Cost Impact of Switching Histamine2-Receptor Antagonists to Nonprescription Status

Abstract

BACKGROUND: There is a recent trend to switching medications from prescription to nonprescription status. Often, such switches are accompanied by dramatic changes in utilization due to increased availability or decreased insurance coverage. The histamine2-receptor antagonists (H2RAs) underwent such status change in the UK in 1994, the US in 1995, and Canada in 1996. OBJECTIVE: To examine the impact of the status change for H2RAs on the market for gastrointestinal (GI) agents in the US, UK, and Canada. METHODS: IMS market sales data from 1992 to 1997 were procured. All costs were converted to 1997 US dollars using the consumer price index. Per capita sales figures were determined using population data from the US Census Bureau's International Database. RESULTS: Overall spending on GI remedies increased in all 3 markets between 1992 and 1997; however, the contribution of prescription sales and number of prescriptions varied across the 3 countries. An increased market share for nonprescription H2RAs occurred in the US, correlating with a decline in prescription numbers for GI remedies. The opposing trend occurred in the UK, where market share of nonprescription H2RAs was minimal and use of prescription H2RAs increased. Prescription and nonprescription H2RA sales could not be differentiated for Canada. CONCLUSIONS: The impact of the H2RA status change varied across countries. Differences in utilization may be attributed to many factors such as differing healthcare systems, patient convenience, and physician prescribing practices. Further research is required to identify the reasons for differences in utilization and to quantify the potential clinical impact.