title: Impact of pharmaceutical policy interventions on utilization of antipsychotic medicines in Finland and Portugal in times of economic recession: interrupted time series analyses.
abstract: OBJECTIVE
  To analyze the impacts of pharmaceutical sector policies implemented to contain country spending during the economic recession--a reference price system in Finland and a mix of policies including changes in reimbursement rates, a generic promotion campaign and discounts granted to the public payer in Portugal - on utilization of, as a proxy for access to, antipsychotic medicines.
  
  
  METHODS
  We obtained monthly IMS Health sales data in standard units of antipsychotic medicines in Portugal and Finland for the period January 2007 to December 2011. We used an interrupted time series design to estimate changes in overall use and generic market shares by comparing pre-policy and post-policy levels and trends.
  
  
  RESULTS
  Both countries' policy approaches were associated with slight, likely unintended, decreases in overall use of antipsychotic medicines and with increases in generic market shares of major antipsychotic products. In Finland, quetiapine and risperidone generic market shares increased substantially (estimates one year post-policy compared to before, quetiapine: 6.80% [3.92%, 9.68%]; risperidone: 11.13% [6.79%, 15.48%]. The policy interventions in Portugal resulted in a substantially increased generic market share for amisulpride (estimate one year post-policy compared to before: 22.95% [21.01%, 24.90%]; generic risperidone already dominated the market prior to the policy interventions.
  
  
  CONCLUSIONS
  Different policy approaches to contain pharmaceutical expenditures in times of the economic recession in Finland and Portugal had intended--increased use of generics--and likely unintended--slightly decreased overall sales, possibly consistent with decreased access to needed medicines--impacts. These findings highlight the importance of monitoring and evaluating the effects of pharmaceutical policy interventions on use of medicines and health outcomes.
authors: Department of Health Economics, Gesundheit Österreich GmbH/Austrian Health Institute/WHO Collaborating Centre for Pricing and Reimbursement Policies, Vienna, Austria. Christine.leopold@goeg.at.
authors: Christine
authors: C
authors: Leopold
authors: Fang
authors: F
authors: Zhang
authors: Aukje K
authors: AK
authors: Mantel-Teeuwisse
authors: Sabine
authors: S
authors: Vogler
authors: Silvia
authors: S
authors: Valkova
authors: Dennis
authors: D
authors: Ross-Degnan
authors: Anita K
authors: AK
authors: Wagner
mesh_terms: D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D003363:Cost Control; D016527:Drug Costs; D004335:Drug and Narcotic Control; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use; D057172:Economic Recession; D017850:Economics, Pharmaceutical; D005387:Finland; D005102:Health Expenditures; D006291:Health Policy; D006801:Humans; D065186:Interrupted Time Series Analysis; D011174:Portugal
chemical_list: D014150:Antipsychotic Agents; D016568:Drugs, Generic