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Wang Z, Wang K, Hua Y, Dong X, Zhang L. Impact and implications of national centralized drug procurement in China. Int J Clin Pharm 2024:10.1007/s11096-024-01767-1. [PMID: 38990456 DOI: 10.1007/s11096-024-01767-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024]
Abstract
The national centralized drug procurement (NCDP) policy, known as the "4 + 7" policy in China, has transformed pharmaceutical procurement and access by leveraging healthcare institutions' collective buying power to reduce drug prices substantially. This policy has profoundly impacted drug pricing mechanisms, healthcare expenditures, market dynamics, and the quality of available drugs. This commentary evaluates the efficacy, challenges, and broader implications of the NCDP, summarizes the current state of post-marketing monitoring of selected generic drugs for centralized procurement, and presents relevant considerations.
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Affiliation(s)
- Zhizhou Wang
- Department of Pharmacy, Xuanwu Hospital, The First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Ke Wang
- Department of Pharmacy, Xuanwu Hospital, The First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yiming Hua
- Department of Pharmacy, Xuanwu Hospital, The First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xianzhe Dong
- Department of Pharmacy, Xuanwu Hospital, The First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Lan Zhang
- Department of Pharmacy, Xuanwu Hospital, The First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China.
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2
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Barnes K, Sydney K, Petkovich K, Hasan Y, Koul S, Humphreys K, Geers AL, Faasse K. Assessing the longevity of attribute framing in attenuating the nocebo effect to brand and generic medication. Appl Psychol Health Well Being 2024. [PMID: 38967323 DOI: 10.1111/aphw.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
The perception of taking a generic, relative to brand, medication has been demonstrated to exacerbate the nocebo effect. Conversely, positive attribute framing has been shown to attenuate the nocebo effect. However, little is known about the longevity of positive attribute framing nor how it interacts with generic versus brand treatment cues. Healthy participants (N = 205) were randomised to receive either sham-modafinil capsules with a brand or generic appearance, in conjunction with standard negative side effect framing (brand-negative: N = 42; generic-negative: N = 41) or positive side effect framing (brand-positive: N = 40; generic-positive: N = 40). The remainder were randomised to a no-treatment control (N = 42). Participants were informed that modafinil could enhance alertness and cognitive performance and reduce fatigue. Critically, modafinil was described as having several potential side effects. Treatment-related side effects, alertness, fatigue and cognitive performance were measured at baseline, 30-min post-treatment and 24 h later. Nocebo and placebo effects were observed across modafinil-treated participants relative to control. Positive framing significantly reduced warned side effects for 24 h. Perceived side effect likelihood, severity, and worry mediated the nocebo, but not framing, effect. Results have important implications for the presentation of side effect information, providing a potential route to reduce unwanted negative effects of generic medication.
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Affiliation(s)
- Kirsten Barnes
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Kurt Sydney
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Kristina Petkovich
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Yasmin Hasan
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Saakshi Koul
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Kiarne Humphreys
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew L Geers
- Department of Psychology, The University of Toledo, Toledo, Ohio, USA
| | - Kate Faasse
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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3
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Wang Z, Wang R, Li X, Bai L, Fan P, Tang Y, Li X, Huang Y, Nie X, Han S, Shi L, Chen J. Influencing Factors of Generic Prescribing Behavior of Physicians: A Structural Equation Model Based on the Theory of Planned Behavior. Risk Manag Healthc Policy 2024; 17:1375-1385. [PMID: 38813068 PMCID: PMC11135567 DOI: 10.2147/rmhp.s446743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
Background Although affordable generics could probably contribute to the solution of rapidly increasing pharmaceutical expenditure, those drugs are prescribed at a lower rate in China. Physicians' perception and knowledge of generics have a great influence on their prescribing behavior. Objective This study aimed to identify factors that affect physicians' generic prescribing behavior based on the theory of planned behaviors (TPB). Methods Data were collected by both electronic and paper-based surveys from 1297 Chinese physicians, and 1047 surveys were retained. The structural equation model (SEM) was employed to investigate the relationship between four behavioral constructs, namely, attitudes, subjective norms, perceived control of behaviors, and intentions. Results About 50% of Chinese physicians had a positive attitude towards generic drugs that had passed the "Consistency Evaluation of Quality and Efficacy of Generic Drugs" (high-quality generic drugs), but their knowledge of generic drugs was relatively inadequate. The path coefficients for the effect of attitudes, subjective norms, and perceived behavioral control on behavioral intention were 0.285, 0.366, and 0.322 respectively. The path coefficients for the effect of behavioral intention and perceived behavioral control on prescribing behavior were 0.009 and 0.410 respectively. Conclusion Physicians' attitudes, subjective norms, and perceived behavioral control were significant positive correlation predictors of behavioral intention. Subjective norms and perceived behavior control had a greater impact than attitude on physicians' prescribing intention. However, the generic prescribing behavior is not under the volitional control of Chinese physicians. Physicians' prescribing practice is likely affected by perceived strong control over prescribing generic drugs.
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Affiliation(s)
- Zhiyuan Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Ruilin Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Xiaoyu Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Pingan Fan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Yuanyuan Tang
- Bidding Management Office, Suqian First Hospital, Suqian, Jiangsu, People’s Republic of China
| | - Xin Li
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Yangmu Huang
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Xiaoyan Nie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
| | - Sheng Han
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
| | - Jing Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
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AlOmeir O, Almuqbil M, Hussam Alsawadi A, Mohamed Genedy A, fawaz Almutairi A, Talal Alaydaa H, Alanazi SA, Alabdan N, Alshakrah M, Gilkaramenthi R, Asdaq SMB, Nayeem N. An exploration of factors influencing the selection of generic and innovator medicines in Saudi Arabia using an observational cross-sectional study. Saudi Pharm J 2024; 32:102021. [PMID: 38497088 PMCID: PMC10943484 DOI: 10.1016/j.jsps.2024.102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objectives Generic medications are cost-effective without compromising therapeutic outcomes. Therefore, the goal of this study was to investigate, using a cross-sectional study design, the factors influencing Saudi Arabian consumers' preferences between innovator and generic medications. Methods This cross-sectional study was carried out in Saudi Arabia using a Google survey form. For data collection, a simple random sampling strategy was used. The recruited participants were surveyed using a validated questionnaire that focused on six influencing domains: physician, pharmacist, perceived effectiveness, price, information availability, and confidence based on prior experience. The obtained data was used to analyze factors that have an association with any of the six domains using multinomial regression analysis. A correlation analysis was performed to examine the relationship between domains. Results The 317 participants included 64.4 % females, 52 % aged ≥ 26, and a large proportion of Saudi nationals (82.6 %) and university graduates (78.9 %). Being employed (OR:3.029; P = 0.006; CI: 6.715-1.366), a healthcare providers (OR:2.298; P = 0.043; CI: 5.151-1.025), and having insurance coverage (OR:1.908; P = 0.017; CI: 3.245-1.122) had a greater influence on medication selection. Participants with linguistic and business educational backgrounds (OR:3.443; P = 0.022; CI: 9.950-1.191), those living in the northern region of Saudi Arabia (OR:3.174; P = 0.009; CI: 7.585-1.328), having chronic ailments (OR:3.863; P = 0.013; CI: 11.274-1.324), and possess insurance (OR:1.748; P = 0.039; CI: 2.971-1.028) get readily influenced by pharmacist. People who were married and lived in Saudi Arabia's southern region were influenced by perceived effectiveness when choosing medicine. Participants from the northern region were found to be influenced by the price of the medicines, information about the medicines, and confidence based on previous experience. The price of medicines has a significant impact on those suffering from chronic diseases. At a significant level of P = 0.01, all six influencing domains were found to be positively correlated with each other. Conclusion The study shows that healthcare providers, drug prices, perceived efficacy, and information availability all have a big influence on the Saudi Arabian population's choice of medications. Educational background, location, and chronic disease status are associated with several influencing domains. Aside from public awareness campaigns, healthcare professionals should be involved in the implementation of the generic medication policy.
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Affiliation(s)
- Othman AlOmeir
- Department of Clinical Pharmacy, College of Pharmacy, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Asmaa Hussam Alsawadi
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | - Alaa Mohamed Genedy
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | - Ashwag fawaz Almutairi
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | - Hams Talal Alaydaa
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | - Saleh A. Alanazi
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Numan Alabdan
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meshal Alshakrah
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rafiulla Gilkaramenthi
- Department of Emergency Medical Services, College of Applied Sciences, AlMaarefa University, Diriyah, 13713 Riyadh, Saudi Arabia
| | | | - Naira Nayeem
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
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Zhao B, Wu J, Lu C, Feng XL. Generic substitution of amlodipine is not associated with increased risk of mortality or adverse cardiovascular events: An observational cohort study. Clin Transl Sci 2024; 17:e13779. [PMID: 38545866 PMCID: PMC10974714 DOI: 10.1111/cts.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/05/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
This study aims to assess clinical outcomes following switching from originator to generic amlodipine. This population-based, matched, cohort study included users of originator amlodipine using claims data during 2018-2020 from a health system in Tianjin, China, in which usage of generic amlodipine was promoted by a drug procurement policy, the national volume-based procurement. Non-switchers refer to those remained on originator after the policy, while pure-switchers were those who switched to and continued using generic amlodipine, and back-switchers were those switched to generic amlodipine but then back to the originator. Propensity score matching generates comparable non-switchers and pure-switchers pairs, and non-switchers and back-switchers pairs. The primary outcome was major adverse cardiovascular events (MACEs), defined as all-cause mortality, stroke, and myocardial infarction during follow-up (April 1, 2019 to December 30, 2020). Secondary outcomes included heart failure, atrial fibrillation, and adherence to amlodipine. The hazard ratio (HR) for each clinical outcome was assessed through Cox proportional hazard regression. In total, 5943 non-switchers, 2949 pure-switchers, and 3061 back-switchers were included (mean age: 62.9 years; 55.5% men). For the matched pairs, pure-switchers (N = 2180) presented no additional risks of clinical outcomes compared to non-switchers (N = 4360) (e.g., MACEs: 2.86 vs. 2.95 events per 100 person-years; HR = 0.97 [95%CI: 0.70-1.33]). Back-switchers (N = 1998) also presented no additional risk compared to non-switchers (N = 3996) for most outcomes except for stroke (HR = 1.55 [95%CI: 1.03-2.34]). Pure-switchers and back-switchers all had better amlodipine adherence than non-switchers. Generic substitution of amlodipine is not associated with increased risk of cardiovascular events or all-cause mortality, but improves medicine adherence.
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Affiliation(s)
- Boya Zhao
- School of Pharmaceutical Science and TechnologyTianjin UniversityTianjinChina
- School of Public HealthPeking UniversityBeijingChina
- Center for Social Science Survey and DataTianjin UniversityTianjinChina
| | - Jing Wu
- School of Pharmaceutical Science and TechnologyTianjin UniversityTianjinChina
- Center for Social Science Survey and DataTianjin UniversityTianjinChina
| | - Chengzhi Lu
- Department of CardiologyTianjin First Central HospitalTianjinChina
| | - Xing Lin Feng
- School of Public HealthPeking UniversityBeijingChina
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6
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Sharma AK, Rastogi S, Ali F, Yadav AP, Goyal RK. A comprehensive quality control and cost comparison study of branded and generic angiotensin receptor blockers. Saudi Pharm J 2024; 32:101985. [PMID: 38380162 PMCID: PMC10877430 DOI: 10.1016/j.jsps.2024.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/04/2024] [Indexed: 02/22/2024] Open
Abstract
This study was designed to assess both the quality and cost aspects of various branded and generic formulations of angiotensin receptor blockers, specifically Irbesartan, Losartan Potassium, Olmesartan Medoxomil, Telmisartan, and Valsartan. The collected samples underwent distinct quality evaluations using the methods outlined in different global Pharmacopoeias (British Pharmacopoeia/European Pharmacopoeia, Indian Pharmacopoeia and United States Pharmacopoeia). These drugs were characterized using Fourier-Transform Infrared Spectroscopy and Nuclear Magnetic Resonance techniques, while their quality and concentration were analysed using High Performance Liquid Chromatography. The release profile of the drugs was examined through dissolution testing. Additionally, a cost comparison analysis was carried out by determining the prevailing market prices of the drugs. The evaluated branded and generic angiotensin receptor blockers were found to meet the established standards for impurities, active drug content, and dissolution as set by these Pharmacopoeias, indicating their optimal quality. Notably, the generic drugs exhibited significantly lower costs compared to their branded counterparts. This study confirms that the quality of generic angiotensin receptor blockers is equivalent to that of their branded counterparts. Consequently, these findings support the practicality of utilizing generic drugs as a more economically sustainable and cost-effective approach to managing diseases, especially those of chronic nature.
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Affiliation(s)
- Arvind Kumar Sharma
- Delhi Pharmaceutical Science and Research University (DPSRU), Mehrauli-Badarpur Road, Sector-3, Pushp Vihar, New Delhi, 110017, India
- Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India, Sector-23 Raj Nagar, Ghaziabad, Uttar Pradesh, 201002, India
| | - Shruti Rastogi
- Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India, Sector-23 Raj Nagar, Ghaziabad, Uttar Pradesh, 201002, India
| | - Faraat Ali
- Department of Analytical Chemistry, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, Hradec Králové, 500 05, Czech Republic
| | - Anuj Prakash Yadav
- Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India, Sector-23 Raj Nagar, Ghaziabad, Uttar Pradesh, 201002, India
| | - Ramesh K. Goyal
- Delhi Pharmaceutical Science and Research University (DPSRU), Mehrauli-Badarpur Road, Sector-3, Pushp Vihar, New Delhi, 110017, India
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McClure GR, McIntyre WF, Belesiotis P, Kaplovitch E, Chan N, Bhagirath V, Chahill G, Hayes A, Sohi G, Bordman W, Whitlock RP, Anand SS, Belley-Côté EP. Strategies to reduce out-of-pocket medication costs for Canadians with peripheral arterial disease. Can J Surg 2024; 67:E1-E6. [PMID: 38171588 PMCID: PMC10790711 DOI: 10.1503/cjs.003722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Given that peripheral arterial disease (PAD) disproportionately affects people of lower socioeconomic status, out-of-pocket expenses for preventive medications are a major barrier to their use. We carried out a cost comparison of drug therapies for PAD to identify prescribing strategies that minimize out-of-pocket expenses for these medications. METHODS Between March and June 2019, we contacted outpatient pharmacies in Hamilton, Ontario, Canada, to assess pricing of pharmacologic therapies at dosages included in the 2016 American College of Cardiology/American Heart Association guideline for management of lower extremity PAD. We also gathered pricing information for supplementary charges, including delivery, pill splitting and blister packaging. We calculated prescription prices with and without dispensing fees for 30-day brand-name and generic prescriptions, and 90-day generic prescriptions. RESULTS Twenty-four pharmacies, including hospital-based, independent and chain, were included in our sample. In the most extreme scenario, total 90-day medication costs could differ by up to $1377.26. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee and delivery cost, if any. CONCLUSION By opting for prescriptions for 90 days or as long as possible, selecting the lowest-cost generic drugs available in each drug class, and identifying dispensing locations with lower fees, prescribers can minimize out-of-pocket patient medication expenses. This may help improve adherence to guideline-recommended therapies for the secondary prevention of vascular events in patients with PAD.
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Affiliation(s)
- Graham R McClure
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - William F McIntyre
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Peter Belesiotis
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Eric Kaplovitch
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Noel Chan
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Vinai Bhagirath
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Gurneet Chahill
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Abigail Hayes
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Gursharan Sohi
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Wendy Bordman
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Richard P Whitlock
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Sonia S Anand
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock)
| | - Emilie P Belley-Côté
- From the Division of Vascular Surgery, McMaster University, Hamilton, Ont. (McClure); the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (McClure, McIntyre, Whitlock, Anand, Belley-Côté); the Population Health Research Institute, Hamilton, Ont. (McClure, McIntyre, Chan, Bhagirath, Whitlock, Anand, Belley-Côté); the Department of Medicine, McMaster University, Hamilton, Ont. (McIntyre, Chan, Bhagirath, Anand, Belley-Côté); the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Belesiotis, Chahill, Hayes, Sohi, Bordman); the Department of Medicine, University of Toronto, Toronto, Ont. (Kaplovitch); and the Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (Whitlock).
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8
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Bergmann F, Nussbaumer-Pröll A, Wulkersdorfer B, Eberl S, Ruppitsch W, Lepuschitz S, Zeitlinger M. Antimicrobial activity and pathogen mutation prevention of originator and generics of cefepime, linezolid and piperacillin/tazobactam against clinical isolates of Staphylococcus aureus. J Glob Antimicrob Resist 2023; 34:179-185. [PMID: 37473915 DOI: 10.1016/j.jgar.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/02/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Although generic medicinal products are required to have the same qualitative and quantitative composition of the active substance as their reference originator product, patients and health care professionals express concerns about their interchangeability and safety. Therefore, the present study investigated the antimicrobial activity and pathogen mutation prevention of original and generic cefepime, linezolid and piperacillin/tazobactam against Staphylococcus aureus. METHODS Two generic formulations of cefepime, linezolid and piperacillin/tazobactam were tested against their respective originator products. Susceptibility testing was performed with twenty-one clinical isolates of S. aureus and ATCC-29213 using broth microdilution. Time kill curves (TKC) were performed with ATCC-29213 at drug concentrations above and below the respective minimum inhibitory concentrations (MIC). Mutation prevention concentration was determined for each drug formulation against ATCC-29213. All experiments were performed in triplicate. Mutant colonies from mutation prevention concentration (MPC) experiments were genotypically tested by sequence analysis. RESULTS MIC ratios between contiguous originator and generic drugs were similar for each isolate. No visual differences were observed in TKCs between originator and generic substances. The MPC did not differ between different formulations of the same substance. Although sequence analysis of mutant colonies revealed genomic differences compared with the original ATCC-29213, no differences in mutation frequencies were observed between clinical isolates and ATCC-29213 treated with originator or generic substances. CONCLUSIONS Similar antimicrobial activity and pathogen mutation prevention was observed between contiguous substances. These results support the interchangeability of generic and originator drug formulations with the same active ingredient.
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Affiliation(s)
- Felix Bergmann
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria; Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria
| | | | | | - Sabine Eberl
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - Werner Ruppitsch
- AGES - Austrian Agency for Health and Food Safety, Institute of Medical Microbiology and Hygiene, Vienna, Austria
| | - Sarah Lepuschitz
- AGES - Austrian Agency for Health and Food Safety, Institute of Medical Microbiology and Hygiene, Vienna, Austria
| | - Markus Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria.
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9
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Vasudev M, Torabi SJ, Michelle L, Meller LLT, Birkenbeuel JL, Roman KM, Nguyen TV, Kuan EC. The rising cost of rhinologic medications. Ann Allergy Asthma Immunol 2023; 131:327-332. [PMID: 37098404 DOI: 10.1016/j.anai.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/22/2023] [Accepted: 04/07/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND The high prescription drug cost in the United States may negatively affect patient prognosis and treatment compliance. OBJECTIVE To fill the knowledge gap and inform clinicians regarding rhinology medications price changes by evaluating trends in price changes of highly used nasal sprays and allergy medications. METHODS The 2014-2020 Medicaid National Average Drug Acquisition Cost database was queried for drug pricing information for the following classes of medications: intranasal corticosteroids, oral antihistamines, antileukotrienes, intranasal antihistamines, and intranasal anticholinergics. Individual medications were identified by Food and Drug Administration-assigned National Drug Codes. Per unit, drug prices were analyzed for average annual prices, average annual percentage price changes, and inflation-adjusted annual and composite percentage price changes. RESULTS Beclometasone (Beconase AQ, 56.7%, QNASL, 77.5%), flunisolide (Nasalide, -14.6%), budesonide (Rhinocort Aqua, -1.2%), fluticasone (Flonase, -6.8%, Xhance, 11.7%), mometasone (Nasonex, 38.2%), ciclesonide (Omnaris, 73.8%), combination azelastine and fluticasone (Dymista, 27.3%), loratadine (Claritin, -20.5%), montelukast (Singulair, 14.5%), azelastine (Astepro, 21.9%), olopatadine (Patanase, 27.3%), and ipratropium bromide (Atrovent, 56.6%) had an overall change in inflation-adjusted per unit cost between 2014 and 2020 (% change). Of 14 drugs evaluated, 10 had an increase in inflation-adjusted prices, for an average increase of 42.06% ± 22.27%; 4 of 14 drugs had a decrease in inflation-adjusted prices, for an average decrease of 10.78% ± 7.36%. CONCLUSION The rising cost of highly used medications contributes to increased patient acquisition costs and may pose barriers of drug adherence to particularly vulnerable populations.
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Affiliation(s)
- Milind Vasudev
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California
| | - Lauren Michelle
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California
| | - Leo L T Meller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California
| | - Kelsey M Roman
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California
| | - Theodore V Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California.
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10
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Chan CC, Tung Y, Lee K, Chan Y, Chu P. Clinical outcomes of generic versus brand-name clopidogrel for secondary prevention in patients with acute myocardial infarction: A nationwide cohort study. Clin Transl Sci 2023; 16:1594-1605. [PMID: 37448335 PMCID: PMC10499421 DOI: 10.1111/cts.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Skepticism exists among healthcare workers and patients regarding the efficacy and safety of generic medication, despite its potential to lower healthcare costs. This study aimed to compare the outcomes of a generic clopidogrel and its brand-name counterpart for secondary prevention in patients with acute myocardial infarction (AMI). Using the Taiwan National Health Insurance Research Database, we identified 49,325 patients who were hospitalized for AMI between January 1, 2008 and December 31, 2013 and prescribed either generic or brand-name clopidogrel. Among them, 2419 (4.9%) were prescribed the generic clopidogrel. After propensity score matching, both the generic and brand-name groups consisted of 2382 patients. The primary efficacy outcome was a composite of myocardial infarction, coronary revascularization, ischemic stroke, and all-cause death. The primary safety outcome was major bleeding requiring hospitalization. At a mean follow-up of 2.5 years, the generic and brand-name clopidogrel groups had comparable risks of primary efficacy outcome (41.9% vs. 42%; hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.88-1.04), and the risks of the individual components were also similar. There were no significant differences between the two groups in major bleeding (7.9% vs. 7.9%; HR 0.99; 95% CI 0.81-1.21). Subgroup analyses also revealed no statistically significant interactions between the treatment effect and various subgroups. In this retrospective database analysis, the generic clopidogrel was comparable to its brand-name counterpart regarding cardiovascular and bleeding outcomes for the treatment of patients with AMI.
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Affiliation(s)
- Cze Ci Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Ying‐Chang Tung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Kuang‐Tso Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Yi‐Hsin Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Pao‐Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
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11
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Pisani E, Dewi A, Palagyi A, Praveen D, Ihsan BRP, Lawuningtyas Hariadini A, Lyrawati D, Sujarwoto, Maharani A, Tampubolon G, Patel A. Variation in Price of Cardiovascular and Diabetes Medicine in Indonesia, and Relationship with Quality: A Mixed Methods Study in East Java. Am J Trop Med Hyg 2023; 108:1287-1299. [PMID: 37160275 PMCID: PMC10540131 DOI: 10.4269/ajtmh.22-0692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/12/2023] [Indexed: 05/11/2023] Open
Abstract
Lower-middle income Indonesia, the world's fourth most populous country, has struggled to contain costs in its mandatory, single-payer public health insurance system since the system's inception in 2014. Public procurement policies radically reduced prices of most medicines in public facilities and the wider market. However, professional associations and the press have questioned the quality of these low-cost, unbranded generic medicines. We collected 204 samples of four cardiovascular and one antidiabetic medicines from health facilities and retail outlets in East Java. We collected amlodipine, captopril, furosemide, simvastatin, and glibenclamide, sampling to reflect patients' likelihood of exposure to specific brands and outlets. We recorded sales prices and maximum retail prices and tested medicines for dissolution and percentage of labeled content using high-performance liquid chromatography. We conducted in-depth interviews with supply chain actors. All samples, including those provided free in public facilities, met quality specifications. Most manufacturers make both branded and unbranded medicines. Retail prices varied widely. The median ratio of price to the lowest price for an equivalent product was 5.1, and a few brands sold for over 100 times the minimum price. Prices also varied between outlets for identical products because retail pharmacies set prices to maximize profit. Because very-low-cost medicines were universally available and of good quality, we believe richer patients who chose to buy branded products effectively protected medicine quality for poorer patients in Indonesia because manufacturers cross-subsidize between branded and unbranded versions of the same medicine.
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Affiliation(s)
- Elizabeth Pisani
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Aksari Dewi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | | | | | - Diana Lyrawati
- Department of Pharmacy, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Sujarwoto
- Department of Public Administration, Brawijaya University, Malang, Indonesia
| | - Asri Maharani
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Gindo Tampubolon
- Global Development Institute, University of Manchester, Manchester, United Kingdom
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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12
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Oguri G, Fujiu K, Oshima T, Komuro I. Appearances of Premature Atrial and Ventricular Contractions After Switching From Brand Name to Generic Cibenzoline. Cureus 2023; 15:e41164. [PMID: 37525781 PMCID: PMC10387168 DOI: 10.7759/cureus.41164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/02/2023] Open
Abstract
In antiarrhythmic drugs, the therapeutic window is narrower than in other drugs. Brand name and generic drugs do not use the same inactive ingredients and binder substances. We report a 78-year-old male patient who had been treated for asymptomatic atrial fibrillation and atrial/ventricular premature contractions. Brand name cibenzoline had completely suppressed all arrhythmias. When the medication was changed to the generic drug, the patient showed frequent palpitations and arrhythmias. After restarting the brand-name drug, the arrhythmias were completely suppressed again. These results showed clear differences between brand name and generic cibenzoline in a specific patient. This report is the first case to describe the diminished effectiveness of generic oral cibenzoline.
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Affiliation(s)
- Gaku Oguri
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, JPN
| | - Katsuhito Fujiu
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, JPN
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, JPN
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, JPN
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, JPN
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13
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McElwee NE. Does the United States Need Better Policies Governing Generic Drug Use? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:392-393. [PMID: 36702300 DOI: 10.1016/j.jval.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Newell E McElwee
- Department of Practice, Science, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
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14
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Weitzel J, Langer K, Rose O. Effects of Generic Exchange of Levodopa Medication in Patients With Parkinson Disease. J Patient Saf 2022; 18:704-710. [PMID: 35532994 DOI: 10.1097/pts.0000000000001015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Generic exchange is common practice in most healthcare systems. This study investigated how patients with Parkinson disease (PD) perceived a switch of their levodopa medication and the resulting effects on their PD symptoms. METHODS A questionnaire was developed, piloted, and finally distributed to 13,857 members of the national PD patient support group. It was designed to be completed by patients and their pharmacies. χ 2 tests for independence statistics with or without Monte Carlo simulation were performed. Cramér φ and Cramér V were calculated. McNemar test was used to investigate whether a generic switch of a levodopa-containing medication had an impact on PD symptoms. RESULTS Analyses were done with 410 finalized respondents of 13,857 distributed questionnaires. More than half of the responders were 75 years or older and rated themselves Hoehn and Yahr stages 3 to 5. Most patients were confused by a change of their medication. A total of 54.7% of the switchers (n = 148) reported swallowing difficulties with medication, which was significantly more frequent than with nonswitchers (37.3% of 204, P = 0.001). Adverse effects related to the switch were reported by 26.6% of all switchers (switchback rate, 20.5%). The patients at higher Hoehn and Yahr stages were affected to a greater extend. CONCLUSIONS Patients, who experienced any brand switch of their levodopa medication, frequently expressed distrust and confusion. Swallowing difficulties and negative effects on their symptoms were problems, which were more pronounced in advanced disease stages. It remains unclear whether the detrimental impact on therapy was caused by the brand switch or by a nocebo effect.
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Affiliation(s)
- Johanna Weitzel
- From the Department of Pharmaceutical Technology and Biopharmacy, Westfälische Wilhelms-University Muenster
| | - Klaus Langer
- From the Department of Pharmaceutical Technology and Biopharmacy, Westfälische Wilhelms-University Muenster
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15
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Pettersen TR, Schjøtt J, Allore HG, Bendz B, Borregaard B, Fridlund B, Larsen AI, Nordrehaug JE, Rotevatn S, Wentzel-Larsen T, Norekvål TM. Perceptions of generic medicines and medication adherence after percutaneous coronary intervention: a prospective multicentre cohort study. BMJ Open 2022; 12:e061689. [PMID: 36127123 PMCID: PMC9490600 DOI: 10.1136/bmjopen-2022-061689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine patient perceptions of generic medicines 2 and 6 months after percutaneous coronary intervention (PCI), and to determine whether these perceptions moderate medication adherence. DESIGN Prospective multicentre cohort study with repeated measures of perceptions of generic medicines and medication adherence. SETTING The CONCARDPCI study conducted at seven large referral PCI centres in Norway and Denmark between June 2017 and May 2020. PARTICIPANTS A total of 3417 adults (78% men), using both generic and brand name medicines, with a mean age of 66 years (SD 11) who underwent PCI were followed up 2 and 6 months after discharge from hospital. MAIN OUTCOME MEASURES Perceptions of generic medicines were the main outcome. The secondary outcome was medication adherence. RESULTS Perceptions of generic medicines were significantly more negative at 2 than at 6 months (1.10, 95% CI 0.41 to 1.79, p=0.002). Female sex (-4.21, 95% CI -6.75 to -1.71, p=0.001), older age (-0.12, 95% CI -0.23 to -0.02, p=0.020), lower education level (overall p<0.001), ethnicity (overall p=0.002), Norwegian nationality (10.27, 95% CI 8.19 to 12.40, p<0.001) and reduced self-reported health status (0.19, 95% CI 0.09 to 0.41, p=0.003) were significantly associated with negative perceptions of generic medicines. There was no evidence to suggest that perceptions of generic medicines moderate the association between sociodemographic and clinical variables and medication adherence (p≥0.077 for all covariates). Moreover, self-reported medication adherence was high, with 99% scoring at or above the Medication Adherence Report Scale midpoint at both time points. There were no substantial correlations between negative perceptions of generic medicines and medication non-adherence at 2 months (r=0.041, 95% CI 0.002 to 0.081, p=0.037) or 6 months (r=0.038, 95% CI -0.005 to 0.081, p=0.057). CONCLUSIONS Mistrust and uncertainty about the safety and efficacy of generic medicines remains in a sizeable proportion of patients after PCI. This applies especially to those of lower socioeconomic status, older age, female sex, immigrants and those with poorer mental health. However, this study demonstrated a shift towards more positive perceptions of generic medicines in the longer term.
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Affiliation(s)
- Trond Røed Pettersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Jan Schjøtt
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Oslo, Norway
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Kalmar, Sweden
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tore Wentzel-Larsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Centre for Child and Adolescent Mental Health Eastern and Southern Norway, Oslo, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
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16
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Son KB. Who initiates price competition when generic entrants are introduced into the South Korean pharmaceutical market? Front Public Health 2022; 10:934161. [PMID: 36187703 PMCID: PMC9515942 DOI: 10.3389/fpubh.2022.934161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023] Open
Abstract
Background Price competition has the potential to reduce health expenditures without hindering pharmaceutical innovation. However, empirical evidence on price competition after generic drugs are introduced is scarce. This study investigates product- and substance-level determinants of price competition following the entry of generics into the South Korean market. Methods We selected substances that were approved by the Ministry of Food and Drug Safety from 2000 to 2019, linked their corresponding pharmaceutical products, measured the degree of price competition under various scenarios, and utilized multilevel analysis to investigate the determinants of price competition. Results A total of 986 substances and 12,109 corresponding pharmaceutical products were identified. Only 11% of products were affected by price competition in the 10% scenario. However, the number increased to 43% when we measured price competition at the substance level. Major domestic manufacturers mainly initiated price competition at the product level, while foreign manufacturers were reluctant to initiate price competition. At the substance level, the maximum reimbursement price was a significant determinant of price competition. Conclusion Price competition at the product level is rare in South Korea. In contrast, the market is quite price competitive at the substance level. Policy options could be introduced to encourage "discounted generic" substitution in an effort to maximize the effects of price competition at the substance level. Major domestic manufacturers are essential in the introduction of discounted generics into the South Korean health system.
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17
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Bergmann F, Wulkersdorfer B, Oesterreicher Z, Bauer M, Al Jalali V, Nussbaumer-Pröll A, Wölfl-Duchek M, Jorda A, Lackner E, Reiter B, Stimpfl T, Ballarini N, König F, Zeitlinger M. Comparison of pharmacokinetics and stability of generics of cefepime, linezolid and piperacillin/tazobactam with their respective originator drugs: an intravenous bioequivalence study in healthy volunteers. J Antimicrob Chemother 2022; 77:3086-3092. [PMID: 36039038 DOI: 10.1093/jac/dkac285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The efficacy and quality of generic antibacterial drug formulations are often questioned by both healthcare specialists and patients. Therefore, the present study investigated the interchangeability of generic drugs with their originators by comparing bioequivalence parameters and stability data of generic cefepime, linezolid and piperacillin/tazobactam with their respective originator drugs. METHODS In this open-label, randomized, crossover bioequivalence study, three groups of 12 healthy volunteers each received a single intravenous infusion of either 2 g of cefepime or 4.5 g of piperacillin/tazobactam and two generic formulations, or 600 mg of linezolid and one generic formulation. Plasma sampling was performed, with a 5 day washout period between study days. Stability was tested by storing reconstituted generic and originator products according to their own storage specifications and those of the comparator products. All concentrations were measured by LC-MS. RESULTS Similar ratios of generic/originator (90% CI) Cmax were observed for Cefepime-MIP/Maxipime [93.7 (88.4-99.4)], Cefepime Sandoz/Maxipime [95.9 (89.1-103.2)], Linezolid Kabi/Zyvoxid [104.5 (91.1-119.9)], Piperacillin Kabi/Tazobac [95.9 (90.4-101.7)], Piperacillin Aurobindo/Tazobac [99.7 (84.9-104.7)], Tazobactam Kabi/Tazobac [93.4 (87.4-99.8)] and Tazobactam Aurobindo/Tazobac [97.4 (89.7-105.8)]. Accordingly, similar ratios of AUC0-t were observed for Cefepime-MIP/Maxipime [91.1 (87.6-94.8)], Cefepime Sandoz/Maxipime [97.9 (92.5-103.5)], Linezolid Kabi/Zyvoxid [99.7 (93.3-106.6)], Piperacillin Kabi/Tazobac [92.2 (88.3-96.3)], Piperacillin Aurobindo/Tazobac [99.9 (97.0-102.8)], Tazobactam Kabi/Tazobac [91.4 (86.4-96.7)] and Tazobactam Aurobindo/Tazobac [98.8 (94.3-103.6)]. Stable and similar concentrations were measured for all contiguous substances, regardless of storage conditions. CONCLUSIONS Compared with their respective originator drugs, generic cefepime, linezolid and piperacillin/tazobactam met the predetermined bioequivalence criteria. All formulations were stable under the storage conditions of their respective comparators.
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Affiliation(s)
- Felix Bergmann
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Beatrix Wulkersdorfer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Zoe Oesterreicher
- Medical University of Vienna, Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Martin Bauer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Valentin Al Jalali
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alina Nussbaumer-Pröll
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Wölfl-Duchek
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Anselm Jorda
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Edith Lackner
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Birgit Reiter
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Stimpfl
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nicolas Ballarini
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Franz König
- Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Markus Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
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18
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Bioequivalence, Drugs with Narrow Therapeutic Index and the Phenomenon of Biocreep: A Critical Analysis of the System for Generic Substitution. Healthcare (Basel) 2022; 10:healthcare10081392. [PMID: 35893214 PMCID: PMC9394341 DOI: 10.3390/healthcare10081392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
The prescription of generic drugs represents one of the main cost-containment strategies of health systems, aimed at reducing pharmaceutical expenditure. In this context, most regulatory authorities encourage or obligate dispensing generic drugs because they are far less expensive than their brand-name alternatives. However, drug substitution can be critical in particular situations, such as the use of drugs with a narrow therapeutic index (NTI). Moreover, generics cannot automatically be considered bioequivalent with each other due to the biocreep phenomenon. In Italy, the regulatory authority has established the Transparency Lists which include the medications that will be automatically substituted for brand-name drugs, except in exceptional cases. This is a useful tool to guide prescribers and guarantee pharmaceutical sustainability, but it does not consider the biocreep phenomenon.
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19
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Lee HW, Huang CC, Leu HB, Lin YJ. Comparative efficacy of generic nifedipine versus brand-name amlodipine for hypertension management in Taiwan. J Clin Hypertens (Greenwich) 2022; 24:870-877. [PMID: 35674192 PMCID: PMC9278574 DOI: 10.1111/jch.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/01/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
The control rate of hypertension remains concerning, indicating the requirement for better management strategies. The calcium channel blockers brand‐name amlodipine and nifedipine with extended‐release formulations demonstrate similar clinical efficacy. However, the efficacy of generic nifedipine remains obscure. We compared the efficacy of generic nifedipine and brand‐name amlodipine in terms of cardiovascular (CV) outcomes. Patients prescribed generic nifedipine (SRFC CYH) or brand‐name amlodipine besylate (Norvasc, Pfizer) between August 1, 2017, and July 31, 2018, were enrolled; patients with CV events within 3 months were excluded. CV outcomes included CV death, nonfatal myocardial infarction (MI), nonfatal ischemic stroke, hospitalization for heart failure, and composite endpoints of 3P‐ and 4P‐major adverse cardiac events (MACE). A total of 1625 patients treated with nifedipine (SRFC CYH) and 16 587 patients treated with Norvasc were included. After propensity score matching, there were 995 and 4975 patients in the nifedipine CYH and Norvasc groups, respectively. At a mean follow‐up period of 30.3 ± 6.4 months, nifedipine CYH was comparable to Norvasc in terms of CV death (P = .107), nonfatal MI (P = .121), nonfatal ischemic stroke (P = .453), hospitalization for heart failure (P = .330), 3P‐MACE (P = .584), and 4P‐MACE (P = .274). Cox regression analysis revealed that nifedipine CYH and Norvasc had similar efficacy in terms of 3P‐MACE (hazard ratio, 0.970; 95% confidence interval, 0.601–1.565, P = .900) and 4P‐MACE (hazard ratio, 0.880; 95% confidence interval, 0.628–1.233, P = .459). In conclusion, Nifedipine SRFC CYH and Norvasc have comparable clinical efficacy for hypertension management.
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Affiliation(s)
- Hao-Wei Lee
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
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20
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Shazly T, Smith A, Uline MJ, Spinale FG. Therapeutic payload delivery to the myocardium: Evolving strategies and obstacles. JTCVS OPEN 2022; 10:185-194. [PMID: 36004211 PMCID: PMC9390211 DOI: 10.1016/j.xjon.2022.04.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Key Words
- BMC, bone marrow cell
- HF, heart failure
- ID, intracoronary delivery
- IMD, intramyocardial delivery
- IPD, intrapericardial delivery
- LV, left ventricle
- MI, myocardial infarct
- MSC, mesenchymal stem cell
- TED, transendocardial delivery
- bFGF, basic fibroblast growth factor
- biomaterial
- cardiac
- injection
- local delivery
- myocardium
- payload
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Affiliation(s)
- Tarek Shazly
- College of Engineering and Computing, School of Medicine, University of South Carolina, Columbia, SC
| | - Arianna Smith
- College of Arts and Sciences, Florida Gulf Coast University, Fort Myers, Fla
| | - Mark J. Uline
- College of Engineering and Computing, School of Medicine, University of South Carolina, Columbia, SC
| | - Francis G. Spinale
- College of Engineering and Computing, School of Medicine, University of South Carolina, Columbia, SC
- Cardiovascular Translational Research Center, School of Medicine, University of South Carolina, Columbia, SC
- Columbia VA Health Care System, Columbia, SC
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21
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Pettinau F, Manca I, Manca I, Pittau B. Rapid Approach for Pharmaceutical Quality Evaluation and Comparison. ChemistrySelect 2022. [DOI: 10.1002/slct.202200712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesca Pettinau
- Institute of Translational Pharmacology National Research Council 09010 Pula CA Italy
| | - Ilaria Manca
- Institute of Translational Pharmacology National Research Council 09010 Pula CA Italy
| | - Ilaria Manca
- Institute of Translational Pharmacology National Research Council 09010 Pula CA Italy
| | - Barbara Pittau
- Institute of Translational Pharmacology National Research Council 09010 Pula CA Italy
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22
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Polyakova OA, Ostroumova OD. The problem of choice: original drug or generic? Emphasis on rosuvastatin. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-04-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An increase in the life expectancy of the population and the number of polymorbid patients with a combination of two or more diseases in different age categories, including among young people, has led to a significant increase in the cost of medical care in the field of public health. The transition from original drugs to generic ones has become a common measure to contain these costs. While this is an important goal for healthcare systems around the world, the impact of this practice on patient outcomes needs to be carefully considered. In some cases, generics may represent a suitable alternative to branded products, but this is not always the case. In particular, studies have shown that changing the drug can negatively affect not only patients' adherence to treatment, but also clinical outcomes, and a subsequent increase in the total cost of treatment, therefore, the use of generics in clinical practice still causes caution and concerns on the part of both the doctor and the patient. Due to the high prevalence of dyslipidemia and hypercholesterolemia both worldwide and in Russia, in this review the problem of choosing an original drug or generic is described by the example of such a hypolipidemic agent as rosuvastatin. According to numerous studies, rosuvastatin is one of the most potent and widely prescribed statins. Considering that most of the clinically significant effects of this drug are demonstrated in relation to its original form, the review emphasizes the importance of prescribing the original drug rosuvastatin in routine clinical practice.
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Affiliation(s)
- O. A. Polyakova
- Russian Medical Academy of Continuous Professional Education
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23
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Tung Y, Lin C, Hsiao F, Ho C, Tzyy‐Jer H, Chu Y, Chen W, Chu P. Comparative effectiveness of generic nifedipine versus Adalat long-acting nifedipine for hypertension treatment: A multi-institutional cohort study. J Clin Hypertens (Greenwich) 2022; 24:621-629. [PMID: 35384251 PMCID: PMC9106077 DOI: 10.1111/jch.14478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/14/2022] [Accepted: 03/19/2022] [Indexed: 11/30/2022]
Abstract
This retrospective multi-institutional database analysis aimed to evaluate the blood-pressure-lowering efficacy and clinical outcomes of a generic versus brand-name nifedipine for hypertension management. A total of 12 693 patients who were prescribed a generic or brand-name nifedipine between January 1, 2011, and December 31, 2018, were identified from the Chang Gung Research Database of Chang Gung Memorial Hospitals, Taiwan. Among them, 2112 (21.4%) were prescribed generic nifedipine. After propensity score matching, both the generic and brand-name groups consisted of 2102 patients. At a mean follow-up of 3 years, the changes in office systolic (p for interaction = .791) and diastolic blood pressure (p for interaction = .689) did not differ significantly between the patients who received the generic and the brand-name nifedipine. There was no significant difference between the two study groups regarding the composite of all-cause mortality, acute myocardial infarction, stroke, coronary revascularization, or hospitalization for heart failure (hazard ratio 0.98, 95% confidence interval 0.85-1.13; p = .774). In conclusion, the generic nifedipine was comparable to its brand-name counterpart regarding office blood pressure reduction and the composite cardiovascular outcome for the treatment of patients with hypertension.
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Affiliation(s)
- Ying‐Chang Tung
- Division of CardiologyDepartment of Internal MedicineChang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan
| | - Chia‐Pin Lin
- Division of CardiologyDepartment of Internal MedicineChang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan
| | - Fu‐Chih Hsiao
- Division of CardiologyDepartment of Internal MedicineChang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan
| | - Chien‐Te Ho
- Division of CardiologyDepartment of Internal MedicineChang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan
| | - Hsu Tzyy‐Jer
- Division of CardiologyDepartment of Internal MedicineChang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan
| | - You‐Chia Chu
- Department of Computer ScienceNational Chiao‐Tung UniversityHsien‐ChuTaiwan
| | - Wen‐Jone Chen
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
- Department of Emergency MedicineCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
- Division of CardiologyDepartment of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Pao‐Hsien Chu
- Division of CardiologyDepartment of Internal MedicineChang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan
- Institute of Stem Cell and Translational Cancer Research Chang Gung Memorial HospitalTaiwan
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24
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Alderfer J, Aggarwal J, Gilchrist K, Alvir JMJ, Cook J, Park SH, Stephens JM. Retrospective Database Analysis to Explore Patterns and Economic Burden of Switchback to Brand After Generic or Authorized Generic Utilization. Clinicoecon Outcomes Res 2022; 14:281-291. [PMID: 35509961 PMCID: PMC9059206 DOI: 10.2147/ceor.s319796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022]
Abstract
Background Despite demonstration of bioequivalence of generics to brands and the potential for reduced costs, some patients switch back from a generic to the brand. A prior retrospective analysis suggested that this switchback rate may be lower among patients that had initially switched to authorized generics (AG), often both produced and marketed by the brand company, compared to those initially switched to another generic. Objective Explore switching patterns of brands, AGs, and generics, switchback rates, and the potential impact of switchbacks on healthcare costs. Methods An analysis of the Pharmetrics Plus™ database (2007–2019), a United States (US) payer administrative database, was conducted to examine the use of Upjohn medications available as AGs across multiple therapeutic areas. Patients initiating treatment with brand medication in the 6 months prior to generic market entry were identified and switch rates to generics and AGs, as well as switchback rates, were evaluated. Costs were descriptively compared between patients who switched back to brand and those who remained on any generic. Results Across 14 brand medications, more than half of the patients initiating treatment with the brand medication were switched to a generic. Generally, switching to AG, which ranged from 0.5 to 39.6%, was lower than switching to non-AG generics (16.7–79.9%). The comparison of switchback rates from AGs to brand and non-AGs to brand showed similar results (AG:1.3–7.5%; non-AG:1.4–12.9%); however, the most substantial differences were observed where non-AG switchbacks were higher. Patients that switched back to brand remained on AG or generic for an average of 1–3 months (32–88 days). The analysis showed a tendency towards increased medical costs in the period immediately preceding switchback for all medications except sildenafil in both indications (erectile dysfunction and pulmonary arterial hypertension). For the remaining medications, medical costs ranged from $63 to $1544 higher for the switchback population. Pharmacy costs similarly tended to be higher for patients who had a switchback, with the exception of sildenafil for pulmonary arterial hypertension and sirolimus. Conclusion Patients receiving a brand medication are likely to be switched to a generic upon market availability. Some patients switch back to the brand medication, usually within 1–3 months; this may be associated with increased medical costs. Additional research is needed to understand switching, its potential disruption to patients, and the role of brands, generics, and AGs.
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Affiliation(s)
- Justine Alderfer
- Medical Affairs, Pfizer Inc., Collegeville, PA, USA
- Correspondence: Justine Alderfer, US Medical Affairs, Pfizer, 500 Arcola Rd., Collegeville, PA, 19426, USA, Tel +1 484-865-3105, Email
| | | | | | | | - Joseph Cook
- Clinical Development and Medical Affairs, Viatris, Canonsburg, PA, USA
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25
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Huang T, Bai L, Wushouer H, Wang Z, Yang M, Lin H, Shen P, Guan X, Shi L. Clinical Outcome and Medical Cost of Originator and Generic Antihypertensive Drugs: A Population-Based Study in Yinzhou, China. Front Pharmacol 2022; 13:757398. [PMID: 35295329 PMCID: PMC8920543 DOI: 10.3389/fphar.2022.757398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The substitution of generic drugs can effectively alleviate the rapid growth of drug costs; however, the clinical effectiveness and medical costs of originator products and generics were barely studied in China. Objectives: To compare the effectiveness of antihypertensive drugs and hypertension-related medical costs between originator and generic initiators in Yinzhou, China. Methods: We conducted a population-based retrospective cohort study using the Chinese Electronic Health Records Research in Yinzhou (CHERRY), from July 1, 2011, to December 31, 2018. Hypertension patients initiating with originator products were compared with patients initiating with generic counterparts. We used 1:1 propensity score matching to pair the two groups based on sociodemographic, clinical, and health service utilization variables. Cox proportional regression was adopted to compare the rate of hospitalization for hypertension-related cardiovascular disease between matched originator and generic initiators. Wilcoxon matched-pairs signed-rank test was used to compare annual hypertension-related medical costs. Results: Matched pairs (10,535) of patients were included in the comparative study of originator products and generics, corresponding to seven antihypertensive drugs including amlodipine, felodipine, nifedipine, irbesartan, losartan, valsartan, and metoprolol. The average age of patients included in the analysis was around 60 years (originator vs. generics initiators: from 59.0 vs. 59.1 years in losartan to 62.9 vs. 63.6 years in nifedipine). Higher hospitalization rates among originator initiators were observed for three calcium channel blockers (hazard ratio[95% CI]: amlodipine, 3.18[1.43, 7.11]; felodipine, 3.60[1.63, 7.98]; and nifedipine, 3.86[1.26, 11.81]; respectively). The remaining four out of seven drugs of the clinical endpoint estimates showed comparable outcomes between originator products and generics (hazard ratio[95% CI]: irbesartan, 1.19[0.50, 2.84]; losartan, 1.84[0.84, 4.07]; valsartan, 2.04[0.72, 5.78]; and metoprolol, 1.25[0.56, 2.80]; respectively). Higher median annual hypertension-related medical costs were observed in originator initiators (all p < 0.001), except for metoprolol (p = 0.646). Conclusion: We observed comparable or even better clinical outcomes and less medical cost associated with the use of antihypertensive generics compared to originator counterparts. This could help increase patient and provider confidence in the efficacy of generic medicines to manage hypertension diseases.
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Affiliation(s)
- Tao Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Zhiyuan Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Mingchun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Hongbo Lin
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Peng Shen
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
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26
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Kini V, Breathett K, Groeneveld PW, Ho PM, Nallamothu BK, Peterson PN, Rush P, Wang TY, Zeitler EP, Borden WB. Strategies to Reduce Low-Value Cardiovascular Care: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2022; 15:e000105. [PMID: 35189687 PMCID: PMC9909614 DOI: 10.1161/hcq.0000000000000105] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Low-value health care services that provide little or no benefit to patients are common, potentially harmful, and costly. Nearly half of the patients in the United States will receive at least 1 low-value test or procedure annually, creating risk of avoidable complications from subsequent cascades of care and excess costs to patients and society. Reducing low-value care is of particular importance to cardiovascular health given the high prevalence and costs of cardiovascular disease in the United States. This scientific statement describes the current scope and impact of low-value cardiovascular care; reviews existing literature on patient-, clinician-, health system-, payer-, and policy-level interventions to reduce low-value care; proposes solutions to achieve meaningful and equitable reductions in low-value care; and suggests areas for future research priorities.
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27
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Heidari B, Avenatti E, Nasir K. Pharmacotherapy for Essential Hypertension: A Brief Review. Methodist Debakey Cardiovasc J 2022; 18:5-16. [PMID: 36561082 PMCID: PMC9733188 DOI: 10.14797/mdcvj.1175] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Hypertension is one of the leading causes of disability-adjusted life years and mortality, with approximately 15% prevalence worldwide. Most patients with hypertension from low- to high-income countries do not receive treatment. Among those who receive treatment, the majority remain undertreated and do not achieve their blood pressure goals. Therefore, new hypertension guidelines introduce more conscientious treatment strategies to maximize the probability of achieving the new strict blood pressure goals compared with the previous guidelines. Who should receive treatment for hypertension? Which antihypertensive medications have the strongest supporting data? Are generic and more affordable medications as effective as expensive brand medications? What are the different treatment strategies to maximize success in controlling blood pressure? Here, we briefly review pharmacotherapy for hypertension and provide answers to these questions as well as some other common questions regarding treatment of hypertension.
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Affiliation(s)
- Behnam Heidari
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
| | - Eleonora Avenatti
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
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28
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Mwita S, Mchau B, Minja W, Katabalo D, Hamasaki K, Marwa K. The magnitude of prescribing medicines by brand names in a tertiary hospital, Mwanza, Tanzania. THE JOURNAL OF MEDICINE ACCESS 2022; 6:27550834221098597. [PMID: 36204526 PMCID: PMC9413497 DOI: 10.1177/27550834221098597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022]
Abstract
Background Globally, one of the most common causes of irrational use of medicines is brand-name prescribing. The consequence of prescribing medicines using brand names is an economic burden on patients and society. Thus, this study aimed to investigate the magnitude of prescribing medicines by brand names in a tertiary hospital in Mwanza, Tanzania. Methods A retrospective cross-sectional study was conducted between April 2020 and March 2021 at the Bugando Medical Centre. Data were collected from electronic prescriptions (outpatients) and medical files (inpatients). The data were analyzed using STATA version 14. A Chi-square test was conducted to examine the relationship between different categorical variables. p-Values of less than 0.05 were considered statistically significant. Results Of 851 prescriptions analyzed, 416 (48.9%) contained medicines prescribed using brand names. Compared to outpatient units, the proportion of prescriptions with medicines prescribed by brand names in inpatient units was significantly higher (58.5% vs 39.1%), p < 0.001. The most frequently prescribed medicines by brand names were Ampiclox (ampicillin + cloxacillin), 35.2%, Buscopan (hyoscine butylbromide), 8.7%, and Amoxyclav (amoxicillin + clavulanic acid), 7.7%. Conclusion Prescriptions written with brand names were found to be common, especially among fixed-dose combinations (FDCs), according to the current study. Governments, institutions, and other stakeholders should support and encourage the use of generic names in prescription writing because it saves money for patients and health care systems. This calls for Tanzania's government to prioritize the development and implementation of generic prescribing policies.
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Affiliation(s)
- Stanley Mwita
- School of Pharmacy, Catholic University
of Health and Allied Sciences, Mwanza, Tanzania
| | - Brigitte Mchau
- School of Pharmacy, Catholic University
of Health and Allied Sciences, Mwanza, Tanzania
| | - Winfrida Minja
- School of Pharmacy, Catholic University
of Health and Allied Sciences, Mwanza, Tanzania
| | - Deogratias Katabalo
- School of Pharmacy, Catholic University
of Health and Allied Sciences, Mwanza, Tanzania
| | - Kayo Hamasaki
- School of Pharmacy, Catholic University
of Health and Allied Sciences, Mwanza, Tanzania
| | - Karol Marwa
- Department of Pharmacology, Catholic
University of Health and Allied Sciences, Mwanza, Tanzania
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Celedón N, González C, Cuadrado C. Perspectives of patients and consumers on the use of generic medicines. Medwave 2021. [DOI: 10.5867/medwave.2021.11.8155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Access to medicines constitutes a public health challenge worldwide. Promoting utilization of generic medicines is one of the strategies that has been proposed to optimize pharmaceutical spending and thus allow greater coverage. However, its use is not yet widespread enough. This study seeks to explore the perspectives and acceptability to the use of generic medicines from patients and consumers. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a evidence synthesis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified four systematic reviews that together include 47 primary studies, of which one corresponds to a randomized trial. A low rate of patients or consumers has a negative perception regarding generic medicines, including dimensions such as risk, quality, safety, risk of adverse effects, among others.
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Leonova MV. Clinical equivalence of generic and brand-name drugs used in cardiology: what do we know? CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.12.201290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The problem of using generics in the treatment of patients with cardiovascular diseases remains relevant for more than a decade. The concern of doctors, pharmacists and patients is not diminishing with the constant rise in cardiovascular morbidity and mortality worldwide. Based on a systematic review of 186 publications, physicians identified concerns about the quality, reliability and replaceability of original drugs; pharmacists have shown the highest level of generic approval. Patients distrust of generics was revealed, caused by a lack of information, concerns about packaging, and negative experience of replacing the original drug. Three meta-analyzes compared generic and original drugs of cardiovascular groups in terms of efficacy and safety. A 2008 meta-analysis (47 studies, 9 classes of cardiovascular drugs) assessed the effect on mild outcomes, a 2016 meta-analysis (74 studies, 7 classes of drugs) also assessed side effects. The cumulative effect revealed a small and nonsignificant difference, which indicated that there was no superiority of original drugs over generics; there were no differences in the frequency and severity of side effects between generics and original drugs. A 2020 meta-analysis (72 studies, 9 drug classes) assessed the frequency of hospital admissions (including emergency department consultations, hospitalizations) and found a significant increase in the risk for generics for any reason (14%), but not for cardiac vascular diseases. A review of 8 cohort studies evaluating antihypertensive drugs for long-term cardiovascular outcomes, duration of retention, and substitution effect did not find significant differences between generics and brands. In a systematic review of studies comparing warfarin and generics, there were no significant differences in international normalized ratio and the incidence of thromboembolic and hemorrhagic complications; however, in one study, the frequency of hospital visits was 10% higher for generics. A systematic review of studies comparing clopidogrel versus generics shows drug comparability for major cardiovascular events and mortality. A review of 5 cohort studies evaluating originator statins and generics showed comparable rates of all-cause mortality and major cardiovascular events, except for one study with conflicting results. Meta-analyzes and large observational studies indicate that generics are not the worst efficacy, sometimes even surpass that of original drugs and can be justifiably used in clinical practice.
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Ma I, Tisdale RL, Vail D, Heidenreich PA, Sandhu AT. Utilization of Generic Cardiovascular Drugs in Medicare's Part D Program. Circ Cardiovasc Qual Outcomes 2021; 14:e007559. [PMID: 34879702 PMCID: PMC9070108 DOI: 10.1161/circoutcomes.120.007559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Generic medications cost less than brand-name medications and are similarly effective, but brand-name medications are still prescribed. We evaluated patterns in generic cardiovascular medication fills and estimated the potential cost savings with increased substitution of generic for brand-name medications. METHODS This was a cross-sectional study of cardiovascular therapies using the Medicare Part D database of prescription medications in 2017. We evaluated drug fill patterns for therapies with available brand-name and generic options. We determined the generic substitution ratio and estimated the potential savings with increased generic substitution at the national, state, and clinician level. We compared states with laws related to mandatory pharmacist generic substitution and patient consent for substitution. RESULTS Of ≈$22.9 billion spent on cardiovascular drugs in Medicare Part D prescription programs in 2017, ≈$11.0 billion was spent on medications with both brand-name and generic options. Although only 2.4% of medication fills were for the brand-name choice, they made up 21.2% of total spending. Accounting for estimated brand-name rebates, generic substitution for these medications would save $641 million, including $135 million in costs shouldered by patients. Furthermore, the minority of clinicians with the lowest generic utilization was responsible for a large proportion of the potential cost savings. CONCLUSIONS There are substantial potential cost savings from substituting brand-name medications with generic medications. These savings would be primarily driven by lower use of brand-name therapies by the minority of clinicians who prescribe them at increased rates.
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Affiliation(s)
- Iris Ma
- California Pacific Medical Center, San Francisco, CA (I.M.)
| | - Rebecca L Tisdale
- Department of Health Policy, Stanford University School of Medicine, CA (R.L.T.)
- Veterans Affairs Palo Alto Health Care System, CA (R.L.T., P.A.H., A.T.S.)
| | - Daniel Vail
- Department of Surgery, Stanford University, CA (D.V.)
| | - Paul A Heidenreich
- Veterans Affairs Palo Alto Health Care System, CA (R.L.T., P.A.H., A.T.S.)
- Division of Cardiology, Department of Medicine, Stanford, CA (P.A.H., A.T.S.)
| | - Alexander T Sandhu
- Veterans Affairs Palo Alto Health Care System, CA (R.L.T., P.A.H., A.T.S.)
- Division of Cardiology, Department of Medicine, Stanford, CA (P.A.H., A.T.S.)
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Nuske EO, Morozov M, Alejandro Serra H. The use of GA-RxODE (Genetics Algorithms and Running simulations from Ordinary Differential Equations-based model) method to optimize bioequivalence studies. Pharmacol Res Perspect 2021; 9:e00824. [PMID: 34609078 PMCID: PMC8491459 DOI: 10.1002/prp2.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022] Open
Abstract
Bioequivalence (BE) studies are prerequisite in generic products approval. Normally, they are quite simple in design and expensive in execution, and sometimes suffer ethical questioning. Genetics Algorithms and Running simulations from Ordinary Differential Equations-based model (GA-RxODE) is a multipurpose method used in pharmacokinetic (PK) optimization. It can be used to complete concentration-time (C-T) missing data. In this investigation, GA-RxODE was applied in BE field. For this purpose, three BE studies were selected as a source data comprising formulations of metformin, alprazolam and clonazepam. From them, five blood samples values per volunteer-round from specific preset times were chosen as if BE study was carried out with five instead of the classic 10-20 samples. With the five values of each volunteer a complete C-T curve was simulated by GA-RxODE and certain PK estimation parameters (as maximum concentration, Cmax , and area under C-T curve from zero to infinite, AUCinf ) were elicited. Finally, with these modeled parameters, a BE analysis was performed according to certain regulatory agencies guidances. Some results, expressed as geometric mean ratios of compared formulations and their 90% confidence intervals (CI90), were as follows: Metformin Cmax = 0.954 (0.878-1.035), AUCinf = 0.949 (0.881-1.022); Alprazolam Cmax = 1.063 (0.924-1.222), AUCinf = 1.036 (0.857-1.249), Clonazepam Cmax = 0.927 (0.831-1.034), and AUCinf = 1.021 (0.931-1.119). All CI90 were inside the 0.8-1.25 BE range. In summary, the simulated data were bioequivalent and non-significantly different from original studies' data. This raises the opportunity to perform more economic BE studies to build reliable PK estimation parameters from a few samples per volunteer.
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Affiliation(s)
- Ezequiel Omar Nuske
- Pharmacology DepartmentSchool of MedicineUniversity of Buenos AiresBuenos AiresArgentina
| | - Mikhail Morozov
- Pharmacology DepartmentSchool of MedicineUniversity of Buenos AiresBuenos AiresArgentina
| | - Héctor Alejandro Serra
- Pharmacology DepartmentSchool of MedicineUniversity of Buenos AiresBuenos AiresArgentina
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Goshtasbi K, Abouzari M, Abiri A, Ziai K, Lehrich BM, Risbud A, Bayginejad S, Lin HW, Djalilian HR. Trends and patterns of neurotology drug prescriptions on a nationwide insurance database. Laryngoscope Investig Otolaryngol 2021; 6:1096-1103. [PMID: 34667853 PMCID: PMC8513439 DOI: 10.1002/lio2.617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/22/2021] [Accepted: 06/22/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To examine neurotologists' 2013 to 2016 Medicare Part-D data and evaluate commonly prescribed medications, longitudinal changes in prescribing patterns, presumed associated pathologies, and cost distribution across United States. METHODS Comprehensive prescription data of Part-D-participating neurotologists was quiered from the 2013 to 2016 Medicare Part-D database. Outcome variables consisted of the 25 most commonly prescribed + refilled medications, cost distribution per medication, presumed associated pathologies, and standardized prescription cost across United States. RESULTS Of the 594 available U.S. neurotologists, 336 (57%) were found in the Medicare Part-D database. In 2016, total prescription costs were $4 483 268 with an averaged $13 343 ± $18 698 per neurotologist. The three most frequently filled drugs were fluticasone propionate, ciprofloxacin, and triamterene-hydrochlorothiazide. From 2013 to 2016, the greatest change in prescription pattern was observed with azelastine (+188%), montelukast sodium (+104%), mupirocin (+63%), and mometasone (-91%), whereas the greatest change in relative drug cost distribution was seen in ofloxacin, (+695.7%) neomycin-polymyxin-hydrocortisone (+262.1%), and mometasone (-83%). Triamterene-hydrochlorothiazide, prednisone, montelukast, amoxicillin-clavulanate, azelastine, spironolactone, and mupirocin had statistically significant increases in average number of prescriptions per physician, whereas ofloxacin and mometasone had significant decreases. Medications presumably treating Eustachian tube dysfunction, Meniere's disease, and vestibular migraine had the greatest percent changes across years. Cost distribution of four drugs increased upwards of 100%. Geographic analysis demonstrated that Southern and Midwest regions had higher standardized prescription costs. CONCLUSIONS This study is the first to analyze neurotologists' trends in prescribing patterns, regional prescription cost distributions, and commonly treated pathologies. This can lead to better standardization of prescribing patterns and cost in the future.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Arash Abiri
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Kasra Ziai
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Brandon M. Lehrich
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Adwight Risbud
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Soha Bayginejad
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Harrison W. Lin
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
- Department of Biomedical EngineeringUniversity of CaliforniaIrvineCaliforniaUSA
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Glerum PJ, Neef C, Burger DM, Yu Y, Maliepaard M. Pharmacokinetics and Generic Drug Switching: A Regulator's View. Clin Pharmacokinet 2021; 59:1065-1069. [PMID: 32557345 PMCID: PMC7467961 DOI: 10.1007/s40262-020-00909-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There appears to be a mismatch between the assumed therapeutic equivalence of generic drugs, their interchangeability, and reported clinical discomfort following generic drug use and drug switches. In this article, we describe why we are of the opinion that the current regulatory approach to the evaluation of generic drugs based on average bioequivalence is sufficient to expect therapeutic equivalence in the clinical setting. This has often been debated, specifically as adverse drug reactions related to generic drug switches are regularly reported. We agree that clinical discomfort during a bioequivalent drug switch may indeed be caused by different exposures to the active substance. However, this difference in exposure is not a result of the characteristics or quality of generic drugs; it is caused by the pharmacokinetic within-subject variability of the active substance, i.e., the variability on the bioavailability of the active substance, when comparing two occasions of administration of the same drug product, to the same patient. Therefore, reported clinical discomfort following generic drug use and drug switches does not warrant a change in the regulatory approach to the evaluation of the bioequivalence of generic drugs. Switching from a brand-name drug to currently approved generic drugs, or between different generic drugs, will in principle result in comparable exposure, within boundaries determined by the within-subject variability of the pharmacokinetics of the active substance involved.
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Affiliation(s)
- Pieter J Glerum
- Medicines Evaluation Board, CBG-MEB, P.O. Box 8275, 3503 GB, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cees Neef
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yang Yu
- Medicines Evaluation Board, CBG-MEB, P.O. Box 8275, 3503 GB, Utrecht, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marc Maliepaard
- Medicines Evaluation Board, CBG-MEB, P.O. Box 8275, 3503 GB, Utrecht, The Netherlands. .,Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Ito Y, Hara K, Sato H, Tomio J. Knowledge, Experience, and Perceptions of Generic Drugs among Middle-Aged Adults and their Willingness-to-Pay: A Nationwide Online Survey in Japan. TOHOKU J EXP MED 2021; 255:9-17. [PMID: 34497247 DOI: 10.1620/tjem.255.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Promoting generic drugs can reduce the financial burden on patients and improve healthcare finances. The insurers have been conducting promotional efforts, such as direct-mail campaigns, but little is known about the public's perception of generic drugs and effective message strategies for promotion. In 2018, we conducted a web-based survey of middle-aged Japanese men and women that investigated: (i) their perceptions of generic drugs, (ii) the association between perceptions and willingness-to-pay for brand-name drugs relative to generic drugs, and (iii) potentially effective forms of information provision to alter individuals' perceptions. Of the 1,005 respondents, over half perceived generic drugs as having the same level of efficacy and safety as brand-name drugs. While willingness-to-pay was dispersed among respondents, two factors were associated with small willingness-to-pay: (a) perceiving generic drugs as having the same level of efficacy and safety as brand-name drugs and (b) perceiving that promoting the use of generic drugs is important for controlling medical expenditures. Moreover, presenting potential savings over five years by choosing generic drugs was a potentially effective tool for altering perceptions, relative to showing monthly savings. Our findings suggest that certain parts of the population still have high willingness-to-pay for brand-name drugs, and strategic communication to alter perception could be effective in promoting the use of generic drugs among those who are price-inelastic.
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Affiliation(s)
- Yuki Ito
- Department of Public Health, Graduate School of Medicine, The University of Tokyo.,Department of Economics, University of California, Berkeley
| | - Konan Hara
- Department of Public Health, Graduate School of Medicine, The University of Tokyo.,Department of Economics, University of Arizona, Tucson
| | - Hajime Sato
- Department of Health Policy and Technology Assessment, National Institute of Public Health.,Faculty of Global Nursing, Iryo Sosei University
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo
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Network Theory and Switching Behaviors: A User Guide for Analyzing Electronic Records Databases. FUTURE INTERNET 2021. [DOI: 10.3390/fi13090228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
As part of studies that employ health electronic records databases, this paper advocates the employment of graph theory for investigating drug-switching behaviors. Unlike the shared approach in this field (comparing groups that have switched with control groups), network theory can provide information about actual switching behavior patterns. After a brief and simple introduction to fundamental concepts of network theory, here we present (i) a Python script to obtain an adjacency matrix from a records database and (ii) an illustrative example of the application of network theory basic concepts to investigate drug-switching behaviors. Further potentialities of network theory (weighted matrices and the use of clustering algorithms), along with the generalization of these methods to other kinds of switching behaviors beyond drug switching, are discussed.
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Godman B, Fadare J, Kwon HY, Dias CZ, Kurdi A, Dias Godói IP, Kibuule D, Hoxha I, Opanga S, Saleem Z, Bochenek T, Marković-Peković V, Mardare I, Kalungia AC, Campbell S, Allocati E, Pisana A, Martin AP, Meyer JC. Evidence-based public policy making for medicines across countries: findings and implications for the future. J Comp Eff Res 2021; 10:1019-1052. [PMID: 34241546 DOI: 10.2217/cer-2020-0273] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Global expenditure on medicines is rising up to 6% per year driven by increasing prevalence of non-communicable diseases (NCDs) and new premium priced medicines for cancer, orphan diseases and other complex areas. This is difficult to sustain without reforms. Methods: Extensive narrative review of published papers and contextualizing the findings to provide future guidance. Results: New models are being introduced to improve the managed entry of new medicines including managed entry agreements, fair pricing approaches and monitoring prescribing against agreed guidance. Multiple measures have also successfully been introduced to improve the prescribing of established medicines. This includes encouraging greater prescribing of generics and biosimilars versus originators and patented medicines in a class to conserve resources without compromising care. In addition, reducing inappropriate antibiotic utilization. Typically, multiple measures are the most effective. Conclusion: Multiple measures will be needed to attain and retain universal healthcare.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Joseph Fadare
- Department of Pharmacology & Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, Korea
| | - Carolina Zampirolli Dias
- Graduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Isabella Piassi Dias Godói
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
- Researcher of the Group (CNPq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Dan Kibuule
- Department of Pharmacy Practice & Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Sylvia Opanga
- Department of Pharmaceutics & Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Zikria Saleem
- Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Tomasz Bochenek
- Department of Nutrition & Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Vanda Marković-Peković
- Department of Social Pharmacy, University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina
| | - Ileana Mardare
- "Carol Davila" University of Medicine & Pharmacy, Bucharest, Romania
| | | | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche 'Mario Negri' IRCCS, Milan, Italy
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Antony P Martin
- Faculty of Health & Life Sciences, The University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Bayram D, Aydin V, Gelal A, Aksoy M, Akici A. Generic drug prescribing in primary care: A nationwide analysis. Int J Clin Pract 2021; 75:e14284. [PMID: 33914404 DOI: 10.1111/ijcp.14284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/26/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Dissemination of generic drug (GD) use could provide significant savings on drug expenditures and contribute to the long-term sustainability of healthcare. We aimed to exhibit the nationwide trend of GD use in primary care and investigate potentially relevant drug and patient factors. METHODS Prescriptions written by primary care physicians in Turkey between 2013 and 2016 were analysed using the National Prescribing Information System. We determined the ratio of GD prescriptions with all prescriptions in terms of quantity and cost. In addition, we analysed the use of GD in terms of demographic characteristics of the patients, the most frequently prescribed preparations and frequent indications. RESULTS In the 4-year period, we identified 518,335,821 prescriptions, those with at least one GD constituted 54.0% (n = 786,972,813) with a total cost-share of 36.9%-37.8%. GD use was the highest in 2016 (54.4%) and lowest in 2014 (53.6%). GD prescribing was higher in women than men every year (P < .001 for each), with the highest difference in 2016 as 54.7% vs 54.0%. GD utilisation decreased as the age group increased, which was 64.0%-64.5% in <18-year-old group and 46.0%-47.1% in ≥75-year-old group. Among the top ten encountered indications, the highest and lowest GD prescribing was detected in acute tonsillitis (68.1%) and hypertension (33.9%). Metformin had the highest percentage of GD prescribing (96.1%-97.7%), whereas esomeprazole showed the lowest GD prescribing (4.5%-14.8%) among the most frequently used preparations in primary care. CONCLUSION This study shows a modest upward trend of GD utilisation in primary care, though its share appears to be lower than expected. GD use revealed a consistent reduction towards older age groups. GDs were more likely to be prescribed for acute conditions, particularly infectious diseases.
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Affiliation(s)
- Dilara Bayram
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Volkan Aydin
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayse Gelal
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mesil Aksoy
- Turkish Medicines and Medical Devices Agency, Ministry of Health, Ankara, Turkey
| | - Ahmet Akici
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
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Effects of SGLT2 Inhibitor on Ischemic Events Stemming From Atherosclerotic Coronary Diseases: A Systematic Review and Meta-analysis With Trial Sequential Analysis of Randomized Controlled Trials. J Cardiovasc Pharmacol 2021; 77:787-795. [PMID: 33843765 DOI: 10.1097/fjc.0000000000001018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/04/2021] [Indexed: 12/18/2022]
Abstract
ABSTRACT Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce cardiovascular complications of type-2 diabetes mellitus. However, the beneficial effects of SGLT2 inhibition are mainly associated with decline in hospitalization and death of heart failure. This systematic review will focus on the effect of SGLT2 inhibitors on ischemic events stemming from atherosclerotic coronary diseases, including angina pectoris, angina unstable, and myocardial infarction. We searched PubMed, Scopus, Embase, and Web of Science for relevant publications before October 2020. Twenty-two clinical trials consisting of 56,064 participants were included in the analysis. Cardiovascular effects following treatment with SGLT2 inhibitors were observed for angina pectoris, angina unstable, and myocardial infarction. A random-effects model was chosen, and after analysis of the P values and I2 statistic indices, we concluded that SGLT2 inhibitor treatment did not result in any significant differences in the incidence rate of angina pectoris [relative risk (RR), 0.98; 95% confidence interval (CI), 0.83-1.14; P = 0.92], angina unstable (RR, 0.95; 95% CI, 0.84-1.07; P = 0.84), or myocardial infarction (RR, 0.94; 95% CI, 0.79-1.11; P = 0.98) between the experimental and control groups with firm evidence from sensitivity and trial sequential analyses. This meta-analysis provides evidence that SGLT2 inhibitors have no significant effects on ischemic events stemming from atherosclerotic coronary diseases in patients with type-2 diabetes mellitus.
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Alderfer J, Hansen RA, Mattingly TJ. Understanding authorized generics-A review of the published clinical data. J Clin Pharm Ther 2021; 46:1489-1497. [PMID: 33829528 DOI: 10.1111/jcpt.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Despite the large body of evidence demonstrating equivalent efficacy and safety for branded drugs and their generic counterparts, some patients and providers have the perception that generics may be less safe and effective than branded agents. Authorized generics (AGs) are a category of generic drugs defined by the United States Food and Drug Administration (FDA) as being the same as the brand-name drug without the brand's name on the label and which may have minor differences, such as tablet or capsule markings for identification. Studies in which AGs are considered along with other generics may increase our understanding of factors that may influence perceptions about generics and shed light on areas where education may be impactful. The objectives of this paper are to provide information about AGs, review studies in which they have been evaluated and explore the role that AGs may fill in the individualized treatment of patients. METHODS A literature review was conducted on 30 September 2019 with follow-up search on 4 March 2020. The search was focussed on published papers and meeting abstracts that provided information on AGs with respect to medical and health outcomes of therapy as well as switching in individuals receiving branded, AG, or other generic agents. Information about patients' perceptions of generic medications and adherence to therapy was also included. Additional information, including relevant government sources, such as the FDA website and the Federal Trade Commission Report, was included as appropriate. RESULTS The literature specific to AGs is limited, but available data clearly highlight the importance of patient perception of generics as well as medication appearance as factors that may affect adherence and potentially more frequent switchbacks to branded agents from generics or AGs. WHAT IS NEW AND CONCLUSION To our knowledge, this is the first narrative review to provide a summary of the published evidence about AGs with respect to clinical and health outcomes and switching. There is a need for more research and education regarding the use of AGs in clinical practice if they are to become more recognized as a potential treatment choice for patients. Generic medications play an important role in the healthcare system, and AGs may be able to provide an option to meet the specific needs of individual patients.
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Affiliation(s)
| | | | - T Joseph Mattingly
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Esam H, Kanukula R, Dhurjati R, Aerram R, Chevireddy S, Bhaumik S, Atkins E, Huffman MD, Rodgers A, Salam A. Systematic reviews of antihypertensive drugs: A review of publication trends, characteristics, and quality. J Clin Hypertens (Greenwich) 2021; 23:915-922. [PMID: 33650776 PMCID: PMC8678774 DOI: 10.1111/jch.14216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 11/27/2022]
Abstract
This review presents publication trends, characteristics, and quality of systematic reviews (SRs) of randomized controlled trials (RCTs) of antihypertensive drugs (AHTDs). Between 1985 and 2017, 1,173 SRs were published, and in the last 20 years, 10, 35, and 116 were published in the year 1996, 2006, and 2016, respectively. Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers were the most common class of drugs studied. Fourteen percent of the SRs were prospectively registered/published protocol. Three-fourth of the SRs did not report a full search strategy, and 45% did not report a PRISMA or similar diagram. Of the 34 SRs published in the five high impact factor journals in the last 10 years, 15%, 21%, and 65% have unclear, low, and high risk of bias, respectively. There has been a steady increase in the publication of SRs of RCTs of AHTDs. However, adherence to standard methods of conduct and reporting continues to be low.
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Affiliation(s)
| | - Raju Kanukula
- The George Institute for Global Health, Hyderabad, India
| | | | - Rupa Aerram
- The George Institute for Global Health, Hyderabad, India
| | | | | | - Emily Atkins
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Abdul Salam
- The George Institute for Global Health, University of New South Wales, Hyderabad, India.,Prasanna School of Public Health, Manipal, India
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Morishima R, Bokuda K. Hydroxypropyl cellulose-induced fixed drug eruption as an adverse effect of generic drugs. Contact Dermatitis 2021; 85:90-91. [PMID: 33460455 DOI: 10.1111/cod.13787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment: a multicenter prospective study in China. Chin Med J (Engl) 2021; 134:292-301. [PMID: 33470655 PMCID: PMC7846498 DOI: 10.1097/cm9.0000000000001360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Generic drugs are bioequivalent to their brand-name counterparts; however, concerns still exist regarding the effectiveness and safety of generic drugs because of small sample sizes and short follow-up time in most studies. The purpose of this study was to evaluate the long-term antihypertensive efficacy, cost-effectiveness and cardiovascular outcomes of generic drugs compared with brand-name drugs. METHODS In a multicenter, community-based study including 7955 hypertensive patients who were prospectively followed up for an average of 2.5 years, we used the propensity-score-matching method to match the patients using brand-name drugs to those using generic drugs in a ratio of 1:2, 2176 patients using brand-name drugs and 4352 patients using generic drugs. RESULTS There were no significant differences between generic drugs and brand-name drugs in blood pressure (BP)-lowering efficacy, BP control rate, and cardiovascular outcomes including coronary heart disease and stroke. The adjusted mean (95% confidence interval [CI]) of systolic BP (SBP)-lowering was -7.9 mmHg (95% CI, -9.9 to -5.9) in the brand-name drug group and -7.1 mmHg (95% CI, -9.1 to -5.1) in the generic drug group after adjusting for age, sex, body mass index, number of antihypertensive drugs and traditionally cardiovascular risk factors. Among patients aged <60 years, brand-name drugs had a higher BP control rate (47% vs. 41%; P = 0.02) and a greater effect in lowering SBP compared with generic drugs, with the between-group difference of 1.5 mmHg (95% CI, 0.2-2.8; P = 0.03). BP control rate was higher in male patients using brand-name drugs compared with those using generic drugs (46% vs. 40%; P = 0.01). Generic drugs treatment yielded an average annual incremental cost-effectiveness ratio of $315.4 per patient per mmHg decrease in SBP compared with brand-name drugs treatment. CONCLUSIONS Our data suggested that generic drugs are suitable and cost-effective in improving hypertension management and facilitating public health benefits, especially in low- and middle-income areas.
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Hadia R, Joshi D, Gohel K, Khambhati N. Knowledge, attitude, and practice of generic medicines among physicians at multispecialty hospital: An observational study. Perspect Clin Res 2021; 13:155-160. [PMID: 35928641 PMCID: PMC9345257 DOI: 10.4103/picr.picr_281_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Methods: Results: Conclusion:
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Comparison of adherence, persistence, and clinical outcome of generic and brand-name statin users: A retrospective cohort study using the Japanese claims database. J Cardiol 2020; 77:545-551. [PMID: 33371973 DOI: 10.1016/j.jjcc.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/04/2020] [Accepted: 11/28/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Non-adherence to statin treatment results in an increased risk of cardiovascular events and all-cause mortality. This study compared adherence, persistence, and clinical outcomes of patients who initiated brand-name and generic statins in the Japanese population. METHODS The retrospective cohort study included adult patients who initiated statins between 2014 and 2016. Primary adherence was measured as the proportion of days covered (PDC) within 1 year. Persistence was assessed using the proportion of non-persistent users. Any major adverse cardiac and cerebrovascular event (MACCE) was assessed as a clinical outcome. Propensity score matching was performed to adjust for confounding factors. RESULTS Among 47,770 patients who met inclusion criteria in the study, 32,130 (67.3%) initiated generic statins. The median age of the patients was 53 (interquartile range: 46-59) years and 60.2% were male. A higher proportion of patients with PDC ≥80% [60.2% vs. 57.1%; odds ratio, 1.14; 95% confidence interval (CI), 1.09-1.19; p<0.001] and a higher PDC value (median, 90.2% vs. 87.9%; difference, 2.3%; p<0.001) were observed in the generic group. Similarly, fewer patients discontinued statins in the generic group [24.2% vs. 27.7%; hazard ratio (HR), 0.91; 95% CI, 0.87-0.95; p<0.001]. Differences in MACCE occurrence were not significant between the groups (4.3% vs. 4.2%; HR, 1.04; 95% CI, 0.93-1.17; p=0.99). CONCLUSIONS Adherence and persistence were higher among generic statin recipients; nevertheless, no significant differences in clinical outcomes were noted between the two groups, suggesting that generic medication did not impair treatment benefits and may improve patient adherence.
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Hamada Y, Uchida M, Arai S, Yamazaki K, Takeda M, Arai K, Nakamura T, Suzuki T, Ishii I. Analysis of patients’ request to switch from a generic drug to the original drug in external prescriptions. J Pharm Health Care Sci 2020; 6:27. [PMID: 33292744 PMCID: PMC7716439 DOI: 10.1186/s40780-020-00180-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/26/2020] [Indexed: 12/04/2022] Open
Abstract
Background Generic drugs are heavily promoted in Japan. The aim of this retrospective single-center study was to clarify whether the frequency and reason that patients request a switch from a generic drug to the original drug differ according to therapeutic category and dosage form. Methods This study was performed at Chiba University Hospital. Prescription inquiries about 121 generic drugs from community pharmacies over a 3-year period (from July 2014 to June 2017) were analyzed. Results Approximately 30% of the requests were related to the efficacy, safety, and comfort of the generic drug. The most cited motive was “patient’s desire with no reason given” at 44.5%. According to multiple logistic regression analysis, therapeutic categories and dosage forms were associated with the requests. The median request frequency differed according to therapeutic category and dosage form. The frequency was highest for “agents affecting the central nervous system” and “tablets and capsules”, respectively. Among the therapeutic categories, “agents affecting the central nervous system” had the highest median number of requests related to “decreased effectiveness”; “cardiovascular agents” had the highest median number of requests related to “physician’s instruction”; and “agents for the epidermis” had the highest median number of requests related to “uncomfortable to use”. Among dosage forms, the odds ratio for patients’ original drug request for “liniment and patch” was about 1.5 times that for “tablets and capsules”. “Liniment and patch” had the highest median frequency of requests related to “decreased effectiveness”, “uncomfortable to use”, and “patient’s desire with no reason given”. Conclusions The request frequency and reason differed according to therapeutic category and dosage form. Pharmacists should advise each patient properly about the choice and switching of drug brands, taking into account the therapeutic category and dosage form, especially liniments and patches.
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Thaver A, Chee M, Wroblewski K, Weissman A, Cook M, Zhang J, Samarth A, Moriates C, Wallingford S, Lynch S, Stebbins M, Shah N, Farnan J, Ngooi S, Tracy C, Meltzer DO, Arora VM. Physician and Nurse Practitioner Attitudes on Generic Prescribing of Oral Contraceptive Pills and Antidepressants. J Gen Intern Med 2020; 35:3478-3484. [PMID: 32989714 PMCID: PMC7728859 DOI: 10.1007/s11606-020-06239-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
IMPORTANCE As prescription drug costs rise, it is important to understand attitudes among primary care physicians and nurse practitioners (NPs) towards generic drugs. OBJECTIVE We aimed to examine the generic skepticism index (GSI) among primary care clinicians, and their willingness to discuss and prescribe generic antidepressants (ADs) and generic oral contraceptives (OCPs). DESIGN We used a factorial vignette design survey to test 4 factors: message source, message, brand preference, and drug class. Participants were randomized to different combinations of factors. SETTING This was a cross-sectional study. PARTICIPANTS Physicians registered with the American College of Physicians (ACP) and NPs registered with the American Association of Nurse Practitioners (AANP) participated in the study. MAIN MEASURES The primary outcomes were generic skepticism as measured using the generic skepticism index (GSI), and clinician willingness to discuss and prescribe generics. RESULTS Surveys were completed by 56% of physicians (n = 369/661) and 60% of NPs (n = 493/819). Compared with physicians, NPs were younger (p < 0.001), predominantly female (p < 0.001), and differed in the race (p < 0.001). According to the GSI, 16% (n = 138/862) were identified as generic skeptics (18.5% of NPs and 12.7% of physicians, p = 0.023). Generic skeptics had lower odds of willingness to discuss switching (OR 0.22, 95% CI (0.14-0.35), p < 0.001) or prescribe (OR 0.18, 95% CI (0.11-0.28), p < 0.001) generic OCPs. Participants had lower odds of willingness to prescribe generic drugs to patients with brand preference compared with brand-neutral patients (OR 0.64, 95% CI 0.50-0.82, p < 0.001). CONCLUSIONS AND RELEVANCE Generic skepticism was associated with lower willingness to discuss or prescribe generic drugs. Clinicians reported lower willingness to discuss switching or prescribe generics for OCPs than for ADs. Patient brand preference hindered generic prescribing. Message source and message type were not significantly associated with outcomes.
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Affiliation(s)
- Ali Thaver
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Mark Chee
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.,Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | | | - Michelle Cook
- American Association of Nurse Practitioners, Austin, TX, USA
| | - James Zhang
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Anita Samarth
- Clinovations Government + Health, Washington, DC, USA
| | - Christopher Moriates
- Dell Medical School, University of Texas, Austin, TX, USA.,Costs of Care, Boston, MA, USA
| | | | - Shalini Lynch
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Marilyn Stebbins
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Neel Shah
- Costs of Care, Boston, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - Jeanne Farnan
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Samantha Ngooi
- Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - Chris Tracy
- American Association of Nurse Practitioners, Austin, TX, USA
| | - David O Meltzer
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.,Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - Vineet M Arora
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA. .,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA. .,Costs of Care, Boston, MA, USA.
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Aretha D, Kiekkas P, Sioulas N, Fligou F. Differences in brand versus generic esmolol in the treatment of perioperative supraventricular tachycardia and hypertension: A pilot study. SAGE Open Med 2020; 8:2050312120962338. [PMID: 33062276 PMCID: PMC7533938 DOI: 10.1177/2050312120962338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Once a patent expires, generic analogue drugs are alternatives to brand name drugs. Because bioequivalence/biodistribution problems have been reported for many generic analogue drugs, we prospectively evaluated 31 patients to reveal the differences in the doses used and the efficacy and adverse events of two different intravenous esmolol formulations. Methods: This was a prospective observational pilot study. Our aim was to reveal the possible differences in the required doses between two different formulations (brand name drug vs generic analogue drug) of intravenous esmolol in beats per minute, systolic blood pressure, diastolic blood pressure and mean arterial pressure in intra- and postoperative patients with supraventricular tachycardia and hypertension. The patients were categorised into two groups according to the medication they received (brand name drug or generic analogue drug). Results: Esmolol was given to 31 patients (16 generic analogue drug and 15 brand name drug). Although there was a statistically significant difference in bolus (mg/kg) and continued (mg/kg/h) drug dose used (brand name drug/generic analogue drug, mean (standard deviation), 0.3 (0.1) vs 0.38 (0.1), p = 0.03 for bolus dose, and 0.22 (0.09) vs 0.29 (0.08) for continued dose at 10 min (p = 0.03), 0.19 (0.06) vs 0.24 (0.05) at 20 min (p = 0.01) and 0.14 (0.05) vs 0.18 (0.05) at 30 min (p = 0.02)), there were no time-related statistical significant differences in the reduction rates of the two drugs (p = 0.47). There were no time-related statistically significant differences between the two groups in systolic blood pressure, diastolic blood pressure, mean arterial pressure and beats per minute, nor in their adverse events. Conclusion: In this pilot study, smaller doses were given for controlling the patient’s haemodynamics when a brand name drug was used. Because there were no significant time-related differences in the reduction rates of the two drugs nor in any haemodynamic differences between the two groups, optimal titration of the drug used could effectively control the patient’s haemodynamics. The adverse events were also similar in both groups.
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Affiliation(s)
- Diamanto Aretha
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, University Hospital of Patras, Patras, Greece
| | | | | | - Fotini Fligou
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, University Hospital of Patras, Rion, Patras, Greece
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Tung YC, Hsu TJ, Lin CP, Hsiao FC, Chu YC, Chen WJ, Chu PH. Efficacy and safety outcomes of one generic nifedipine versus ADALAT long-acting nifedipine for hypertension management. J Clin Hypertens (Greenwich) 2020; 22:2296-2305. [PMID: 33035392 DOI: 10.1111/jch.14070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
Data regarding the long-term outcomes of generic antihypertensive drugs are limited. This nationwide retrospective database analysis aimed to evaluate the efficacy and safety of a generic versus brand-name nifedipine for hypertension treatment. Patients who were prescribed generic or brand-name nifedipine between January 1, 2008, and December 31, 2013, were identified from the National Health Insurance Research Database of Taiwan. The efficacy outcomes included all-cause mortality and the composite cardiovascular (CV) outcome, including CV death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularization, and hospitalization for heart failure. Safety outcomes included headache, peripheral edema, constipation, acute kidney injury, hypotension, syncope, new diagnosis of cancer, and cancer death. Among the 98 335 patients who were eligible for analysis, 21 087 (21.4%) were prescribed generic nifedipine. Both the generic and the brand-name groups included 21 087 patients after propensity score matching. At a mean follow-up of 4.1 years, the generic nifedipine was comparable to the brand-name drug with regard to all-cause mortality (7.2% vs. 7.1%; hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.95-1.09) and the composite CV outcomes (11.6% vs. 11.9%; HR 0.97; 95% CI 0.92-1.03). The generic nifedipine was associated with higher rates of headache, peripheral edema, and constipation but a modest reduction in the risk of newly diagnosed cancer (7.1% vs. 7.8%; subdistribution HR 0.90, 95% CI 0.84-0.97). The risks of acute kidney injury, hypotension, syncope, and cancer death were not significantly different between the two groups. In conclusion, the generic nifedipine was comparable to the brand-name drug with regard to the risks of all-cause mortality and the composite CV outcome. The finding of cancer risk could be chance and should be interpreted with caution.
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Affiliation(s)
- Ying-Chang Tung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Tzyy-Jer Hsu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chia-Pin Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Fu-Chih Hsiao
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - You-Chia Chu
- Department of Computer Science, National Chiao-Tung University, Hsien-Chu, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Arafat M, Fahelelbom KM, Sarfraz MK, Bostanudin MF, Sharif QUA, Esmaeil A, Al Hanbali OA, Aburuz S. Comparison between Branded and Generic Furosemide 40 mg Tablets Using Thermal Gravimetric Analysis and Fourier Transform Infrared Spectroscopy. J Pharm Bioallied Sci 2020; 12:489-498. [PMID: 33679098 PMCID: PMC7909057 DOI: 10.4103/jpbs.jpbs_365_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 01/06/2023] Open
Abstract
Background and Purpose There has been a long-standing belief that generic drugs are of lower value in comparison to their branded name counterparts. They are in particular under scrutiny due to their low market price. Even though the reduction in costs is largely based on skipping expensive preclinical studies and clinical trials for generic drugs, the purity and quality of the raw materials in the production of generic drugs is debatable. Thus, the objective of the study was to analyze and assess the quality comparability of generic furosemide 40 mg (FSD) tablets to branded product available in the market. Materials and Methods Quality control tests, in vitro drug release assessments, and thermal analysis investigations for both analog products of FSD were performed. Various physical parameters related to the tablet quality, such as hardness, weight variation, and friability tests, were examined. In vitro drug release behavior evaluations were conducted according to United States Pharmacopeia (USP) specifications and guidelines, whereas thermal analysis was carried out using thermal gravimetric analysis (TGA), and tablets were further evaluated by Fourier transform infrared (FTIR) spectroscopy. Results The results indicated a significant variation between the two products in terms of hardness, weight variation, and friability. This could be correlated to variation appeared in thermal and spectroscopic spectra between the two products using TGA and FTIR. Drug release of FSD was slightly different between both products following incubation in different pH media (1.2, 3.0, and 6.5; 120 min), however, this was in accordance with USP dissolution requirements as < 80% of drug release was obtained within the first 30 min from each product. Conclusion This study is a useful example for the independent investigations using thermal and spectroscopic analysis to confirm potential hidden variations between generic and branded products that could not be obtained by the bioequivalence studies.
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Affiliation(s)
- Mosab Arafat
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, UAE
| | | | | | | | | | - Anna Esmaeil
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, UAE
| | | | - Salahdein Aburuz
- College of Medicine and Health Sciences, The United Arab Emirates University, Al Ain, UAE.,Faculty of Pharmacy, University of Jordan, Amman, Jordan
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