Axel Leporowski1, Brian Godman2,3,4,5, Amanj Kurdi2,6, Sean MacBride-Stewart7, Margaret Ryan7, Simon Hurding8, Renata Crm Do Nascimento2,9,10, Marion Bennie2, Alec Morton1. 1. a Department of Management Science , Strathclyde Business School, University of Strathclyde , Glasgow , United Kingdom. 2. b Department of Pharmacoepidemiology , Strathclyde Institute of Pharmacy and Biomedicial Sciences, University of Strathclyde , Glasgow , United Kingdom. 3. c Division of Clinical Pharmacology , Karolinska University Hospital Huddinge , Stockholm , Sweden. 4. d School of Pharmaceutical Sciences , Universiti Sains Malaysia , Penang , Malaysia. 5. e Department of Public Health Pharmacy and Management , School of Pharmacy, Sefako Makgatho Health Sciences University , Garankuwa , South Africa. 6. f Department of pharmacology , College of Pharmacy, Hawler Medical University , Erbil , Iraq. 7. g Pharmacy Prescribing Support Unit, National Health Service Greater Glasgow and Clyde , Glasgow , UK. 8. h NHS Health Scotland , Edinburgh , UK. 9. i Post-Graduate Program of Medicines and Pharmaceutical Assistance, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil. 10. j SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil.
Abstract
BACKGROUND: Prescribing of lipid-lowering agents (LLAs) has increased worldwide including in Scotland with increasing prevalence of coronary heart disease, and higher dose statins have been advocated in recent years. There have also been initiatives to encourage prescribing of generic versus patented statins to save costs without compromising care. There is a need to document these initiatives and outcomes to provide future direction. METHOD: Assessment of utilization (items dispensed) and expenditure of key LLAs (mainly statins) between 2001 and 2015 in Scotland alongside initiatives. RESULTS: Multiple interventions over the years have increased international nonproprietary name prescribing (99% for statins) and preferential prescribing of generic versus patented statins, and reduced inappropriate prescribing of ezetimibe. This resulted in a 50% reduction in expenditure of LLAs between 2001 and 2015 despite a 412% increase in utilization, increased prescribing of higher dose statins (71% in 2015) especially atorvastatin following generic availability, and reduced prescribing of ezetimibe (reduced by 72% between 2010 and 2015). As a result, the quality of prescribing has improved. CONCLUSION: Generic availability coupled with multiple measures has resulted in appreciable shifts in statin prescribing behavior and reduced ezetimibe prescribing, resulting in improvements in both the quality and efficiency of prescribing.
BACKGROUND: Prescribing of lipid-lowering agents (LLAs) has increased worldwide including in Scotland with increasing prevalence of coronary heart disease, and higher dose statins have been advocated in recent years. There have also been initiatives to encourage prescribing of generic versus patented statins to save costs without compromising care. There is a need to document these initiatives and outcomes to provide future direction. METHOD: Assessment of utilization (items dispensed) and expenditure of key LLAs (mainly statins) between 2001 and 2015 in Scotland alongside initiatives. RESULTS: Multiple interventions over the years have increased international nonproprietary name prescribing (99% for statins) and preferential prescribing of generic versus patented statins, and reduced inappropriate prescribing of ezetimibe. This resulted in a 50% reduction in expenditure of LLAs between 2001 and 2015 despite a 412% increase in utilization, increased prescribing of higher dose statins (71% in 2015) especially atorvastatin following generic availability, and reduced prescribing of ezetimibe (reduced by 72% between 2010 and 2015). As a result, the quality of prescribing has improved. CONCLUSION: Generic availability coupled with multiple measures has resulted in appreciable shifts in statin prescribing behavior and reduced ezetimibe prescribing, resulting in improvements in both the quality and efficiency of prescribing.
Entities:
Keywords:
Lipid lowering agents; Scottish NHS; drug utilization; expenditure; reforms
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