Ongoing initiatives within the Scottish National Health Service to affect the prescribing of selective serotonin reuptake inhibitors and their influence

Abstract

Aim: Increasing use of selective serotonin-reuptake inhibitors (SSRIs) in Scotland, coupled with safety concerns with some SSRIs, and the increasing availability of generic SSRIs, have resulted in multiple initiatives to improve the quality and efficiency of their prescribing in Scotland. Our aim is to assess their influence to provide future direction. Materials & methods: The prescription costs analysis database was used to document utilization and expenditure on SSRIs between 2001 and 2017 alongside documenting the initiatives. Results: Multiple interventions over the years increased international nonproprietary name prescribing up to 99.9% lowering overall costs. This, coupled with initiatives to limit escitalopram prescribing due to concerns with its value, resulted in a 73.7% reduction in SSRI expenditure between 2001 and 2017 despite a 2.34-fold increase in utilization. Safety warnings resulted in a significant reduction in the prescribing of paroxetine, citalopram and escitalopram alongside a significant increase in sertraline Conclusion: Multiple initiatives have increased the quality and efficiency of SSRI prescribing in Scotland providing direction to others.

Prescribing trends of inhaler treatments for asthma and chronic obstructive pulmonary disease within a resource-constrained environment in the Scottish national health service: findings and implications

“…The usage and expenditure patterns for respiratory inhalers (Figures 1 and 2) did not follow the same patterns as seen with other common classes of medicines prescribed in ambulatory care in Scotland when medicines lose their patent such as antihypertensive medicines, PPIs, SSRIs and statins [42][43][44]53]. Consequently, we did not see appreciable reductions in inhaler expenditures as the constituent medicines lost their patents with the launch of newer inhalers replacing the older ones (Appendix 1A) and, as mentioned, price reductions with newer inhalers being more modest [42,43].…”

“…We are also aware that alternatives to Seretide® and Symbicort® are typically priced at a discount of only 20% to 30% below originator prices rather than the 85% to 95% reductions seen for generic PPIs, statins and selective serotonin reuptake inhibitors (SSRIs) versus pre-patent loss prices [42,53,54]. As a result, expenditure on LABA/ICS and LAMA inhalers has grown in recent years to become the highest of any medicine type in Scotland.…”

Drug Utilization and Drug Pricing in the Private Primary Healthcare System in Malaysia: An Employer Price Control Mechanism

“…For chronic illnesses, prescribing of low-cost generic drugs that have similar therapeutic activity should be promoted. These products have similar efficacy profiles to originators or branded drugs; thus, patient care will not be undermined, and substantial saving can be achieved (19)(20)(21), as well as improved prescribing efficiency (22,23). Several initiatives have been introduced to enhance the generic prescribing in Western European Countries, such as demand-side measures (24) which include educational activities, prescribing targets, prescribing restrictions, compulsory International Nonproprietary Name (INN) prescribing and financial incentives for patient copayment differentials (20,21).…”

Consumption of psychotropic medicines at a referral hospital Namibia: findings and implications

“…antipsychotics, antidepressants, mood stabilizers and sedative-hypnotics have been associated with adverse effects, poor medication compliance, heath care financial burden 18 and interference with normal functioning 19 . Recently there has been conflicting data on the benefits and/or effectiveness of antidepressants [20][21][22][23] and sedative-hypnotics 24 yet they remain widely used in Namibia. This is a concern as it exposes patients to ineffective treatments at leads to poor outcomes and drains the health care budgets in these resource constrained LMIC 7 .…”