Impact of recent reforms in Austria on utilization and expenditure of PPIs and lipid-lowering drugs: implications for the future

Abstract

Aim: To assess the impact of a plethora of reforms and initiatives introduced in Austria since 2002 on the actual utilization and expenditure of proton pump inhibitors and statins. Methods: Utilization of dispensed prescriptions in ambulatory care was captured from 2001 to 2007 using defined daily doses (DDD) as well as DDDs/1000 inhabitants/day for patients covered by the social health insurance system. The data were provided by the internal data warehouse of Hauptverband der Österreichischen Sozialversicherungsträger. Total costs in Euros were used for the analysis from the payer’s perspective. Results: The reduction in the expenditure per DDD for both generic PPIs and statins was generally in line with expectations at over 60% of originator prices before multiple sources became available. There was also increased utilization of generics following the range of demand-side initiatives. This was 89.5% for generic omeprazole versus total omeprazole and 95.1% for generic simvastatin versus total simvastatin by the end of 2007. The utilization of atorvastatin fell substantially from 36.5% of all statins in 2002 to 10.7% by the end of 2007 following restrictions on its prescribing to patients not achieving target lipid levels with, for instance, generic simvastatin. The combined initiatives reduced expenditure per DDD for the PPIs and the statins by 41 and 60%, respectively, in 2007 versus 2001 levels. This reduction translated into lower expenditure for the statins in 2007 versus 2001 despite substantially increased utilization. Conclusion: The results provide examples to other European countries, especially the restrictions on atorvastatin utilization. Nevertheless, further initiatives will be needed to conserve resources as utilization rates grow in chronic disease areas. This includes potential lessons from other European countries.

Keywords::

• drug cost
• generic
• proton pump inhibitor
• reference pricing
• reform
• statin

Acknowledgements

The authors acknowledge the help of Arash Ghaffarian with designing the protocol for the drug utilization study as well as the analysis. The authors also acknowledge the help of Manuela Schmitzer and Adele Ruschitzka with analyzing data from the Hauptverband der Österreichischen Sozialversicherungsträger (HBV) as well as critiquing the manuscripts. Finally, the authors acknowledge the help of Fredrik Granath from the Karolinska Institutet when assessing potential statistical analyses that could be undertaken.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Financial disclosures

Thomas Burkhardt, Anna Bucsics and Peter Wieninger are employed by the Hauptverband der Österreichischen Sozialversicherungsträger. 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.