title: Cost impact of switching histamine(2)-receptor antagonists to nonprescription status.
abstract: BACKGROUND
  There is a recent trend to switching medications from prescription to nonprescription status. Often, such switches are accompanied by dramatic changes in utilization due to increased availability or decreased insurance coverage. The histamine(2)-receptor antagonists (H(2)RAs) underwent such status change in the UK in 1994, the US in 1995, and Canada in 1996.
  
  
  OBJECTIVE
  To examine the impact of the status change for H(2)RAs on the market for gastrointestinal (GI) agents in the US, UK, and Canada.
  
  
  METHODS
  IMS market sales data from 1992 to 1997 were procured. All costs were converted to 1997 US dollars using the consumer price index. Per capita sales figures were determined using population data from the US Census Bureau's International Database.
  
  
  RESULTS
  Overall spending on GI remedies increased in all 3 markets between 1992 and 1997; however, the contribution of prescription sales and number of prescriptions varied across the 3 countries. An increased market share for nonprescription H(2)RAs occurred in the US, correlating with a decline in prescription numbers for GI remedies. The opposing trend occurred in the UK, where market share of nonprescription H(2)RAs was minimal and use of prescription H(2)RAs increased. Prescription and nonprescription H(2)RA sales could not be differentiated for Canada.
  
  
  CONCLUSIONS
  The impact of the H(2)RA status change varied across countries. Differences in utilization may be attributed to many factors such as differing healthcare systems, patient convenience, and physician prescribing practices. Further research is required to identify the reasons for differences in utilization and to quantify the potential clinical impact.
authors.affiliation: Graduate Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada. s.furler@utoronto.ca
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Furler
authors.forename: Mark S
authors.initials: MS
authors.lastname: Rolnick
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Lawday
authors.forename: Miranda W
authors.initials: MW
authors.lastname: Mak
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Einarson
mesh_terms: D002170:Canada; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000191:economics; D006635:Histamine H2 Antagonists / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D004366:Nonprescription Drugs / Q000008:administration & dosage* / Q000191:economics; D017891:Pharmacoepidemiology; D006113:United Kingdom; D014481:United States
chemical_list: D005765:Gastrointestinal Agents; D006635:Histamine H2 Antagonists; D004366:Nonprescription Drugs