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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