Multiple initiatives continue to enhance the prescribing efficiency for the proton pump inhibitors and statins in Scotland

Abstract

Introduction: Multiple and intensive demand measures in Scotland have appreciably enhanced prescribing efficiency for proton pump inhibitors (PPIs) and statins in 2007 versus 2001. Statin utilization enhanced by measures to increase doses prescribed, including the Quality and Outcome Framework (QoF). Aims: Ascertain whether the plethora of measures continue to enhance prescribing efficiency for PPIs and statins. Second, assess whether the combined impact of the QoF targets and guidance enhances the prescribing of higher strength statins, mirroring the situation in England. Method: PPI and statin utilization measured in terms of defined daily doses (DDDs) and DDDs per 1000 inhabitants per day (2010 DDDs) between 2001 and 2010, number and strength of simvastatin and atorvastatin tablets dispensed, and reimbursed expenditure per DDD and 1000 inhabitants per year. Results: Expenditure per DDD for generic omeprazole in 2010 was 91% below the 2001 originator price, leading to expenditure per 1000 inhabitants for PPIs in 2010 to be 56% below 2001 despite a threefold increase in utilization. Expenditure per DDD for generic simvastatin in 2010 was 97% below the 2002 originator price. Expenditure per 1000 inhabitants for statins in 2010 only increased by 7% compared with 2001 despite a 6.2-fold increase in utilization. Utilization of higher strength statins has increased in recent years, with higher strength simvastatin (40 and 80 mg) accounting for 85% of total statins (DDD basis) in 2010. Conclusion: Reforms appear to be working to further enhance prescribing efficiency. Utilization of higher strength statins in recent years should further improve outcomes.

Keywords::

• demand-side reforms
• drug utilization
• generics
• prescribing efficiency
• Scotland

Acknowledgements

The authors acknowledge the help of Fredrik Granath from the Karolinska Institutet, Stockholm, Sweden, for his helpful advice regarding statistical analysis.

Financial & competing interests disclosure

The work was supported in part by grants from the Karolinska Institutet. M Bennie and I Bishop are employed by NHS Scotland. 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.