title: Quality and efficiency of statin prescribing across countries with a special focus on South Africa: findings and future implications.
abstract: BACKGROUND
  Statins are recommended first-line treatment for hyperlipidemia, with published studies suggesting limited differences between them. However, there are reports of under-dosing. South Africa has introduced measures to enhance generic utilization. Part one documents prescribed doses of statins in 2011. Part two determines the extent of generics versus originator and single-sourced statins in 2011 and their costs.
  
  
  RESULTS
  Underdosing of simvastatin in 2011 with average prescribed dose of 23.7 mg; however, not for atorvastatin (20.91 mg) or rosuvastatin (15.02 mg). High utilization of generics versus originators at 93-99% for atorvastatin and simvastatin, with limited utilization of single-sourced statins (22% of total statins - defined daily dose basis), mirroring Netherlands, Sweden and UK. Generics priced 33-51% below originator prices.
  
  
  CONCLUSIONS
  Opportunity to increase simvastatin dosing through education, prescribing targets and incentives. Opportunity to lower generic prices with generic simvastatin 96-98% below single-sourced prices in some European countries.
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden.
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.forename: Iain
authors.initials: I
authors.lastname: Bishop
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Campbell
authors.forename: Rickard E
authors.initials: RE
authors.lastname: Malmström
authors.forename: Ilse
authors.initials: I
authors.lastname: Truter
mesh_terms: D000069059:Atorvastatin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D016527:Drug Costs; D016568:Drugs, Generic / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D000068718:Rosuvastatin Calcium / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D019821:Simvastatin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D013019:South Africa
chemical_list: D016568:Drugs, Generic; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin; D019821:Simvastatin
keywords: PDDs; South Africa; demand-side measures; dosing; drug utilisation; generics; prices; statins