Department of Economics, Faculty of Social Sciences, University of Southampton,Southampton SO17 1BJ, UK.
School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
J R Soc Med. 2022 Mar;115(3):100-111. doi: 10.1177/01410768211051713. Epub 2021 Nov 18.
To investigate the relative impact of generic entry and National Institute for Health and Care Excellence clinical guidelines on prescribing using statins as an exemplar.
Retrospective analysis of statin prescribing in primary care and cost simulation model.
Royal College of General Practitioners Research and Surveillance Centre (RCGP R&SC) database and Prescription Cost Analysis (PCA) database.
New patients prescribed statins for the first time between July 2003 and September 2018.
Shares of new patients prescribed one of the five statins available in the British National Formulary, and cost of prescribing statins to new and existing patients in primary care in England.
General trends of statin' prescriptions were largely driven by a decrease in acquisition costs triggered by patent expiration, preceding NICE guidelines which themselves did not seem to affect prescription trends. Significant heterogeneity is observed in the prescription of the most cost-effective statin acrossGPs. A cost simulation shows that, between 2004 and 2018, the NHS could have saved £2.8bn (around 40% of the £6.3bn spent on statins during this time) if all GP practices had prescribed only the most cost-effective treatment.
There is potential for large savings for the NHS if new and, whenever possible, ongoing patients are promptly switched to the first medicine that becomes available as generic within a therapeutic class as long as it has similar efficacy to still-patented medicines.
以他汀类药物为例，研究仿制药进入市场和英国国家卫生与保健优化研究所临床指南对处方的相对影响。
在初级保健中对他汀类药物处方进行回顾性分析和成本模拟模型。
皇家全科医师学院研究与监测中心（RCGP R＆SC）数据库和处方成本分析（PCA）数据库。
2003 年 7 月至 2018 年 9 月间首次开具他汀类药物的新患者。
在英国国家处方集（British National Formulary）中可用的五种他汀类药物之一中，新患者处方的比例，以及在英格兰初级保健中为新患者和现有患者开具他汀类药物的成本。
他汀类药物处方的总体趋势主要是由于专利到期导致的采购成本下降所驱动的，而 NICE 指南本身似乎并没有影响处方趋势。在全科医生中，最具成本效益的他汀类药物的处方存在显著的异质性。成本模拟表明，在 2004 年至 2018 年期间，如果所有的全科医生都只开最具成本效益的治疗药物，NHS 本可以节省 28 亿英镑（大约是这段时间内他汀类药物支出的 63 亿英镑的 40%）。
如果新患者（并在可能的情况下，持续患者）及时切换到治疗类别中可用的第一种仿制药，只要它与仍受专利保护的药物具有相似的疗效，那么 NHS 就有可能节省大量资金。
