Measures to improve angiotensin receptor blocker prescribing efficiency in the UK: Findings and implications

Background: Generic losartan provides an opportunity to enhance angiotensin receptor blocker (ARB) prescribing efficiency, with all ARBs essentially being similar. Initially, there was limited activity in NHS Bury (UK). This changed in March 2011 with therapeutic switching and other measures encouraging the prescribing of losartan following generics to enhance its utilization versus patented ARBs. Aim: This study aims to assess the impact of multiple measures on losartan utilization, its price and total ARB expenditure. Methods: An interrupted time series analysis was performed. Utilization was measured as prescription items dispensed, typically 28 days. Results: No immediate change in losartan utilization was observed following generics. This changed after the multiple initiatives with losartan accounting for 65% of all single ARB items dispensed by the study end. ARB expenditure was 59% below prestudy levels by the study end, which was helped by a 92% reduction in expenditure per item for losartan. Annual net savings from the program were estimated at just under GB£290,000, which is over eight-times the cost of implementation. Conclusion: Multiple measures can enhance prescribing efficiency. Health authorities cannot rely on a 'spillover effect from other classes in order to affect changes in physician prescribing habits.