Potential to enhance the prescribing of generic drugs in patients with mental health problems in Austria; implications for the future

Brian Godman, Anna Bucsics, Thomas Burkhardt, Jutta Piessnegger, Manuela Schmitzer, Corrado Barbui, Emanuel Raschi, Marion Bennie, Lars L Gustafsson

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Abstract

Scrutiny over
pharmaceutical expenditure is increasing leading to multiple reforms. This
includes Austria with measures to lower generic prices and enhance their
utilization. However the situation for newer antidepressants and atypical
antipsychotic medicines (AAPs) is different to PPIs, statins, and
renin-angiotensin inhibitor drugs with greater tailoring of therapy and no wish
to switch products in stable patients. Authorities welcome generics though
given the high costs particularly of single-sourced AAPs. Assess (a)
changes in utilization of venlafaxine versus other newer antidepressants before
and after availability of generics, (b) utilization of generic versus
originator venlafaxine, (c) price reductions of venlafaxine over time and their
influence on total expenditure, (d) utilization of risperidone versus other
AAPs, (e) suggest potential additional reforms that could be introduced if
pertinent to further enhance the use of generics. 
A quasi-experimental study design with a segmented time series and an
observational study. Utilization measured in defined daily doses (DDDs) and
total expenditure per DDD and over time. No appreciable changes in the
utilization of venlafaxine and risperidone after generics. The reduction in
expenditure/DDD for venlafaxine decreased overall expenditure on newer
antidepressants by 5% by the end of the study versus just before generics
despite a 37% increase in utilization. Expenditure will further decrease if
reduced prescribing of duloxetine. Depression, schizophrenia, and bipolar
diseases are complex diseases. As a result, specific measures are needed to
encourage the prescribing of generic risperidone and venlafaxine when multiple
choices are appropriate. Authorities cannot rely on a "Hawthorne"
effect between classes to enhance the use of generics. Measures may include
prescribing restrictions for duloxetine. No specific measures planned for AAPs
with more multiple-sourced AAPs becoming available

Original languageEnglish
Article number198
Number of pages10
JournalFrontiers in Pharmacology
Volume3
Early online date7 Jan 2013
DOIs
Publication statusPublished - 2013

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Keywords

  • prescribing
  • generic drugs
  • patients
  • mental health
  • austria
  • implications
  • pharmaceutical expenditure
  • healthcare reform
  • atypical antipsychotic medicines
  • AAPs
  • renin-angiotensin inhibitor drugs
  • PPIs
  • statins
  • antidepressants
  • drug utilization studies
  • generics
  • risperidone
  • schizophrenia

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