title: Potential to enhance the prescribing of generic drugs in patients with mental health problems in austria; implications for the future.
abstract: BACKGROUND
  Scrutiny over pharmaceutical expenditure is increasing leading to multiple reforms. This includes Austria with measures to lower generic prices and enhance their utilization. However the situation for newer antidepressants and atypical antipsychotic medicines (AAPs) is different to PPIs, statins, and renin-angiotensin inhibitor drugs with greater tailoring of therapy and no wish to switch products in stable patients. Authorities welcome generics though given the high costs particularly of single-sourced AAPs.
  
  
  OBJECTIVE
  Assess (a) changes in utilization of venlafaxine versus other newer antidepressants before and after availability of generics, (b) utilization of generic versus originator venlafaxine, (c) price reductions of venlafaxine over time and their influence on total expenditure, (d) utilization of risperidone versus other AAPs, (e) suggest potential additional reforms that could be introduced if pertinent to further enhance the use of generics.
  
  
  METHODS
  A quasi-experimental study design with a segmented time series and an observational study. Utilization measured in defined daily doses (DDDs) and total expenditure per DDD and over time.
  
  
  RESULTS
  No appreciable changes in the utilization of venlafaxine and risperidone after generics. The reduction in expenditure/DDD for venlafaxine decreased overall expenditure on newer antidepressants by 5% by the end of the study versus just before generics despite a 37% increase in utilization. Expenditure will further decrease if reduced prescribing of duloxetine.
  
  
  CONCLUSIONS
  Depression, schizophrenia, and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic risperidone and venlafaxine when multiple choices are appropriate. Authorities cannot rely on a "Hawthorne" effect between classes to enhance the use of generics. Measures may include prescribing restrictions for duloxetine. No specific measures planned for AAPs with more multiple-sourced AAPs becoming available.
authors: Division of Clinical Pharmacology, Karolinska University Hospital Huddinge Stockholm, Sweden ; Mario Negri Institute for Pharmacological Research Milan, Italy ; Prescribing Research Group, University of Liverpool Management School Liverpool, UK.
authors: Brian
authors: B
authors: Godman
authors: Anna
authors: A
authors: Bucsics
authors: Thomas
authors: T
authors: Burkhardt
authors: Jutta
authors: J
authors: Piessnegger
authors: Manuela
authors: M
authors: Schmitzer
authors: Corrado
authors: C
authors: Barbui
authors: Emanuel
authors: E
authors: Raschi
authors: Marion
authors: M
authors: Bennie
authors: Lars L
authors: LL
authors: Gustafsson
keywords: Austria; antidepressants; atypical antipsychotics; drug utilization studies; generics; reforms; risperidone; schizophrenia