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The impact of the use of a generic substitution on treatment costs and outcomes
Researchers: Noa Triki1, Gabi Chodick1, Nachman Ash1, Varda Shalev1
- Maccabi Healthcare Services
Background: Generic substitution in chronically-ill patients may reduce treatment costs. Nonetheless, little research has been done on its real-world effectiveness.
Objectives: 1. Examine whether generic drug substitution has led to a change in patients' health outcomes;
2. Examine the medical conditions in which generic drug substitution resulted in reduced costs of medication;
3.Examine the rate of patients returning to the original drug after switching to a generic one.
2. Examine the medical conditions in which generic drug substitution resulted in reduced costs of medication;
3.Examine the rate of patients returning to the original drug after switching to a generic one.
Method: This retrospective cohort study examined the effect of generic substitution in chronically-ill patients, members of Maccabi Healthcare Services (MHS) in three therapeutic area: Atorvastatin in hyperlipidemia (n=5,155) metformin in diabetes, and Enalapril (n=1,815) and Ramipril (n=4,899) in hypertension. Included patients were adults who switched from a brand to a generic medication, from a generic to a brand or from one generic to another generic medication within each medical condition, with at least two years of treatment with one type of drug prior the switch and two years of treatment with the other type after the switch. Only patients with >80% treatment adherence in both treatment periods were included.
Findings: Hyperlipidemia: there was no change in LDL cholesterol. In the vast majority of patients, a dose increase was not required following the transition to a generic alternative.
Diabetes: In the switch from the branded drug to the generic alternative, there was a statistically significant increase in HbA1C values, but this increase is not clinically significant. Drug treatment costs have been significantly reduced in the transition from the branded to the generic drug.
Hypertension: In the transition from one generic drug to another, a decrease in systolic blood pressure was observed after the transition. The change in the cost of medication was dependent on the type of transition between the generic alternatives.
Diabetes: In the switch from the branded drug to the generic alternative, there was a statistically significant increase in HbA1C values, but this increase is not clinically significant. Drug treatment costs have been significantly reduced in the transition from the branded to the generic drug.
Hypertension: In the transition from one generic drug to another, a decrease in systolic blood pressure was observed after the transition. The change in the cost of medication was dependent on the type of transition between the generic alternatives.
Conclusions: Switching from a branded to a generic alternative does not affect the health outcomes of patients and may reduce the cost of pharmaceutical care.
Recommendations: Rational substitution of medication treatment from branded to generic drug is a valuable tool in restraining national expenditure on health.
Research number: R/108/2016
Research end date: 05/2019