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J Mark Access Health Policy. 2019 Oct 19;7(1):1678563. doi: 10.1080/20016689.2019.1678563. eCollection 2019.

The impact of non-medical switching among ambulatory patients: an updated systematic literature review.

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The College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA.
Department of Pharmacy Practice, Idaho State University College of Pharmacy, Boise, ID, USA.
Real World Value & Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
University of Connecticut School of Pharmacy, Storrs, CT, USA.


Background: Non-medical switching (NMS) is defined as switching to a clinically similar but chemically distinct medication for reasons apart from lack of effectiveness, tolerability or adherence. Objective: To update a prior systematic review evaluating the impact of NMS on outcomes. Data sources: An updated search through 10/1/2018 in Medline and Web of Science was performed. Study selection: We included studies evaluating ≥25 patients and measuring the impact of NMS of drugs on ≥1 endpoint. Data extraction: The direction of association between NMS and endpoints was classified as negative, positive or neutral. Data synthesis: Thirty-eight studies contributed 154 endpoints. The direction of association was negative (n = 48; 31.2%) or neutral (n = 91; 59.1%) more often than it was positive (n = 15; 9.7%). Stratified by endpoint type, NMS was associated with a negative impact on clinical, economic, health-care utilization and medication-taking behavior in 26.9%,41.7%,30.3% and 75.0% of cases; with a positive effect seen in 3.0% (resource utilization) to 14.0% (clinical) of endpoints. Of the 92 endpoints from studies performed by the entity dictating the NMS, 88.0%were neutral or positive; whereas, only 40.3%of endpoints from studies conducted separately from the interested entity were neutral or positive. Conclusions: NMS was commonly associated with negative or neutral endpoints and was seldom associated with positive ones.


Managed care; non-medical switch; outcome assessment; therapeutic interchange

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