PP063—Changes in the utilisation of venlafaxine after the introduction of generics in Sweden: Implications for other countries

2013 e37 Significant but lesser changes in losartan utilization were seen in Austria and Belgium. There was no change in losartan utilization patterns in Scotland or Spain. Losartan typically generic at low prices, leading to appreciable increases in prescribing efficiency in NHS Bury, Sweden, Austria, and Belgium. There were some savings in Scotland with generic losartan. Conclusion: Multiple demand-side measures appreciably enhanced ARB prescribing efficiency. This mirrors previous findings that multiple measures are need to change prescribing habits. No significant increase in losartan utilization following generics where countries have not instigated specific measures suggests authorities cannot rely on a "spillover" effect between classes to change physician prescribing habits. This is the case even with multiple demand-side activities encouraging preferential prescribing of generics in related classes. This may be exacerbated on this occasion by a more complex message; for example, away from ACEIs first line versus ARBs to ACEIs + low cost ARBs first line. Disclosure of Interest: None declared

Policies for biosimilar uptake in Europe : an overview

Background: Across European countries, differences exist in biosimilar policies, leading to variations in uptake of biosimilars and divergences in savings all over Europe. Objectives: The aim of this article is to provide an overview of different initiatives and policies that may influence the uptake of biosimilars in different European countries. Recommendations will be formulated on how to create sustainable uptake. Methods: An overview of policies on biosimilars was obtained via a questionnaire, supplemented with relevant articles. Topics were organized in five themes: availability, pricing, reimbursement, demand-side policies, and recommendations to enhance uptake. Results: In all countries studied, biological medicines are available. Restrictions are mainly dependent on local organization of the healthcare system. Countries are willing to include biosimilars for reimbursement, but for commercial reasons they are not always marketed. In two thirds of countries, originator and biosimilar products may be subjected to internal reference pricing systems. Few countries have implemented specific incentives targeting physicians. Several countries are implementing pharmacist substitution; however, the scope and rules governing such substitution tend to vary between these countries. Reported educational policies tend to target primarily physicians, whereas fewer initiatives were reported for patients. Recommendations as proposed by the different country experts ranged from the need for information and communication on biosimilars to competitive pricing, more support for switching and guidance on substitution. Conclusions: Most countries have put in place specific supply-side policies for promoting access to biosimilars. To supplement these measures, we propose that investments should be made to clearly communicate on biosimilars and educate stakeholders. Especially physicians need to be informed on the entry and use of biosimilars in order to create trust. When physicians are well-informed on the treatment options, further incentives should be offered to prescribe biosimilars. Gainsharing can be used as an incentive to prescribe, dispense or use biosimilars. This approach, in combination with binding quota, may support a sustainable biosimilar market

Regions of interest placement for DTI analyses.

<p>Representative example of ROI placements (red circles) on high-resolution T2 images (A-C, coronal orientation; D, sagittal orientation). A: thalamus, B: internal capsule (inset: corresponding MD map), C: periventricular white matter, D: cerebellar vermis</p

Ventilation and oxygenation.

<p>Ventilation and arterial blood gas measurements in lambs ventilated with an injurious strategy (black squares) versus a protective strategy (open circles) during the first 15 minutes, followed by maintenance ventilation until 1 hour. A) Tidal volume (V_T; Group: p = 0.002, F = 19.14; Time: p = 0.58, F = 0.87; Group × Time: p = 0.17, F = 1.42) B) Peak inspiratory pressure (PIP: Group: p = 0.002, F = 19.24; Time: p&lt;0.001, F = 5.72; Group × Time: p = 0.07, F = 1.70) C partial pressure of arterial (Pa) oxygen (PaO₂; Group: p = 0.87, F = 0.03; Time: p = 0.13, F = 1.6; Group × Time: p = 0.03, F = 2.2) and D) Pa carbon dioxide (PaCO₂; Group: p = 0.55, F = 0.37; Time: p = 0.49, F = 0.88; Group × Time: p&lt;0.001, F = 5.21)</p

Regions of interest placement for DTI analyses.

<p>Representative example of ROI placements (red circles) on high-resolution T2 images (A-C, coronal orientation; D, sagittal orientation). A: thalamus, B: internal capsule (inset: corresponding MD map), C: periventricular white matter, D: cerebellar vermis</p

Diffusion measures in the cerebellum.

<p>Individual values of fractional anisotropy (FA) and mean diffusitivity (MD) within the cerebellum of protectively ventilated (PROT; open circles) and injuriously ventilated (INJ; black squares) preterm lambs, measured in 30 directions using diffusion tensor imaging. Two of the injuriously venilated lambs had higher FA and lower MD (p&lt;0.05) in the cerebellum compared to the other lambs.</p

Peak-area MRS lactate ratios.

<p>Individual peak area MRS ratios using a single voxel encompassing supratentorial deep grey matter and central WM in protectively ventilated (PROT; open circles) and injuriously ventilated (INJ; black squares) preterm lambs. LAC; lactate, Cr; creatine, NAA; N-acetylaspartate, Cho; choline. Compared to the PROT group, MRS peak-area ratios of lactate to other metabolites (Cr, NAA, Cho) were more scattered in INJ lambs.</p

Magnetic resonance spectroscopy.

<p>Sample 270(TE) spectra from one lamb that received injurious ventilation with a representative example of voxel placement (right). Cho; choline, Cr; creatine, NAA; N-acetylaspartate, Lac; lactate. Peak ratios were determined for Lac/Cr, Lac/NAA, Lac/Cho, NAA/Cr, NAA/Cho and Cho/Cr.</p

Policies for biosimilar uptake in Europe: an overview

Across European countries, differences exist in biosimilar policies, leading to variations in uptake of biosimilars and divergences in savings all over Europe.status: publishe