Initial effects of a reimbursement restriction to improve the cost-effectiveness of antihypertensive treatment.

OBJECTIVE: The Swedish Dental and Pharmaceutical Benefits Agency is re-assessing the value of all drugs included in the reimbursement scheme in order to make the most efficient use of resources. Their recent review of antihypertensive drugs included 46 substances with total annual sales of euro230 million (euro25/capita). This resulted in reimbursement restrictions for 26 substances, e.g. all angiotensin receptor blockers (ARBs). METHODS: We used the Swedish prescribed drug register to evaluate the initial effects on prescribing patterns using a before-and-after design, comparing utilization and expenditure with corresponding periods previous years. RESULTS: The proportion of the Swedish population being dispensed antihypertensive drugs increased by 0.5%-units to 16.5% in September-December 2008 compared to the same period in 2007. Patients initiated on ARBs decreased by 24%, whilst increasing for ACE inhibitors (ACEI) and calcium channel blockers, by 14% and 12%, respectively. The proportion initiated on ARBs prescribed an ACEI within 24 months prior to an ARB increased from 51% to 67%, with a substantial regional variation (extremal quotient 31; coefficient of variation 36%). The total expenditure decreased by 4.7% to euro73 million in September-December 2008 compared to the same period in 2007. CONCLUSIONS: Reimbursement restrictions had a positive impact on enhancing the efficiency of antihypertensive prescribing. Resources released can be used to improve care in the future.

Utilisation of angiotensin receptor blockers in Sweden: combining survey and register data to study adherence to prescribing guidelines.

PURPOSE: Angiotensin receptor blockers (ARBs) offer a new treatment alternative for patients with hypertension and heart failure. Due to comparatively high prices, most guidelines suggest ARBs be restricted to patients intolerant to angiotensin-converting enzyme inhibitors (ACEi). We analysed the prescribing patterns of ARBs in Sweden by combining prescription register data with patient self-reported data. METHODS: Survey data from 517 patients dispensed ARBs in 55 pharmacies and data on dispensed prescriptions from the Swedish Prescribed Drug Register were used to study indication, comorbidity and whether ARBs were initiated as first-line treatment. RESULTS: In 2006, ARBs were dispensed to 3.6% of the Swedish population. The survey showed that 92% used them for hypertension. Register data showed that 23% of all patients initiated on an ARB had not been prescribed any other antihypertensive drugs 1 year prior to the initiation. CONCLUSIONS: ARBs are commonly used in Sweden, mainly to treat hypertension. Adherence to prescribing guidelines may be improved.