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Godman B, Wettermark B, van Woerkom M, et al. Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: findings and future implications. Front Pharmacol. 2014;5:106doi: 10.3389/fphar.2014.00106.
Godman, B., Wettermark, B., van Woerkom, M., Fraeyman, J., Alvarez-Madrazo, S., Berg, C., Bishop, I., Bucsics, A., Campbell, S., Finlayson, A. E., Fürst, J., Garuoliene, K., Herholz, H., Kalaba, M., Laius, O., Piessnegger, J., Sermet, C., Schwabe, U., Vlahović-Palčevski, V. V., Markovic-Pekovic, V., Vončina, L., Malinowska, K., Zara, C., & Gustafsson, L. L. (2014). Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: findings and future implications. Frontiers in pharmacology, 5106. https://doi.org/10.3389/fphar.2014.00106
Godman, Brian, et al. "Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: findings and future implications." Frontiers in pharmacology vol. 5 (2014): 106. doi: https://doi.org/10.3389/fphar.2014.00106
Godman B, Wettermark B, van Woerkom M, Fraeyman J, Alvarez-Madrazo S, Berg C, Bishop I, Bucsics A, Campbell S, Finlayson AE, Fürst J, Garuoliene K, Herholz H, Kalaba M, Laius O, Piessnegger J, Sermet C, Schwabe U, Vlahović-Palčevski VV, Markovic-Pekovic V, Vončina L, Malinowska K, Zara C, Gustafsson LL. Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: findings and future implications. Front Pharmacol. 2014 Jun 17;5:106. doi: 10.3389/fphar.2014.00106. eCollection 2014. PMID: 24987370; PMCID: PMC4060455.
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Front Pharmacol. 2014 Jun 17;5:106. doi: 10.3389/fphar.2014.00106. eCollection 2014.

Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: findings and future implications.

Frontiers in pharmacology

Brian Godman, Bjorn Wettermark, Menno van Woerkom, Jessica Fraeyman, Samantha Alvarez-Madrazo, Christian Berg, Iain Bishop, Anna Bucsics, Stephen Campbell, Alexander E Finlayson, Jurij Fürst, Kristina Garuoliene, Harald Herholz, Marija Kalaba, Ott Laius, Jutta Piessnegger, Catherine Sermet, Ulrich Schwabe, Vera V Vlahović-Palčevski, Vanda Markovic-Pekovic, Luka Vončina, Kamila Malinowska, Corinne Zara, Lars L Gustafsson

Affiliations

  1. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden ; Medicines Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK ; Liverpool Health Economics Centre, University of Liverpool Management School Liverpool, UK.
  2. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden ; Centre for Pharmacoepidemiology, Karolinska Institute, Karolinska University Hospital Solna, Stockholm, Sweden ; Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council Stockholm, Sweden.
  3. Dutch Institute for Rational Use of Medicines Utrecht, Netherlands.
  4. Epidemiology and Social Medicine, Research Group Medical Sociology and Health Policy, University of Antwerp Antwerp, Belgium.
  5. Medicines Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK.
  6. Division of Epidemiology, Department of Pharmacoepidemiology, Norwegian Institute of Public Health Oslo, Norway.
  7. Public Health and Intelligence Business Unit, National Services NHS Scotland Edinburgh, UK.
  8. Department of Finance, Faculty of Business, Economics and Statistics, University of Vienna Vienna, Austria ; Department of Reimbursement, Hauptverband der Österreichischen Sozialversicherungsträger Vienna, Austria.
  9. Centre for Primary Care, Institute of Population Health, University of Manchester Manchester, UK.
  10. Green Templeton College, University of Oxford Oxford, UK.
  11. Health Insurance Institute Ljubljana, Slovenia.
  12. Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, University of Vilnius Vilnius, Lithuania ; Medicines Reimbursement Department, National Health Insurance Fund Vilnius, Lithuania.
  13. Kasemarzliche Vereinigung Hessen Frankfurt am Main, Germany.
  14. Department of Medicines and Pharmacoeconomics, Republic Fund for Health Insurance Belgrade, Serbia.
  15. State Agency of Medicines Tartu, Estonia.
  16. Department of Reimbursement, Hauptverband der Österreichischen Sozialversicherungsträger Vienna, Austria.
  17. IRDES Paris, France.
  18. Institute of Pharmacology, University of Heidelberg Heidelberg, Germany.
  19. Department of Clinical Pharmacology, University Hospital Rijeka Rijeka, Croatia.
  20. Faculty of Medicine, University of Banja Luka Banja Luka, Republic Srpska, Bosnia and Herzegovina ; Ministry of Health and Social Welfare Banja Luka, Republic Srpska, Bosnia and Herzegovina.
  21. Ministry of Health Republic of Croatia, Zagreb, Croatia.
  22. Department of Epidemiology and Health Promotion, Public Health School Warsaw, Poland ; Drug Management Department, National Health Fund Warsaw, Poland.
  23. Barcelona Health Region, Catalan Health Service Barcelona, Spain.
  24. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden.

PMID: 24987370 PMCID: PMC4060455 DOI: 10.3389/fphar.2014.00106

Abstract

INTRODUCTION: The appreciable growth in pharmaceutical expenditure has resulted in multiple initiatives across Europe to lower generic prices and enhance their utilization. However, considerable variation in their use and prices.

OBJECTIVE: Assess the influence of multiple supply and demand-side initiatives across Europe for established medicines to enhance prescribing efficiency before a decision to prescribe a particular medicine. Subsequently utilize the findings to suggest potential future initiatives that countries could consider.

METHOD: An analysis of different methodologies involving cross national and single country retrospective observational studies on reimbursed use and expenditure of PPIs, statins, and renin-angiotensin inhibitor drugs among European countries.

RESULTS: Nature and intensity of the various initiatives appreciably influenced prescribing behavior and expenditure, e.g., multiple measures resulted in reimbursed expenditure for PPIs in Scotland in 2010 56% below 2001 levels despite a 3-fold increase in utilization and in the Netherlands, PPI expenditure fell by 58% in 2010 vs. 2000 despite a 3-fold increase in utilization. A similar picture was seen with prescribing restrictions, i.e., (i) more aggressive follow-up of prescribing restrictions for patented statins and ARBs resulted in a greater reduction in the utilization of patented statins in Austria vs. Norway and lower utilization of patented ARBs vs. generic ACEIs in Croatia than Austria. However, limited impact of restrictions on esomeprazole in Norway with the first prescription or recommendation in hospital where restrictions do not apply. Similar findings when generic losartan became available in Western Europe.

CONCLUSIONS: Multiple demand-side measures are needed to influence prescribing patterns. When combined with supply-side measures, activities can realize appreciable savings. Health authorities cannot rely on a "spill over" effect between classes to affect changes in prescribing.

Keywords: PPIs; demand-side measures; drug utilization studies; generics; renin-angiotensin inhibitor drugs; statins

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