Generic Substitution in Lebanon: A Controlled Interrupted Time Series Analysis of Statins
Author(s)
Allam B, Saadeh G, Kiwan G
Bellevue Medical Center, El Metn, JL, Lebanon
OBJECTIVES: A new generic substitution (GS) policy was implemented in Lebanon in 2015 in order to promote utilization of generics. We aim in this research to assess the impact of this new policy on the consumption of statins. METHODS: Private sales data for Lipitor®, Crestor®, and their generic counterparts (from January 2014 to December 2016) were obtained from IQVIA, Inc. Monthly sales were converted to defined daily doses per 1000 inhabitants per month (DDD/TIM). Interrupted time-series (ITS) analyses were conducted to estimate the changes in level and trend of use of the studied drugs after the GS policy. A controlled ITS analysis using ratios was also done with Livazo®, a statin with no generic equivalent, as control. Ratios of Livazo/Lipitor and Livazo/Crestor monthly sales were then derived and studied in the controlled ITS. Seasonality was adjusted for by including Fourier terms in the model. RESULTS: The GS policy resulted in a slight increase in the level of utilization of Lipitor® (1.32 DDD/TIM, p=0.847) with a decreasing trend (-0.28 DDD/TIM, p=0.645). The utilization of Crestor decreased (level -8.27 DDD/TIM, p=0.643); slope -0.16 DDD/TIM, p=0.919). There was a decrease in the trend of use of atorvastatin generics by 3.24 DDD/TIM (p=0.038)relatively to the pre-intervention trend whereas no major change was witnessed for rosuvastatin generics (level -9.43 DDD/TIM, p=0.339; slope 0.02 DDD/TIM, p=0.986). The intervention resulted in an increase in the level and trend of Livazo/Lipitor ratio of 7.4% (p=0.563) and 0.5% (p=0.637), respectively. The same was noted for Livazo/Crestor ratio (level 2.5%, p=0.288 and slope 0.09%, p=0.674). CONCLUSIONS: We found no decrease in the use of two branded statins after the implementation of the new GS policy in Lebanon. A decrease in the trend of use of atorvastatin generics was noted after the policy.
Conference/Value in Health Info
2020-11, ISPOR Europe 2020, Milan, Italy
Value in Health, Volume 23, Issue S2 (December 2020)
Code
PDG35
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Prescribing Behavior, Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
Cardiovascular Disorders, Diabetes/Endocrine/Metabolic Disorders, Drugs, Generics