title: Dosage of angiotensin-II receptor blockers in heart failure patients following changes in Danish drug reimbursement policies.
abstract: OBJECTIVE
  National reimbursement policies in Denmark were changed in November 2010 favouring a shift in angiotensin-II receptor blocker (ARB) treatment to generic losartan for heart failure (HF) patients. We examined how changes in reimbursement policies affected the fraction of HF patients up-titrated to optimal or suboptimal ARB dosage.
  
  
  METHODS
  A historical cohort study was performed including HF patients with at least one prescription of ARB in the months of May-Jul 2010 (baseline). Patients were considered up-titrated at doses 100, 16 or 160 mg for losartan, valsartan and candesartan, respectively. Individual-level linkage of nationwide registries of hospitalization and drug dispensing in Denmark was used to describe patterns of ARB prescriptions and estimate dosage before and after November 2010. Logistic regression models were used to assess the probability for being up-titrated in the period.
  
  
  RESULTS
  Of 6036 individuals included (mean age 73.5 [standard deviation 11.2] years; 51% males), 3346 (55.4%) used losartan, 541 (9.0%) valsartan and 2149 (35.6%) candesartan at inclusion, respectively. 2887 (47.8%) were up-titrated at baseline (May-Jul 2010), followed by 2878 (48.2%) in the three months before the policy change (Aug-Oct 2010), and 2492 (43.7%) in the first months after the policy change (Feb-Apr 2011). Odds ratios for being up-titrated according to time period were 1.02 [0.95-1.09] in Aug-Oct 2010 (before policy change) and 0.84 [0.78-0.90] in Feb-Apr 2011 (after policy change), compared with May-Jul 2010 (reference).
  
  
  CONCLUSIONS
  Probability of being up-titrated in ARB treatment was reduced 20% following changes in drug reimbursement policies.
authors: Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark; Department of Endocrinology, Herlev University Hospital, Herlev, Denmark.
authors: Christian
authors: C
authors: Selmer
authors: Morten
authors: M
authors: Lamberts
authors: Søren Lund
authors: SL
authors: Kristensen
authors: Lene Mia
authors: LM
authors: von Kappelgaard
authors: Lars
authors: L
authors: Køber
authors: Gunnar Hilmar
authors: GH
authors: Gislason
authors: Christian
authors: C
authors: Torp-Pedersen
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage* / Q000191:economics*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000191:economics; D001713:Biphenyl Compounds; D003718:Denmark; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000639:trends*; D019808:Losartan / Q000008:administration & dosage / Q000191:economics; D008297:Male; D013777:Tetrazoles / Q000008:administration & dosage / Q000191:economics; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D000068756:Valsartan
chemical_list: D057911:Angiotensin Receptor Antagonists; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine; D019808:Losartan; C081643:candesartan
keywords: angiotensin receptor blocker; drug reimbursement; heart failure; pharmacoepidemiology