Research in Norway has shown that there have been substantial savings in drug costs since the introduction of a regulation requiring doctors to prescribe the recommended first-line treatment for hypertension (high blood pressure).
Since March 2004, family doctors have been reimbursed for drug costs only if they prescribe thiazides as first-line therapy for uncomplicated hypertension, unless there are medical reasons for selecting other drugs.
Atle Fretheim and colleagues, in a research article published in PLoS Medicine, show that the change in prescribing practices reduced drug costs per Norwegian by US$0.16 in the first year.
Antihypertensive drugs are a major part of national drug expenditure in developed countries, where as many as one person in ten is treated for hypertension. The different classes of antihypertensive are all effective but their costs vary widely. Thiazides, for example, are a tenth of the price of many non-thiazide drugs.
In Norway, as in many other developed countries, guidelines were introduced to encourage doctors to use thiazides but the level of their use remained low. This led the government to impose the new reimbursement rule, with the aim of reducing public expenditure on antihypertensive drugs.
Before the change, one in ten patients starting antihypertensive medication was prescribed a thiazide drug. This proportion gradually increased during the transition period, before stabilizing at one in four patients throughout the post-intervention period.
A slightly higher proportion of patients reached their recommended blood-pressure goal after the rule was introduced than before, though this small difference may have been due to chance. The fact that three-quarters of patients were still not getting thiazides indicates how hard it is to change what doctors prescribe.
Norwegian Knowledge Centre for the Health Services
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