The potential influence of various initiatives to improve rational prescribing for proton pump inhibitors and statins in Belgium

Background: Proton pump inhibitors (PPIs) and statins have been among the top three most prescribed medicines in Belgium for more than a decade. Multiple demand-side measures have been introduced to improve rational prescribing generally, as well as for these two classes. Objectives: First, assessing the influence of general and specific reforms introduced in Belgium since 1997 on utilization and expenditure of the PPIs and statins. Second, suggesting additional measures to further improve rational prescribing based on experiences in other European countries. Methods: A retrospective observational study for assessing the influence of multiple initiatives in Belgium on utilization and expenditure of the PPIs and statins from 1997 to 2009 was carried out. Data were extracted from the administrative database Pharmanet. Utilization was measured in terms of defined daily doses (DDDs) and DDDs/thousand inhabitants per day. Results: Multiple reforms, including co-payments and reference pricing, appreciably enhanced rational prescribing for both PPIs and statins following generic availability. There was an eightfold increase in PPI utilization between 1997 and 2009, but only a twofold increase in reimbursed expenditure, helped by decreasing expenditure/DDD for the PPIs from (sic)1.91 in 1997 to (sic)0.52 in 2009. Similarly, a 20-fold increase was observed in statin utilization between 1997 and 2009, but only a fivefold increase in reimbursed expenditure, helped again by reimbursed expenditure/DDD decreasing from (sic)2.05 in 1997 to (sic)0.57 in 2009. Reduced co-payments for larger packs enhanced their prescription. Conclusion: Multiple reforms influenced utilization patterns and expenditure for the PPIs and statins, as well as the pack sizes dispensed. Additional demand-side measures are needed to further enhance rational prescribing, which can build on the experiences in other countries. These can be potentially transferred to other classes.