Generic substitution: additional challenge for adherence in hypertensive patients?

Håkonsen, Helle; Eilertsen, Marlene; Borge, Hilde; Toverud, Else‐Lydia

doi:10.1185/03007990903192223

Cited by 101 publications

(139 citation statements)

References 25 publications

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“…19 There have been concerns that generic substitution negatively influences therapy adherence. 20 The costs of improving adherence should be low because of the generics price drops. More recently, other policy reforms opened up the possibility for direct financial reimbursement of pharmaceutical care.…”

Section: Patient Populationmentioning

confidence: 99%

Improving Adherence to Lipid-Lowering Therapy in a Community Pharmacy Intervention Program: A Cost-Effectiveness Analysis

Vegter

Oosterhof²,

Boven

et al. 2014

JMCP

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BACKGROUND: Pharmaceutical care in community pharmacies has been shown to improve adherence to chronic therapies. Long-term impact on clinical outcomes or medical cost savings, however, remains understudied. OBJECTIVE: To estimate the cost-effectiveness of a pharmaceutical care intervention program in Dutch community pharmacies that improved patients' adherence to lipid-lowering therapy. METHODS: An economic evaluation was performed using a time-dependent Markov model from the health care payer perspective. Participants were patients initiating lipid-lowering therapy for primary prevention (40%) or secondary prevention (60%) of cardiovascular events (CVEs). The intervention was the pharmaceutical care program MeMO (Medication Monitoring and Optimisation) in 9 community pharmacies in the Netherlands, based on continuous monitoring and optimization of lipid-lowering therapy in new patients. The follow-up period of the program was 1 year. The main outcome of the intervention program was discontinuation of lipid-lowering therapy. This outcome was extrapolated in the economic model to lifelong costs, quality of life, reductions in cardiovascular events, and incremental cost-effectiveness ratios. RESULTS: Patients in the MeMO program had a lower risk for therapy discontinuation, RR = 0.49 (0.37 to 0.66); the effectiveness was similar in primary and secondary prevention. In a cohort of 1,000 primary and secondary prevention patients, the MeMO program resulted in a reduction of 7 nonfatal strokes, 2 fatal strokes, 16 nonfatal myocardial infarctions (MIs), 7 fatal MIs, and 16 revascularizations over patients' lifetime. Additional medication, disease management, and intervention costs in the MeMO program were €411,000; the cost savings due to reduced CVEs were €443,000. The MeMO program resulted in 84 quality-adjusted life-years (QALYs) gained and net cost savings of €32,000. Clinical benefits and cost savings were highest in the secondary prevention population. CONCLUSION: Pharmaceutical care in community pharmacies can improve statin therapy adherence, resulting in better prevention of CVEs. The MeMO program resulted in considerable clinical benefits and net cost savings. Programs by community pharmacies targeted at improving adherence may provide good value for money, and health care insurers should consider reimbursing these activities.

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Section: Patient Populationmentioning

confidence: 99%

Improving Adherence to Lipid-Lowering Therapy in a Community Pharmacy Intervention Program: A Cost-Effectiveness Analysis

Vegter

Oosterhof²,

Boven

et al. 2014

JMCP

View full text Add to dashboard Cite

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“…This association could be related 332 to many switching-related concerns that would potentially decrease patients' adherence, 333 such as changes in product packaging and tablet appearance [38] and taste [35], differences 334 in adherence profiles of the various antihypertensive drug classes [8], and impairing patient's 335 confidence in drug therapy [39]. Furthermore, it has been shown that patients' concerns 336 about switching may produce a nocebo effect (i.e.…”

mentioning

confidence: 99%

Exploring factors associated with patients’ adherence to antihypertensive drugs among people with primary hypertension in the United Kingdom

Kurdi

Chen

Elliott

2017

Journal of Hypertension

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“…Previous research has found that up to ten percent of patients in certain social groups erroneously used two equivalent medications or were unaware of their equivalence (168). The risk of overuse of the same medication may increase with the oversupply, especially in the elderly who have cognitive and sight decline.…”

Section: Discussionmentioning

confidence: 99%

“…Patients, in particular the elderly with multiple medications, may be confused about which medications they are supposed to take. They may for example unintentionally overuse the same medication (168,169), which increases the risk to experience ADRs. Previous studies have found that oversupply of medications was found in up to 53% of patients taking antidiabetics (152,(170)(171)(172)(173), up to 52% with antihypertensive medications (152,170,174,175), and up to 35% with lipid lowering medications (152,170).…”

Section: Non-adherence To Long-term Medicationsmentioning

confidence: 99%

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Hedna

2015

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Aim:The aim of this thesis is to estimate and analyse the burden of potentially inappropriate prescriptions (PIPs) in the elderly and non-adherence to long-term medications among adults across care settings, and to investigate how IUM is associated to DRMs. Methods:A meta-analysis summarised the previous evidence on the percentage of adverse drug reactions (ADRs) associated to IUM across healthcare settings (Study I). From a cohort in the general population, using medical records and register data, the prevalence of PIPs in the elderly and its association with ADRs were estimated retrospectively (Study II). From the same cohort, the factors associated with refill non-adherence to antihypertensive therapy, considering the use of multiple medications, and the association between non-adherence and sub-therapeutic effects (STEs) were investigated (Study III). A survey assessed the refill behaviour to antihypertensive, lipid lowering and oral antidiabetic medications (undersupply, adequate supply and oversupply), and its association with perceived ADRs and STEs (Study IV).Results: IUM was the cause 52% and 45% of ADRs occurring in adult outpatients and inpatients respectively. Across healthcare settings, 46% of the elderly refilled PIPs over a 6-month period;PIPs were considered the cause of 30% of all ADRs; and the elderly who were prescribed PIPs had increased odds to experience ADRs (OR 2.47, 95% CI 1.65-3.69). In total, 35% was nonadherent to the full multidrug therapy and 13% was non-adherent to any medication (complete vi non-adherence). Sociodemographic factors (working age and lower income) were associated with non-adherence to any medication, while clinical factors (use of specialised care, use of multiple medications, and being a new user) with non-adherence to the full multidrug therapy. STEs were associated with non-adherence to any medication a month prior to a healthcare visit (OR 3.27, 95% CI 1.27-8.49), but not with long-term measures of non-adherence. Among survey respondents, 22% of the medications were oversupplied and 12% were undersupplied. Inadequate refill behaviour was not associated with reporting ADRs or STEs (p<0.05). Conclusions:A large proportion of ADRs occurring in hospital is caused by IUM, but more knowledge is needed in other settings. PIPs are common in the elderly general population and associated with ADRs. Therefore decreasing PIPs could contribute towards ADR prevention.Considering the use of multiple medications may help to better understand the factors associated with non-adherence to a multidrug therapy for tailoring the interventions to patient needs.Monitoring the adherence prior to a healthcare visit may facilitate interpreting STEs. Yet, the absence of an association between long-term measures of refill non-adherence with clinical and perceived DRMs suggest the need to enhance the knowledge of this association in clinical practice.In summary, this thesis shows a significant potential for improvements of medication use and outcomes.Key words: Drug-related morbidity, medica...

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Generic substitution: additional challenge for adherence in hypertensive patients?

Cited by 101 publications

References 25 publications

Improving Adherence to Lipid-Lowering Therapy in a Community Pharmacy Intervention Program: A Cost-Effectiveness Analysis

Improving Adherence to Lipid-Lowering Therapy in a Community Pharmacy Intervention Program: A Cost-Effectiveness Analysis

Exploring factors associated with patients’ adherence to antihypertensive drugs among people with primary hypertension in the United Kingdom

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

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