title: Effects of expiring reimbursability of pentaerythrityl tetranitrate (PETN, pentalong®) on anti-anginal therapy: an observational study.
abstract: OBJECTIVE
  Pentaerythrityl tetranitrate (PETN) was the most commonly prescribed long-acting nitrate in Germany. We aimed to assess whether the discontinuation of PETN reimbursability in 2011 resulted in alternative prescriptions of anti-anginal medications or in a discontinuation of anti-anginal therapy.
  
  
  METHODS
  This is an observational study using health claims data from one German federal state analysing all patients discontinuing a PETN treatment. Patients starting a new alternative anti-anginal treatment (long-acting nitrates, molsidome, ivabradine and ranolazine) were compared with patients without a new anti-anginal treatment with respect to use of short-acting nitrates, beta blockers (BBs) and calcium channel blockers (CCBs).
  
  
  RESULTS
  Out of 12,909 patients, 12,763 (99%) discontinued PETN until 12/2012. Of these, 52% started an alternative anti-anginal treatment, 43% did not receive any alternative treatment and 5% were excluded from analysis. Before termination of PETN reimbursability, 65% of patients received BBs, 29% CCBs and 10% short-acting nitrates. In patients started on alternative anti-anginal treatment, prescription rates for short-acting nitrates, BBs and CCBs remained constant after discontinuing PETN. In patients without any alternative anti-anginal treatment, prescription rates for BBs and CCBs did not change meaningfully (<3%), and prescription rates for short-acting nitrates decreased from 9% to 6%.
  
  
  CONCLUSIONS
  Half of the patients discontinued PETN without alternative. This did not lead to increased prescription rates of standard IHD medications or total medication number indicating that there might still be a high percentage of ischaemic heart disease patients treated unnecessarily with long-acting nitrates. The undertreatment with prognostically relevant first-line medications indicates a need for better guideline implementation activities.
authors.affiliation: Health Insurance Medical Service (MDK) Mecklenburg-Vorpommern, Schwerin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Grimmsmann
authors.affiliation: Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Chenot
authors.affiliation: Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Aniela
authors.initials: A
authors.lastname: Angelow
mesh_terms: D000787:Angina Pectoris / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D016527:Drug Costs; D011307:Drug Prescriptions; D057915:Drug Substitution / Q000191:economics; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005858:Germany; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000639:trends; D010417:Pentaerythritol Tetranitrate / Q000191:economics* / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000639:trends; D013997:Time Factors; D014665:Vasodilator Agents / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D010417:Pentaerythritol Tetranitrate
keywords: drug regulation; ischaemic heart disease; long-acting nitrates; market withdrawal; pentaerythrityl tetranitrate; pharmacoepidemiology