Influence of demand-side measures to enhance renin-angiotensin prescribing efficiency in Europe: Implications for the future

Luka Vončina, Tihomir Strizrep, Brian Godman*, Marion Bennie, Iain Bishop, Stephen Campbell, Vera Vlahović-Palčevski, Lars L. Gustafsson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

69 Citations (Scopus)


European countries strive to enhance prescribing efficiency. This includes renin-angiotensin drugs following the availability of generic angiotensin-converting enzyme inhibitors (ACEIs). Aims: To compare angiotensin receptor blocker utilization and expenditure patterns in Austria and Croatia following prescribing restrictions, as well as with other European countries introducing different supply- and demand-side measures. Lastly, to appraise the impact of generic losartan in Croatia on utilization of patented angiotensin receptor blockers. Method: Observational retrospective study principally between 2001 and 2007, using defined daily doses and €/1000 inhabitants/year. Demand-side measures were based on the four 'E's - education, engineering, economics and enforcement. Results: Greater intensity of follow-up of prescribing restrictions in Croatia enhanced utilization of ACEIs versus Austria. There was high utilization of ACEIs in Scotland following intensive demand-side measures, similar to Austria and Croatia. Demand-side measures in Spain (Catalonia) and Sweden also appeared to moderate angiotensin receptor blockers utilization. The combination of measures helped stabilize expenditure on renin-angiotensin drugs when adjusted for population sizes despite appreciable increases in volumes. The only exception was Portugal, with less intensive measures. Conclusion: Multiple and intensive demand-side measures enhanced prescribing efficiency. The more intense follow-up of ARB prescribing restrictions in Croatia had a greater influence on subsequent utilization patterns than Austria. Both findings confirm earlier studies. Reforms also favorably enhanced the prescribing of generic losartan once available.

Original languageEnglish
Pages (from-to)469-479
Number of pages11
JournalExpert Review of Pharmacoeconomics and Outcomes Research
Issue number4
Publication statusPublished - Aug 2011
Externally publishedYes


  • demand-side reforms
  • efficiency
  • generics
  • prescribing restrictions
  • renin-angiotensin drugs


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