Changes prescription patterns for peripheral and cerebral vasoactive drugssubsequent to the advent of prescription standards in France

OBJECTIVES: Assess changes in the number of prescriptions for peripheral an d cerebral vasoactive drugs for the treatment of lower limb arteritis and c erebrovascular disease since the promulgation in 1995 of prescription stand ards for the treatment of lower limb arteritis. Assess compliance to prescr iption standards with a detailed analysis of patient features, prescription s written for lower limb arteritis, cerebrovascular disease and concomitant diseases and evaluate changes in treatment costs for lower limb arteritis and cerebrovascular disease as well as cost of the full prescription, inclu ding treatments far associated diseases. METHODS: This study was based on data recorded during the Permanent Study o f Medical Prescriptions conducted from March 1944 to February 1995 and from March 1995 to February 1996 by the IMS. Presumption costs were established from the National Description Flies of the IMS. Treatment costs were expre ssed as public price (FF) tax included. Prescriptions meeting the following criteria were selected for each period: prescriptions written by general p ractitioners for drugs with peripheral and cerebral vasoactivity (excepting calcium antagonists with a cerebral target) belonging to the Anatomic Ther apeutic Classes C4A1 of the European Pharmaceutical Marketing Research Asso ciation, Bromly 1996; prescriptions for diagnoses 447.6 (arteritis) and 437 .9 (cerebrovascular disease) according to the 9th WHO classification. A ran dom sample of 500 prescriptions was selected to calculate costs. RESULTS: Since the advent of the prescription standards in 1995, prescripti ons have dropped off by 6.3% for lower limb arteritis and by 14.8% for cere brovascular disease. There was a 3.7 point decline in the percentage of mul tiple prescriptions of vasoactive drugs for laver limb arteritis (21.7% pri or to March 1995 venus 18% after promulgation of the prescription standards , p > 0.1) and a 1.8 increase in the percentage of multiple prescriptions f or cerebrovascular disease (14% prior to March 1995 and 15.8% after promulg ation of the prescription standards, p > 0.1). For the treatment of lower l imb arteritis, prescription costs fell by a mean 9% per prescription and fo r the treatment of cerebrovascular disease they rose by a mean 7% per presc ription. The price rise, due to multiple prescriptions of vasoactive drugs was 190 FF per prescription for lower limb arteritis and 104 FF per prescri ption for cerebrovascular disease. CONCLUSION: Despite the retrospective nature of this study where confoundin g factors could not be controlled, our findings are in agreement with those reported earlier suggesting that cost containment policy implemented by th e prescription standards has had little efficacy. In patients with arterial disease of the lower limbs, the percentage of prescriptions not complying with the recommended standards decreased by one-third to one-half over a 2- year period since the prescription standards were first announced in 1994.