%0 Journal Article %A Nguyen, Elaine %A Weeda, Erin R. %A M. Sobieraj, Diana %A Bookhart, Brahim K. %A Piech, Catherine Tak %A I. Coleman, Craig %D 2016 %T Impact of non-medical switching on clinical and economic outcomes, resource utilization and medication-taking behavior: a systematic literature review %U https://tandf.figshare.com/articles/journal_contribution/Impact_of_non-medical_switching_on_clinical_and_economic_outcomes_resource_utilization_and_medication-taking_behavior_a_systematic_literature_review/3509831 %R 10.6084/m9.figshare.3509831.v1 %2 https://ndownloader.figshare.com/files/5575526 %K Managed care %K Non-medical switch %K Outcome assessment %K Therapeutic interchange %X

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.

%I Taylor & Francis