title: Influence of demand-side measures to enhance renin-angiotensin prescribing efficiency in Europe: implications for the future.
abstract: European countries strive to enhance prescribing efficiency. This includes renin-angiotensin drugs following the availability of generic angiotensin-converting enzyme inhibitors (ACEIs).
  
  
  OBJECTIVE
  To compare angiotensin receptor blocker utilization and expenditure patterns in Austria and Croatia following prescribing restrictions, as well as with other European countries introducing different supply- and demand-side measures. Lastly, to appraise the impact of generic losartan in Croatia on utilization of patented angiotensin receptor blockers.
  
  
  METHODS
  Observational retrospective study principally between 2001 and 2007, using defined daily doses and €/1000 inhabitants/year. Demand-side measures were based on the four 'E's - education, engineering, economics and enforcement.
  
  
  RESULTS
  Greater intensity of follow-up of prescribing restrictions in Croatia enhanced utilization of ACEIs versus Austria. There was high utilization of ACEIs in Scotland following intensive demand-side measures, similar to Austria and Croatia. Demand-side measures in Spain (Catalonia) and Sweden also appeared to moderate angiotensin receptor blockers utilization. The combination of measures helped stabilize expenditure on renin-angiotensin drugs when adjusted for population sizes despite appreciable increases in volumes. The only exception was Portugal, with less intensive measures.
  
  
  CONCLUSIONS
  Multiple and intensive demand-side measures enhanced prescribing efficiency. The more intense follow-up of ARB prescribing restrictions in Croatia had a greater influence on subsequent utilization patterns than Austria. Both findings confirm earlier studies. Reforms also favorably enhanced the prescribing of generic losartan once available.
authors.affiliation: Croatian Institute for Health Insurance, Margaretska 3, Zagreb, Croatia.
authors.forename: Luka
authors.initials: L
authors.lastname: Vončina
authors.forename: Tihomir
authors.initials: T
authors.lastname: Strizrep
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.forename: Marion
authors.initials: M
authors.lastname: Bennie
authors.forename: Iain
authors.initials: I
authors.lastname: Bishop
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.forename: Vera
authors.initials: V
authors.lastname: Vlahović-Palčevski
authors.forename: Lars L
authors.initials: LL
authors.lastname: Gustafsson
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use; D005060:Europe; D006801:Humans; D019808:Losartan / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D016568:Drugs, Generic; D019808:Losartan