Impact of non-medical switching on clinical and economic outcomes, resource utilization and medication-taking behavior: a systematic literature review
| Autor: | Diana M Sobieraj, Craig I Coleman, Erin R. Weeda, Catherine Tak Piech, Elaine Nguyen, Brahim Bookhart |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Health Behavior MEDLINE 030204 cardiovascular system & hematology Medication Adherence Resource Allocation 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Clinical efficacy Intensive care medicine Medication taking Drug Substitution business.industry Significant difference General Medicine Treatment Outcome Systematic review Immune System Diseases Cardiovascular Diseases Resource allocation Managed care business Resource utilization |
| Zdroj: | Current Medical Research and Opinion. 32:1281-1290 |
| ISSN: | 1473-4877 0300-7995 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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