Heart Hospital Imaging Centre, The Heart Hospital, University College Hospital London, UK.
Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden ; Medicine Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK ; National Institute for Science and Technology on Innovation on Neglected Diseases, Centre for Technological Development in Health, Oswaldo Cruz Foundation (Fiocruz) Rio de Janeiro, Brazil.
Front Pharmacol. 2014 Oct 8;5:219. doi: 10.3389/fphar.2014.00219. eCollection 2014.
There is an urgent need for health authorities across Europe to fully realize potential savings from increased use of generics to sustain their healthcare systems. A variety of strategies were used across Europe following the availability of generic losartan, the first angiotensin receptor blocker (ARB) to be approved and marketed, to enhance its prescribing vs. single-sourced drugs in the class. Demand-side strategies ranged from 100% co-payment for single-sourced ARBs in Denmark to no specific measures. We hypothesized this heterogeneity of approaches would provide opportunities to explore prescribing in a class following patent expiry.
Contrast the impact of the different approaches among European countries and regions to the availability of generic losartan to provide future guidance.
Retrospective segmented regression analyses applying linear random coefficient models with country specific intercepts and slopes were used to assess the impact of the various initiatives across Europe following the availability of generic losartan. Utilization measured in defined daily doses (DDDs). Price reductions for generic losartan were also measured.
Utilization of losartan was over 90% of all ARBs in Denmark by the study end. Multiple measures in Sweden and one English primary care group also appreciably enhanced losartan utilization. Losartan utilization actually fell in some countries with no specific demand-side measures. Considerable differences were seen in the prices of generic losartan.
Delisting single-sourced ARBs produced the greatest increase in losartan utilization. Overall, multiple demand-side measures are needed to change physician prescribing habits to fully realize savings from generics. There is no apparent "spill over" effect from one class to another to influence future prescribing patterns even if these are closely related.
欧洲各国卫生当局急需充分认识到通过增加仿制药的使用来节省潜在费用，以维持其医疗保健系统。在首个被批准和上市的血管紧张素受体阻滞剂（ARB）——氯沙坦的仿制药上市后，欧洲各国采用了各种策略来提高其相对于同类单源药物的处方量。需求方策略从丹麦对单源 ARB 实行 100%共付额到不采取具体措施不等。我们假设这种方法的异质性将为专利过期后探索某一类药物的处方提供机会。
对比欧洲各国和地区在氯沙坦仿制药上市后采用的不同方法对处方的影响，为未来提供指导。
采用具有国家特定截距和斜率的线性随机系数模型进行回顾性分段回归分析，以评估氯沙坦仿制药上市后欧洲各地的各种举措的影响。利用限定日剂量（DDD）来衡量利用率。还测量了氯沙坦仿制药的价格降低情况。
到研究结束时，丹麦所有 ARB 中超过 90%为氯沙坦。瑞典的多项举措和一个英国初级保健组也显著提高了氯沙坦的利用率。一些没有具体需求方措施的国家，氯沙坦的利用率实际上有所下降。氯沙坦仿制药的价格存在相当大的差异。
取消单源 ARB 的上市使氯沙坦的利用率增长最大。总体而言，需要采取多种需求方措施来改变医生的处方习惯，以充分实现仿制药的节省。即使这些药物密切相关，也没有明显的从一类药物到另一类药物的“溢出”效应来影响未来的处方模式。
