engleski

Recent policies to enhance renin-angiotensin prescribing efficiency in Europe ; implications for the future

Background: Renin-angiotensin (RA) drugs (Angiotensin Converting Enzyme Inhibitors ACEIs and Angiotensin Receptor Blockers ARBs) are accepted treatments for hypertension and Congestive Heart Failure. Coughing can occur with ACEIs leading to development of ARBs. Trials showed though discontinuation due to coughing in a minority of patients on ACEIs (2 3%). ARB prescribing restrictions in Austria as higher costs than ACEIs moderated utilisation. Other demand side measures in Spain (Catalonia) following generic ACEIs also moderated ARB utilisation. Objectives: Document the influence of reforms on ARB utilisation patterns in other European countries (Croatia, Portugal, and Sweden) vs. Austria and Spain (Catalonia) using the 4 Es (education, engineering, economics and enforcement). Methods: Retrospective observational DU study documenting the influence of reforms on utilisation of ACEIs alone/ combination (C09AA01to16, C09BA01 to 15, C09BB02 to 12) and ARBs alone/ combination (C09CA01 to 08, C09DA01 to 07, C09DB01 to 04) from 2001 to 2007 using DDDs. Years chosen to mirror published studies. Only administrative databases used. Utilisation patterns and reforms validated with data providers. Results: (a) RA drug utilisation increased in all countries - 70% to 160%, (b) Prescribing restrictions in Croatia greater influence in moderating ARB utilisation than in Austria enhanced by educational activities (Health Insurance physicians visit primary care physicians where concerns with abuse), (c) Similar moderation of ARBs in Scotland vs. Austria and Croatia helped by intense demand side activities (3 of 4 Es) especially prescribing targets, (d) moderation of ARBs in recent years in Sweden mirroring Spain (Catalonia) with again 3 of 4 Es, (e) growing ARB utilisation in Portugal with limited demand side measures resulted in rising expenditure ( /1000 inhabitants/ year) vs. stabilisation in other EU countries despite increased utilisation. Conclusions: Multiple demand side reforms essential to moderate ARB utilisation. Similar findings in Portugal to PPIs and statins confirms growing utilisation of patented products if only limited demand side initiatives.

policy; prescribing; ACE inhibitors; ARB agents

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