Measures to enhance angiotensin-receptor blocker prescribing efficiency in Belgium following generic losartan: impact and implications for the future

Steven Simoens, Kristien De Bruyn, Jamilette Miranda, Marion Bennie, Rickard E. Malmström, Brian Godman

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: Compare the utilisation of losartan before and after the availability of generics in Belgium and its inclusion in the reference price system, which changed its reimbursement status. Determine the impact of reforms on expenditure/defined daily dose (DDD) for losartan and overall reimbursed expenditure for the angiotensin-receptor blockers (ARBs). Methods: Interrupted time-series analysis of monthly reimbursed prescriptions was used for all patients in Belgium covered by the social health insurance system prescribed an ARB alone or in combination between January 2007 and August 2011; that is, 42 months before generic losartan was included in the reference price system (July 2010) to 13 months after. Key findings: A significant increase in losartan utilisation was seen following its change in reimbursement status whereas all other ARBs still required prior approval for reimbursement. Losartan utilisation increased from 18% of all single ARBs on a moving annual total (MAT) DDD basis just before the inclusion of losartan in the reference price system to 24% on a MAT basis 12 months after this. During this period, total ARB utilisation increased by 1%, consequently representing both new and switched patients. Reimbursed expenditure for losartan decreased 40% 12 months after its inclusion in the reference price system despite a 22% increase in utilisation. Total ARB expenditure reduced by 15% during this period. Conclusion: The reforms, including altering the prescribing regulations for losartan, significantly enhanced its utilisation, reduced its expenditure/DDD and reduced overall ARB expenditure in Belgium. No further measures are suggested for Belgium with more ARBs losing or about to lose their patents. There has been no change in the utilisation patterns of losartan in countries following generic availability where there are no specific demand-side measures. These findings confirm that multiple measures are needed to change physician prescribing patterns.
LanguageEnglish
Pages173-181
Number of pages9
JournalJournal of Pharmaceutical Health Services Research
Volume4
Issue number3
Early online date17 Jun 2013
DOIs
Publication statusPublished - Sep 2013

Fingerprint

Losartan
Angiotensin Receptor Antagonists
Belgium
Health Expenditures
Physicians' Practice Patterns
Expenditure
Prescribing
Patents
Social Security
Health Insurance
Prescriptions
Reference price
Reimbursement
Inclusion

Keywords

  • ARBs
  • drug utilisation
  • generics
  • losartan
  • pharmaceuticals
  • reforms
  • angiotensin receptor antagonist
  • generic drug
  • social insurance
  • article
  • Belgium
  • controlled study
  • cost control
  • drug approval
  • drug cost
  • drug industry
  • drug utilization
  • health care availability
  • health care policy
  • pharmaceutical care
  • prescription
  • priority journal
  • reimbursement

Cite this

@article{fb59e5b66caa44659672ead4ce603f4b,
title = "Measures to enhance angiotensin-receptor blocker prescribing efficiency in Belgium following generic losartan: impact and implications for the future",
abstract = "Objective: Compare the utilisation of losartan before and after the availability of generics in Belgium and its inclusion in the reference price system, which changed its reimbursement status. Determine the impact of reforms on expenditure/defined daily dose (DDD) for losartan and overall reimbursed expenditure for the angiotensin-receptor blockers (ARBs). Methods: Interrupted time-series analysis of monthly reimbursed prescriptions was used for all patients in Belgium covered by the social health insurance system prescribed an ARB alone or in combination between January 2007 and August 2011; that is, 42 months before generic losartan was included in the reference price system (July 2010) to 13 months after. Key findings: A significant increase in losartan utilisation was seen following its change in reimbursement status whereas all other ARBs still required prior approval for reimbursement. Losartan utilisation increased from 18{\%} of all single ARBs on a moving annual total (MAT) DDD basis just before the inclusion of losartan in the reference price system to 24{\%} on a MAT basis 12 months after this. During this period, total ARB utilisation increased by 1{\%}, consequently representing both new and switched patients. Reimbursed expenditure for losartan decreased 40{\%} 12 months after its inclusion in the reference price system despite a 22{\%} increase in utilisation. Total ARB expenditure reduced by 15{\%} during this period. Conclusion: The reforms, including altering the prescribing regulations for losartan, significantly enhanced its utilisation, reduced its expenditure/DDD and reduced overall ARB expenditure in Belgium. No further measures are suggested for Belgium with more ARBs losing or about to lose their patents. There has been no change in the utilisation patterns of losartan in countries following generic availability where there are no specific demand-side measures. These findings confirm that multiple measures are needed to change physician prescribing patterns.",
keywords = "ARBs, drug utilisation, generics, losartan, pharmaceuticals, reforms, angiotensin receptor antagonist, generic drug, social insurance, article, Belgium, controlled study, cost control, drug approval, drug cost, drug industry, drug utilization, health care availability, health care policy, pharmaceutical care, prescription, priority journal, reimbursement",
author = "Steven Simoens and {De Bruyn}, Kristien and Jamilette Miranda and Marion Bennie and Malmstr{\"o}m, {Rickard E.} and Brian Godman",
year = "2013",
month = "9",
doi = "10.1111/jphs.12024",
language = "English",
volume = "4",
pages = "173--181",
journal = "Journal of Pharmaceutical Health Services Research",
issn = "1759-8885",
number = "3",

}

Measures to enhance angiotensin-receptor blocker prescribing efficiency in Belgium following generic losartan : impact and implications for the future. / Simoens, Steven; De Bruyn, Kristien; Miranda, Jamilette; Bennie, Marion; Malmström, Rickard E.; Godman, Brian.

In: Journal of Pharmaceutical Health Services Research, Vol. 4, No. 3, 09.2013, p. 173-181.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Measures to enhance angiotensin-receptor blocker prescribing efficiency in Belgium following generic losartan

T2 - Journal of Pharmaceutical Health Services Research

AU - Simoens, Steven

AU - De Bruyn, Kristien

AU - Miranda, Jamilette

AU - Bennie, Marion

AU - Malmström, Rickard E.

AU - Godman, Brian

PY - 2013/9

Y1 - 2013/9

N2 - Objective: Compare the utilisation of losartan before and after the availability of generics in Belgium and its inclusion in the reference price system, which changed its reimbursement status. Determine the impact of reforms on expenditure/defined daily dose (DDD) for losartan and overall reimbursed expenditure for the angiotensin-receptor blockers (ARBs). Methods: Interrupted time-series analysis of monthly reimbursed prescriptions was used for all patients in Belgium covered by the social health insurance system prescribed an ARB alone or in combination between January 2007 and August 2011; that is, 42 months before generic losartan was included in the reference price system (July 2010) to 13 months after. Key findings: A significant increase in losartan utilisation was seen following its change in reimbursement status whereas all other ARBs still required prior approval for reimbursement. Losartan utilisation increased from 18% of all single ARBs on a moving annual total (MAT) DDD basis just before the inclusion of losartan in the reference price system to 24% on a MAT basis 12 months after this. During this period, total ARB utilisation increased by 1%, consequently representing both new and switched patients. Reimbursed expenditure for losartan decreased 40% 12 months after its inclusion in the reference price system despite a 22% increase in utilisation. Total ARB expenditure reduced by 15% during this period. Conclusion: The reforms, including altering the prescribing regulations for losartan, significantly enhanced its utilisation, reduced its expenditure/DDD and reduced overall ARB expenditure in Belgium. No further measures are suggested for Belgium with more ARBs losing or about to lose their patents. There has been no change in the utilisation patterns of losartan in countries following generic availability where there are no specific demand-side measures. These findings confirm that multiple measures are needed to change physician prescribing patterns.

AB - Objective: Compare the utilisation of losartan before and after the availability of generics in Belgium and its inclusion in the reference price system, which changed its reimbursement status. Determine the impact of reforms on expenditure/defined daily dose (DDD) for losartan and overall reimbursed expenditure for the angiotensin-receptor blockers (ARBs). Methods: Interrupted time-series analysis of monthly reimbursed prescriptions was used for all patients in Belgium covered by the social health insurance system prescribed an ARB alone or in combination between January 2007 and August 2011; that is, 42 months before generic losartan was included in the reference price system (July 2010) to 13 months after. Key findings: A significant increase in losartan utilisation was seen following its change in reimbursement status whereas all other ARBs still required prior approval for reimbursement. Losartan utilisation increased from 18% of all single ARBs on a moving annual total (MAT) DDD basis just before the inclusion of losartan in the reference price system to 24% on a MAT basis 12 months after this. During this period, total ARB utilisation increased by 1%, consequently representing both new and switched patients. Reimbursed expenditure for losartan decreased 40% 12 months after its inclusion in the reference price system despite a 22% increase in utilisation. Total ARB expenditure reduced by 15% during this period. Conclusion: The reforms, including altering the prescribing regulations for losartan, significantly enhanced its utilisation, reduced its expenditure/DDD and reduced overall ARB expenditure in Belgium. No further measures are suggested for Belgium with more ARBs losing or about to lose their patents. There has been no change in the utilisation patterns of losartan in countries following generic availability where there are no specific demand-side measures. These findings confirm that multiple measures are needed to change physician prescribing patterns.

KW - ARBs

KW - drug utilisation

KW - generics

KW - losartan

KW - pharmaceuticals

KW - reforms

KW - angiotensin receptor antagonist

KW - generic drug

KW - social insurance

KW - article

KW - Belgium

KW - controlled study

KW - cost control

KW - drug approval

KW - drug cost

KW - drug industry

KW - drug utilization

KW - health care availability

KW - health care policy

KW - pharmaceutical care

KW - prescription

KW - priority journal

KW - reimbursement

U2 - 10.1111/jphs.12024

DO - 10.1111/jphs.12024

M3 - Article

VL - 4

SP - 173

EP - 181

JO - Journal of Pharmaceutical Health Services Research

JF - Journal of Pharmaceutical Health Services Research

SN - 1759-8885

IS - 3

ER -