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Determinants of generic drug substitution in Switzerland

BACKGROUND: Since generic drugs have the same therapeutic effect as the original formulation but at generally lower costs, their use should be more heavily promoted. However, a considerable number of barriers to their wider use have been observed in many countries. The present study examines the inf...

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Autores principales: Decollogny, Anne, Eggli, Yves, Halfon, Patricia, Lufkin, Thomas M
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038892/
https://www.ncbi.nlm.nih.gov/pubmed/21269426
http://dx.doi.org/10.1186/1472-6963-11-17
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author Decollogny, Anne
Eggli, Yves
Halfon, Patricia
Lufkin, Thomas M
author_facet Decollogny, Anne
Eggli, Yves
Halfon, Patricia
Lufkin, Thomas M
author_sort Decollogny, Anne
collection PubMed
description BACKGROUND: Since generic drugs have the same therapeutic effect as the original formulation but at generally lower costs, their use should be more heavily promoted. However, a considerable number of barriers to their wider use have been observed in many countries. The present study examines the influence of patients, physicians and certain characteristics of the generics' market on generic substitution in Switzerland. METHODS: We used reimbursement claims' data submitted to a large health insurer by insured individuals living in one of Switzerland's three linguistic regions during 2003. All dispensed drugs studied here were substitutable. The outcome (use of a generic or not) was modelled by logistic regression, adjusted for patients' characteristics (gender, age, treatment complexity, substitution groups) and with several variables describing reimbursement incentives (deductible, co-payments) and the generics' market (prices, packaging, co-branded original, number of available generics, etc.). RESULTS: The overall generics' substitution rate for 173,212 dispensed prescriptions was 31%, though this varied considerably across cantons. Poor health status (older patients, complex treatments) was associated with lower generic use. Higher rates were associated with higher out-of-pocket costs, greater price differences between the original and the generic, and with the number of generics on the market, while reformulation and repackaging were associated with lower rates. The substitution rate was 13% lower among hospital physicians. The adoption of the prescribing practices of the canton with the highest substitution rate would increase substitution in other cantons to as much as 26%. CONCLUSIONS: Patient health status explained a part of the reluctance to substitute an original formulation by a generic. Economic incentives were efficient, but with a moderate global effect. The huge interregional differences indicated that prescribing behaviours and beliefs are probably the main determinant of generic substitution.
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spelling pubmed-30388922011-02-15 Determinants of generic drug substitution in Switzerland Decollogny, Anne Eggli, Yves Halfon, Patricia Lufkin, Thomas M BMC Health Serv Res Research Article BACKGROUND: Since generic drugs have the same therapeutic effect as the original formulation but at generally lower costs, their use should be more heavily promoted. However, a considerable number of barriers to their wider use have been observed in many countries. The present study examines the influence of patients, physicians and certain characteristics of the generics' market on generic substitution in Switzerland. METHODS: We used reimbursement claims' data submitted to a large health insurer by insured individuals living in one of Switzerland's three linguistic regions during 2003. All dispensed drugs studied here were substitutable. The outcome (use of a generic or not) was modelled by logistic regression, adjusted for patients' characteristics (gender, age, treatment complexity, substitution groups) and with several variables describing reimbursement incentives (deductible, co-payments) and the generics' market (prices, packaging, co-branded original, number of available generics, etc.). RESULTS: The overall generics' substitution rate for 173,212 dispensed prescriptions was 31%, though this varied considerably across cantons. Poor health status (older patients, complex treatments) was associated with lower generic use. Higher rates were associated with higher out-of-pocket costs, greater price differences between the original and the generic, and with the number of generics on the market, while reformulation and repackaging were associated with lower rates. The substitution rate was 13% lower among hospital physicians. The adoption of the prescribing practices of the canton with the highest substitution rate would increase substitution in other cantons to as much as 26%. CONCLUSIONS: Patient health status explained a part of the reluctance to substitute an original formulation by a generic. Economic incentives were efficient, but with a moderate global effect. The huge interregional differences indicated that prescribing behaviours and beliefs are probably the main determinant of generic substitution. BioMed Central 2011-01-26 /pmc/articles/PMC3038892/ /pubmed/21269426 http://dx.doi.org/10.1186/1472-6963-11-17 Text en Copyright ©2011 Decollogny et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Decollogny, Anne
Eggli, Yves
Halfon, Patricia
Lufkin, Thomas M
Determinants of generic drug substitution in Switzerland
title Determinants of generic drug substitution in Switzerland
title_full Determinants of generic drug substitution in Switzerland
title_fullStr Determinants of generic drug substitution in Switzerland
title_full_unstemmed Determinants of generic drug substitution in Switzerland
title_short Determinants of generic drug substitution in Switzerland
title_sort determinants of generic drug substitution in switzerland
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038892/
https://www.ncbi.nlm.nih.gov/pubmed/21269426
http://dx.doi.org/10.1186/1472-6963-11-17
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