Initiatives to enhance renin-angiotensin prescribing efficiency in Austria: impact and implications for other countries.
OBJECTIVE
To assess the utilization of renin-angiotensin drugs, including combinations, in Austria in practice given the limited availability of diuretics, as well as the impact of recent reforms and initiatives on the utilization and expenditure of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs), following prescribing restrictions on ARBs immediately after their introduction.


METHODS
Utilization of dispensed prescriptions in ambulatory care was captured from 2001 to 2007 using defined daily doses as well as defined daily doses/1000 inhabitants/day for patients covered by the social health-insurance system. The data were provided by the internal data warehouse of Hauptverband der Osterreichischen Sozialversicherungsträger. Total costs in Euros were used for the analysis to facilitate comparisons with earlier studies.


RESULTS
There was appreciable utilization of fixed-dose diuretic combinations at between 36 and 38% of all renin-angiotensin products, in line with expectations. The reduction in expenditure/defined daily dose for originator and generic ACEis and their combinations is, again, in line with expectations, mirroring earlier findings for proton pump inhibitors and statins. ARB utilization was just under 27% of all renin-angiotensin products. This is higher than the low utilization rates seen with atorvastatin following its prescribing restrictions, and may reflect the difficulties if restrictions are based on subjective criteria. ARB utilization rates were lower or similar to other countries, who have implemented a different range of demand-side reforms to limit their prescribing with the advent of generic ACEis.


CONCLUSIONS
The results confirm the successful implementation of the latest pricing policies and demand-side measures for generics and originators in Austria. We believe the prescribing restrictions for ARBs reduced their utilization in practice and offer an alternative approach to other demand-side measures.
Godman
Brian
B
Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden. godman@marionegri.it
Bucsics
Anna
A
Burkhardt
Thomas
T
Schmitzer
Manuela
M
Wettermark
Björn
B
Wieninger
Peter
P
D000553:Ambulatory Care / Q000191:economics / Q000639:trends; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001317:Austria; D016208:Databases, Factual; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use; D016527:Drug Costs / Q000639:trends; D004359:Drug Therapy, Combination; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use; D018166:Health Care Reform; D006801:Humans; D009313:National Health Programs / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D016568:Drugs, Generic