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Changes in the Utilization of Venlafaxine after the Introduction of Generics in Sweden

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Abstract

Background

There has been an appreciable increase in the prescribing efficiency of proton pump inhibitors, statins, and renin–angiotensin inhibitor drugs in Sweden in recent years. This has been achieved through multiple reforms encouraging the prescription of generics at low prices versus patented drugs in the same class. Generic venlafaxine also presents an opportunity to save costs given the prevalence of depression. However, depression is more complex to treat, with physicians reluctant to change prescriptions if patients are responding to a particular antidepressant.

Objectives

We assessed (a) changes in the utilization pattern of venlafaxine versus other newer antidepressants before and after the availability of generic venlafaxine and before and after the initiation of prescription restrictions for duloxetine limiting its prescription to refractory patients, (b) utilization of generic versus original venlafaxine after its availability, and (c) price reductions for generic venlafaxine and the subsequent influence on total expenditure on newer antidepressants over time.

Methodology

We performed interrupted time series analysis of changes in monthly reimbursed prescriptions using defined daily doses (DDDs) of patients dispensed at least one newer antidepressant from January 2007 to August 2011. DDDs was defined as the average maintenance dose of a drug when used in its major indication in adults. This included 19 months after the availability of generic venlafaxine and before initiation of prescription restrictions for duloxetine to 13 months after prescription restrictions. Total expenditure and expenditure/DDD for venlafaxine were measured over time.

Results

No appreciable change in the utilization pattern for venlafaxine was observed after generic availability when no appreciable demand-side activities by the regions (counties) were implemented to encourage its use. The utilization of venlafaxine significantly increased after prescription restrictions for duloxetine. Generic venlafaxine was dispensed once available, reaching 99.6 % of total venlafaxine (DDD basis) by August 2011. There was an appreciable fall in expenditure for newer antidepressants in Sweden after generic venlafaxine despite increased utilization, helped by a 90 % reduction in expenditure/DDD for venlafaxine by the end of the study versus prepatent loss prices.

Conclusion

Multiple demand-side measures are needed to change physician prescribing habits. Authorities should not rely on a spillover effect between drug classes to effect change. Limited influence of prescription restrictions on the subsequent utilization of duloxetine reflects the complexity of this disease area. This is exacerbated by heterogeneous indications for duloxetine.

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Acknowledgements

The authors acknowledge the help of Karl Arnberg (TLV) for his helpful comments, especially regarding potential follow-on studies.

Financial disclosure

BW, MP, and JM are employed by Stockholm County Council, Stockholm. The authors have no other conflicts of interest to declare. This work was in part supported by Grants from the Karolinska Institutet, Sweden. No writing assistance was provided for this article.

Author contributions

Brian Godman undertook the analysis of utilization and expenditure data, produced the first draft, and submitted the article following comments. He is the guarantor for the results presented in the article. Marie Persson critiqued the first draft and provided data on expenditure on patented antidepressants in Stockholm County Council. Jamilette Miranda undertook the statistical analysis and critiqued the results. Peter Skiöld provided the rationale behind the study, provided data on the recent reforms regarding generic prices in Sweden, and provided input on the prescription restrictions for duloxetine. Björn Wettermark provided the rationale behind the study and the methodology, provided the data for Sweden and reviewed the results. Corrado Barbui critiqued early drafts especially with respect to the effectiveness and side-effects of the newer antidepressants. Lars L Gustafsson critiqued earlier drafts.

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Authors and Affiliations

  1. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden

    Brian Godman, Björn Wettermark & Lars L. Gustafsson

  2. Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK

    Brian Godman

  3. Liverpool Health Economics Centre, University of Liverpool, Chatham Street, Liverpool, UK

    Brian Godman

  4. Unit of Medicine Support, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden

    Marie Persson

  5. Department of Healthcare Development, Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden

    Jamilette Miranda & Björn Wettermark

  6. Dental and Pharmaceuticals Benefits Agency (TLV), PO Box 22520, Flemingatan 7, 104, Stockholm, Sweden

    Peter Skiöld

  7. Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital Solna, 17176, Stockholm, Sweden

    Björn Wettermark

  8. Section of Psychiatry, Department of Public Health and Community Medicine, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy

    Corrado Barbui

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  1. Brian Godman
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  2. Marie Persson
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  3. Jamilette Miranda
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  7. Lars L. Gustafsson
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Correspondence to Brian Godman.

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Godman, B., Persson, M., Miranda, J. et al. Changes in the Utilization of Venlafaxine after the Introduction of Generics in Sweden. Appl Health Econ Health Policy 11, 383–393 (2013). https://doi.org/10.1007/s40258-013-0037-x

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