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Abstract
Introduction: Statins are recommended first-line treatment for hyperlipidemia, with published studies suggesting limited differences between them. However, there are reports of under-dosing. South Africa has introduced measures to enhance generic utilization. Part one documents prescribed doses of statins in 2011. Part two determines the extent of generics versus originator and single-sourced statins in 2011 and their costs. Results: Underdosing of simvastatin in 2011 with average prescribed dose of 23.7 mg; however, not for atorvastatin (20.91 mg) or rosuvastatin (15.02 mg). High utilization of generics versus originators at 93–99% for atorvastatin and simvastatin, with limited utilization of single-sourced statins (22% of total statins – defined daily dose basis), mirroring Netherlands, Sweden and UK. Generics priced 33–51% below originator prices. Discussion: Opportunity to increase simvastatin dosing through education, prescribing targets and incentives. Opportunity to lower generic prices with generic simvastatin 96–98% below single-sourced prices in some European countries.
Disclaimer
Any opinion, findings and conclusions or recommendations expressed in this paper are those of the authors and therefore the National Research Foundation (NRF), South Africa does not accept any liability in regard thereto.
Financial & competing interests disclosure
This work was in part supported by grants from the Karolinska Institutet, Sweden and the National Research Foundation (NRF), South Africa. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Statins are recommended as first-line treatment in patients with hypercholesterolemia and are used extensively to reduce morbidity and mortality, especially in high-risk patients and for secondary prevention. However, there are concerns with underdosing including in South Africa.
A study conducted in 2011 in South Africa showed that there was underdosing of prescribed doses of simvastatin (23.7 mg) but not for atorvastatin (20.91 mg) or rosuvastatin (15.02 mg). This needs to be addressed to help reduce coronary events in these patients, with potential activities including formularies, guidelines prescribing targets and incentives mirroring the situation in the UK.
There have been recent reforms in South Africa to increase the prescribing of generics in a class. This includes mandated generic substitution as well as additional co-payments if patients want a more expensive product than the available generic.
These measures resulted in generic atorvastatin and simvastatin at 93–99% of total utilization for these molecules (DDD basis) in South Africa in 2011, with similar patterns seen in the Netherlands, Sweden and the UK. The utilization of single-sourced (patented) statins was only 22% of total statin utilization (DDD basis) in South Africa in 2011, with low utilization of ezetimibe (2.1% of total lipid-lowering medicines).
This low utilization of single-sourced statins as well as ezetimibe mirrors patterns in the Netherlands, Sweden and the UK with their multiple demand-side measures.
Prices of generic statins were 33 to 51% below originator prices in South Africa in 2011. This could be improved through a number of initiatives with prices of generic simvastatin at 96 to 98% below prices prior to the loss of patents in the Netherlands, Sweden and the UK through a variety of initiatives.