The impact of changes in national prescribing conditions for statins on their public expenditure and utilization in the Czech Republic 1997-2013

- The evolution of statin market in the Czech Republic from 1990s to 2013 was analyzed.
- Changes in utilization, expenditure and reimbursement prices and prescribing conditions of statins were evaluated.
- The utilization rose from 2 DDD/TID to 96 DDD/TID while the public expenditure rose 5.5-fold between 1997 and 2013.
- The utilization rose significantly after allowing prescription, initially specialist-restricted, for GPs.
- The reimbursement price strongly decreased with the coming of generics, namely of simvastatin in 2001 and atorvastatin in 2004.

ObjectivesIn the Czech Republic (CZ) extensive price regulation and prescribing conditions are common instruments often employed with new drugs. Since the introduction of statins onto the market in 1990s the originally strict conditions gradually relaxed while the prescription rates and public costs were rising. The aim was to analyze long-term utilization trends of statins, changes in their reimbursement prices and prescribing conditions, and the evolution of the market.MethodsFrom January 1997 to December 2013 statin use was measured in terms of defined daily doses per 1000 insured per day (DDD/TID). The prescription-based database of the General Health Insurance Company of the Czech Republic in 1997 covering 7825,216 inhabitants, i.e. 76% of CZ population, was used as the administrative data source. Also the overall expenditure, unit prices, and reimbursement criteria were analyzed.ResultsBetween 1997 and 2013 the utilization of statins rose from 2 to 96 DDD/TID while the expenditure rose 5.5-fold. The rise of prescription for each molecule was always observed after the liberation of the prescribing criteria. In the study period reimbursement prices of simvastatin and atorvastatin gradually decreased to just 5% of their initial values.ConclusionsThe rising consumption of statins in CZ clearly corresponds in time with the liberation of prescribing conditions allowing for prescription by general practitioners and with the introduction of generics accompanied by a swift and repeated reimbursement price cuts.