Distribution and trends in outpatient utilization of generic versus brand name psychopharmaceuticals during a ten-year period in Croatia

BMC Health Services Research

Ingrid Tripković²  Zvonimir Šostar¹  Danijela Štimac³  Marina Polić-Vižintin¹ 

[1] Dr Andrija Štampar Institute of Public Health, Vrhovčev vijenac 22, HR-10000 Zagreb, Croatia;Institute of Public Health of Split and Dalmatia County, Zagreb, Croatia;School of Medicine, University of Zagreb, Zagreb, Croatia

关键词: Croatia;    Pharmacoeconomics;    Generics;    ATC/DDD methodology;    Psychopharmaceuticals;    Outpatient utilization;   

Others  :  1126766
DOI  :  10.1186/1472-6963-14-343

 received in 2014-02-28, accepted in 2014-08-12,  发布年份 2014

【 摘 要 】

Background

Drug costs increasingly pose a burden upon the otherwise inadequate health care resources and rational drug utilization is an important segment of every national health policy. Optimal patient care should be the goal of rational pharmacotherapy, whereby the economic burden of treatment is just one of the elements to be considered on choosing appropriate therapy.

The aim of this study was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period.

Methods

Using the World Health Organization Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from pharmacies on the number and size of drug packages. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization.

Results

Total cost for psychopharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to financial indicators decreased by 9.6% and according to DDD/1000/day by 12%. The greatest decrease was in antidepressants, i.e. by 33.8% according to financial indicators and by 46% according to DDD/1000/day; and in antipsychotics by 30.9% according to DDD/1000/day, while showing an increase by 8.5% according to financial indicators. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day, but increased by 25.1% according to financial indicators.

Conclusions

The lack of uniform national guidelines and the still strong impact of pharmaceutical industry marketing continue favoring the rise in prescribing brand name antidepressants and antipsychotics. Depression, schizophrenia and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic psychopharmaceuticals.

【 授权许可】

   
2014 Polić-Vižintin et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Vukušić I, Čulig J: Izvori podataka o uporabi lijekova u Hrvatskoj i Europi. Acta Med Croatica 2005, 59:277-282.
• [2]Štimac D, Vukušić I, Čulig J, Šostar Z, Bucalić M: Outpatient utilization of psychopharmaceuticals: comparison between Croatia and Scandinavian countries (2001-2003). Coll Antropol 2009, 33:237-43.
• [3]Larsen TH: Drug industry and rational pharmacotherapy. Perspectives and achievements with rational pharmacotherapy. http://www.irf.dk/dk/kurser_og_konferencer/konferencer/perspectives_and_achievements_with_rational_pharma.htm webcite
• [4]Godman B, Buscics A, Burkhardt T, Piessnegger J, Schmitzer M, Barbui C, Raschi E, Bennie M, Gustafsson L: Potential to enhance the prescribing of generic drugs in patients with mental health problems in Austria; implications for the future. Front Pharmacol 2012, 3:198.
• [5]World Health Organization (WHO): Drug and therapeutics committees-a practical guide. http://apps.who.int/medicinedocs/pdf/s4882e/s4882e.pdf webcite
• [6]Godman B, Shrank W, Andersen M, Berg CH, Bishop I, Burkhardt TH, Garuoliene K, Herholz H, Jopp R, Kalaba M, Laius O, Lonsdale J, Malmstrom RE, Martikainen JE, Samaluk V, Sermet C, Schwabe U, Teixeira I, Tilson L, Cankat Tulunay F, Vlahović-Palčevski V, Wendykowska K, Wettermark B, Zara C, Gustafsson LL: Policies to enhance prescribing efficiency in Europe: findings and future implications. Front Pharmacol 2010, 1:141.
• [7]Bennie M, Godman B, Bishop I, Campbell S: Multiple initiatives continue to enhance the prescribing efficiency for the proton pump inhibitors and statins in Scotland. Expert Rev Pharmacoecon Outcomes Res 2012, 12:125-130.
• [8]Vogler S, Habl C, Bogut M, Vončina L: Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States. Croat Med J 2011, 52:183-197.
• [9]Vončina L, Strizrep T, Godman B, Bennie M, Bishop I, Campbell S, Vlahović-Palčevski V, Gustafsson LL: Influence of demand-side measures to enhance renin-angiotensin prescribing efficiency in Europe: implications for the future. Expert Rev Pharmacoecon Outcomes Res 2011, 11:469-79.
• [10]Croatian Institute of Health Insurance: Directive on the List of Drugs of the Croatian Institute of Health Insurance. Official Gazette 2001, 65:1-9. in Croatian
• [11]Ministry of Health: Bylaw on the conditions and method of supplementary health insurance. Official Gazette 2002, 28:622. in Croatian
• [12]Ministry of Health: Bylaw on the criteria for wholesale drug pricing and reporting. Official Gazette 2004, 87:1-3. in Croatian
• [13]Ministry of Health: Bylaw on the criteria for wholesale drug pricing and reporting. Official Gazette 2009, 155:3-4. in Croatian
• [14]Croatian Institute of Health Insurance: Directive on the essential list of drugs of the Croatian institute of health insurance. Official Gazette 2006, 120:8017-22. in Croatian
• [15]Croatian Institute of Health Insurance: Directive on the supplementary list of drugs of the Croatian institute of health insurance. Official Gazette 2006, 120:8044-46. in Croatian
• [16]Voncina L, Strizrep T: Croatia: 2009/2010 pharmaceutical pricing and reimbursement reform. Eurohealth 2011, 16:20-24.
• [17]The EURO-MED-STAT Group: Monitoring expenditure and utilization of medicines in the European Union. A public health approach. Ital J Public Health 2006, 3(1):15-21.
• [18]World Health Organization (WHO) Euromedstat: The library of european union pharmaceutical indicators. Expenditure and utilisation indicators. http://ec.europa.eu/health/ph_projects/2001/monitoring/fp_monitoring_2001_frep_12_3_en.pdf webcite
• [19]Croatian Institute of Health Insurance: Directive on the Essential List of Drugs of the Croatian Institute of Health Insurance. Official Gazette 2010, 69:102-28. in Croatian
• [20]Croatian Institute of Health Insurance: Directive on the Supplementary List of Drugs of the Croatian Institute of Health Insurance. Official Gazette 2010, 69:147-56. in Croatian
• [21]Borgheini G: The bioequivalence and therapeutic efficacy of generic versus brand-name psychoactive drugs. Clin Ther 2003, 25(6):1578-1592.
• [22]Cuenca E, Zaragoza F: Generic drugs in psychopharmacology: pros and cons. Actas Esp Psiquiatr 1999, 27(6):351-357.
• [23]Wu EQ, Lauzon V, Ramakrishnan K, Marynchenko M, Ben-Hamadi R, Blum S, Erder MH: Economic impact of therapeutic substitution of a brand selective serotonin reuptake inhibitor with an alternative generic selective serotonin reuptake inhibitor in patients with major depressive disorder. Ann Pharmacother 2011, 45(4):441-451.
• [24]Vlahiotis A, Devine ST, Eicholz J, Kautzner A: Discontinuation rates and health care costs in adult patients starting generic versus brand SSRI or SNRI antidepressants in commercial health plans. J Manag Care Pharm 2011, 17(2):123-132.
• [25]Liu X, Chen Y, Faries D: Adherence and persistence with branded antidepressants and generic SSRIs among managed care patients with major depressive disorder. Clinicoecon Outcomes Res 2011, 3:63-72.
• [26]Godman B, Persson M, Miranda J, Skiold P, Wettermark B, Barbui C, Gustafsson LL: Change in utilization of venlafaxine after introduction of generics in Sweden. Appl Econ Health Policy 2013, 11(4):383-393.
• [27]Kesselheim AS, Stedman MR, Bubrick EJ, Gagne JJ, Misono AS, Lee JL, Brookhart MA, Avorn J, Shrank WH: Seizure outcomes following use of generic vs. brand-name antiepileptic drugs: a systematic review and meta-analysis. Drugs 2010, 70:605-621.
• [28]Buck TC, Schmedes A, Branslund I: Does generic lamotrigine lead to larger variations in plasma concentrations? Ugeskr Laegr 2007, 169(21):2013-2015.
• [29]Hartung DM, Middleton L, Svoboda L, McGregor JC: Generic substitution of lamotrigine among Medicaid patients with diverse indications: a cohort-crossover study. CNS Drugs 2012, 26(8):707-716.
• [30]Valenstein M, Ganoczy D, McCarthy JF, Myra KH, Lee TA, Blow FC: Antipsychotic adherence over time among patients receiving treatment for schizophrenia: a retrospective review. J Clin Psychiatry 2006, 67:1542-1550.
• [31]Gilmer TP, Dolder CR, Lacro JP, Folsom DP, Lindamer L, Garcia P, Jeste DV: Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. Am J Psychiatry 2004, 161:692-699.
• [32]Treur M, Heeg B, Moller HJ, Schmeding A, Van Hout B: A pharmaco-economic analysis with schizophrenia switching to generic risperidone involving a possible compliance loss. BMC Health Serv Res 2009, 9:32. BioMed Central Full Text
• [33]Ganther JM, Kreling DH: Consumer perceptions of risk and required cost savings for generic prescription drugs. J Am Pharm Assoc (Wash) 2000, 40:378-383.
• [34]Araszkiewitcz AA, Szabert K, Godman B, Wladysiuk M, Barbui C, Haycox A: Generic olanzapine: health authority opportunity or nightmare? Expert Rev Pharmacoecon Outcomes Res 2008, 8:549-555.
• [35]Jakovljević M: Suvremena terapija shizofrenije od neurobiologije do potpune reintegracije. Zagreb: Medicinska naklada, Pro Mente; 2001.
• [36]Godman B, Bishop I, Finlayson AE, Campbell S, Kwon HY, Bennie M: Reforms and initiatives in Scotland in recent years to encourage the prescribing of generic drugs, their influence and implications for other countries. Expert Rev Pharmacoecon Outcomes Res 2013, 13:469-482.
• [37]Wladysiuk M, Araszkiewicz A, Godman B, Szabert K, Barbui C, Haycox A: Influence of patient co-payments on atypical antipsychotic choice in Poland: implications once generic atypicals are available. Appl Health Econ Health Policy 2011, 9:101-110.
• [38]Garuoliene K, Godman B, Gulbinovic J, Wettermark B, Haycox A: European countries with small populations can obtain low prices for drugs: Lithuania as a case history. Expert Rev Pharmacoecon Outcomes Res 2011, 11:343-349.
• [39]Francetić I: Uloga generičkih lijekova. http://www.cybermed.hr/osvrti/prof_dr_sc_igor_francetic_dr_med webcite
• [40]Bennie M, Bishop I, Godman B, Barbui C, Raschi E, Campbell S, Miranda J, Gustafsson LL: Are specific initiatives required to enhance prescribing of generic atypical antipsychotics in Scotland?: International implications. Int J Clin Pract 2013, 67:170-180.
• [41]Godman B, De Bruyn K, Miranda J, Raschi E, Bennie M, Barbui C, Simoens S: Generic atypical antipsychotic drugs in Belgium: their influence and implications. J Comp Eff Res 2013, 2:551-561.
• [42]Brkičić LS, Godman B, Vončina L, Sović S, Relja M: Initiatives to improve prescribing efficiency for drugs to treat Parkinson’s disease in Croatia:influence and future directions. Expert Rev Pharmacoecon Outcomes Res 2012, 12:373-384.