title: Different initiatives across Europe to enhance losartan utilization post generics: impact and implications.
abstract: BACKGROUND
  There is an urgent need for health authorities across Europe to fully realize potential savings from increased use of generics to sustain their healthcare systems. A variety of strategies were used across Europe following the availability of generic losartan, the first angiotensin receptor blocker (ARB) to be approved and marketed, to enhance its prescribing vs. single-sourced drugs in the class. Demand-side strategies ranged from 100% co-payment for single-sourced ARBs in Denmark to no specific measures. We hypothesized this heterogeneity of approaches would provide opportunities to explore prescribing in a class following patent expiry.
  
  
  OBJECTIVE
  Contrast the impact of the different approaches among European countries and regions to the availability of generic losartan to provide future guidance.
  
  
  METHODS
  Retrospective segmented regression analyses applying linear random coefficient models with country specific intercepts and slopes were used to assess the impact of the various initiatives across Europe following the availability of generic losartan. Utilization measured in defined daily doses (DDDs). Price reductions for generic losartan were also measured.
  
  
  RESULTS
  Utilization of losartan was over 90% of all ARBs in Denmark by the study end. Multiple measures in Sweden and one English primary care group also appreciably enhanced losartan utilization. Losartan utilization actually fell in some countries with no specific demand-side measures. Considerable differences were seen in the prices of generic losartan.
  
  
  CONCLUSIONS
  Delisting single-sourced ARBs produced the greatest increase in losartan utilization. Overall, multiple demand-side measures are needed to change physician prescribing habits to fully realize savings from generics. There is no apparent "spill over" effect from one class to another to influence future prescribing patterns even if these are closely related.
authors.affiliation: Heart Hospital Imaging Centre, The Heart Hospital, University College Hospital London, UK.
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
authors.affiliation: Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden ; Medicine Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK ; National Institute for Science and Technology on Innovation on Neglected Diseases, Centre for Technological Development in Health, Oswaldo Cruz Foundation (Fiocruz) Rio de Janeiro, Brazil.
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.affiliation: Occupational and Environmental Medicine, Centre for Applied Biostatistics, University of Gothenburg Gothenburg, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: Medicine Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK.
authors.forename: Samantha
authors.initials: S
authors.lastname: Alvarez-Madrazo
authors.affiliation: Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James Hospital Dublin, Ireland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Public Health and Intelligence Business Unit, NHS National Services Scotland Edinburgh, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Bishop
authors.affiliation: Department of Finance, Faculty of Business, Economics and Statistics, University of Vienna Vienna, Austria ; Hauptverband der Österreichischen Sozialversicherungsträger Vienna, Austria.
authors.forename: Anna
authors.initials: A
authors.lastname: Bucsics
authors.affiliation: National Institute for Health Data and Disease Control Copenhagen, Denmark.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Hesse
authors.affiliation: NHS Greater Manchester Commissioning Support Unit Salford, Manchester, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Martin
authors.affiliation: KU Leuven Department of Pharmaceutical and Pharmacological Sciences Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Simoens
authors.affiliation: Barcelona Health Region, Catalan Health Service Barcelona, Spain.
authors.forename: Corinne
authors.initials: C
authors.lastname: Zara
authors.affiliation: Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna Stockholm, Sweden.
authors.forename: Rickard E
authors.initials: RE
authors.lastname: Malmström
keywords: Europe; cross-national study; demand-side measures; drug utilisation; generics; losartan