Policies to enhance the efficiency of prescribing in the Spanish Catalan region: Impact and future direction

Aim: To assess the impact of recent national and regional initiatives on the utilization and expenditure of four high-volume classes to provide future guidance. These were proton pump inhibitors, statins and ezetimibe, and renin-angiotensin drugs, as well as newer antidepressants. Methods: An observational study of prescriptions dispensed in ambulatory care in Catalonia was conducted from 2003 to 2007. Utilization was converted into defined daily doses (DDDs) and DDDs per 1000 inhabitants per day, and compared over the study period, as well as with other European countries. Results: As expected, there was increasing utilization of statins and renin-angiotensin drugs during the study period, as well as increased utilization of generics versus originators in each class; the latter figures were substantially greater than those published previously. There was also increased utilization of the proton pump inhibitors, which is a cause for concern. There were substantial reductions in the expenditure/DDDs of generics and originator products in 2007 versus 2003. For instance, expenditure/DDDs of generic and originator simvastatin were 81 and 72%, respectively, below 2003 originator prices. These reductions were much greater than those seen in previous publications. The increased utilization of generics, coupled with lower expenditure/DDDs for the classes, led to reduced reimbursed expenditure for the proton pump inhibitors, statins and newer antidepressants over time. Conclusion: The findings are in line with expectations and do provide direction to other European countries, especially those with higher expenditures/DDDs for generics. There is an opportunity for Catalonia to learn from other countries to further enhance the quality and efficiency of its prescribing, and possible initiatives are discussed.