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Table 1 Estimation of the potential for reduction in costs with medicines for prevention and treatment of cardiovascular diseases in Portugal, through an increase in the use of generic medicines and essential medicines among the most consumed (40 subgroups responsible for the highest consumptions, including the top 30 in DDD and the top 30 in value, in 2012)

From: Use of generic and essential medicines for prevention and treatment of cardiovascular diseases in Portugal

  

Potential expenditure reduction through replacement (up to 90% of the number of DDD)b:

Overall consumption in 2012

Non-generics by generics

Non-essential by essential

Fixed dose combinations by associations of essential medicines with a single active ingredient

 

% from generics

Million DDDl

Million €

DDD

€

Million € (%)

Million € (%)

Million € (%)

Acetylsalicylic acida

219.1

21.2

2.9

1.7

7.8 (37.0)

---

---

Simvastatina

176.8

26.0

97.4

94.6

---

---

---

Trimetazidine

112.8

20.4

37.3

30.9

2.9 (14.3)

---

---

Furosemidea

110.9

8.2

26.3

19.6

1.8 (21.9)

---

---

Ramiprila

98.2

8.9

91.8

78.8

---

---

---

Amlodipinea

81.0

8.3

82.7

69.8

0.5 (6.6)

---

---

Rosuvastatin

72.1

58.2

0.0

0.0

---

41.5 (71.4)c

---

Losartana

62.8

11.1

92.7

81.8

---

---

---

Lisinopril

62.2

5.6

85.4

72.2

0.3 (4.9)

0.7 (13.0)d

---

Losartan + diureticsa

59.8

21.4

87.7

75.4

0.6 (2.6)

---

8.7 (40.7)h

Perindopril

52.5

15.8

43.4

35.5

2.4 (15.0)

10.6 (66.9)d

---

Clopidogrela

51.7

21.2

91.9

81.1

---

---

---

Atorvastatin

45.4

23.4

82.9

65.2

2.1 (8.9)

14.3 (60.9)c

---

Indapamide

44.2

10.7

61.6

46.8

1.9 (17.8)

---

---

Candesartana

44.1

15.0

2.1

0.8

8.6 (57.7)

---

---

Lercanidipine

43.9

9.6

69.6

53.7

1.5 (15.3)

5.2 (54.2)e

---

Bisoprolola

39.8

10.1

36.2

22.8

3.1 (31.1)

---

---

Valsartan + diuretics

38.8

26.0

0.0

0.0

---

---

17.8 (68.4)h

Diosmin, combinations

38.3

19.5

0.0

0.0

---

---

---

Enalaprila

36.8

3.6

86.1

82.4

0.0 (1.2)

---

---

Fenofibrate

34.6

7.9

48.4

31.9

2.2 (27.4)

---

---

Irbesartan + diuretics

33.1

24.5

6.0

2.5

12.8 (52.0)

---

17.3 (70.5)h

Pravastatin

32.9

11.5

94.3

90.3

---

5.4 (47.1)c

---

Perindopril + diuretics

31.7

15.9

55.1

39.5

3.5 (22.0)

---

10.9 (68.9)i

Olmesartan medoxomil + diuretics

31.0

18.6

0.0

0.0

---

---

12.2 (65.9)h

Irbesartan

30.3

8.3

77.8

60.6

1.0 (12.1)

4.2 (50.3)f

---

Nifedipine

29.2

9.4

2.1

1.1

4.2 (44.0)

6.2 (65.8)e

---

Nebivolol

29.0

7.3

60.5

42.1

1.7 (22.7)

2.4 (32.8)g

---

Isosorbide mononitrate

27.5

4.0

23.4

14.6

1.3 (32.7)

---

---

Lisinopril + diuretics

26.0

5.5

80.4

72.2

0.3 (5.0)

---

2.2 (39.7)i

Candesartan + diuretics

25.0

19.8

1.1

0.4

12.1 (61.3)

---

14.2 (71.7)h

Valsartan + amlodipine

23.8

20.7

0.0

0.0

---

---

14.2 (68.5)j

Telmisartan + diuretics

22.4

16.8

0.0

0.0

---

---

11.9 (70.7)h

Olmesartan medoxomil

18.4

10.7

0.0

0.0

---

7.6 (71.2)f

---

Enalapril + lercanidipine

17.6

10.5

0.0

0.0

---

---

6.8 (65.1)k

Olmesartan medoxomil + amlodipine

17.3

14.2

0.0

0.0

---

---

9.5 (67.1)j

Pitavastatin

13.9

9.7

0.0

0.0

---

6.7 (68.6)c

---

Simvastatin + ezetimibe

13.7

24.4

0.0

0.0

---

---

2.4 (9.7)

Dabigatran etexilate

3.0

9.7

0.0

0.0

---

---

---

Enoxaparin

1.4

11.9

0.0

0.0

---

---

---

  1. DDD defined daily doses, NA not applicable
  2. aessential medicines, according to the “wise list” for essential drug recommendations in ambulatory care issued by the Stockholm County Pharmaceutical Committee [45, 46]
  3. bWe computed the difference between the observed expenditure in 2012 and the expected expenditure in the simulated scenarios. The latter were obtained by adding the expenditure with medicines not replaced to the product of the number of DDD to be replaced by the mean cost per DDD of the generic substitutes. For example, for a medicine whose total sales in 2012 were 100,000 DDD, from which 30% corresponded to generics, with a mean cost of 0.5€ per DDD, and 70% to non-generics, with a mean cost of 1.0 € per DDD, the total expenditure would be (100,000 DDD*0.3*0.5 €) + (100,000 DDD*0.7*1.0 €) = 85,000 €. The replacement of non-generics up to a share of 90% for generics would result in a total expenditure of (100,000 DDD*0.9*0.5 €) + (100,000 DDD*0.1*1.0 €) = 55,000 €, corresponding to the saving of 85,000 € - 55,000 € = 30,000 €. In the simulated scenario in which the replacement was an essential medicine with mean cost of 0.3 per DDD, the total expenditure would be (85,000 €*0.1) + (100,000 DDD*0.9*0.3 €) = 35,500 €, and the estimated cost saving would be 85,000 € - 35,500 € = 49,500 €, corresponding to 58.2% of the observed expenditure in 2012 (49,500 € / 85,000 € * 100)
  4. creplacement by simvastatin (a daily dose of 40 mg was considered for half of the DDD replaced)
  5. dreplacement by ramipril
  6. ereplacement by amlodipine
  7. freplacement by candesartan
  8. greplacement by bisoprolol
  9. hreplacement by losartan and chlortalidone
  10. ireplacement by ramipril and chlortalidone
  11. jreplacement by losartan and amlodipine
  12. kreplacement by ramipril and amlodipine
  13. lDDD can be converted in DDD/1000/inhabitants/day by dividing the absolute number of DDD by 3,838,347.774
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BMC Health Services Research

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