Influence of demand-side measures to enhance renin–angiotensin prescribing efficiency in Europe: implications for the future

Abstract

European countries strive to enhance prescribing efficiency. This includes renin–angiotensin drugs following the availability of generic angiotensin-converting enzyme inhibitors (ACEIs). Aims: To compare angiotensin receptor blocker utilization and expenditure patterns in Austria and Croatia following prescribing restrictions, as well as with other European countries introducing different supply- and demand-side measures. Lastly, to appraise the impact of generic losartan in Croatia on utilization of patented angiotensin receptor blockers. Method: Observational retrospective study principally between 2001 and 2007, using defined daily doses and €/1000 inhabitants/year. Demand-side measures were based on the four ‘E’s – education, engineering, economics and enforcement. Results: Greater intensity of follow-up of prescribing restrictions in Croatia enhanced utilization of ACEIs versus Austria. There was high utilization of ACEIs in Scotland following intensive demand-side measures, similar to Austria and Croatia. Demand-side measures in Spain (Catalonia) and Sweden also appeared to moderate angiotensin receptor blockers utilization. The combination of measures helped stabilize expenditure on renin–angiotensin drugs when adjusted for population sizes despite appreciable increases in volumes. The only exception was Portugal, with less intensive measures. Conclusion: Multiple and intensive demand-side measures enhanced prescribing efficiency. The more intense follow-up of ARB prescribing restrictions in Croatia had a greater influence on subsequent utilization patterns than Austria. Both findings confirm earlier studies. Reforms also favorably enhanced the prescribing of generic losartan once available.

Keywords::

• demand-side reforms
• efficiency
• generics
• prescribing restrictions
• renin–angiotensin drugs

Acknowledgements

The authors would like to acknowledge the help of INFARMED for the provision of NHS data from Portugal. They also acknowledge the help of Fredrik Granath from the Karolinska Institutet, Stockholm, Sweden, for his helpful advice regarding statistical analyses.

Financial & competing interests disclosure

The study was in part funded by a grant from the Karolinska Institutet. Luka Vončina, Tihomir Strizrep, Marion Bennie and Iain Bishop are employed by health authorities or health insurance agencies, while Stephen Campbell is an adviser to the Department of Health in the UK. 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.