The contribution of generic substitution to rationalizing pharmaceutical expenditure in Greek public hospitals under recent economic crisis

Objectives This paper focuses on practices and policies implemented by the Greek Ministry of Health to reduce pharmaceutical expenditure in public hospitals in light of the economic crisis, and presents cost savings resulting from brand-generic substitution. Methods All Greek national health service (GNHS) hospitals (n = 133) were included in the sample and data were collected from the monthly reports of a recently established web-based facility named ESY. net. Data were analysed by healthcare region, hospital type and size, and also by medicine type to determine if the generics policy had been more favourable for certain drugs. Key findings Expenditure gradually decreased from 2009 to 2011 but geographical variations in reductions were observed. In 2011, brand-generic substitution was 26%, implying that the 35% target for end-2012 was feasible. Psychiatric facilities and small hospitalhealth centres were more favourable in adopting generics (47.7% and 38.2% respectively), whereas specialized and children's hospitals (14.1% and 12.0%) performed more poorly in this respect. Smaller hospitals achieved better brand-generic substitution. By drug type, substitution was higher for antibiotics (51.9%), cardiologic drugs (38.2%) and antidepressants (48.2%). Conclusions The demanding effort to rationalize pharmaceutical expenditure in the GNHS appears to be on course, based on results being achieved in a stressful environment, caused by the Greek economic crisis. Data are continuously collected and processed, allowing for corrective actions and longitudinal (i.e. time-series) comparisons from which more valid conclusions will emerge in the following years.