Distribution and trends in outpatient utilization of generic versusbrand name psychopharmaceuticals during a ten-year period in Croatia

Abstract

BackgroundDrug costs increasingly pose a burden upon the otherwise inadequate health care resources and rational drug utilization is an important segment of every national health policy. Optimal patient care should be the goal of rational pharmacotherapy, whereby the economic burden of treatment is just one of the elements to be considered on choosing appropriate therapy.The aim of this study was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period.MethodsUsing the World Health Organization Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from pharmacies on the number and size of drug packages. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization.ResultsTotal cost for psychopharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to financial indicators decreased by 9.6% and according to DDD/1000/day by 12%. The greatest decrease was in antidepressants, i.e. by 33.8% according to financial indicators and by 46% according to DDD/1000/day; and in antipsychotics by 30.9% according to DDD/1000/day, while showing an increase by 8.5% according to financial indicators. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day, but increased by 25.1% according to financial indicators.ConclusionsThe lack of uniform national guidelines and the still strong impact of pharmaceutical industry marketing continue favoring the rise in prescribing brand name antidepressants and antipsychotics. Depression, schizophrenia and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic psychopharmaceuticals.

Croatia: Country Health Profile 2017

“…A large share of health expenditure goes to pharmaceuticals Indicative of poor efficiency, Croatia is among the EU Member States with the highest expenditure on medical goods (mainly pharmaceuticals) as a percentage of current health expenditure, amounting to 28.5% in 2015, compared to an EU average of 18.5% (Figure 15). While comparable data on the share of generics in the pharmaceutical market in Croatia are not readily available, a study of outpatient utilisation of psychopharmaceuticals in 2001-10 found that the share of generics was decreasing rather than increasing (Polić-ViŽintin et al, 2014).…”

Challenges of Reproductive Health Management in the Camps of Internally Displaced Persons: A Systematic Review

“…Reference-based pricing system: In this system, patients should pay the difference between prices of medicine and reference prices (announced price by a health insurer). Patients pay these differences, if the price of selected medicine by them, be more than the reference price ( 3 , 5 , 13 , 23 , 24 , 26 , 32 , 33 , 35 , 40 , 60 ).…”

Policies and Practices Catalyzing the Use of Generic Medicines: A Systematic Search and Review

“…Reference-based pricing system: In this system, patients should pay the difference between prices of medicine and reference prices (announced price by a health insurer). Patients pay these differences, if the price of selected medicine by them, be more than the reference price (3,5,13,23,24,26,32,33,35,40,60).…”

“…Guidelines, websites, campaigns, newsletters, Proper Education of students in pharmacy school(3, 12, 13, 28, 34) Mandatory, voluntary, forbidden(3, 5, 23, 25, 28, 29, 31-33, 35, 38, 40, 46, 60) Fixed Fee per item, fee-for -performance payment, Regressive margins or regressive markup, Ceilings on the markup of expensive medicines (Mass media publicity campaign, educational campaigns, information campaigns, anthropomorphic images, Poster and pamphlet, Media campaign in TV, radio and internet(3, 10, 12, 13, 16, 19, 25, 28, 31, 33, 35) Caps, Tiered co-payment, Reference-based pricing system(3,5, 13, 16, 19, 23, 24, 28, 32, 33, 38, 40,60) Prohibition of direct-to-consumer pharmaceutical advertising (DTCPA), Limiting the distribution of free medicine samples(3, 16, 25,44) Healthcare organizationsGuidelines on primary health care problems, leaflets in hospitals and healthcare centers, billboards and the internet (30, 31)Mandatory use of generics by hospitals, Mandatory Prescription by INN, Mandatory generic substitution in the inpatient setting (35, 42, 45) Rewards for achieving budget goals and penalties for budget deficits, Fixed fee per item or fee for prescriptions, Pay for performance (p4p), Budget-cap (5, 30, 31, 39, 42) Category 1: Prescribing…”