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Curr Med Res Opin. 2016 Jul;32(7):1281-90. doi: 10.1185/03007995.2016.1170673. Epub 2016 Apr 1.

Impact of non-medical switching on clinical and economic outcomes, resource utilization and medication-taking behavior: a systematic literature review.

Author information

1
a University of Connecticut School of Pharmacy , Storrs , CT , U.S.A. ;
2
b Hartford Hospital Evidence-Based Practice Center , Hartford , CT , U.S.A. ;
3
c Janssen Scientific Affairs L.L.C. , Raritan , NJ , U.S.A.

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.

KEYWORDS:

Managed care; Non-medical switch; Outcome assessment; Therapeutic interchange

PMID:
27033747
DOI:
10.1185/03007995.2016.1170673
[Indexed for MEDLINE]

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