Influence of demand-side measures to enhance renin–angiotensin prescribing efficiency in Europe: implications for the future

Abstract

Multiple and intensive demand-side measures enhanced prescribing efficiency. The more intense follow-up of ARB prescribing restrictions in Croatia had a greater influence on subsequent utilization patterns than Austria. Both findings confirm earlier studies. Reforms also favorably enhanced the prescribing of generic losartan once available.

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.…”

“…Patented statins were restricted to second line in Norway and Finland, limiting their utilization in Finland to just 18.3% of total statin utilization, ARBs were restricted to second line after angiotensin converting enzyme inhibitors (ACEIs) in a number of European countries limiting their utilization, and more recently patented ARBs were restricted to second line versus generic ARBs in Austria and Belgium following generic availability again significantly reducing their use [10][11][12][13][14].…”

“…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].…”

European payer initiatives to reduce prescribing costs through use of generics

“…As a result, these measures help fund increased drug volumes and new drugs without having to raise taxes or health insurance premiums. However, recent research has shown that among the proton pump inhibitors (PPIs), 3-hydroxy-3-methil-gluteryl-CoA reductase inhibitors (statins) and renin-angiotensin products, there is considerable variation in the prescribing of generics within a class or related classes once generics become available in a class [5,8,15,26,27]. Consequently, there are appreciable opportunities for countries to further enhance their prescribing of generics and lower their prescribing costs through learning from each other.…”

Trends and pattern of the utilization of cardiovascular medicines in Lithuania in 2003–2012

“…The plain ARBs compose 11.9% and ARB combinations make up 3.3% of all CV drugs DDD/TID. An increase in the use of ARB is also noticed in other countries despite prescribing restrictions by the authorities (29).…”