Trying to reduce expenditure on medicine is a major driving force for reforms by many governments. This includes Austria, where measures have been introduced to lower generics prices and enhance their use. However, the situation for newer antidepressants and atypical antipsychotic medicines (AAPs) is different to proton pump inhibitors (PPIs) (anti-reflux), statins (cholesterol-reducing), and renin-angiotensin inhibitor (blood-pressure reducing) drugs. For antidepressants therapy, it is more often tailored to meet the patient’s needs and there is resistance to switch products in stable patients.
In order to study whether such reforms had affected use of antidepressants in Austria, Godman et al. studied changes in the use of venlafaxine versus other newer antidepressants before and after generics became available, use of generic versus originator venlafaxine and price reductions of venlafaxine over time and their influence on total expenditure.
Venlafaxine is a selective serotonin reuptake inhibitor (SSRI), which is used to treat a range of mental diseases including depression, panic disorder and generalized and social anxiety disorder. The drug lost its patent protection in Austria in 2008 and generic immediate release (IR) and extended release (ER) formulations were introduced in Austria from May 2009.
The study covered the period from May 2007, i.e. 24 months before generic venlafaxine became available in Austria; to August 2011, 27 months after generic venlafaxine availability. The results showed no appreciable changes in the use of venlafaxine as a percentage of total antidepressant use after generics were introduced to Austria (46% versus 44%). The reduction in expenditure/defined daily dose (DDD) for venlafaxine decreased overall expenditure on newer antidepressants by 5% by the end of the study versus just before generics were introduced. This was despite a 37% increase in the use of newer antidepressants, mainly driven by increasing use of duloxetine.
Total expenditure/DDD for generic IR venlafaxine in August 2011 was 68% below single-sourced prices, with a similar reduction in the price of the originator. For generic ER venlafaxine a reduction in expenditure/DDD of 42% was observed from May 2009 to August 2011.
The lack of change in the use of venlafaxine after the introduction of generics was attributed to the complexity of treating patients with depression. As a result, the authors concluded that ‘specific measures are needed to encourage the prescribing of generic venlafaxine when multiple choices are appropriate.’ Measures may include prescribing restrictions for duloxetine for which no generics yet exist.
Editor’s comment
Readers interested to learn more about the instruments applied to improve uptake of generics in Austria are invited to visit www.gabi-journal.net to view the following peer reviewed article due to be published in GaBI Journal:
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Source: www.gabionline.net
