Key result
Lifting prescribing restrictions for losartan significantly increased its utilization (p>0.001) and reduced the growth rate of single-sourced ARBs (p>0.01), with losartan expenditure/DDD declining 78%.
Why the study?
Does lifting prescribing restrictions for generic losartan improve ARB-prescribing efficiency and utilization in ambulatory care?
Observational
Does lifting prescribing restrictions for generic losartan improve ARB-prescribing efficiency and utilization in ambulatory care?
p-value: p=>0.001
Lifting prescribing restrictions for generic losartan significantly increased its utilization and improved ARB-prescribing efficiency, providing a model for other health authorities.
Supports removing losartan restrictions to increase generic use and cut costs; leaves open generalizability to other agents or systems.
INTRODUCTION: Prescribing restrictions for angiotensin receptor blockers (ARBs) limited their utilization in Austria. Recently, generic losartan became available with its prescribing restrictions lifted while still in place for patented ARBs. OBJECTIVES: The main aim of this study is to assess the impact of the lifting of the prescribing restriction on utilization of losartan in ambulatory care versus other single ARBs, expenditure per defined daily dose (DDD) of losartan as well as total ARB expenditure and utilization of ARB combinations. Finally, to suggest potential measures that could be introduced to further enhance ARB-prescribing efficiency. METHODOLOGY: A quasi-experimental study of the utilization of different ARBs alone or in fixed dose combinations using a segmented time series. Utilization measured in DDDs, defined as 'the average maintenance dose of a drug when used in its major indication in adults'. Costs measured as total expenditure for different ARBs as well as their expenditure/DDD. RESULTS: Losartan utilization increased significantly following the withdrawal of prescribing restrictions (p > 0.001). Utilization of single-sourced ARBs also increased , but the growth rate was appreciably reduced once restrictions were lifted for losartan (p > 0.01). As a result, total expenditure of single ARBs increased but at an appreciably lower rate than utilization, helped by total expenditure/DDD for losartan declining by 78% over the study period. There was continuing appreciable utilization of fixed-dose combinations. CONCLUSION: Lifting of prescribing restrictions for losartan significantly enhanced its utilization, increasing ARB-prescribing efficiency, providing direction to other European authorities. Additional reforms are being considered to further switch utilization away from single-sourced ARBs to additionally improve prescribing efficiency as more multiple sourced ARBs become available.
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Bucsics et al. (2012) conducted an observational in Patients prescribed angiotensin receptor blockers (ARBs). Lifting prescribing restrictions for losartan vs. Prior to lifting restrictions / patented ARBs was evaluated on Utilization of losartan in ambulatory care versus other single ARBs, expenditure per DDD, total ARB expenditure, and utilization of ARB combinations (p=>0.001). Lifting prescribing restrictions for losartan significantly increased its utilization (p>0.001) and reduced the growth rate of single-sourced ARBs (p>0.01), with losartan expenditure/DDD declining 78%.
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