Potential impact of policy regulation and generic competition on sales of cholesterol lowering medication, antidepressants and acid blocking agents in Belgium.
BACKGROUND
Pharmaceutical expenditures are increasing as a proportion of health expenditures in most rich countries. Antidepressants, acid blocking agents and cholesterol lowering medication are major contributors to medicine sales around the globe.


METHODS
We aimed to document the possible impact of policy regulations and generic market penetration on the evolution of sales volume and average cost per unit (Defined Daily Doses and packages) of antidepressants, acid blocking agents and cholesterol lowering medication. We extracted data from the IMS health database regarding the public price and sales volume of the antidepressants (selective serotonin reuptake inhibitors (SSRI's), monoamine oxidase inhibitors (MAOl's) and tricyclic and remaining antidepressants (TCA's)), acid blocking agents (proton pump inhibitors (PPl's) and H2 receptor antagonists) and cholesterol lowering medication (statins and fibrates) in Belgium between 1995 and 2009. We describe these sales data in relation to various national policy measures which were systematically searched in official records.


RESULTS
Our analysis suggests that particular policy regulations have had immediate impact on sales figures and expenditures on pharmaceuticals in Belgium: changes in reimbursement conditions, a public tender and entry of generic competitors in a reference pricing system. However, possible sustainable effects seem to be counteracted by other mechanisms such as marketing strategies, prescribing behaviour, brand loyalty and the entry of pseudogenerics. It is likely that demand-side measures have a more sustainable impact on expenditure.


CONCLUSIONS
Compared with other European countries, generic penetration in Belgium remains low. Alternative policy regulations aimed at enlarging the generic market and influencing pharmaceutical expenditures deserve consideration. This should include policies aiming to influence physicians' prescribing and a shared responsibility of pharmacists, physicians and patients towards expenditures.
Epidemiology and Social Medicine, University of Antwerp, Wilrijk, Antwerp, Belgium. jessica.fraeyman@ua.ac.be
J
J
Fraeyman
G
G
Van Hal
H
H
De Loof
R
R
Remmen
G R Y
GR
De Meyer
P
P
Beutels
D000924:Anticholesteremic Agents / Q000191:economics; D000928:Antidepressive Agents / Q000191:economics; D001530:Belgium; D003363:Cost Control; D016208:Databases, Factual; D016527:Drug Costs; D016568:Drugs, Generic / Q000191:economics*; D004465:Economic Competition; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006635:Histamine H2 Antagonists / Q000191:economics; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics; D000960:Hypolipidemic Agents / Q000191:economics; D054328:Proton Pump Inhibitors / Q000191:economics
D000924:Anticholesteremic Agents; D000928:Antidepressive Agents; D016568:Drugs, Generic; D006635:Histamine H2 Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D054328:Proton Pump Inhibitors