Can authorities appreciably enhance the prescribing of oral generic risperidone to conserve resources? Findings from across Europe and their implications
1 Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
2 Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
3 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
4 Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
5 Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin 8, Ireland
6 Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh EH12 9EB, UK
7 University of Vienna, Vienna, Austria
8 Hauptverband der Österreichischen Sozialversicherungsträger, Kundmanngasse 21, A-1031 Wien, Austria
9 Department of Primary Care Sciences, Oxford University, Oxford, UK
10 NHS Greater Manchester Commissioning Support Unit, Salford, Manchester M6 5FW, UK
11 Unit of Medicine Support, Public Healthcare Services Committee, Stockholm County Council, PO Box 17533, SE-118 91 Stockholm, Sweden
12 Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, I-40126 Bologna, Italy
13 KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Herestraat 49, 3000 Leuven, Belgium
14 Barcelona Health Region, Catalan Health Service, Esteve Terrades 30, 08023 Barcelona, Spain
15 WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A., Scuro 10 37134 Verona, Italy
BMC Medicine 2014, 12:98 doi:10.1186/1741-7015-12-98Published: 13 June 2014
Generic atypical antipsychotic drugs offer health authorities opportunities for considerable savings. However, schizophrenia and bipolar disorders are complex diseases that require tailored treatments. Consequently, generally there have been limited demand-side measures by health authorities to encourage the preferential prescribing of generics. This is unlike the situation with hypertension, hypercholaesterolaemia or acid-related stomach disorders.
The objectives of this study were to compare the effect of the limited demand-side measures in Western European countries and regions on the subsequent prescribing of risperidone following generics; to utilise the findings to provide future guidance to health authorities; and where possible, to investigate the utilisation of generic versus originator risperidone and the prices for generic risperidone.
Principally, this was a segmented regression analysis of retrospective time-series data of the effect of the various initiatives in Belgium, Ireland, Scotland and Sweden following the introduction of generic risperidone. The study included patients prescribed at least one atypical antipsychotic drug up to 20 months before and up to 20 months after generic risperidone. In addition, retrospective observational studies were carried out in Austria and Spain (Catalonia) from 2005 to 2011 as well as one English primary care organisation (Bury Primary Care Trust (PCT)).
There was a consistent steady reduction in risperidone as a percentage of total selected atypical antipsychotic utilisation following generics. A similar pattern was seen in Austria and Spain, with stable utilisation in one English PCT. However, there was considerable variation in the utilisation of generic risperidone, ranging from 98% of total risperidone in Scotland to only 14% in Ireland. Similarly, the price of generic risperidone varied considerably. In Scotland, generic risperidone was only 16% of pre-patent loss prices versus 72% in Ireland.
Consistent findings of no increased prescribing of risperidone post generics with limited specific demand-side measures suggests no ‘spillover’ effect from one class to another encouraging the preferential prescribing of generic atypical antipsychotic drugs. This is exacerbated by the complexity of the disease area and differences in the side-effects between treatments. There appeared to be no clinical issues with generic risperidone, and prices inversely reflected measures to enhance their utilisation.