Society already achieves economic benefits from generic substitution but fails to do the same for therapeutic substitution

Abstract

AimsTo assess the potential annual savings due to generic and therapeutic substitution of statin therapy for the general Dutch population, taking the patients medical history into account. MethodsWe conducted a population-based costing study using the PHARMO Record Linkage System (RLS). PHARMO RLS contains drug dispensing records from a representative sample of pharmacies located in more than 50 regions in the Netherlands. We selected all statin users in the database since 2003. The cost-savings of generic substitution of statin therapy for all simvastatin and pravastatin users, and of therapeutic substitution of statin therapy for other statin users were calculated. Substituting current users and new users of statins were considered separately. Therapeutic substitution was based on the medical history of the individual patient. Patients were only substituted if there was an appropriate substitute available. The appropriateness of substitution was based on drug-drug interactions between statins and possible comedication and the availability of an equipotent alternative. ResultsSubstituting (generic and therapeutic) statin therapy for all current users would lead to potential annual savings of approximately €87 million. Substituting (generic and therapeutic) all starters on statin therapy would lead to potential annual savings of around €51 million. In the case of generic substitution only, the potential annual savings for all current simvastatin and pravastatin users would be €2.4 million and for the new users about €1.8 million. ConclusionsFrom an economic point of view, society could gain a lot from substituting statin therapy, especially from therapeutic substitution.

Statin prescribing in Northern Ireland and England pre and post introduction of the quality and outcomes framework

“…Significantly less statins were dispensed (based on DDDs/1,000 patients) in Northern Ireland compared with the matched region in England both before (19,866 vs. 32,432; P \ 0.001) and after the introduction of QOF (32,757 vs. 42,716; P \ 0.001). However, significantly more statins were dispensed in both regions after the introduction of QOF (52,623 DDDs/1,000 patients rising to 75,148 DDDs/1,000 patients) ( Table 2).…”

“…This highlights once more the power of generic prescribing in cost containment [17]. Finally, in a recent study in the Netherlands, Gumbs et al concluded that society could benefit from an economic point of view by employing a dual strategy of both therapeutic substitution and generic substitution [19]. The differences in total statin prescribing (DDDs/1000 patients) pre and post QOF in NY Fig.…”

Generic Statins in Cardiovascular Medicine

“…In general, from an economic point of view, society could gain a lot from substituting statin therapy, especially from therapeutic substitution [29]. Moreover, prescribing generic or preferred medications within a therapeutic class was associated with improvements in adherence to therapy [30].…”

Price control as a strategy for pharmaceutical cost containment—What has been achieved in Norway in the period 1994–2004?

“…Price reductions in the offpatent market can also be achieved by generic substitution or generic prescribing [12][13][14].…”