title: Potential savings in prescription drug costs for hypertension, hyperlipidemia, and diabetes mellitus by equivalent drug substitution in Austria: a nationwide cohort study.
abstract: BACKGROUND
  Healthcare systems spend considerable proportions of their budgets on pharmaceutical treatment of hypertension, hyperlipidemia, and diabetes mellitus. From data on almost all residents of Austria, a country with mandatory health insurance and universal health coverage, we estimated potential cost savings by substituting prescribed medicines with the cheapest medicines that were of the same chemical substance and strength, and available during the same time.
  
  
  METHODS
  Data from 8.3 million persons (98.5 % of the total Austrian insured population) from 2009-2012 were analyzed. Real prescription costs for antihypertensive, lipid-lowering, and hypoglycemic medicines achievable by same-substance, same-strength drug substitution were computed for each active ingredient, and per gender and 1-year age category of patients.
  
  
  RESULTS
  In 2012, health insurance providers spent <euro>231.3 million, <euro>77.8 million, and <euro>91.9 million for antihypertensive, lipid-lowering, and diabetes medications, of which <euro>52.2 million (22.6 %), <euro>15.9 million (20.5 %), and <euro>4.1 million (4.5 %), respectively, could have been saved by same-substance drug substitution. Highest potential savings were calculated for amlodipine (<euro>8.0 million, 65.4 %), simvastatin (<euro>12.2 million, 59.3 %), and metformin (<euro>2.4 million, 54.6 %), respectively. Higher savings for men than for women resulted from differing prescribed cumulative dosages and proportions of patients with co-payment waiver. Potential cost savings in antihypertensive and lipid-lowering drugs increased from 2009-2012.
  
  
  CONCLUSIONS
  Our study highlights the cost-savings potential from arguably the most acceptable of interventions, simply switching to the cheapest available same-substance, same-strength product. In 2012, this strategy could have reduced costs for antihypertensive, lipid-lowering, and hypoglycemic treatment by up to 18.0 %.
authors.affiliation: Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria, georg.heinze@meduniwien.ac.at.
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.forename: Milan
authors.initials: M
authors.lastname: Hronsky
authors.forename: Berthold
authors.initials: B
authors.lastname: Reichardt
authors.forename: Christoph
authors.initials: C
authors.lastname: Baumgärtel
authors.forename: Marcus
authors.initials: M
authors.lastname: Müllner
authors.forename: Anna
authors.initials: A
authors.lastname: Bucsics
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D000959:Antihypertensive Agents / Q000191:economics*; D001317:Austria; D003363:Cost Control; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000188:drug therapy*; D016527:Drug Costs / Q000706:statistics & numerical data*; D016568:Drugs, Generic / Q000191:economics*; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000191:economics*; D000960:Hypolipidemic Agents / Q000191:economics*
chemical_list: D000959:Antihypertensive Agents; D016568:Drugs, Generic; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents