title: Can authorities appreciably enhance the prescribing of oral generic risperidone to conserve resources? Findings from across Europe and their implications.
abstract: BACKGROUND
  Generic atypical antipsychotic drugs offer health authorities opportunities for considerable savings. However, schizophrenia and bipolar disorders are complex diseases that require tailored treatments. Consequently, generally there have been limited demand-side measures by health authorities to encourage the preferential prescribing of generics. This is unlike the situation with hypertension, hypercholaesterolaemia or acid-related stomach disorders.The objectives of this study were to compare the effect of the limited demand-side measures in Western European countries and regions on the subsequent prescribing of risperidone following generics; to utilise the findings to provide future guidance to health authorities; and where possible, to investigate the utilisation of generic versus originator risperidone and the prices for generic risperidone.
  
  
  METHODS
  Principally, this was a segmented regression analysis of retrospective time-series data of the effect of the various initiatives in Belgium, Ireland, Scotland and Sweden following the introduction of generic risperidone. The study included patients prescribed at least one atypical antipsychotic drug up to 20 months before and up to 20 months after generic risperidone. In addition, retrospective observational studies were carried out in Austria and Spain (Catalonia) from 2005 to 2011 as well as one English primary care organisation (Bury Primary Care Trust (PCT)).
  
  
  RESULTS
  There was a consistent steady reduction in risperidone as a percentage of total selected atypical antipsychotic utilisation following generics. A similar pattern was seen in Austria and Spain, with stable utilisation in one English PCT. However, there was considerable variation in the utilisation of generic risperidone, ranging from 98% of total risperidone in Scotland to only 14% in Ireland. Similarly, the price of generic risperidone varied considerably. In Scotland, generic risperidone was only 16% of pre-patent loss prices versus 72% in Ireland.
  
  
  CONCLUSIONS
  Consistent findings of no increased prescribing of risperidone post generics with limited specific demand-side measures suggests no 'spillover' effect from one class to another encouraging the preferential prescribing of generic atypical antipsychotic drugs. This is exacerbated by the complexity of the disease area and differences in the side-effects between treatments. There appeared to be no clinical issues with generic risperidone, and prices inversely reflected measures to enhance their utilisation.
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden. brian.godman@ki.se.
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.forename: Marion
authors.initials: M
authors.lastname: Bennie
authors.forename: Anna
authors.initials: A
authors.lastname: Bucsics
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Finlayson
authors.forename: Andrew
authors.initials: A
authors.lastname: Martin
authors.forename: Marie
authors.initials: M
authors.lastname: Persson
authors.forename: Jutta
authors.initials: J
authors.lastname: Piessnegger
authors.forename: Emanuel
authors.initials: E
authors.lastname: Raschi
authors.forename: Steven
authors.initials: S
authors.lastname: Simoens
authors.forename: Corinne
authors.initials: C
authors.lastname: Zara
authors.forename: Corrado
authors.initials: C
authors.lastname: Barbui
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D011307:Drug Prescriptions; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use*; D005060:Europe; D006295:Health Resources / Q000191:economics*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D018967:Risperidone / Q000191:economics / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy
chemical_list: D014150:Antipsychotic Agents; D016568:Drugs, Generic; D018967:Risperidone