title: Imperative to consider multiple initiatives to maximize prescribing efficiency from generic availability: case history from Abu Dhabi.
abstract: BACKGROUND
  Pharmaceutical expenditure has risen rapidly in Abu Dhabi, resulting in policies surrounding generics. However, various circumstances will reduce potential savings, including pharmacists still being free to dispense either originator or branded generics and be fully reimbursed.
  
  
  OBJECTIVE
  To research the changes in utilization patterns of proton pump inhibitors (PPIs) and lipid-lowering drugs before and after combined reforms on generics; and subsequently, calculate potential savings based on 'best practices' among Western European countries.
  
  
  METHODS
  An uncontrolled before-and-after observational study of utilization and expenditure of PPIs, statins and ezetimibe between 2004 and 2010, as well as up to 12 months before the first generic policy, to 1 year after the second generic policy, was carried out. Utilization was converted to defined daily doses (DDDs; 2011 DDDs) and DDDs/1000 inhabitants per day. Expenditure/DDD was calculated for omeprazole and simvastatin.
  
  
  RESULTS
  PPI utilization rose by 6.5-fold from 2004 to 2010, principally driven by increased utilization of patent-protected PPIs, although more recently stabilization in esomperazole utilization has occurred. Similar changes were seen for statins. Introduction of best practices would reduce PPI expenditure in 2010 by 32.8 million United Arab Emirates dirham (AED; €6.26 million) and statins by over 27 million AED (€5.15 million).
  
  
  CONCLUSIONS
  Limited demand-side measures led to increased utilization of patent-protected products in Abu Dhabi following the generic reforms. Successful measures will release considerable resources.
authors.affiliation: Drugs and Medical Products Regulation, Health Authority - Abu Dhabi, PO Box 5674, Abu Dhabi, United Arab Emirates.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abuelkhair
authors.forename: Shajahan
authors.initials: S
authors.lastname: Abdu
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.forename: Sahar
authors.initials: S
authors.lastname: Fahmy
authors.forename: Rickard E
authors.initials: RE
authors.lastname: Malmström
authors.forename: Lars L
authors.initials: LL
authors.lastname: Gustafsson
mesh_terms: D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use*; D006291:Health Policy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D009853:Omeprazole / Q000191:economics / Q000627:therapeutic use; D010330:Patents as Topic / Q000331:legislation & jurisprudence; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D054328:Proton Pump Inhibitors / Q000191:economics / Q000627:therapeutic use*; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use; D014479:United Arab Emirates
chemical_list: D016568:Drugs, Generic; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D054328:Proton Pump Inhibitors; D019821:Simvastatin; D009853:Omeprazole