Abstract
BackgroundGeneric 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.MethodsPrincipally, 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)).ResultsThere 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.ConclusionConsistent 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.
Highlights
Generic atypical antipsychotic drugs offer health authorities opportunities for considerable savings
There was a consistent steady reduction in the utilisation of risperidone as a percentage of total selected atypical utilisation in all the four countries over time following the introduction of generic risperidone (Figure 1)
The average decline in the percentage of risperidone versus the other selected atypical antipsychotic drugs persisted after generic risperidone was introduced but to a lesser extent, with an initial average drop of −0.0774 and a change in slope from −0.144% to −0.00548% per month (Table 1)
Summary
Generic atypical antipsychotic drugs offer health authorities opportunities for considerable savings. 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. There are considerable opportunities for authorities across Europe to realise appreciable savings from the increased use of low-cost generics [1]. The availability of generic risperidone provides a further opportunity for authorities to achieve considerable savings This is because worldwide sales of atypical antipsychotic drugs were over $US 5 billion per year in the early 2000s, reaching $14.6bn in the US alone in 2009 [6,7]. Medicine costs can be an appreciable component of the overall cost of treating patients with schizophrenia, as pharmacological treatments represent the backbone of managing these patients [8,9,10,11]
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