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Can authorities take advantage of the availability of generic atypical antipsychotic drugs? Findings from Sweden and potential implications

Authors

  • Brian Godman,

    Corresponding author
    1. Liverpool Health Economics Centre, University of Liverpool, Liverpool, UK
    2. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
    • Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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  • Marie Persson,

    1. Unit of Medicine Support, Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden
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  • Jamilette Miranda,

    1. Department of Healthcare Development, Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden
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  • Corrado Barbui,

    1. 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, Verona, Italy
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  • Marion Bennie,

    1. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
    2. Information Services Division, NHS National Services Scotland, Edinburgh, UK
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  • Alexander E Finlayson,

    1. King's Centre for Global Health, Global Health Offices, Weston Education Centre, London, UK
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  • Emanuel Raschi,

    1. Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum – University of Bologna, Bologna, Italy
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  • Bjorn Wettermark

    1. Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
    2. Department of Healthcare Development, Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden
    3. Centre for Pharmacoepidemilogy, Karolinska Institute, Karolinska University Hospital Solna, Stockholm, Sweden
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Correspondence: Brian Godman, Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.

E-mail: brian.godman@ki.se

Abstract

Introduction

Multiple reforms in Sweden appreciably enhanced prescribing efficiency for proton pump inhibitors, statins and renin-angiotensin inhibitor drugs. Potential exists to extend this to atypical antipsychotic drugs (AAPs), given their expenditure and oral generic risperidone available in Sweden from January 2009. However schizophrenia and bipolar disease are complex to treat and there is a need to tailor treatments, given the considerable inter-patient variability in responses and side-effects to different AAPs.

Objectives

Assess changes in risperidone utilisation before and after oral generic risperidone reimbursed in January 2009 alongside any specific demand-side measures. In addition, to: (a) assess price reductions for risperidone over time and overall AAP expenditure; (b) suggest additional measures that could potentially be introduced; and (c) provide guidance to other European countries on the implications of any findings.

Method

Principally a retrospective observational study and interrupted time series design.

Key findings

No specific measures to encourage the prescribing of risperidone, and no appreciable change in its utilisation, after generics reimbursed. Oral risperidone was 96% generic, and its price 80% below pre-patent loss prices, by August 2011. This limited the increase in AAP expenditure compared with utilisation after generics.

Conclusion

No apparent effectiveness or safety problems with generic risperidone. Authorities cannot rely on a spill-over from other disease areas to effect changes in physician prescribing habits. Specific measures are needed to encourage the prescribing of generic AAPs first line, where appropriate, exacerbated by the complexity of the disease areas. Their influence will be probably limited by the need to tailor treatment.

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