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Drug Cost Development of Citalopram and Fluoxetine Following the Introduction of Generic Substitution in Finland

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Abstract

Background: Spending on pharmaceuticals is increasing faster than the gross national product in western European countries. The use of generic drugs may result in direct drug cost-savings for patients, governments and insurers.

Objective: The objective of this study was to examine the drug cost development of the two most commonly dispensed antidepressant drugs in Finland following the introduction of regulatory changes to mandate generic substitution by pharmacists in April 2003.

Methods: The prescription claims database of the Social Insurance Institution of Finland was used to calculate the quarterly cost of reimbursements per user for citalopram and fluoxetine from January 2003 to June 2004. Price data for the originator brand of citalopram, market incumbent brand of fluoxetine, and generic versions of both citalopram and fluoxetine were extracted from the registry of the Association of Finnish Pharmacies for April 2003 to April 2004.

Results: The quarterly drug cost of citalopram and fluoxetine per user to the Social Insurance Institution of Finland decreased by 45% and 48%, respectively, 1 year following the changes to the regulations regarding generic substitution. The companies that marketed the originator brand of citalopram and the market incumbent brand of fluoxetine adopted two contrasting pricing policies in response to changes in the regulations regarding generic substitution. A ‘pseudo-generic’ version of citalopram, but not fluoxetine, was available throughout the study period. Regardless of the pricing policy, equivalent drug cost-savings were realised for both patients and government. These cost reductions did not lead to a corresponding increase in the use of citalopram or fluoxetine.

Conclusions: The introduction of changes to regulations regarding generic substitution was followed by a decrease in price for the two most commonly dispensed antidepressant drugs in Finland. High price elasticity was observed within but not between active ingredients. Price did not appear to be an important factor guiding antidepressant prescribing by physicians.

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Notes

  1. The TRIPs Agreement is a World Trade Organization agreement on intellectual property rights (further information on the agreement can be found at http://www.wto.org/english/docs_e/legal_e/legal_e.htm#TRIPs).

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Acknowledgements

No external sources of financial support were sought or gained to conduct this study. All authors declare they have no conflicts of interest directly relevant to the study. Dr Kanerva is a former employee of Oriola. Dr Bell has received honoraria and/or grant funding from Eli Lilly, AstraZeneca and Alphapharm.

The authors would like to thank the Social Insurance Institution of Finland and the Association of Finnish Pharmacies for granting permission to access their data. The results of this study were presented at the International Society for Pharmacoeconomics and Outcomes Research 12th International Meeting, Arlington, VA, USA on May 19–23, 2007.

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Authors and Affiliations

  1. Faculty of Pharmacy, University of Helsinki, PO Box 56, Helsinki, 00014, Finland

    Ville Aalto-Setälä, Risto Kanerva & J. Simon Bell

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  1. Ville Aalto-Setälä
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  2. Risto Kanerva
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  3. J. Simon Bell
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Correspondence to Ville Aalto-Setälä.

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Aalto-Setälä, V., Kanerva, R. & Bell, J.S. Drug Cost Development of Citalopram and Fluoxetine Following the Introduction of Generic Substitution in Finland. Int J Pharm Med 21, 363–368 (2007). https://doi.org/10.2165/00124363-200721050-00007

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