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. 2013 Jan 7:3:198.
doi: 10.3389/fphar.2012.00198. eCollection 2012.

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

Brian Godman  1 , Anna Bucsics, Thomas Burkhardt, Jutta Piessnegger, Manuela Schmitzer, Corrado Barbui, Emanuel Raschi, Marion Bennie, Lars L Gustafsson
Affiliations

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

Brian Godman et al. Front Pharmacol. .

Abstract

Background: 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.

Objective: 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.

Methodology: 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.

Results: 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.

Conclusion: 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.

Keywords: Austria; antidepressants; atypical antipsychotics; drug utilization studies; generics; reforms; risperidone; schizophrenia.

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Figures

Figure 1
Figure 1
Utilization pattern of newer antidepressants in DDDs before and after generic IR and ER venlafaxine (May 2009).
Figure 2
Figure 2
Total expenditure on antidepressants in Austria before and after the availability of generic ER venlafaxine (May 2009).
Figure 3
Figure 3
Total expenditure/DDD for venlafaxine IR over time (€).
Figure 4
Figure 4
Utilization of atypical antipsychotic drugs in Austria 2005–2010 (DDDs).
See this image and copyright information in PMC

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