartburn medications were not non-prescription it would cost third-party payers an extra USD 757 million in total costs.
PAGB^33 (2007)	Retrospective	Grouped	If treatments for conditions suitable for self-medication were made available as non-prescription medicines it would save GBP 2 billion annually.
Collins et al.^34 (2005)	Retrospective with a prospective component	Grouped	Based on survey results from 7,797 respondents evaluating chronic conditions, employees with depression, anxiety, or emotional disorders (36.4% decrement), or breathing disorders (23.8% decrement) had the greatest work impairment and absences.
Gurwitz et al.^35 (1992)	Retrospective	Vaginitis	For one integrated-delivery network, savings associated with vaginal anti-fungal treatments being available as non-prescription medicines were between USD 94,926 and USD 117,176.
Lee et al.^36 (2016)	Retrospective	Pain	Opioids in combination with non-prescription products for patients experiencing pain improved activity impairment and pain intensity, and reduced healthcare resource use.
Lee et al.^36 (2016)	Retrospective	Pain	Of 25,851 respondents reporting pain in the 2013 National Health and Welfare Survey database, 14.6% were untreated, 51.3% were non-prescription only, 19% were prescription only, and 15.1% used a combination of non-prescription and prescription. Those taking non-prescription products showed improvements in resource use, presenteeism, and work/activity impairment when compared with other groups (results were not consistent across the board, but this was the general consensus).
Temin^37 (1992)	Retrospective	Cold	Non-prescription cold medicines reduced physician visits by 1.65 million in a year, saving between USD 70 million and USD 120 million.

Consumerism, self-care trends and broader value of employee health. The Center for Workforce Health and Performance; 2016. http://www.tcwhp.org/sites/default/files/reports/CWHP%20Report%20August%202016_Consumerism_Self-Care%20Trends_Broader%20Value%20of%20Employee%20Health.pdf

 Google Scholar

Consumer Healthcare Products Association. The value of OTC medicine to the United States [internet]. CHPA; January 2012. http://www.chpa.org/ValueofOTCMeds2012.aspx

 Google Scholar

The value of OTC medicines in Australia 2014 [internet]. MacQuarie University Centre for the Health Economy (MUCHE); 2014. http://www.wsmi.org/wp-content/data/pdf/FINALWEBCOPYASMI_ValueStudy.pdf

 Google Scholar

Millier A, Cohen J, Toumi M. Economic impact of a triptan Rx-to-OTC switch in six EU countries. PLoS One 2013;8:e84088

 PubMed Web of Science ®Google Scholar

Stomberg C, Albaugh M, Shiffman S, et al. A cost-effectiveness analysis of over-the-counter statins. Am J Manag Care 2016;22:e294-e303

 PubMed Web of Science ®Google Scholar

Shanahan C. Healthcare cost savings of omega 3 food supplements in the European Union: economic implication of managing CVD through targeted enhanced nutrition. Frost and Sullivan; 2016. http://www.foodsupplementseurope.org/sites/0023/uploads/content/hccs-omega-3/hccs-omega-3-report.pdf

 Google Scholar

Lee LJ, DiBonaventura M, Kudel I, et al. The incremental effect of over-the-counter medications on work productivity and healthcare resource utilization among adults with pain in the United States. Poster presented at the International Society for Pharmacoeconomics and Outcomes Research 21st Annual International Meeting; May 21–25, 2016, Washington, DC

 Google Scholar

Shanahan C, de Lorimier R. Targeted use of complimentary medicines: potential health outcomes and cost savings in Australia. Frost & Sullivan; 2014. http://www.asmi.com.au/media/14046/final_frost_sullivan_report_photocopy_ready_8_oct_2014.pdf

 Google Scholar

Anderson M, Bolton C, Morgan S, et al. The economics of self-medication. Kingston, Ontario: Queen’s Health Policy Research Unit; 1995

 Google Scholar

Tasch RF, Goeree R, Henke CJ, et al. Switching the histamine h2 receptor antagonist famotidine to nonprescription status in Canada. Pharmacoeconomics 1996;9:61-75

 PubMed Web of Science ®Google Scholar

Sullivan PW, Follin SL, Nichol MB. Transitioning the second-generation antihistamines to over-the-counter status: a cost-effectiveness analysis. Med Care 2003;41:1382-95

 PubMed Web of Science ®Google Scholar

Rankin PJ, Tsvetkova IV, Estus E, et al. Managing access to dextromethorphan: cost implications of a potential over-the-counter to prescription-only conversion. Charles River Associates; 2016. http://www.crai.com/publication/managing-access-dextromethorphan-cost-implications-potential-over-counter-prescription

 Google Scholar

Mansfield JE, Callahan D. Benefits of over-the-counter heartburn medication to consumers and the healthcare system [internet]. 2008. https://www.chpa.org/01_26_09_NielsenReportHeartburn.aspx

 Google Scholar

Proprietary Association of Great Britain. Releasing capacity in general practice for 21st century healthcare. 2007 [Data on file]

 Google Scholar

Collins JJ, Baase CM, Sharda CE, et al. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med 2005;47:547-57

 PubMed Web of Science ®Google Scholar

Gurwitz JH, McLuaghlin TJ, Fish LS. The effect of an Rx-to-OTC switch on medication prescribing patterns and utilization of physician services: the case of vaginal antifungal products. Health Serv Res 1995;30:672-85

 PubMed Web of Science ®Google Scholar

Temin P. Realized benefits from switching drugs. J Law Econ 1992;35:351-69

 Web of Science ®Google Scholar