title: Initial effects of a reimbursement restriction to improve the cost-effectiveness of antihypertensive treatment.
abstract: OBJECTIVE
  The Swedish Dental and Pharmaceutical Benefits Agency is re-assessing the value of all drugs included in the reimbursement scheme in order to make the most efficient use of resources. Their recent review of antihypertensive drugs included 46 substances with total annual sales of euro230 million (euro25/capita). This resulted in reimbursement restrictions for 26 substances, e.g. all angiotensin receptor blockers (ARBs).
  
  
  METHODS
  We used the Swedish prescribed drug register to evaluate the initial effects on prescribing patterns using a before-and-after design, comparing utilization and expenditure with corresponding periods previous years.
  
  
  RESULTS
  The proportion of the Swedish population being dispensed antihypertensive drugs increased by 0.5%-units to 16.5% in September-December 2008 compared to the same period in 2007. Patients initiated on ARBs decreased by 24%, whilst increasing for ACE inhibitors (ACEI) and calcium channel blockers, by 14% and 12%, respectively. The proportion initiated on ARBs prescribed an ACEI within 24 months prior to an ARB increased from 51% to 67%, with a substantial regional variation (extremal quotient 31; coefficient of variation 36%). The total expenditure decreased by 4.7% to euro73 million in September-December 2008 compared to the same period in 2007.
  
  
  CONCLUSIONS
  Reimbursement restrictions had a positive impact on enhancing the efficiency of antihypertensive prescribing. Resources released can be used to improve care in the future.
authors.affiliation: Karolinska Institutet, Centre for Pharmacoepidemiology, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. bjorn.wettermark@ki.se
authors.forename: Björn
authors.initials: B
authors.lastname: Wettermark
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.forename: Martin
authors.initials: M
authors.lastname: Neovius
authors.forename: Niklas
authors.initials: N
authors.lastname: Hedberg
authors.forename: Tor-Olov
authors.initials: TO
authors.lastname: Mellgren
authors.forename: Thomas
authors.initials: T
authors.lastname: Kahan
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000458:organization & administration*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics*; D007345:Insurance Claim Review / Q000191:economics; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D011247:Pregnancy; D013548:Sweden
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents