title: Distribution and trends in outpatient utilization of generic versus brand name psychopharmaceuticals during a ten-year period in Croatia.
abstract: BACKGROUND
  Drug costs increasingly pose a burden upon the otherwise inadequate health care resources and rational drug utilization is an important segment of every national health policy. Optimal patient care should be the goal of rational pharmacotherapy, whereby the economic burden of treatment is just one of the elements to be considered on choosing appropriate therapy.The aim of this study was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period.
  
  
  METHODS
  Using the World Health Organization Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from pharmacies on the number and size of drug packages. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization.
  
  
  RESULTS
  Total cost for psychopharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to financial indicators decreased by 9.6% and according to DDD/1000/day by 12%. The greatest decrease was in antidepressants, i.e. by 33.8% according to financial indicators and by 46% according to DDD/1000/day; and in antipsychotics by 30.9% according to DDD/1000/day, while showing an increase by 8.5% according to financial indicators. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day, but increased by 25.1% according to financial indicators.
  
  
  CONCLUSIONS
  The lack of uniform national guidelines and the still strong impact of pharmaceutical industry marketing continue favoring the rise in prescribing brand name antidepressants and antipsychotics. Depression, schizophrenia and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic psychopharmaceuticals.
authors.affiliation: Dr Andrija Štampar Institute of Public Health, Vrhovčev vijenac 22, HR-10000 Zagreb, Croatia. marina.polic-vizintin@stampar.hr.
authors.forename: Marina
authors.initials: M
authors.lastname: Polić-ViŽintin
authors.forename: Danijela
authors.initials: D
authors.lastname: Stimac
authors.forename: Zvonimir
authors.initials: Z
authors.lastname: Sostar
authors.forename: Ingrid
authors.initials: I
authors.lastname: Tripković
mesh_terms: D000553:Ambulatory Care; D017523:Croatia; D016527:Drug Costs; D004363:Drug Utilization / Q000639:trends*; D016568:Drugs, Generic / Q000627:therapeutic use*; D017850:Economics, Pharmaceutical / Q000639:trends; D006801:Humans; D055553:Prescription Drugs / Q000627:therapeutic use*; D011619:Psychotropic Drugs / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D016568:Drugs, Generic; D055553:Prescription Drugs; D011619:Psychotropic Drugs