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Huo N, Chen L, Ullah Mishuk A, Li C, Hansen RA, Harris I, Kiptanui Z, Wang Z, Dutcher SK, Qian J. Generic levothyroxine initiation and substitution among Medicare and Medicaid populations: a new user cohort study. Endocrine 2020; 68:336-348. [PMID: 31993992 DOI: 10.1007/s12020-020-02211-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Generic levothyroxine has been approved and available since 2004 but its substitution remains controversial. Therefore, the objective was to examine patterns of and identify factors associated with initiation and substitution of generic levothyroxine treatment. METHODS This was a retrospective observational study, including new users of brand and generic levothyroxine in 2013-2015 Medicare (n = 15,877) or 2011-2012 Medicaid (n = 9390) administrative claim databases. The primary outcomes included (1) generic levothyroxine initiation, and (2) among brand-new users, generic levothyroxine substitution in 12 months. The factors associated with generic levothyroxine initiation and substitution were measured. RESULTS Among all levothyroxine new users, Medicare beneficiaries had a higher proportion of generic levothyroxine initiation than Medicaid beneficiaries (66.40% vs. 44.04%, respectively). Medicare beneficiaries' demographic factors, and health service utilizations were associated with generic levothyroxine initiation. Medicaid beneficiaries who were male and residing in the northeast region and rural areas were more likely to initiate generic levothyroxine. Among brand levothyroxine new users, the generic substitution rate was higher in the Medicare than the Medicaid cohort (18.26 vs. 3.88%). Medicare brand levothyroxine new users' demographic factors and health service utilizations were associated with generic levothyroxine substitution. Medicaid brand levothyroxine new users who were residing in the northeast region, with more prior hospitalization, and initiating a lower dosage of brand levothyroxine, had higher rates of generic substitution. CONCLUSION Patient demographic factors and health service utilizations are associated with generic levothyroxine initiation and substitution. Educational outreach programs targeted to increase generic levothyroxine use and prescription savings should be tailored based on different patient populations.
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Affiliation(s)
- Nan Huo
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Li Chen
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IL, USA
| | | | - Chao Li
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | | | | | | | - Zhong Wang
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sarah K Dutcher
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Jingjing Qian
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
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Smallridge RC, Sangaralingham LR, Mwangi R, Kusumoto F, Van Houten H, Bernet V. Comparison of Incident Cardiovascular Event Rates Between Generic and Brand l-Thyroxine for the Treatment of Hypothyroidism. Mayo Clin Proc 2019; 94:1190-1198. [PMID: 31036352 DOI: 10.1016/j.mayocp.2018.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/15/2018] [Accepted: 11/01/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine whether levothyroxine (L-T4) preparation (generic vs brand) affected hospitalization for cardiovascular events. PATIENTS AND METHODS We performed a retrospective analysis using a large administrative claims database, OptumLabs Data Warehouse, creating two 1-to-1 propensity score-matched cohorts initiating generic or brand L-T4. Patients were followed for a mean of 1.0±1.2 years (range, 0-9.3 years). We included 87,902 propensity score-matched patients (43,951 patients per cohort) initiating generic or brand L-T4. Variables included in matching were age, sex, race/ethnicity, residence region, selected comorbidities, and Charlson-Deyo comorbidity score. Patients with previous use of any thyroid preparation, amiodarone, or lithium were excluded. Primary outcomes were the event rates for hospitalizations for incident atrial fibrillation, myocardial infarction, congestive heart failure, or stroke. RESULTS In the generic L-T4 cohort, 35,242 (80.2%) were women and 7327 (16.7%) were 65 years of age or older; in the brand L-T4 cohort, 34,633 (78.8%) were women and 8092 (18.4%) were 65 years of age or older. We found no differences in event rates (events per 1000 person-years) for 4 outcomes comparing generic and brand L-T4 therapy: (1) atrial fibrillation (1.82 vs 2.19; hazard ratio [HR], 1.22; 95% CI, 0.90-1.65; P=.19); (2) myocardial infarction (2.12 vs 1.83; HR, 0.86; 95% CI, 0.64-1.17; P=.35); (3) congestive heart failure (2.27 vs 2.00; HR, 0.88; 95% CI, 0.66-1.18; P=.41); and (4) stroke (3.10 vs 2.38; HR, 0.77; 95% CI, 0.59-1.00; P=.05). Stratification by age group revealed no differences. CONCLUSION In patients with newly treated hypothyroidism, cardiovascular event rates were similar for generic and brand L-T4.
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Affiliation(s)
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; OptumLabs, Cambridge, MA
| | - Raphael Mwangi
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Fred Kusumoto
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Holly Van Houten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; OptumLabs, Cambridge, MA
| | - Victor Bernet
- Division of Endocrinology, Mayo Clinic, Jacksonville, FL
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Ross JS, Rohde S, Sangaralingham L, Brito JP, Choi L, Dutcher SK, Graham DJ, Jenkins MR, Lipska KJ, Mendoza M, Qiang Y, Wang Z, Wu Y, Yao X, Shah ND. Generic and Brand-Name Thyroid Hormone Drug Use Among Commercially Insured and Medicare Beneficiaries, 2007 Through 2016. J Clin Endocrinol Metab 2019; 104:2305-2314. [PMID: 30690529 DOI: 10.1210/jc.2018-02197] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/22/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Generic drugs account for 9 out of 10 prescriptions dispensed in the United States but for a lower proportion of commonly prescribed thyroid hormone replacement therapies. OBJECTIVE Characterize temporal patterns of generic and brand-name thyroid hormone drug use, including patient and prescriber characteristics associated with brand-name use. DESIGN AND SETTING Cross-sectional longitudinal analysis of national data from a large administrative claims database from January 2007 through December 2016. PATIENTS Adults with insurance coverage through commercial, Medicare Advantage, and Medicare Part D health plans. MAIN OUTCOME MEASURES Generic and brand-name thyroid hormone drug use. RESULTS From 2007 to 2016, the annual number of thyroid hormone treatment pharmacy fills increased from 8,905,836 in 2007 to 11,613,923 in 2016, 73.6% of which were for generic levothyroxine, 23.4% for brand-name levothyroxine, and the remaining for other formulations. Dispensing of generic thyroid hormone drugs increased from 59.8% in 2007 to 84.9% in 2016 and was consistently higher among Medicare Advantage and Medicare Part D when compared with the commercial beneficiary population. For all three beneficiary populations, use of brand-name products was less common among older adults and more common among women and those receiving prescriptions from endocrinologists and was more common among those of white race and with greater household income for the Medicare Advantage and commercial beneficiary populations (P < 0.001). CONCLUSIONS Brand-name thyroid hormone product use declined from 2007 to 2016 among three large, national insurer beneficiary populations. Although certain patient characteristics were associated with brand-name use, prescriber specialty was the strongest predictor.
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Affiliation(s)
- Joseph S Ross
- Section of General Internal Medicine and the National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut 06510
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut 06510
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut 06510
| | | | | | - Juan P Brito
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Lauren Choi
- Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, White Oak, Maryland 20993
| | - Sarah K Dutcher
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, White Oak, Maryland 20993
| | - David J Graham
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, White Oak, Maryland 20993
| | - Marjorie R Jenkins
- Office of Women's Health, US Food and Drug Administration, White Oak, Maryland 20993
| | - Kasia J Lipska
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut 06510
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut 06510
| | - Martin Mendoza
- Office of Minority Health, US Food and Drug Administration, White Oak, Maryland 20993
| | - Yandong Qiang
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, White Oak, Maryland 20993
| | - Zhong Wang
- Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, White Oak, Maryland 20993
| | - Yute Wu
- Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, White Oak, Maryland 20993
| | - Xiaoxi Yao
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota 55905
| | - Nilay D Shah
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota 55905
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