1
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Vinatier C, Hoffmann S, Patel C, DeVito NJ, Cristea IA, Tierney B, Ioannidis JPA, Naudet F. What is the vibration of effects? BMJ Evid Based Med 2024:bmjebm-2023-112747. [PMID: 38997151 DOI: 10.1136/bmjebm-2023-112747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Constant Vinatier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Centre d'investigation clinique de Rennes (CIC1414), Rennes, France
| | - Sabine Hoffmann
- Department of Statistics, Ludwig-Maximilians-Universität München, München, Germany
- LMU Open Science Center, Ludwig-Maximilians-Universität München, München, Germany
| | - Chirag Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas J DeVito
- Nuffield Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Braden Tierney
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, New York, USA
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Florian Naudet
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Centre d'investigation clinique de Rennes (CIC1414), Rennes, France
- Institut Universitaire de France (IUF), Paris, France
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2
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Cavanah LR, Ray P, Goldhirsh JL, Huey LY, Piper BJ. Rise of escitalopram and the fall of citalopram. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.07.23289632. [PMID: 37214883 PMCID: PMC10197723 DOI: 10.1101/2023.05.07.23289632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Introduction Citalopram and escitalopram are among the most used medications and are key treatments for many psychiatric disorders. Previous findings suggest citalopram and escitalopram prescription rates are changing because of the patent for citalopram ending as opposed to evidence of a clear therapeutic advantage, which is called evergreening. This retrospective study focuses on characterizing the chronologic and geographic variation in the use of citalopram and escitalopram among US Medicaid and Medicare patients. We hypothesized that prescription rates of citalopram will decrease with a concurrent increase in escitalopram, consistent with evergreening. Methods Citalopram and escitalopram prescription rates and costs per state were obtained from the Medicaid State Drug Utilization Database and Medicare Provider Utilization and Payment Data. Annual prescription rates outside a 95% confidence interval were considered significantly different from the average. Results Overall, a decreasing trend for citalopram and an increasing trend for escitalopram prescription rates were noted in both Medicare and Medicaid patients. Cost differences between generic and brand were noted for both drugs, with generic forms being cheaper compared to the brand-name version. Discussion Despite limited evidence suggesting that citalopram and escitalopram have any meaningful differences in therapeutic or adverse effects, there exists a noticeable decline in the use of citalopram that cooccurred with an increase in escitalopram prescribing, consistent with our hypothesis. Moreover, among these general pharmacoepidemiologic trends exists significant geographic variability. There was disproportionate spending (relative to their use) on the brand versions of these medicines compared to their generic forms.
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Affiliation(s)
| | - Parita Ray
- Geisinger Commonwealth School of Medicine, Scranton, PA
| | - Jessica L. Goldhirsh
- Geisinger Commonwealth School of Medicine, Scranton, PA
- Behavioral Health Initiative, Scranton, PA
| | - Leighton Y. Huey
- Geisinger Commonwealth School of Medicine, Scranton, PA
- Behavioral Health Initiative, Scranton, PA
| | - Brian J. Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA
- Center for Pharmacy Innovation and Outcomes, Forty Fort, PA
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3
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Andrade JKL, Fujimoto CJ, Hishinuma ES, Miyamoto IA, Agapoff JA, Kracher SL, Takeshita J, China CO. Evergreening of Psychiatric Medications: A Systemic Literature Review of Strategies, Case Examples, and the Implications of Cost. Community Ment Health J 2023; 59:451-458. [PMID: 36094749 DOI: 10.1007/s10597-022-01022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022]
Abstract
Evergreening consists of multiple ways that pharmaceutical companies extend patent protection and prolong profitability of brand name drugs past patent expiration. In psychotropic medications, these strategies do not necessarily make more effective drugs, and often increase drug prices, which can result in lower access and utilization. There has not been a systematic literature review of evergreening strategies for psychiatric medications. Based on such a review, 11 strategies were identified and relevant examples were provided. Four case examples of commonly used psychiatric medications indicated evergreen prices 3 to 211 times the cost of the original medication, and the evergreen costs ranging from $132.00 to $10,125.24 higher than the original cost on an annual basis. The higher cost of evergreening medications can create inefficiencies and waste in healthcare resulting in lower-quality patient care. Healthcare providers, patient advocates, health insurance companies, and policy-makers should be aware of these practices to improve healthcare systems.
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Affiliation(s)
- Joy K L Andrade
- Department of Psychiatry, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.
| | - Cierra J Fujimoto
- Department of Psychiatry, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Earl S Hishinuma
- Department of Psychiatry, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Isa A Miyamoto
- Department of Psychiatry, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Jame A Agapoff
- Department of Psychiatry, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Stacy L Kracher
- Department of Psychiatry, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Junji Takeshita
- Department of Psychiatry, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Carol O China
- Pharmacy Department, Queen's Medical Center, Honolulu, Hawai'i, USA
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4
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Godman B, Wladysiuk M, McTaggart S, Kurdi A, Allocati E, Jakovljevic M, Kalemeera F, Hoxha I, Nachtnebel A, Sauermann R, Hinteregger M, Marković-Peković V, Tubic B, Petrova G, Tachkov K, Slabý J, Nejezchlebova R, Krulichová IS, Laius O, Selke G, Langner I, Harsanyi A, Inotai A, Jakupi A, Henkuzens S, Garuolienė K, Gulbinovič J, Bonanno PV, Rutkowski J, Ingeberg S, Melien Ø, Mardare I, Fürst J, MacBride-Stewart S, Holmes C, Pontes C, Zara C, Pedrola MT, Hoffmann M, Kourafalos V, Pisana A, Banzi R, Campbell S, Wettermark B. Utilisation Trend of Long-Acting Insulin Analogues including Biosimilars across Europe: Findings and Implications. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9996193. [PMID: 34676266 PMCID: PMC8526244 DOI: 10.1155/2021/9996193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes mellitus rates and associated costs continue to rise across Europe enhancing health authority focus on its management. The risk of complications is enhanced by poor glycaemic control, with long-acting insulin analogues developed to reduce hypoglycaemia and improve patient convenience. There are concerns though with their considerably higher costs, but moderated by reductions in complications and associated costs. Biosimilars can help further reduce costs. However, to date, price reductions for biosimilar insulin glargine appear limited. In addition, the originator company has switched promotional efforts to more concentrated patented formulations to reduce the impact of biosimilars. There are also concerns with different devices between the manufacturers. As a result, there is a need to assess current utilisation rates for insulins, especially long-acting insulin analogues and biosimilars, and the rationale for patterns seen, among multiple European countries to provide future direction. Methodology. Health authority databases are examined to assess utilisation and expenditure patterns for insulins, including biosimilar insulin glargine. Explanations for patterns seen were provided by senior-level personnel. RESULTS Typically increasing use of long-acting insulin analogues across Europe including both Western and Central and Eastern European countries reflects perceived patient benefits despite higher prices. However, activities by the originator company to switch patients to more concentrated insulin glargine coupled with lowering prices towards biosimilars have limited biosimilar uptake, with biosimilars not currently launched in a minority of European countries. A number of activities were identified to address this. Enhancing the attractiveness of the biosimilar insulin market is essential to encourage other biosimilar manufacturers to enter the market as more long-acting insulin analogues lose their patents to benefit all key stakeholder groups. CONCLUSIONS There are concerns with the availability and use of insulin glargine biosimilars among European countries despite lower costs. This can be addressed.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Magdalene Wladysiuk
- Chair of Epidemiology and Preventive Medicine, Medical College, Jagiellonian University, Krakow, Poland
- HTA Consulting, Starowiślna Str. 17/3, 31-038 Krakow, Poland
| | - Stuart McTaggart
- Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche ‘Mario Negri' IRCCS, Milan, Italy
| | - Mihajlo Jakovljevic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Institute of Comparative Economic Studies, Faculty of Economics, Hosei University Tokyo, Tokyo, Japan
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Anna Nachtnebel
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Robert Sauermann
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Manfred Hinteregger
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Vanda Marković-Peković
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Tubic
- Faculty of Medicine, Department of Medicinal Chemistry, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Agency for Medicinal Product and Medical Devices of Bosnia and Herzegovina, 78000 Banja Luka, Bosnia and Herzegovina
| | - Guenka Petrova
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Juraj Slabý
- State Institute for Drug Control, Prague, Czech Republic
| | | | - Iva Selke Krulichová
- Department of Medical Biophysics, Faculty of Medicine in Hradec Králové, Charles University, Simkova 870, 500 03 Hradec Králové, Czech Republic
| | - Ott Laius
- State Agency of Medicines, Nooruse 1, 50411 Tartu, Estonia
| | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, 10178 Berlin, Germany
| | - Irene Langner
- Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, 10178 Berlin, Germany
| | - András Harsanyi
- Department of Health Policy and Health Economics, Eotvos Lorand University, Budapest, Hungary
| | - András Inotai
- Syreon Research Institute and Semmelweis University, Center of Health Technology Assessment, Budapest, Hungary
| | - Arianit Jakupi
- Faculty of Pharmacy, UBT Higher Education Institute, Pristina, Kosovo
| | | | - Kristina Garuolienė
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Health Services Management, University of Malta, Valletta, Malta
| | - Jakub Rutkowski
- HTA Consulting, Starowiślna Str. 17/3, 31-038 Krakow, Poland
| | - Skule Ingeberg
- Medicines Committee, Oslo University Hospitals, Oslo, Norway
| | - Øyvind Melien
- Medicines Committee, Oslo University Hospitals, Oslo, Norway
| | - Ileana Mardare
- Faculty of Medicine, Public Health and Management Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, 050463 Bucharest, Romania
| | - Jurij Fürst
- Health Insurance Institute, Miklosiceva 24, SI-1507 Ljubljana, Slovenia
| | | | | | - Caridad Pontes
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Corinne Zara
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | - Marta Turu Pedrola
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | | | - Vasileios Kourafalos
- National Organization for the Provision of Healthcare Services (EOPYY), Athens, Greece
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rita Banzi
- Istituto di Ricerche Farmacologiche ‘Mario Negri' IRCCS, Milan, Italy
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Bjorn Wettermark
- Department of Pharmacy, Disciplinary Domain of Medicine and Pharmacy, Uppsala University, Uppsala, Sweden
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5
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Revet A, Moulis G, Raynaud JP, Bui E, Lapeyre-Mestre M. Use of the French national health insurance information system for research in the field of mental health: Systematic review and perspectives. Fundam Clin Pharmacol 2021; 36:16-34. [PMID: 33998708 DOI: 10.1111/fcp.12696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE This systematic review registered in PROSPERO (CRD42021225296) aimed to describe the use of the French national health insurance information system, which covers the entire French population (67 million inhabitants), for research in the field of mental health. METHODS Three electronic databases and a journal hand-search identified 15 265 articles from January 1, 2003 (year of creation of the database) to October 31, 2020. Studies of any design were eligible for inclusion provided that they (i) made use of at least one component of the French health insurance database and (ii) focused on a topic in near and far connection with the field of mental health in France. Database used, design and methods, study period, population, key findings, and type of use for medical research were described. RESULTS A total of 152 studies were included in the review analysis. There was an increase in the number of published articles over time throughout the studied period. Studies focusing on adults (n = 139) largely outnumbered those focusing on children and adolescents (n = 11). Pharmacoepidemiological studies were by far the most frequent (n = 123), followed by methodological studies (n = 23), epidemiological studies (n = 17), and health economics studies (n = 3). The most studied psychotropic drugs were antidepressants (n = 27), anxiolytics (n = 27), and opioids (n = 25) while fewer studies focused on methylphenidate (n = 6) and on mood stabilizers (n = 5). Few studies specifically focused on psychiatric disorders, mainly depression (n = 4), suicide (n = 4), and psychotic disorders (n = 3). CONCLUSION This systematic review highlighted a relatively poor exploitation of the Système national des données de santé database in the field of psychiatric research with regard to the great possibilities it offers, with a clear lag in certain fields such as epidemiological or health economics studies and in specific populations, in particular children and adolescents.
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Affiliation(s)
- Alexis Revet
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France.,CERPOP, Inserm, UPS, Université de Toulouse, Toulouse, France.,CIC 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Toulouse University Hospital, Toulouse, France
| | - Guillaume Moulis
- CIC 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Toulouse University Hospital, Toulouse, France.,Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Philippe Raynaud
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France.,CERPOP, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Caen University Hospital, University of Caen Normandy, Caen, France
| | - Maryse Lapeyre-Mestre
- CIC 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Toulouse University Hospital, Toulouse, France
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6
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Sanzenbacher GT, Wettstein G. Drug insurance and the strategic behavior of drug manufacturers: Evergreening and generic entry after Medicare Part D. JOURNAL OF HEALTH ECONOMICS 2020; 72:102332. [PMID: 32416367 DOI: 10.1016/j.jhealeco.2020.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 04/17/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
For branded drug manufacturers, maintaining market power by managing product lifecycle - evergreening - is an important tool to navigate pharmaceutical markets. For generic manufacturers, the key decision is to enter the market at all. Expansion of drug insurance may lead firms to change their behavior because of increased demand-side market power - due to consolidation of buyers into a small number of insurers - and because of increased drug utilization. We analyze manufacturer responses to such changes through the introduction of Medicare Part D, which expanded drug coverage among seniors, in a difference-in-differences design comparing drugs used frequently by those over age 65 to those used infrequently by this population. The results show that Part D reduced generic entry, and suggest that it increased evergreening. Furthermore, while these effects are associated with higher drug prices, they are more than offset by the consolidation of demand, reducing prices overall.
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Affiliation(s)
- Geoffrey T Sanzenbacher
- Boston College, Economics Department, Maloney Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, United States
| | - Gal Wettstein
- Center for Retirement Research at Boston College, Hovey House, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, United States(1).
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7
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Jacobson GA, Raidal S, Hostrup M, Calzetta L, Wood-Baker R, Farber MO, Page CP, Walters EH. Long-Acting β2-Agonists in Asthma: Enantioselective Safety Studies are Needed. Drug Saf 2018; 41:441-449. [PMID: 29332144 DOI: 10.1007/s40264-017-0631-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Long-acting β2-agonists (LABAs) such as formoterol and salmeterol are used for prolonged bronchodilatation in asthma, usually in combination with inhaled corticosteroids (ICSs). Unexplained paradoxical asthma exacerbations and deaths have been associated with LABAs, particularly when used without ICS. LABAs clearly demonstrate effective bronchodilatation and steroid-sparing activity, but long-term treatment can lead to tolerance of their bronchodilator effects. There are also concerns with regard to the effects of LABAs on bronchial hyperresponsiveness (BHR), where long-term use is associated with increased BHR and loss of bronchoprotection. A complicating factor is that formoterol and salmeterol are both chiral compounds, usually administered as 50:50 racemic (rac-) mixtures of two enantiomers. The chiral nature of these compounds has been largely forgotten in the debate regarding LABA safety and effects on BHR, particularly that (S)-enantiomers of β2-agonists may be deleterious to asthma control. LABAs display enantioselective pharmacokinetics and pharmacodynamics. Biological plausibility of the deleterious effects of β2-agonists (S)-enantiomers is provided by in vitro and in vivo studies from the short-acting β2-agonist (SABA) salbutamol. Supportive clinical findings include the fact that patients in emergency departments who demonstrate a blunted response to salbutamol are more likely to benefit from (R)-salbutamol than rac-salbutamol, and resistance to salbutamol appears to be a contributory mechanism in rapid asthma deaths. More effort should therefore be applied to investigating potential enantiospecific effects of LABAs on safety, specifically bronchoprotection. Safety studies directly assessing the effects of LABA (S)-enantiomers on BHR are long overdue.
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Affiliation(s)
- Glenn A Jacobson
- School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia.
| | - Sharanne Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Morten Hostrup
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.,Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Luigino Calzetta
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Richard Wood-Baker
- School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia
| | - Mark O Farber
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Clive P Page
- Sackler Institute of Pulmonary Pharmacology, Kings College London, London, UK
| | - E Haydn Walters
- School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia
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8
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Ng I, Greenblatt HK, Greenblatt DJ. Stereo-Psychopharmacology: The Case of Citalopram and Escitalopram. Clin Pharmacol Drug Dev 2018; 5:331-5. [PMID: 27452501 DOI: 10.1002/cpdd.293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Isaac Ng
- Tufts University School of Medicine, Boston, MA, USA
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9
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Jang YE, Kim CB, Kim NH. Utilization of Preventive Dental Services Before and After Health Insurance Covered Dental Scaling in Korea. Asia Pac J Public Health 2017; 29:70-80. [DOI: 10.1177/1010539516684944] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health insurance reduces the economic burden of diseases and enhances access to medical services. This study compared, among social classes, the utilization of preventive dental service before and after health insurance covered dental scaling. We analyzed time-series secondary data for 3 175 584 participants from 253 survey areas nationwide in the Community Health Survey (2009-2014) in Korea. The weighted proportion of participants who underwent dental scaling was defined as the scaling rate. Data regarding demographic and socioeconomic characteristics were collected. Scaling rates continuously increased over the 6-year period, particularly in 2014. College graduates had significantly higher scaling rates. Monthly income and scaling rate were positively related. Differences by education decreased over time. Differences by income were particularly high between 2012 and 2014. For women, the temporal rate was 2 times higher for professionals than for the unemployed. Despite increased dental scaling rates since the health coverage change in 2013, socioeconomic differences persist.
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Affiliation(s)
| | - Chun-Bae Kim
- Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Nam-Hee Kim
- Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
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10
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Gartlehner G, Matyas N. How contextual issues can distort shared decision making. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 118-119:17-23. [PMID: 27987564 DOI: 10.1016/j.zefq.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 11/17/2022]
Abstract
Shared decision making in medicine has become a widely promoted approach. The goal is for patients and physicians to reach a mutual, informed decision by taking into consideration scientific evidence, clinical experience, and the patient's personal values or preferences. Shared decision making, however, is not a straightforward process. In practice, it might fall short of what it promises and might even be misused to whitewash monetary motives. In this article, which summarizes a presentation given at the 17th Annual Conference of the German Network Evidence-based Medicine on March 4th, 2016 in Cologne, Germany, we discuss three contextual factors that in our opinion can have a tremendous impact on any informed decision making: 1) opinions and convictions of physicians or other clinicians; 2) uncertainty of the evidence regarding benefits and harms; 3) uncertainty of patients about their own values and preferences. But despite barriers and shortcomings, modern medicine currently does not have an alternative to shared decision making. Shared decision making has become a central theme in good quality health care because it has a strong ethical component. Advocates of shared decision making, however, must realize that not all patients prefer to participate in decision making. For those who do, however, we must ensure that shared decisions can be made in a neutral environment as free of biases and conflicts of interest as possible.
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Affiliation(s)
- Gerald Gartlehner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Austria; RTI International, NC, USA.
| | - Nina Matyas
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Austria
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11
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Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, Wormald R, Dickersin K. Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis. Ophthalmology 2015; 123:129-40. [PMID: 26526633 DOI: 10.1016/j.ophtha.2015.09.005] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/01/2015] [Accepted: 09/04/2015] [Indexed: 10/22/2022] Open
Abstract
TOPIC Primary open-angle glaucoma (POAG) is a highly prevalent condition worldwide and the most common cause of irreversible sight loss. The objective is to assess the comparative effectiveness of first-line medical treatments in patients with POAG or ocular hypertension through a systematic review and network meta-analysis, and to provide relative rankings of these treatments. CLINICAL RELEVANCE Treatment for POAG currently relies completely on lowering the intraocular pressure (IOP). Although topical drops, lasers, and surgeries can be considered in the initial treatment of glaucoma, most patients elect to start treatment with eye drops. METHODS We included randomized controlled trials (RCTs) that compared a single active topical medication with no treatment/placebo or another single topical medication. We searched CENTRAL, MEDLINE, EMBASE, and the Food and Drug Administration's website. Two individuals independently assessed trial eligibility, abstracted data, and assessed the risk of bias. We performed Bayesian network meta-analyses. RESULTS We included 114 RCTs with data from 20 275 participants. The overall risk of bias of the included trials is mixed. The mean reductions (95% credible intervals) in IOP in millimeters of mercury at 3 months ordered from the most to least effective drugs were as follows: bimatoprost 5.61 (4.94; 6.29), latanoprost 4.85 (4.24; 5.46), travoprost 4.83 (4.12; 5.54), levobunolol 4.51 (3.85; 5.24), tafluprost 4.37 (2.94; 5.83), timolol 3.70 (3.16; 4.24), brimonidine 3.59 (2.89; 4.29), carteolol 3.44 (2.42; 4.46), levobetaxolol 2.56 (1.52; 3.62), apraclonidine 2.52 (0.94; 4.11), dorzolamide 2.49 (1.85; 3.13), brinzolamide 2.42 (1.62; 3.23), betaxolol 2.24 (1.59; 2.88), and unoprostone 1.91 (1.15; 2.67). CONCLUSIONS All active first-line drugs are effective compared with placebo in reducing IOP at 3 months. Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within-class differences were small and may not be clinically meaningful. All factors, including adverse effects, patient preferences, and cost, should be considered in selecting a drug for a given patient.
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Affiliation(s)
- Tianjing Li
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Kristina Lindsley
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Benjamin Rouse
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hwanhee Hong
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Qiyuan Shi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David S Friedman
- The Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Richard Wormald
- Cochrane Eyes and Vision Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kay Dickersin
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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MacPherson R. The curious stories of drugs with two lives: a new paradigm in drug development. J R Soc Med 2015; 108:255-8. [PMID: 25827907 PMCID: PMC4530410 DOI: 10.1177/0141076815578653] [Citation(s) in RCA: 372] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ross MacPherson
- Royal North Shore Hospital, Pacific Highway, St Leonards, New South Wales 2065, Australia
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13
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Naudet F, Boussageon R, Palpacuer C, Gallet L, Reymann JM, Falissard B. Understanding the Antidepressant Debate in the Treatment of Major Depressive Disorder. Therapie 2015; 70:321-7. [PMID: 25679188 DOI: 10.2515/therapie/2014228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/20/2014] [Indexed: 11/20/2022]
Abstract
There is a long-standing polemic concerning the usefulness of antidepressants in the treatment of major depressive disorder. In this paper, we propose to highlight some aspects of this controversy by exploring the mutual influence of psychopharmacology and trial methodologies. Indeed, antidepressant efficacy, if not proved, was accepted before antidepressant randomised controlled trials (RCTs) were run. While RCTs became a gold standard to meet the requirements of the regulatory bodies, methodological tools were required to measure outcomes and to test whether antidepressants provide statistically significant benefits as compared with a placebo. All these methodological options have nonetheless introduced fuzziness in our interpretation of study results, in terms of clinical meaningfulness and in terms of transposability to a real life settings. Additionally, selective publication raises concerns about the published literature, and results in many paradoxes. Instead of providing easy answers, the application of the RCT paradigm in MDD raises numerous questions. This is probably in the nature of all scientific studies, but it can be in contradiction with clinicians' expectations, who want to be sure that the treatment will (or will not) work for their individual patients.
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Affiliation(s)
- Florian Naudet
- INSERM U669, Paris, France - Centre d'Investigation Clinique CIC-P INSERM 1414, Hôpital de Pontchaillou, Centre Hospitalier Universitaire de Rennes & Université de Rennes 1, Rennes, France - Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de psychiatrie, Rennes, France
| | - Rémy Boussageon
- Faculté de Médecine de Poitiers, Département de Médecine Générale, Poitiers, France
| | - Clément Palpacuer
- Centre d'Investigation Clinique CIC-P INSERM 1414, Hôpital de Pontchaillou, Centre Hospitalier Universitaire de Rennes & Université de Rennes 1, Rennes, France
| | - Laurent Gallet
- Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de psychiatrie, Rennes, France
| | - Jean-Michel Reymann
- Centre d'Investigation Clinique CIC-P INSERM 1414, Hôpital de Pontchaillou, Centre Hospitalier Universitaire de Rennes & Université de Rennes 1, Rennes, France - Laboratoire de Pharmacologie Expérimentale et Clinique, Faculté de Médecine de Rennes, Rennes, France
| | - Bruno Falissard
- INSERM U669, Paris, France - Université Paris-Sud et Université Paris Descartes, UMR-S0669, Paris, France - AP-HP, Hôpital Paul Brousse, Département de Santé Publique, Villejuif, France
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Bafeta A, Trinquart L, Seror R, Ravaud P. Reporting of results from network meta-analyses: methodological systematic review. BMJ 2014; 348:g1741. [PMID: 24618053 PMCID: PMC3949412 DOI: 10.1136/bmj.g1741] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine how the results of network meta-analyses are reported. DESIGN Methodological systematic review of published reports of network meta-analyses. DATA SOURCES Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Medline, and Embase, searched from inception to 12 July 2012. STUDY SELECTION All network meta-analyses comparing the clinical efficacy of three or more interventions in randomised controlled trials were included, excluding meta-analyses with an open loop network of three interventions. DATA EXTRACTION AND SYNTHESIS The reporting of the network and results was assessed. A composite outcome included the description of the network (number of interventions, direct comparisons, and randomised controlled trials and patients for each comparison) and the reporting of effect sizes derived from direct evidence, indirect evidence, and the network meta-analysis. RESULTS 121 network meta-analyses (55 published in general journals; 48 funded by at least one private source) were included. The network and its geometry (network graph) were not reported in 100 (83%) articles. The effect sizes derived from direct evidence, indirect evidence, and the network meta-analysis were not reported in 48 (40%), 108 (89%), and 43 (36%) articles, respectively. In 52 reports that ranked interventions, 43 did not report the uncertainty in ranking. Overall, 119 (98%) reports of network meta-analyses did not give a description of the network or effect sizes from direct evidence, indirect evidence, and the network meta-analysis. This finding did not differ by journal type or funding source. CONCLUSIONS The results of network meta-analyses are heterogeneously reported. Development of reporting guidelines to assist authors in writing and readers in critically appraising reports of network meta-analyses is timely.
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Affiliation(s)
- Aïda Bafeta
- Assistance Publique-Hôpitaux de Paris, Centre d'Epidémiologie Clinique, INSERM U1153, Hôpital Hôtel-Dieu, 75004 Paris, France
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Naudet F, Millet B, Charlier P, Reymann JM, Maria AS, Falissard B. Which placebo to cure depression? A thought-provoking network meta-analysis. BMC Med 2013; 11:230. [PMID: 24160565 PMCID: PMC3819667 DOI: 10.1186/1741-7015-11-230] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 10/04/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Antidepressants are often considered to be mere placebos despite the fact that meta-analyses are able to rank them. It follows that it should also be possible to rank different placebos, which are all made of sucrose. To explore this issue, which is rather more epistemological than clinical, we designed an unusual meta-analysis to investigate whether the effects of placebo in one situation are different from the effects of placebo in another situation. METHODS Published and unpublished studies were searched for by three reviewers on Medline, the Cochrane Library, Embase, clinicaltrials.gov, Current Controlled Trial, in bibliographies, and by mailing key organizations. The following studies in first-line treatment for major depressive disorder were considered to construct an "evidence network": 1) randomized controlled trials (RCTs) versus placebo on fluoxetine, venlafaxine and 2) fluoxetine versus venlafaxine head-to-head RCTs.Two network meta-analyses were run to indirectly compare response and remission rates among three different placebos: 1) fluoxetine placebo, 2) venlafaxine placebo, and 3) venlafaxine/fluoxetine placebo (that is, placebo compared to both venlafaxine and fluoxetine). Publication biases were assessed using funnel plots and statistically tested. RESULTS The three placebos were not significantly different in terms of response or remission. The antidepressant agents were significantly more efficacious than the placebos, and venlafaxine was more efficacious than fluoxetine. The funnel plots, however, showed a major publication bias. CONCLUSION The presence of significant levels of publication bias indicates that we cannot even be certain of the conclusion that sucrose equals sucrose in trials of major depressive disorder. This result should remind clinicians to step back to take a more objective view when interpreting a scientific result. It is of crucial importance for their practice, far more so than ranking antidepressant efficacy.
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Affiliation(s)
- Florian Naudet
- INSERM U669, Maison de Solenn, 97 Boulevard de Port Royal, 75679 Paris Cedex 14, France.
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