title: Review of ongoing initiatives to improve prescribing efficiency in China; angiotensin receptor blockers as a case history.
abstract: BACKGROUND
  Pharmaceutical expenditure is rising by 16% per annum in China and is now 46% of total expenditure. Initiatives to moderate growth include drug pricing regulations and encouraging international non-proprietary name prescribing. However, there is no monitoring of physician prescribing quality and perverse incentives.
  
  
  OBJECTIVE
  Assess changes in angiotensin receptor blocker (ARB) utilization and expenditure as more generics become available; compare findings to Europe.
  
  
  METHODS
  Observational retrospective study of ARB utilization and expenditure between 2006 and 2012 in the largest hospital in Chongqing district.
  
  
  RESULTS
  Variable and low use of generics versus originators with a maximum of 31% among single ARBs. Similar for fixed dose combinations. Prices typically reduced over time, greatest for generic telmisartan (-54%), mirroring price reductions in some European countries. However, no preferential increase in prescribing of lower cost generics. Accumulated savings of 33 million CNY for this large provider if they adopted European practices.
  
  
  CONCLUSIONS
  Considerable opportunities to improve prescribing efficiency in China.
authors.affiliation: School of Management, Chongqing Jiaotong University, No.66 Xuefu Road, Nan'an District, Chongqing 400074, China.
authors.forename: Wenjie
authors.initials: W
authors.lastname: Zeng
authors.forename: Lars L
authors.initials: LL
authors.lastname: Gustafsson
authors.forename: Marion
authors.initials: M
authors.lastname: Bennie
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Finlayson
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000191:economics / Q000627:therapeutic use; D001565:Benzoates / Q000191:economics / Q000627:therapeutic use; D002681:China; D016527:Drug Costs; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D009042:Motivation; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies; D000077333:Telmisartan; D013997:Time Factors
chemical_list: D057911:Angiotensin Receptor Antagonists; D001562:Benzimidazoles; D001565:Benzoates; D016568:Drugs, Generic; D000077333:Telmisartan
keywords: China; angiotensin receptor blockers; drug utilization; generics; health reforms; pharmaceuticals