Different initiatives across Europe to enhance losartan utilization post generics: impact and implications

Abstract

Introduction: There is an urgent need for health authorities across Europe to fully realize potential savings from increased use of generics to sustain their healthcare systems. A variety of strategies were used across Europe following the availability of generic losartan, the first angiotensin receptor blocker (ARB) to be approved and marketed, to enhance its prescribing vs. single-sourced drugs in the class. Demand-side strategies ranged from 100% co-payment for single-sourced ARBs in Denmark to no specific measures. We hypothesized this heterogeneity of approaches would provide opportunities to explore prescribing in a class following patent expiry.Objective: Contrast the impact of the different approaches among European countries and regions to the availability of generic losartan to provide future guidance.Methodology: Retrospective segmented regression analyses applying linear random coefficient models with country specific intercepts and slopes were used to assess the impact of the various initiatives across Europe following the availability of generic losartan. Utilization measured in defined daily doses (DDDs). Price reductions for generic losartan were also measured.Results: Utilization of losartan was over 90% of all ARBs in Denmark by the study end. Multiple measures in Sweden and one English primary care group also appreciably enhanced losartan utilization. Losartan utilization actually fell in some countries with no specific demand-side measures. Considerable differences were seen in the prices of generic losartan.Conclusion: Delisting single-sourced ARBs produced the greatest increase in losartan utilization. Overall, multiple demand-side measures are needed to change physician prescribing habits to fully realize savings from generics. There is no apparent “spill over” effect from one class to another to influence future prescribing patterns even if these are closely related.

Differences in utilization rates between commercial and administrative databases: implications for future health-economic and cross-national studies

“…Not surprisingly, there was convergence in utilization rates between the databases once the reimbursement restrictions were lifted for the statins (Tables 1 and 2) in view of the prevalence of CHD in Lithuania [15]. The lack of any major difference in the utilization of the renin-angiotensin inhibitors between the different databases with no prescribing restrictions in Lithuania (Tables 1 and 4), and similar utilization patterns to Western European countries in 2007 [10,26], further demonstrates that prescribing restrictions can appreciably influence subsequent utilization rates [21,28] and, as a result, demonstrating the need to accurately document ongoing reforms in any CNC study. The increase in statin utilization following the removal of prescribing restrictions (Table 3) further supports this.…”

“…This has now been extended to investigate utilization differences between different databases in Lithuania among four high volume classes seen in Western European countries [6,10,19,[21][22][23], where there are differences in patient co-payment levels and other measures ( Table 1). Medicines that are not reimbursed are not included in the Lithuanian National Health Insurance Fund (NHIF) database, with the robustness and accuracy of this database assured by the computerized dispensing records subject to frequent financial audits [24].…”

Ongoing Initiatives in China to Enhance Prescribing Efficiency: Impact and Proposals for Improvement

“…There was also appreciable utilization of generic oral PPIs at 82% to 87% of total oral PPI utilisation between 2007 and 2013 [21]. This is similar to the high utilisation of generics versus originators among a number of European countries [14,15,36,37,44,45,59]. For instance in Scotland, generics accounted for between 98% to 99% of total utilisation across a range of molecules, aided by high voluntary INN prescribing [15].…”

“…Thirdly, introducing measures to restrict prescribing choices within a class. This was seen with the ARBs among European countries including Austria, Belgium, Croatia, Lithuania and Sweden [47,59,[71][72][73].…”

“…ARBs [54,[59][60][61][62][63] Restricting the formulary to just one ARB and one ARB FDC based on the cheapest ARB (telmisartan for single ARBs and irbesartan for FDCs) would have saved an accumulated 17million CNY for this hospital group alone between 2006 and 2012 with limited differences between the ARBs at therapeutically equivalent doses. In addition, no concerns with reduced outcomes or persistence from generics versus originators Total expenditure on ARBs (alone and FDCs) was 9.87million CNY in 2012…”