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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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2
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Lin SY, Chen YM, Chen WJ, Li CY, Ku CK, Chen CH, Chien LN. Treatment patterns of long-dose-interval medication for persistent management of osteoporosis in Taiwan. Arch Osteoporos 2022; 17:94. [PMID: 35840845 DOI: 10.1007/s11657-022-01125-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
Treatment persistence was higher among the patients who initially received an anti-osteoporosis medication (AOM) with a long-dose-interval. PURPOSE With long-dose-interval anti-osteoporosis medications (AOMs) available for osteoporosis management, it is important to evaluate persistence of any AOM as long as it is continuously used. The purpose of this study was to investigate the treatment pattern and persistence of AOMs, allowing for medication switch. METHODS This study was an observational retrospective cohort study using Taiwan's National Health Insurance claims data. We selected patients who first initiated an AOM between January 1, 2013, and June 30, 2016. AOM therapy included alendronate, raloxifene, teriparatide, denosumab, zoledronate, and ibandronate; the latter three were categorized as long-dose-interval medications. Persistence was defined as continual prescription of any AOM at a given time point with a grace period of 45 days within which to obtain prescription refill. The competing risk model was used to examine the factors affecting patients switching their initial AOM. RESULTS During the study period, 126,539 patients with mean age of 75 years met the inclusion criteria; 85% were female. For initial AOM, 43.3%, 25.6%, 14.6%, 9.3%, 5.3%, and 1.9% of the patients received alendronate, denosumab, raloxifene, zoledronate, ibandronate, and teriparatide, respectively. During a mean 36-month follow-up, 29.6% of the patients who received at least two AOM pharmacy claims throughout the study period have ever switched their initial medication. Long-dose-interval medications, mainly denosumab and zoledronate, were the preferred choice for medication switch. Treatment persistence was higher in patients who initiated with long-dose-interval AOMs. CONCLUSION The real-world data reveal long-dose-interval therapy as an initial treatment or at the first switch stage may improve management of persistent AOM treatment.
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Affiliation(s)
- Sung-Yen Lin
- Orthopaedic Research Center, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung, 80708, Taiwan.,Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.,Departments of Orthopedics, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.,Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, No. 68, Jhonghua 3rd Rd, Cianjin District, Kaohsiung City, 80145, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei City, 112304, Taiwan
| | - Wei-Ju Chen
- Amgen Taiwan Limited, 13F.-1, No. 100, Songren Rd., Xinyi Dist., Taipei City, 110, Taiwan
| | - Chun-Yi Li
- Amgen Taiwan Limited, 13F.-1, No. 100, Songren Rd., Xinyi Dist., Taipei City, 110, Taiwan
| | - Chieh-Ko Ku
- Amgen Taiwan Limited, 13F.-1, No. 100, Songren Rd., Xinyi Dist., Taipei City, 110, Taiwan
| | - Chung-Hwan Chen
- Orthopaedic Research Center, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan. .,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung, 80708, Taiwan. .,Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan. .,Departments of Orthopedics, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan. .,Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, No. 68, Jhonghua 3rd Rd, Cianjin District, Kaohsiung City, 80145, Taiwan. .,Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan. .,Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan. .,Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, 912301, Taiwan.
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, No. 250, Wu-Xing Street, Taipei, 11031, Taiwan.
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3
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Lumbreras B, Sanz-Valero J, López-Pintor E. Impact of Variation in Pill/Package Appearance of Drugs on Patients' Behavior: A Systematic Review. J Patient Saf 2022; 18:310-317. [PMID: 35452203 DOI: 10.1097/pts.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This systematic review aims to identify and critically evaluate the available evidence on the impact of switches in pill appearance/packaging on patient's behavior. METHODS Studies from inception to March 2021 were searched across MEDLINE through PubMed, the Cochrane Library, Embase, and Scopus. Included studies carried out an original evaluation in English or Spanish language that evaluated the impact of switches in pill appearance/packaging on patient's behavior. Two authors independently extracted study data and evaluated studies for methodological quality according to the STROBE guidelines. RESULTS Ten studies were included, and the mean (SD) number of STROBE criteria satisfied was 17.2 (3.9). Three of 5 studies found a significant association between change in pill appearance and persistence to treatment; the 3 studies that evaluated the impact of a change on adherence to treatment found a significant association; 1 of the 2 studies that evaluated the relationship between a change a clinical outcome found a significant association with the prevalence of uncontrolled blood pressure; and 1 study showed lower rates of switchbacks to the branded product compared with patients who switched to generic drug products, with different appearance. CONCLUSIONS This systematic review showed an impact of the change in pill/package appearance on patients' behavior in 7 of the 10 studies included. Generic switching may lead to unintended consequences on patients' behavior, mainly regarding adherence to treatment.
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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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5
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van Loon WEE, Borgsteede SDS, Baas GWG, Kruijtbosch MM, Buurma HH, De Smet PAGMP, Egberts ACGT, Bouvy MM, Floor-Schreudering AA. Nature and frequency of prescription modifications in community pharmacies: A nationwide study in the Netherlands. Br J Clin Pharmacol 2020; 87:1455-1465. [PMID: 32901959 PMCID: PMC9328355 DOI: 10.1111/bcp.14548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022] Open
Abstract
AIMS To investigate the nature and frequency of prescription modifications in Dutch community pharmacies. METHODS In this cross-sectional study, Dutch community pharmacists documented prescription modifications in their pharmacy during 1 predetermined day. Pharmacists from all Dutch community pharmacies were invited to participate. A prescription modification was defined as any modification in a prescription for a medicine or other healthcare product because of an administrative problem, logistic issue or potential drug-related problem (DRP). All documented modifications were assessed to establish the nature and frequency of prescription modifications. RESULTS Pharmacists in 275 pharmacies completed the study. A modification was performed in 5.5% of all prescriptions. 1.3% of the prescriptions contained an administrative problem, of which insufficient specification of the dosing regimen was most common (63.1%). A modification was performed due to a logistic issue in 2.4% of the prescriptions. The most frequently recorded issues were unavailability of medication (40.9%) and obligatory product substitutions due to reimbursement policies (33.2%). A modification was performed in 1.8% of the prescriptions to solve or prevent potential DRPs. Of these, 69.2% was potentially clinically relevant according to the pharmacist concerned. The most frequently prevented potential DRP was an incorrect strength or dose (31.9%). CONCLUSION Dutch community pharmacists modified almost 1 in 20 prescriptions per pharmacy. The nature of the modifications reflects current community pharmacy practice, in which pharmacists frequently deal with logistic issues and intervene to solve or prevent for DRPs several times a day. The majority of the DRPs were considered to be potentially clinically relevant.
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Affiliation(s)
- W E Ellen van Loon
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.,Pharmacy de Drie Stellingen, Oosterwolde, the Netherlands
| | - S D Sander Borgsteede
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.,Department of Clinical Decision Support, Health Base Foundation, Houten, the Netherlands
| | - G W Gert Baas
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - M Martine Kruijtbosch
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - P A G M Peter De Smet
- Department of Clinical Pharmacy, University Medical Centre St Radboud, Nijmegen, the Netherlands
| | - A C G Toine Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.,Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Marcel Bouvy
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - A Annemieke Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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Kirby MG, Allchorne P, Appanna T, Davey P, Gledhill R, Green JSA, Greene D, Rosario DJ. Prescription switching: Rationales and risks. Int J Clin Pract 2020; 74:e13429. [PMID: 31573733 DOI: 10.1111/ijcp.13429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Therapeutic drug switching is commonplace across a broad range of indications and, within a drug class, is often facilitated by the availability of multiple drugs considered equivalent. Such treatment changes are often considered to improve outcomes via better efficacy or fewer side effects, or to be more cost-effective. Drug switching can be both appropriate and beneficial for several reasons; however, switching can also be associated with negative consequences. AIM To consider the impact of switching in two situations: the use of statins as a well-studied example of within-class drug switching, and gonadotropin-releasing hormone (GnRH)-targeting drug switching as an example of cross-class switching. RESULTS With the example of statins, within-class switching may be justified to reduce side effects, although the decision to switch is often also driven by the lower cost of generic formulations. With the example of GnRH agonists/antagonists, switching often occurs without the realisation that these drugs belong to different classes, with potential clinical implications. CONCLUSION Lessons emerging from these examples will help inform healthcare practitioners who may be considering switching drug prescriptions.
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Affiliation(s)
| | - Paula Allchorne
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | | | | | | | - James S A Green
- Barts Health NHS Trust, The Royal London Hospital, London, UK
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Clinical and economic implications of therapeutic switching of angiotensin receptor blockers to angiotensin-converting enzyme inhibitors. J Hypertens 2019; 37:1285-1293. [DOI: 10.1097/hjh.0000000000002009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adrover-Rigo M, Fraga-Fuentes MD, Puigventos-Latorre F, Martinez-Lopez I. Systematic literature review of the methodology for developing pharmacotherapeutic interchange guidelines and their implementation in hospitals and ambulatory care settings. Eur J Clin Pharmacol 2018; 75:157-170. [PMID: 30341498 DOI: 10.1007/s00228-018-2573-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To summarize literature specific to therapeutic interchange (TI) focusing on methodological approaches in order to develop a list of steps that healthcare facilities can consult when developing pharmacotherapeutic interchange guidelines (PTIGs) in hospitals and primary care centers. METHODS A search was conducted in PreMEDLINE, Medline, EMBASE, PsycINFO, and the Cochrane Library up to and including December 2015. PRISMA guidelines were used. The inclusion criteria were articles published on TI: methodology, implementation, guidelines, and position statements of scientific societies. Two authors independently reviewed all articles for eligibility and extracted the data. RESULTS A total of 102 articles were selected for full-text review; we included three guidelines on how to effect TI, nine position papers of various scientific societies with regard to TI, two articles dealt exclusively about methodology, three articles consisted of recommendations and perspectives on TI, three articles dealt with legal aspects, four articles examined general implementation procedures, two articles were a post-discharge follow-up of patients who had TI, six were surveys referring to TI, and three were articles on the use of TI in ambulatory care The remaining 67 articles focused on therapeutic groups. Study quality was generally low. CONCLUSIONS This review identified articles on TI as published guidelines, recommendations, and studies on TI carried out in hospital settings. As a result, eight fundamental steps were established for obtaining adequate results in the development of TI programs.
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Affiliation(s)
- Maria Adrover-Rigo
- Department of Pharmacy, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07010, Palma de Mallorca, Balearic Islands, Spain.
| | | | - Francesc Puigventos-Latorre
- Department of Pharmacy, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07010, Palma de Mallorca, Balearic Islands, Spain
| | - Iciar Martinez-Lopez
- Department of Pharmacy, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07010, Palma de Mallorca, Balearic Islands, Spain
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9
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Mondelo-García C, Mendoza E, Movilla-Fernández MJ, Coronado C. Perceptions of pharmacists and physicians on generic substitution in a financial crisis context in Northwestern Spain: A qualitative study. Health Policy 2018; 122:1316-1325. [PMID: 30201184 DOI: 10.1016/j.healthpol.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/14/2018] [Accepted: 08/24/2018] [Indexed: 11/28/2022]
Abstract
In Spain, the use of generics has considerably evolved in a short period of time through different anti-crisis legislation changes. Before the financial crisis the proposal of generics was an option for patients. Nowadays its use is actively enforced by Health authorities. OBJECTIVE To explore the perceptions of pharmacists and physicians regarding the generic substitution driven by new Spanish drugs policies as well as their adaptive strategies intended to lessen the impact of changes to their patients' treatment. METHODS Pharmacists (16) and physicians (13) from Ferrol and A Coruña participated in a qualitative study using semi-structured in-depth interviews. RESULTS Qualitative analysis allowed identification of nine key components in the substitution process: Enabling factors: 'Adequate information to patients', 'Acute treatments', 'Bioappearance', 'Prescription by Estate Official Denomination followed by laboratory name', 'Personalized dosage systems'. Obstructing factors: 'Generics/Authorities distrust', 'Lack of time', 'Patient characteristics', 'Pharmacy financial management'. CONCLUSIONS Pharmacists and physicians in our economic crisis context perceive different barriers resulting in difficulties in the generic substitution process. They have implemented strategies to capitalize on the enablers and overcome the additional budget-cut barriers imposed by the Administration that had prevented them from maintaining their patient's treatment preferences. Spanish health authorities could improve current legislation either by reducing the number of new laboratories of authorized generic manufacturers or by extending the pharmacist capability for equivalent drugs substitution.
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Affiliation(s)
- Cristina Mondelo-García
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain
| | - Elvia Mendoza
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain
| | - María-Jesús Movilla-Fernández
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain
| | - Carmen Coronado
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain.
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10
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Flores NM, Patel CA, Bookhart BK, Bacchus S. Consequences of non-medical switch among patients with type 2 diabetes. Curr Med Res Opin 2018; 34:1475-1481. [PMID: 29661086 DOI: 10.1080/03007995.2018.1465904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to describe real-world experiences following a non-medical switch among adults with type 2 diabetes mellitus (T2DM) in the United States. METHODS For this cross-sectional study, patients with T2DM (N = 451) provided data on demographics, and how a non-medical switch of their anti-hyperglycemic agent (AHA) affected their general health, HbA1c levels and medication management, via an Internet-based survey. Patients self-reported their level of satisfaction with the original medication and emotional reactions to the non-medical switch. Patients who recently experienced a non-medical switch of their AHA(s) (n = 379) were asked about the consequences of switching and their satisfaction with the switch (vs. the original) medication. RESULTS Patients most frequently reported feeling very/extremely frustrated, surprised, upset and angry in reaction to a non-medical switch. Patients were somewhat satisfied with their original medication. Between 20% and 30% of patients reported the non-medical switch had a moderate/major effect on their general health, diabetes, mental well-being and control over their health. The blood glucose levels of recent switchers were somewhat/much worse (20.7%) and medication management was somewhat/much worse (12.9%) on the switch (vs. the original) medication. Some recent switchers reported old symptoms returning (7.7%) and experiencing new side-effects (14.2%). CONCLUSIONS Approximately one in five patients reported a moderate/major negative impact on their blood glucose level, diabetes, mental well-being, general health and control over their health following a non-medical switch. Findings suggest that a non-medical switch may have unintended negative health consequences and results in considerable burden across multiple domains for a sizeable minority of patients with T2DM.
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Affiliation(s)
- Natalia M Flores
- a Health Outcomes Research , Kantar Health , Foster City , CA , USA
| | - Charmi A Patel
- b Health Economics & Outcomes Research , Janssen Pharmaceuticals Inc. , Titusville , NJ , USA
| | - Brahim K Bookhart
- b Health Economics & Outcomes Research , Janssen Pharmaceuticals Inc. , Titusville , NJ , USA
| | - Shaffeeulah Bacchus
- c Health Economics & Clinical Outcomes Research , Janssen Pharmaceuticals Inc. , Titusville , NJ , USA
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11
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Khandelwal N, Johns B, Hepp Z, Castelli-Haley J. The economic impact of switching from Synthroid for the treatment of hypothyroidism. J Med Econ 2018; 21:518-524. [PMID: 29458287 DOI: 10.1080/13696998.2018.1443110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS To compare hypothyroidism-related costs for patients who continuously used Synthroid and patients who switched from Synthroid to alternative therapies. MATERIALS AND METHODS Truven's Health Analytics MarketScan Commercial Claims and Encounters database from January 1, 2007 to June 30, 2014 was queried for US adults diagnosed with hypothyroidism who initiated Synthroid and adhered to such therapy for at least 6 months. Propensity score matching matched continuous users of Synthroid to patients who switched from Synthroid to alternative levothyroxine agents. Kruskal-Wallis tests assessed differences between the matched cohorts in several categories of costs, including disease-related drug costs, non-drug medical costs, and total direct medical costs. RESULTS There were 10,159 individuals included in the study, with 7,991 continuous users of Synthroid and 2,168 switchers. After matching (n = 2,052 for each cohort), continuous use of Synthroid was associated with significantly lower hypothyroidism-related non-drug medical costs ($595 vs $1,023; p = .003) and reduced hypothyroidism-related total medical costs ($757 vs $1,132; p = .010), despite being associated with significantly higher drug costs ($161 vs $109; p < .001). Hypothyroidism-related total medical costs rose as the number of switches of hypothyroidism treatment increased, with continuous users having significantly lower hypothyroidism-related total medical costs ($757) compared with patients who switched twice ($1,179; p = .001) or three or more times ($1,268; p = .004). LIMITATIONS The analyses focused on continuously insured patients who were adherent to Synthroid for at least 6 months and results may not be generalizable. The reliance on claims data does not allow for clinical examination of hypothyroidism or inclusion of some factors that may be associated with outcomes. The analyses assume that all prescriptions filled are taken as prescribed. CONCLUSIONS Results indicate that there are significant direct economic healthcare costs associated with switching from Synthroid to alternative levothyroxine therapies, and that these costs increase as patients switch therapies more frequently.
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Affiliation(s)
| | | | - Zsolt Hepp
- a AbbVie, Inc. , North Chicago , IL , USA
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12
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Abstract
Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003-2013 using key words of "generic switching" or "substitution" was conducted using PubMed, OvidSP, and ScienceDirect. Of 30 articles identified and reviewed, most were related to the diseases of the central nervous system, especially epilepsy. Based on our review, potential impacts of switching fell into 3 broad categories: patient attitudes and adherence, clinical and safety outcomes, and cost and resource utilization. Although in many cases generics may represent an appropriate alternative to branded products, this may not always be the case. Specifically, several studies suggested that switching may negatively impact medication adherence, whereas other studies found that generic switching was associated with poorer clinical outcomes and more adverse events. In some instances, switching accomplished cost savings but did so at increased total cost of care because of increased physician visits or hospitalizations. Although in many cases generics may represent an appropriate alternative, mandatory generic switching may lead to unintended consequences, especially in certain therapeutic areas. Although further study is warranted, based on our review, it may be medically justifiable for physicians and patients to retain the right to request the branded product in certain cases.
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The Effect of Dongeui Qigong for Prehypertension and Mild Essential Hypertension. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:4274538. [PMID: 29234395 PMCID: PMC5671714 DOI: 10.1155/2017/4274538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/09/2017] [Accepted: 09/24/2017] [Indexed: 11/17/2022]
Abstract
Although several previous studies have reported the effect of qigong on lowering blood pressure, rigorous trials are lacking. Studies evaluating the effect of qigong on prehypertension are also scarce. This study aimed to assess the effect of qigong on prehypertension and mild hypertension. Participants with prehypertension or mild hypertension were randomized to the Dongeui qigong group or a nontreated control group. In the qigong group, Dongeui qigong was administered 5 times/week for 12 weeks. The control group did not receive any intervention for blood pressure control. Fifty-two participants were included in this study. Even though diastolic blood pressure was significantly reduced in the qigong group after 8 weeks (p = 0.04) compared to baseline, the difference in change in blood pressure between the qigong and control groups was not significant. There were no significant differences in quality of life between the qigong and control groups. Dongeui qigong is not significantly effective in pre/mild hypertension compared with controls. This result could be due to a lack of effect of qigong or caused by other factors, such as the type of qigong, target symptoms, inappropriate sample size, and compliance of participants. Trial Registration. This trial is registered with KCT0001397 (Clinical Research Information Service).
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14
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Barata-Silva C, Hauser-Davis RA, Silva ALOD, Moreira JC. Desafios ao controle da qualidade de medicamentos no Brasil. ACTA ACUST UNITED AC 2017. [DOI: 10.1590/1414-462x201700030075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Resumo Introdução O desenvolvimento científico e tecnológico, assim como a adoção de políticas públicas voltadas à redução do custo dos medicamentos, tem ampliado o acesso da população a alternativas terapêuticas, as quais incluem medicamentos genéricos, biossimilares, nanomedicamentos e complexos não biológicos. As categorias já comercializadas exigem procedimentos próprios para a garantia de sua qualidade, eficácia terapêutica e segurança. Nesse contexto, o presente estudo procura realizar uma avaliação do cenário atual no Brasil sobre esse tema, apontando para situações que certamente terão de ser enfrentadas em um futuro próximo. Metodologia Foi realizado um levantamento de dados nas bases eletrônicas MEDLINE, PubMed e SCIELO, buscando artigos originais, tanto em português quanto em inglês, indexados retrospectivamente até 1999. Foram utilizados termos de busca relevantes em língua portuguesa e inglesa. Mais de 50 artigos científicos foram encontrados. Resultados e Discussão A maioria dos artigos avaliados aponta problemas tanto na fabricação quanto no controle de medicamentos genéricos e biossimilares, seja no mercado internacional, seja no nacional. No entanto, novas formas medicamentosas estão sendo criadas e necessitam do desenvolvimento de legislação e de metodologias específicas para a garantia da qualidade desses produtos. Uma avaliação do atual sistema brasileiro de registro e controle da qualidade aponta falhas e, especialmente, falta de uma farmacovigilância mais bem estruturada e ativa no país. Conclusão O atual cenário demonstra que os órgãos responsáveis no país necessitam rever a atual sistemática utilizada na fabricação e controle de medicamentos e aprimorá-la, bem como se preparar para o enfrentamento de outras demandas, algumas ainda mais complexas, que já se encontram em desenvolvimento.
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Costa FV. Improving Adherence to Treatment and Reducing Economic Costs of Hypertension: The Role of Olmesartan-Based Treatment. High Blood Press Cardiovasc Prev 2017; 24:265-274. [PMID: 28695464 DOI: 10.1007/s40292-017-0221-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/30/2017] [Indexed: 02/06/2023] Open
Abstract
Poor adherence to antihypertensive treatment is the single most important factor of unsatisfactory blood pressure (BP) control. This review focuses on therapy-related factors affecting adherence and suggests how to improve it with a wise choice of treatment schedule. Complex drug treatment schemes, poor tolerability and drug substitutions are frequent causes of poor adherence which, in turn, causes insufficient BP control, greater incidence of cardiovascular events and, finally, higher global health costs. The effects of prescribing generic drugs and of drug substitutions on adherence is also discussed. In terms of adherence, generic drugs do not seem to be better than branded drugs, unless patients have to bear very high "out of pocket" expenses to buy original drugs, suggesting no advantages in switching drug with the mere goal of reducing the cost of therapy. An important role in improving adherence (and thus cardiovascular events and health expenditure) is also played by the availability of fixed-dose combinations; among antihypertensive drugs, angiotensin receptor blockers (ARBs) are those associated with higher levels of adherence and persistence. Among ARBs, olmesartan stands out for a wide choice of effective fixed-dose combinations.
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Attara G. Pharmacare: Are we getting the right medicines? Healthc Manage Forum 2017; 30:193-196. [PMID: 28929869 DOI: 10.1177/0840470417696710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Canada is the only country in the world with a national healthcare plan that does not include drug coverage. Coverage of necessary medications is a patchwork of inconsistent programs that does not always serve the very individuals it was created to help-those patients who need prescribed medicines. Our system needs radical, intuitive changes.
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Affiliation(s)
- Gail Attara
- 1 Gastrointestinal Society, Vancouver, British Columbia, Canada
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17
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Wong J, Motulsky A, Abrahamowicz M, Eguale T, Buckeridge DL, Tamblyn R. Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system. BMJ 2017; 356:j603. [PMID: 28228380 PMCID: PMC5320934 DOI: 10.1136/bmj.j603] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective To examine off-label indications for antidepressants in primary care and determine the level of scientific support for off-label prescribing.Design Descriptive study of antidepressant prescriptions written by primary care physicians using an indication based electronic prescribing system.Setting Primary care practices in and around two major urban centres in Quebec, Canada.Participants Patients aged 18 years or older who visited a study physician between 1 January 2003 and 30 September 2015 and were prescribed an antidepressant through the electronic prescribing system.Main outcome measures Prevalence of off-label indications for antidepressant prescriptions by class and by individual drug. Among off-label antidepressant prescriptions, the proportion of prescriptions in each of the following categories was measured: strong evidence supporting use of the prescribed drug for the respective indication; no strong evidence for the prescribed drug but strong evidence supporting use of another drug in the same class for the indication; or no strong evidence supporting use of the prescribed drug and all other drugs in the same class for the indication. Results 106 850 antidepressant prescriptions were written by 174 physicians for 20 920 adults. By class, tricyclic antidepressants had the highest prevalence of off-label indications (81.4%, 95% confidence interval, 77.3% to 85.5%), largely due to a high off-label prescribing rate for amitriptyline (93%, 89.6% to 95.7%). Trazodone use for insomnia was the most common off-label use for antidepressants, accounting for 26.2% (21.9% to 30.4%) of all off-label prescriptions. For only 15.9% (13.0% to 19.3%) of all off-label prescriptions, the prescribed drug had strong scientific evidence for the respective indication. For 39.6% (35.7% to 43.2%) of off-label prescriptions, the prescribed drug did not have strong evidence but another antidepressant in the same class had strong evidence for the respective indication. For the remaining 44.6% (40.2% to 49.0%) of off-label prescriptions, neither the prescribed drug nor any other drugs in the class had strong evidence for the indication.Conclusions When primary care physicians prescribed antidepressants for off-label indications, these indications were usually not supported by strong scientific evidence, yet often another antidepressant in the same class existed that had strong evidence for the respective indication. There is an important need to generate and provide physicians with evidence on off-label antidepressant use to optimise prescribing decisions.
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Affiliation(s)
- Jenna Wong
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Aude Motulsky
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, School of Public Health, University of Montréal, Montréal, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Tewodros Eguale
- Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - David L Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
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Vedanthan R, Bernabe-Ortiz A, Herasme OI, Joshi R, Lopez-Jaramillo P, Thrift AG, Webster J, Webster R, Yeates K, Gyamfi J, Ieremia M, Johnson C, Kamano JH, Lazo-Porras M, Limbani F, Liu P, McCready T, Miranda JJ, Mohan S, Ogedegbe O, Oldenburg B, Ovbiagele B, Owolabi M, Peiris D, Ponce-Lucero V, Praveen D, Pillay A, Schwalm JD, Tobe SW, Trieu K, Yusoff K, Fuster V. Innovative Approaches to Hypertension Control in Low- and Middle-Income Countries. Cardiol Clin 2017; 35:99-115. [PMID: 27886793 PMCID: PMC5131527 DOI: 10.1016/j.ccl.2016.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Elevated blood pressure, a major risk factor for ischemic heart disease, heart failure, and stroke, is the leading global risk for mortality. Treatment and control rates are very low in low- and middle-income countries. There is an urgent need to address this problem. The Global Alliance for Chronic Diseases sponsored research projects focus on controlling hypertension, including community engagement, salt reduction, salt substitution, task redistribution, mHealth, and fixed-dose combination therapies. This paper reviews the rationale for each approach and summarizes the experience of some of the research teams. The studies demonstrate innovative and practical methods for improving hypertension control.
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Affiliation(s)
- Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Omarys I Herasme
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Rohina Joshi
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | | | - Amanda G Thrift
- School of Clinical Sciences at Monash Health, Monash University, Wellington Road and Blackburn Road, Clayton, VIC 3800, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Ruth Webster
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Karen Yeates
- School of Medicine, Queens University, 15 Arch Street, Kingston, ON K7L 3N6, Canada
| | - Joyce Gyamfi
- School of Medicine, New York University, 550 1st Avenue, New York, NY 10016, USA
| | - Merina Ieremia
- Samoan Ministry of Health, Motootua, Ifiifi street, Apia, Samoa
| | - Claire Johnson
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Jemima H Kamano
- College of Health Sciences, School of Medicine, Moi University, PO Box 3900, Eldoret 30100, Kenya
| | - Maria Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Felix Limbani
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg 2000, South Africa
| | - Peter Liu
- University of Ottawa, 75 Laurier Avenue East, Ottawa, ON K1N 6N5, Canada
| | - Tara McCready
- Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Sailesh Mohan
- Public Health Foundation of India, Plot No. 47, Sector 44, New Delhi, India
| | - Olugbenga Ogedegbe
- School of Medicine, New York University, 550 1st Avenue, New York, NY 10016, USA
| | - Brian Oldenburg
- School of Population and Global Health, University of Melbourne, Parkville, VC 3010, Australia
| | - Bruce Ovbiagele
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | | | - David Peiris
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Vilarmina Ponce-Lucero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Devarsetty Praveen
- The George Institute for Global Health, 301 ANR Centre, Road No 1, Banjara Hills, Hyderabad 500034, India
| | - Arti Pillay
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, Fiji National University, Suva, Fiji
| | - Jon-David Schwalm
- Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Sheldon W Tobe
- University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A1, Canada
| | - Kathy Trieu
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selangor and UCSI University, Kuala Lumpur, Malaysia
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
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Nguyen E, Weeda ER, Sobieraj DM, Bookhart BK, Piech CT, Coleman CI. Impact of non-medical switching on clinical and economic outcomes, resource utilization and medication-taking behavior: a systematic literature review. Curr Med Res Opin 2016; 32:1281-90. [PMID: 27033747 DOI: 10.1185/03007995.2016.1170673] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate current knowledge of the impact of non-medical switching on clinical and economic outcomes, resource utilization and medication-taking behavior. METHODS The literature was searched (Medline and Web of Science, January 2000-November 2015) to identify United States' studies evaluating ≥25 patients and measuring the impact of non-medical switching of drugs (switching to a chemically distinct but similar medication for reasons other than lack of clinical efficacy/response, side effects or poor adherence) on ≥1 clinical, economic, resource utilization or medication-taking behavior outcome. The direction of association between non-medical switching and outcomes was classified as negative or positive if a statistically significant worsening or improvement was reported, or neutral if no significant difference was observed. RESULTS Twenty-nine studies contributed 96 outcomes (60.4% clinical; 21.9% resource utilization; 13.5% economic; 4.2% medication-taking behavior) within six disease categories (cardio-metabolic, immune-mediated, acid suppression, psychiatric, hormone replacement therapy and pain). The direction of association was more frequently negative (33.3%) or neutral (55.2%) than it was positive (11.5%). Stratified by outcome type, non-medical switching was negatively associated with clinical, economic, healthcare utilization and medication-taking behavior outcomes in 20.7%, 69.2%, 38.1% and 75.0% of cases, respectively; and positively in only 4.8%-17.2% of outcomes subgroups. Of 32 outcomes in patients demonstrating stable/well controlled disease, 68.8% and 31.3% had a negative and neutral direction of association. In patients without demonstrated disease stability, outcomes were negatively, neutrally and positively impacted by non-medical switching in 15.6%, 67.2% and 17.2% of 64 outcomes. LIMITATIONS Our inability to evaluate specific disease state categories and studies/outcomes received equal weight regardless of sample size or magnitude of effect. CONCLUSIONS Non-medical switching was more often associated with negative or neutral effects than positive effects on an array of important outcomes. Among patients with stable/well controlled disease, non-medical switching was associated with mostly negative effects.
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Affiliation(s)
- Elaine Nguyen
- a University of Connecticut School of Pharmacy , Storrs , CT , U.S.A.
- b Hartford Hospital Evidence-Based Practice Center , Hartford , CT , U.S.A.
| | - Erin R Weeda
- a University of Connecticut School of Pharmacy , Storrs , CT , U.S.A.
- b Hartford Hospital Evidence-Based Practice Center , Hartford , CT , U.S.A.
| | - Diana M Sobieraj
- a University of Connecticut School of Pharmacy , Storrs , CT , U.S.A.
- b Hartford Hospital Evidence-Based Practice Center , Hartford , CT , U.S.A.
| | | | | | - Craig I Coleman
- a University of Connecticut School of Pharmacy , Storrs , CT , U.S.A.
- b Hartford Hospital Evidence-Based Practice Center , Hartford , CT , U.S.A.
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Carcel C, Sato S, Anderson CS. Blood Pressure Management in Intracranial Hemorrhage: Current Challenges and Opportunities. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:22. [PMID: 26909816 DOI: 10.1007/s11936-016-0444-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OPINION STATEMENT Non-traumatic intracranial hemorrhage (i.e. intracerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]) are more life threatening and least treatable despite being less common than ischemic stroke. Elevated blood pressure (BP) is a strong predictor of poor outcome in both ICH and SAH. Data from a landmark clinical trial INTERACT 2, wherein 2839 participants enrolled with spontaneous ICH were randomly assigned to receive intensive (target systolic BP <140 mmHg) or guideline recommended BP lowering therapy (target systolic BP <180 mmHg), showed that intensive BP lowering was safe, and more favorable functional outcome and better overall health-related quality of life were seen in survivors in the intensive treatment group. These results contributed to the shift in European and American guidelines towards more aggressive early management of elevated BP in ICH. In contrast, the treatment of BP in SAH is less well defined and more complex. Although there is consensus that hypertension needs to be controlled to prevent rebleeding in the acute setting, induced hypertension in the later stages of SAH has questionable benefits.
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Affiliation(s)
- Cheryl Carcel
- Neurological and Mental Health Division, The George Institute for Global Health, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Shoichiro Sato
- Neurological and Mental Health Division, The George Institute for Global Health, Sydney, NSW, Australia
| | - Craig S Anderson
- Neurological and Mental Health Division, The George Institute for Global Health, Sydney, NSW, Australia. .,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. .,Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. .,The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia.
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21
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O'Leary A, Usher C, Lynch M, Hall M, Hemeryk L, Spillane S, Gallagher P, Barry M. Generic medicines and generic substitution: contrasting perspectives of stakeholders in Ireland. BMC Res Notes 2015; 8:790. [PMID: 26670010 PMCID: PMC4678461 DOI: 10.1186/s13104-015-1764-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 11/30/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Health (Pricing and Supply of Medical Goods) Act 2013 passed into law in July 2013 and legislated for generic substitution in Ireland. The aim of the study was to ascertain the knowledge and perceptions of stakeholders i.e. patients, pharmacists and prescribers, of generic medicines and to generic substitution with the passing of legislation. METHODS Three stakeholder specific questionnaires were developed to assess knowledge of and perceptions to generic medicines and generic substitution. Purposive samples of patients, prescribers and pharmacists were analysed. Descriptive quantitative and qualitative analyses were undertaken. RESULTS AND DISCUSSION A total of 762 healthcare professionals and 353 patients were recruited. The study highlighted that over 84% of patients were familiar with generic medicines and are supportive of the concept of generic substitution. Approximately 74% of prescribers and 84% of pharmacists were supportive of generic substitution in most cases. The main areas of concern highlighted by the healthcare professionals that might impact on the successful implementation of the policy, were the issue of bioequivalence with generic medicines, the computer software systems used at present in general practitioner (GP) surgeries and the availability of branded generics. The findings from this study identify a high baseline rate of acceptance to generic medicines and generic substitution among patients, prescribers and pharmacists in the Irish setting. The concerns of the main stakeholders provide a valuable insight into the potential difficulties that may arise in its implementation, and the need for on-going reassurance and proactive dissemination of the impact of the generic substitution policy. CONCLUSION The existing positive attitude to generic medicines and generic substitution among key stakeholders in Ireland to generic substitution, combined with appropriate support and collaboration should result in the desired increase in rates of prescribing, dispensing and use of generic medicines.
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Affiliation(s)
- A O'Leary
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland.
- School of Pharmacy, Royal College of Surgeons, St. Stephens Green, Dublin 2, Ireland.
| | - C Usher
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland.
| | - M Lynch
- School of Pharmacy, Royal College of Surgeons, St. Stephens Green, Dublin 2, Ireland.
| | - M Hall
- Department of Pharmacology and Therapeutics, St. James's Hospital, Dublin 8, Ireland.
| | - L Hemeryk
- Department of Pharmacology and Therapeutics, St. James's Hospital, Dublin 8, Ireland.
| | - S Spillane
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland.
| | - P Gallagher
- School of Pharmacy, Royal College of Surgeons, St. Stephens Green, Dublin 2, Ireland.
| | - M Barry
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland.
- Department of Pharmacology and Therapeutics, St. James's Hospital, Dublin 8, Ireland.
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22
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Kaló Z, Holtorf AP, Alfonso-Cristancho R, Shen J, Ágh T, Inotai A, Brixner D. Need for multicriteria evaluation of generic drug policies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:346-51. [PMID: 25773570 DOI: 10.1016/j.jval.2014.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 10/26/2014] [Accepted: 12/10/2014] [Indexed: 05/16/2023]
Abstract
Policymakers tend to focus on improving patented drug policies because they are under pressure from patients, physicians, and manufacturers to increase access to novel therapies. The success of pharmaceutical innovation over the last few decades has led to the availability of many off-patent drugs to treat disease areas with the greatest public health need. Therefore, the success of public health programs in improving the health status of the total population is highly dependent on the efficiency of generic drug policies. The objective of this article was to explore factors influencing the true efficiency of generic prescription drug policies in supporting public health initiatives in the developed world. Health care decision makers often assess the efficiency of generic drug policies by the level of price erosion and market share of generics. Drug quality, bioequivalence, in some cases drug formulations, supply reliability, medical adherence and persistence, health outcomes, and nondrug costs, however, are also attributes of success for generic drug policies. Further methodological research is needed to measure and improve the efficiency of generic drug policies. This also requires extension of the evidence base of the impact of generic drugs, partly based on real-world evidence. Multicriteria decision analysis may assist policymakers and researchers to evaluate the true value of generic drugs.
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Affiliation(s)
- Zoltán Kaló
- Faculty of Social Sciences, Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE), Budapest, Hungary; Syreon Research Institute, Budapest, Hungary.
| | - Anke-Peggy Holtorf
- Health Outcomes Strategies, Basel, Switzerland; Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | | | - Jie Shen
- Abbott Products Operations AG, Allschwil, Switzerland
| | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary
| | | | - Diana Brixner
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
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Takizawa O, Urushihara H, Tanaka S, Kawakami K. Price difference as a predictor of the selection between brand name and generic statins in Japan. Health Policy 2015; 119:612-9. [PMID: 25697888 DOI: 10.1016/j.healthpol.2015.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 01/07/2015] [Accepted: 01/15/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to explore the predictors of the selection between brand name drug (BR) and generic drug (GE) and to clarify the quantitative relationship about selection. METHODS We identified "incident users" who dispensed statins between April 2008 and June 2011 in commercially databases consisted of dispensing claims databases (DCD) of out-of-hospital pharmacies and hospital claims databases (HCD) of in-house pharmacies in Japan. Predictors of the selection between BR and GE, including price difference (PD), the price of BR, their interaction and percent change of the price of GE relative to BR were explored by logistic regression using DCD and HCD separately. RESULTS We extracted records of 670 patients who have opportunity for selection both BR and GE. Logistic regression analysis demonstrated that PD, the price of BR, interaction between them, and prescriber affiliation were factors significantly associated with the selection in the DCD; logit (p)=9.735-0.251×PD-0.071×the price of BR+0.002×PD×the price of BR-1.816×affiliation+0.220×gender-0.008×age+0.038×monthly medical fee. PD was inversely proportional to BR choice in DCD and lead to the opposite result in HCD. Numerical simulation of selection revealed that the quantitative relationships heavily depend on situations. CONCLUSIONS PD and the price of BR are predictors of the selection between BR and GE interactively in out-of-hospital pharmacies, but not in in-house pharmacies of medical facilities. Results may support policies which increase the power of out-of-hospital pharmacies for selection.
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Affiliation(s)
- Osamu Takizawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Hisashi Urushihara
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
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Jiang XJ, Liu ZL, She Q, Ying YH, Huang J, Deng SB, Zhou LY, Ye SQ, Hu R. Blood pressure control rate and associated risk factors in hospitals of different grades in Chongqing, China. Int J Cardiol 2014; 176:800-4. [PMID: 25150470 DOI: 10.1016/j.ijcard.2014.07.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/27/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The present article aimed to provide accurate estimate of the control rate of hypertension and the influencing factors in hospitals of different grades in Chongqing. METHODS In this survey, hypertensive outpatients were recruited from 5 tertiary hospitals, 6 secondary hospitals and 5 primary hospitals in 9 districts of Chongqing from November 2011 to May 2012. Outpatients were investigated by clinical interview with BP measurement and questionnaire. Univariate analyses and logistic regression analysis was used to assess the effect of variables on control of hypertension. RESULT A total of 2742 hypertensives were studied, of which 820 were from primary hospitals, 901 from secondary hospitals and 1021 from tertiary hospitals. The total control rate for hypertensive outpatients in Chongqing was 46.0%. The control rate of the primary,secondary and tertiary hospitals were 38.7%、46.7%、51.1%. Multinomial Logistic Regression showed that the control rate was positively correlated with mastery of knowledge of hypertension, normal BMI;whereas it was positively correlated with peasantry,the dissatisfactory with doctor's manner and the distrust to doctor. CONCLUSION Blood pressure control rate of hypertensive outpatients in Chongqing was low.High BMI, peasantry, lack of knowledge of hypertension, doctors' manners, distrust to doctor were the key reasons for low BP control rate.
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Affiliation(s)
- Xiu-Juan Jiang
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhan-Lan Liu
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; The Central Hospital of Xiaogan, China
| | - Qiang She
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue-Hui Ying
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Huang
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Song-Bai Deng
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Yuan Zhou
- Division of Cardiology, People's Hospital of Santai Country, Sichuan, Province, China
| | - Shi-Quan Ye
- Division of Cardiology, People's Hospital of Santai Country, Sichuan, Province, China
| | - Rong Hu
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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The hypotensive agent dodoneine inhibits L-type Ca2+ current with negative inotropic effect on rat heart. Eur J Pharmacol 2014; 728:119-27. [DOI: 10.1016/j.ejphar.2014.01.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/23/2014] [Accepted: 01/29/2014] [Indexed: 12/29/2022]
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Salam A, Webster R, Singh K, Kallakuri S, Rodgers A, Prabhakaran D, Maulik PK, Jan S, Thom S, Naik N, Guggilla R, Selak V, Patel A. TRIple pill vs Usual care Management for Patients with mild-to-moderate Hypertension (TRIUMPH): Study protocol. Am Heart J 2014; 167:127-32. [PMID: 24439972 DOI: 10.1016/j.ahj.2013.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/20/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypertension management strategies have traditionally focused on "tailored therapy" and "stepped-care" approaches. These tend to be costly and time consuming and often fail to achieve adequate blood pressure (BP) control. The TRIUMPH study aims to investigate the effectiveness, cost-effectiveness, and acceptability of early use of a 3-in-1 BP-lowering pill ("Triple Pill") compared with usual care for the management of hypertension. METHODS The prospective, open, randomized controlled clinical trial (n = 700) will compare Triple Pill-based strategy to usual care among individuals with persistent mild-to-moderate hypertension (systolic BP >140 mm Hg and/or diastolic BP >90 mm Hg, or systolic BP >130 mm Hg and/or diastolic BP >80 mm Hg in patients with diabetes or chronic kidney disease) on no or minimal drug therapy. The study will be conducted within approximately 20 hospital-based clinics in India. Participants will be randomized to the Triple Pill (initially strength 1-telmisartan 20 mg, amlodipine 2.5 mg, hydrochlorothiazide 6.25 mg, with the option of subsequent titration to strength 2-telmisartan 40 mg, amlodipine 5 mg, hydrochlorothiazide 12.5 mg) or continued usual care. Participants will be followed up for 6 months. The primary outcome is the proportion of participants achieving target BP at the end follow-up. CONCLUSION This study will determine whether early use of a low-dose triple combination therapy has the potential to address some of the challenges in hypertension control through earlier achievement of BP control, better adherence, and fewer adverse effects, in the context of less intensive clinical follow-up.
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Sander JW, Ryvlin P, Stefan H, Booth DR, Bauer J. Generic substitution of antiepileptic drugs. Expert Rev Neurother 2014; 10:1887-98. [DOI: 10.1586/ern.10.163] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sousa CVE, Mesquita JMCD, Lara JE. [Analysis of the decision to buy medicine in light of the existence of generic products: a study in the city of Belo Horizonte, Brazil]. CIENCIA & SAUDE COLETIVA 2013; 18:3311-20. [PMID: 24196896 DOI: 10.1590/s1413-81232013001100021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/13/2012] [Indexed: 11/22/2022] Open
Abstract
The scope of this study is to identify the factors that influence the consumer's decision when buying medicine. Prior to the Generics Act (Lei dos Genéricos), consumers had at their disposal two product purchase options in the private market, namely buying a reference drug and a similar one. Generic drugs are part of a public policy which was intended to broaden access to medication by the general population at more accessible costs, while maintaining the same quality as the reference drug, as ensured by bioequivalence tests from the national health surveillance agency ANVISA. Nevertheless, a question arises as to whether the potential consumer knows the difference between generic, similar and reference drugs, especially when taking into account the decision at the moment of purchase. In order to fulfill the proposed objective, a survey was conducted with 403 residents in Belo Horizonte, Brazil. The data gathered was tabulated and analyzed using factor analysis and crosstab. The results made it possible to infer that there is a strong predisposition among consumers to accept the suggestions of the pharmacists and/or salesman, and a significant portion of the population is confused at the moment of purchase.
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Alahdab OG, Crealey G, Scott MG, Mairs J, McElnay JC. Product standardisation as a tool to control prescribing costs – a case study of alginate liquid preparations. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2013; 21:73-81. [DOI: 10.1111/j.2042-7174.2012.00230.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 05/03/2012] [Indexed: 11/29/2022]
Abstract
Abstract
Introduction
Product standardisation involves promoting the prescribing of pre-selected products within a particular category across a healthcare region and is designed to improve patient safety by promoting continuity of medicine use across the primary/secondary care interface, in addition to cost containment without compromising clinical care (i.e. maintaining safety and efficacy).
Objectives
To examine the impact of product standardisation on the prescribing of compound alginate preparations within primary care in Northern Ireland.
Methods
Data were obtained on alginate prescribing from the Northern Ireland Central Services Agency (Prescription Pricing Branch), covering a period of 43 months. Two standardisation promotion interventions were carried out at months 18 and 33. In addition to conventional statistical analyses, a simple interrupted time series analysis approach, using graphical interpretation, was used to facilitate interpretation of the data.
Results
There was a significant increase in the prescribed share of the preferred alginate product in each of the four health boards in Northern Ireland and a decrease in the cost per Defined Daily Dose for alginate liquid preparations overall. Compliance with the standardisation policy was, however, incomplete and was influenced to a marked degree by the activities of the pharmaceutical industry. The overall economic impact of the prescribing changes during the study was small (3.1%).
Conclusion
The findings suggested that product standardisation significantly influenced the prescribing pattern for compound alginate liquid preparations within primary care across Northern Ireland.
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Affiliation(s)
- Ola G Alahdab
- Clinical and Practice Research Group (CPRG), School of Pharmacy, Queen's University, Northern Ireland, UK
| | - Grainne Crealey
- Clinical Research Support Centre, Royal Group of Hospitals Trust, Belfast, Northern Ireland, UK
| | - Michael G Scott
- Pharmacy and Medicines Management, Northern Health and Social Care Trust, Antrim, Northern Ireland, UK
| | - Jill Mairs
- Pharmaceutical Procurement Centre, Whiteabbey Hospital, Newtownabbey, Northern Ireland, UK
| | - James C McElnay
- Clinical and Practice Research Group (CPRG), School of Pharmacy, Queen's University, Northern Ireland, UK
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Dunne S, Shannon B, Dunne C, Cullen W. A review of the differences and similarities between generic drugs and their originator counterparts, including economic benefits associated with usage of generic medicines, using Ireland as a case study. BMC Pharmacol Toxicol 2013; 14:1. [PMID: 23289757 PMCID: PMC3579676 DOI: 10.1186/2050-6511-14-1] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 12/24/2012] [Indexed: 12/31/2022] Open
Abstract
Generic medicines are those where patent protection has expired, and which may be produced by manufacturers other than the innovator company. Use of generic medicines has been increasing in recent years, primarily as a cost saving measure in healthcare provision. Generic medicines are typically 20 to 90% cheaper than originator equivalents. Our objective is to provide a high-level description of what generic medicines are and how they differ, at a regulatory and legislative level, from originator medicines. We describe the current and historical regulation of medicines in the world's two main pharmaceutical markets, in addition to the similarities, as well as the differences, between generics and their originator equivalents including the reasons for the cost differences seen between originator and generic medicines. Ireland is currently poised to introduce generic substitution and reference pricing. This article refers to this situation as an exemplar of a national system on the cusp of significant health policy change, and specifically details Ireland's history with usage of generic medicines and how the proposed changes could affect healthcare provision.
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Affiliation(s)
- Suzanne Dunne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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Westerlund T, Gelin U, Pettersson E, Skärlund F, Wågström K, Ringbom C. A retrospective analysis of drug-related problems documented in a national database. Int J Clin Pharm 2012. [PMID: 23187961 DOI: 10.1007/s11096-012-9724-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Numerous patients are subject to drug-related problems (DRPs) every day, resulting in sub-optimal therapy, suffering and decreased quality of life, as well as in high societal health care costs. Classifying DRPs is important for the development of counselling skills and for pharmaceutical care practice and research, including assessments of the value of pharmacists' clinical interventions. Pharmacy practitioners have also reported to become more attentive to patients' drug-related needs, when requested to document their clinical interventions. Several studies have been conducted on DRPs, but there is still a need for a more thorough knowledge about their nature and the reasons for their occurrence. To examine DRP characteristics and causes by retrospectively analysing data and patient case histories, as documented by pharmacy practitioners in the Swedish national DRP database. SETTING Community pharmacy based patient documentation, entered into the Swedish national DRP database. METHOD Documented DRPs, clinical interventions and patient data were retrospectively examined and analysed. Particular attention was paid to case history reports in free text fields. Only reports containing adequate information for analysis and actual, correctly categorised DRPs were included. MAIN OUTCOME MEASURE Subdivided DRP characteristics and causes. RESULTS Both similarities and differences between DRP subclasses of prescription patients (n = 5,571) and OTC drug consumers (n = 2,894) were observed. Most DRP categories could be subdivided into at least three subclasses, according to their characteristics. Causes of DRPs could be extracted from free text field reports in four prescription DRP categories and three OTC DRP categories. Uncertainty about the aim of the drug was commonly characterised by a lack of knowledge about the indication in prescription patients and in an inappropriate drug selection in OTC drug consumers. A switch from a brand-name drug to a generic drug or from one generic to another was the cause in half of the therapy failures, which in turn was a frequent reason for overuse of drug. CONCLUSION The study demonstrates the multi-facetted drug-related problems in patients and confirms the importance of attention by pharmacy practitioners for the detection of and intervention for DRPs.
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Affiliation(s)
- Tommy Westerlund
- Social Pharmacy, Department of Rational Use of Medicines, Medical Products Agency, Uppsala, Sweden.
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Mackenzie IS, Wei L, Paterson KR, Macdonald TM. Cluster randomized trials of prescription medicines or prescribing policy: public and general practitioner opinions in Scotland. Br J Clin Pharmacol 2012; 74:354-61. [PMID: 22288609 PMCID: PMC3437468 DOI: 10.1111/j.1365-2125.2012.04195.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS To understand public and general practitioner (GP) opinion on the acceptability of randomized policy design (RPD) studies (cluster randomized trials) of prescription medicines in Scotland. METHODS We surveyed public opinion on the concept of RPD studies in a sample of 1040 adults to determine acceptability and understand how people feel when changes are made to their medicines. We also surveyed GPs (n = 1034) about the concept of RPD studies as a tool for improving understanding of comparative effectiveness and safety of medicines in the ‘usual care’ setting. RESULTS Thirty per cent of people would be happy to receive a letter about randomized policy changes to their therapy, 31% would not mind or had no opinion and 39% would be unhappy. This view was sensitive to the reason for change; effectiveness and safety reasons were most acceptable (96%) and cost saving least acceptable (39%). Only 19% thought randomized policy change was not an acceptable method of determining the best treatments. Eighty-one per cent of respondents were willing for their medical data to be followed up to compare drug treatments (further 10% undecided). Participants reporting long-term medical conditions and those reporting previous changes to drug therapy were more in favour of RPD studies than other participants. Thirty-three per cent (n = 341) of GPs responded to our survey. Of these, 45% were in favour of RPD studies, 19% were undecided and 36% not in favour. CONCLUSIONS The public in Scotland is broadly supportive of the concept of randomized policy design studies of medicines, while there is a spread of opinion among GPs.
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Affiliation(s)
- Isla S Mackenzie
- Medicines Monitoring Unit-MEMO, University of Dundee, Dundee, UK.
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Baker TM, Goh J, Johnston A, Falvey H, Brede Y, Brown RE. Cost-effectiveness analysis of valsartan versus losartan and the effect of switching. J Med Econ 2012; 15:253-60. [PMID: 22084957 DOI: 10.3111/13696998.2011.641043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Losartan will shortly become generic, and this may encourage switching to the generic drug. However, valsartan was shown in a meta-analysis to be statistically superior in lowering blood pressure (BP) to losartan. This paper examines the costs of treatment with these two drugs and the potential consequences of switching established valsartan patients to generic losartan. METHODS A US payer cost-effectiveness model was developed incorporating the risk of cardiovascular disease (CVD) events related to systolic blood pressure (SBP) control comparing valsartan to continual losartan and switching from valsartan to generic losartan. The model, based upon a meta-analysis by Nixon et al. and Framingham equations, included first CVD event costs calculated from US administrative data sets and utility values from published sources. The modeled outcomes were number of CVD events, costs and incremental cost per quality-adjusted life-year (QALY) and life-year (LY). RESULTS Fewer patients had fatal and non-fatal CVD events with valsartan therapy compared with continual losartan and with patients switched from valsartan to generic losartan. The base-case model results indicated that continued treatment with valsartan had an incremental cost-effectiveness ratio of $27,268 and $25,460 per life year gained, and $32,313 and $30,170 per QALY gained, relative to continual losartan and switching treatments, respectively. Sensitivity analyses found that patient discontinuation post-switching was a sensitive parameter. Including efficacy offsets with lowered adherence or discontinuation resulted in more favorable ratios for valsartan compared to switching therapy. LIMITATIONS The model does not evaluate post-primary CVD events and considers change in SBP from baseline level as the sole predictor of CVD risk. CONCLUSIONS Valsartan appears to be cost-effective compared to switching to generic losartan and switching to the generic drug does not support a cost offset argument over the longer term. Physicians should continue to consider the needs of individual patient and not cost offsets.
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Vončina L, Strizrep T, Godman B, Bennie M, Bishop I, Campbell S, Vlahović-Palčevski V, Gustafsson LL. Influence of demand-side measures to enhance renin-angiotensin prescribing efficiency in Europe: implications for the future. Expert Rev Pharmacoecon Outcomes Res 2011; 11:469-79. [PMID: 21831028 DOI: 10.1586/erp.11.42] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED European countries strive to enhance prescribing efficiency. This includes renin-angiotensin drugs following the availability of generic angiotensin-converting enzyme inhibitors (ACEIs). AIMS To compare angiotensin receptor blocker utilization and expenditure patterns in Austria and Croatia following prescribing restrictions, as well as with other European countries introducing different supply- and demand-side measures. Lastly, to appraise the impact of generic losartan in Croatia on utilization of patented angiotensin receptor blockers. METHOD Observational retrospective study principally between 2001 and 2007, using defined daily doses and €/1000 inhabitants/year. Demand-side measures were based on the four 'E's - education, engineering, economics and enforcement. RESULTS Greater intensity of follow-up of prescribing restrictions in Croatia enhanced utilization of ACEIs versus Austria. There was high utilization of ACEIs in Scotland following intensive demand-side measures, similar to Austria and Croatia. Demand-side measures in Spain (Catalonia) and Sweden also appeared to moderate angiotensin receptor blockers utilization. The combination of measures helped stabilize expenditure on renin-angiotensin drugs when adjusted for population sizes despite appreciable increases in volumes. The only exception was Portugal, with less intensive measures. CONCLUSION Multiple and intensive demand-side measures enhanced prescribing efficiency. The more intense follow-up of ARB prescribing restrictions in Croatia had a greater influence on subsequent utilization patterns than Austria. Both findings confirm earlier studies. Reforms also favorably enhanced the prescribing of generic losartan once available.
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Affiliation(s)
- Luka Vončina
- Croatian Institute for Health Insurance, Margaretska 3, Zagreb, Croatia
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Underuse of generic medicines in Portugal: an empirical study on the perceptions and attitudes of patients and pharmacists. Health Policy 2011; 104:61-8. [PMID: 22024369 DOI: 10.1016/j.healthpol.2011.10.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 09/07/2011] [Accepted: 10/01/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objectives of this study were to identify: perceptions regarding underuse and characteristics of generic medicines; patients' attitudes towards drug substitution and pharmacists' attitudes towards substitution recommendation. METHODS Two questionnaires were designed and interviewer-administered - one to patients and another to pharmacists. A binary variable 'correct understanding' was created and multiple logistic regression analysis was used to identify factors associated with experience and willingness to accept generic medicine substitution. Statistical analyses were performed by SPSS version 19.0. RESULTS All of the 417 patients knew the term 'generic medicine'. Level of education, experience and discussion with doctor were significantly associated with correct understanding. 77.5% of respondents had consumed generic medicines and 88.7% (64.5%) were willing to accept drug substitution based on doctor's (pharmacist's) recommendation. Having at least one chronic condition, discussion with doctor and perception that generic drug substitution is cost-saving were significantly associated with experience. In addition to the last two, having correct understanding and having experience were significantly associated with willingness to accept generic drug substitution. 91.6% of pharmacists (95 respondents) said that drug substitution is recommended in their pharmacies. CONCLUSIONS More information should be given to patients preferably by doctors and pharmacists. Prescription should be encouraged and experience promoted.
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Loke YK, Ferro A, Lewis LD, Cohen AF, Somogyi A, Ritter JM. Editors' pick 2010. Br J Clin Pharmacol 2010; 71:3-6. [PMID: 21143495 DOI: 10.1111/j.1365-2125.2010.03862.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yoon K Loke
- School of Medicine, University of East Anglia, Norwich, UK
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