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1.
Front Endocrinol (Lausanne) ; 15: 1358278, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38948522

RESUMEN

Objective: This study aims to determine whether the live birth rates were similar between GnRH antagonist original reference product Cetrotide® and generic Ferpront®, in gonadotropin-releasing hormone (GnRH) antagonist protocol for controlled ovarian stimulation (COS). Methods: This retrospective cohort study investigates COS cycles utilizing GnRH antagonist protocols. The research was conducted at a specialized reproductive medicine center within a tertiary care hospital, spanning the period from October 2019 to October 2021. Within this timeframe, a total of 924 cycles were administered utilizing the GnRH antagonist originator, Cetrotide® (Group A), whereas 1984 cycles were undertaken using the generic, Ferpront® (Group B). Results: Ovarian reserve markers, including anti-Mullerian hormone, antral follicle number, and basal follicular stimulating hormone, were lower in Group A compared to Group B. Propensity score matching (PSM) was performed to balance these markers between the groups. After PSM, baseline clinical features were similar, except for a slightly longer infertile duration in Group A versus Group B (4.43 ± 2.92 years vs. 4.14 ± 2.84 years, P = 0.029). The duration of GnRH antagonist usage was slightly longer in Group B than in Group A (6.02 ± 1.41 vs. 5.71 ± 1.48 days, P < 0.001). Group B had a slightly lower number of retrieved oocytes compared to Group A (14.17 ± 7.30 vs. 14.96 ± 7.75, P = 0.024). However, comparable numbers of usable embryos on day 3 and good-quality embryos were found between the groups. Reproductive outcomes, including biochemical pregnancy loss, clinical pregnancy, miscarriage, and live birth rate, did not differ significantly between the groups. Multivariate logistic regression analyses suggested that the type of GnRH antagonist did not independently impact the number of oocytes retrieved, usable embryos, good-quality embryos, moderate to severe OHSS rate, clinical pregnancy, miscarriage, or live birth rate. Conclusion: The retrospective analysis revealed no clinically significant differences in reproductive outcomes between Cetrotide® and Ferpront® when used in women undergoing their first and second COS cycles utilizing the GnRH antagonist protocol.


Asunto(s)
Hormona Liberadora de Gonadotropina , Antagonistas de Hormonas , Inducción de la Ovulación , Humanos , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Hormona Liberadora de Gonadotropina/análogos & derivados , Femenino , Estudios Retrospectivos , Inducción de la Ovulación/métodos , Embarazo , Adulto , Antagonistas de Hormonas/uso terapéutico , Antagonistas de Hormonas/administración & dosificación , Antagonistas de Hormonas/efectos adversos , Índice de Embarazo , Tasa de Natalidad , Medicamentos Genéricos/uso terapéutico , Reserva Ovárica/efectos de los fármacos
2.
Global Health ; 20(1): 46, 2024 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-38867208

RESUMEN

BACKGROUND: Thailand has expressed interest in joining the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP), a twelve-country plurilateral trade agreement whose original incarnation included the United States of America (USA). When the USA withdrew from this agreement, key intellectual property clauses relevant to pharmaceuticals were suspended. These could be reinstated should the CPTPP Parties decide to do so. METHODS: This study uses two scenarios to cost the impact the CPTPP would have had on Thailand's 2020 hepatitis C treatment regime if Thailand joined the CPTPP and suspended clauses were reinstated. RESULTS: Joining the CPTPP could have increased the cost more than tenfold if suspended CPTPP clauses were reinstated and Thailand was not willing or able to issue compulsory licenses. Based on the 2020 budget, the price for this possible scenario could have reduced hepatitis C treatment coverage by 90%. CONCLUSIONS: Acceding to trade agreements such as the CPTPP that require increasing intellectual property protection, could compromise Thailand's hepatitis C program and other national treatment programs reliant on affordable generic medicines. The CPTPP could also prevent Thailand from relying on its own pharmaceutical capabilities to manufacture medicines needed to sustain its treatment programs.


Asunto(s)
Hepatitis C , Cooperación Internacional , Tailandia , Humanos , Hepatitis C/tratamiento farmacológico , Estados Unidos , Propiedad Intelectual , Antivirales/uso terapéutico , Medicamentos Genéricos/uso terapéutico
4.
JAMA Health Forum ; 5(6): e241468, 2024 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-38874962

RESUMEN

This economic evaluation estimates the out-of-pocket cost savings patients could achieve if generic drugs were purchased directly from the Mark Cuban Cost Plus Drug Company rather than using their health insurance.


Asunto(s)
Industria Farmacéutica , Medicamentos Genéricos , Medicamentos Genéricos/economía , Medicamentos Genéricos/uso terapéutico , Humanos , Cuba , Industria Farmacéutica/economía , Ahorro de Costo , Costos de los Medicamentos , Femenino , Masculino
5.
Drug Des Devel Ther ; 18: 1573-1582, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38765878

RESUMEN

Objective: Atrial fibrillation (AF) is the most common abnormal heart rhythm in elderly patients. Rivaroxaban has been widely used for stroke prevention. The anticoagulant response to rivaroxaban increases with age, which may make elderly patients susceptible to adverse outcomes resulting from small differences in bioavailability between generic and brand products. Methods: We designed a cohort study of ≥65-year-old inpatients with AF. Sociodemographic and laboratory measures of qualified patients who received brand or generic rivaroxaban for at least 72 hours at the study hospital from January 2021 to June 2023 were collected retrospectively. The primary outcome was the incidence of bleeding. Results: A total of 1008 qualifying patients were included for analysis, with 626 (62.1%) receiving brand rivaroxaban and 382 (37.9%) receiving generic rivaroxaban. After propensity score matching and weighting to account for confounders, the odds ratios comparing brand vs generic rivaroxaban (95% confidence intervals) for the bleeding was 1.15 (0.72-1.82). Results from subgroup analyses of patients with age ≥85, HAS-BLED score ≥ 3, containment of antiplatelet drugs, and female patients were consistent with the primary analysis. Conclusion: It provides evidence regarding the clinical safety outcome of generic rivaroxaban in the elderly AF population that may be particularly susceptible to adverse outcomes resulting from small allowable differences in pharmacokinetics.


Asunto(s)
Fibrilación Atrial , Medicamentos Genéricos , Inhibidores del Factor Xa , Hemorragia , Rivaroxabán , Humanos , Fibrilación Atrial/tratamiento farmacológico , Rivaroxabán/efectos adversos , Rivaroxabán/administración & dosificación , Rivaroxabán/farmacocinética , Anciano , Femenino , Hemorragia/inducido químicamente , Masculino , Anciano de 80 o más Años , Medicamentos Genéricos/efectos adversos , Medicamentos Genéricos/uso terapéutico , Medicamentos Genéricos/farmacocinética , Medicamentos Genéricos/administración & dosificación , Estudios Retrospectivos , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/farmacocinética , Inhibidores del Factor Xa/administración & dosificación , Pacientes Internos , Estudios de Cohortes , Accidente Cerebrovascular/prevención & control
6.
Ann Hepatol ; 29(4): 101509, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38710472

RESUMEN

INTRODUCTION AND OBJECTIVES: Treatment of chronic hepatitis B (CHB) with nucelos(t)ide analogues (NA) can improve outcomes, but NA treatment is expensive for insurance plans. MATERIALS AND METHODS: The Centers for Medicare & Medicaid Services database was assessed from 2012 to 2021 to assess the use of NA for CHB in patients on Medicaid. Data extracted included the number of claims, units, and costs of each agent stratified by originator and generic. RESULTS: Over the study period, 1.9 billion USD was spent on NA, with spending peaking in 2016 at $289 million US, which has subsequently decreased. Lower expenditures since 2016 have been associated with increased use of generics. The use of generic tenofovir or entecavir led to savings of $669 million US over the study period. CONCLUSIONS: Increased generic use has significantly reduced expenditures for NA drugs; policy shifts towards generic drug use may help with sustainability.


Asunto(s)
Antivirales , Costos de los Medicamentos , Medicamentos Genéricos , Gastos en Salud , Hepatitis B Crónica , Medicaid , Humanos , Estados Unidos , Medicaid/economía , Antivirales/uso terapéutico , Antivirales/economía , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/economía , Medicamentos Genéricos/economía , Medicamentos Genéricos/uso terapéutico , Nucleósidos/uso terapéutico , Nucleósidos/economía , Tenofovir/uso terapéutico , Tenofovir/economía , Guanina/análogos & derivados , Guanina/uso terapéutico , Guanina/economía
8.
Clin Neurol Neurosurg ; 242: 108341, 2024 07.
Artículo en Inglés | MEDLINE | ID: mdl-38772280

RESUMEN

In the last decade there is an increasing frequency of sudden generic switches of antiseizure medications (ASMs) due to delivery problems. We here explored the patient's views toward generic substitution of ASMs and their experiences with delivery problems and switches of the manufacturer. A questionnaire already used in 2011 was updateded and published on the website of a patient's organisation from March 2022 until November 2022. 54.4 % of the responders reported delivery problems. Delivery problems were reported from Germany by a higher number of responders than from Switzerland. To 83.7 % of the responders the delivery problems were communicated by the pharmacists. In 41.9 % of these the delivery problems were coped by generic substitution. In 33 % of the latter breakthrough seizures occurred. 26 % of the respondents with experience of a change of the manufacturer not due to a delivery problem reported breakthrough seizures after being substituted. The majority of patients denied having been well informed about the possible consequences of a switch of the manufacturer. A thorough counselling on the low risks caused by change of the manufacturer and the need for good adherence to further reduce the risks should be part of the general information about their treatment with ASMs for people with epilepsy.


Asunto(s)
Anticonvulsivantes , Sustitución de Medicamentos , Epilepsia , Humanos , Anticonvulsivantes/uso terapéutico , Alemania , Encuestas y Cuestionarios , Suiza , Epilepsia/tratamiento farmacológico , Femenino , Masculino , Adulto , Persona de Mediana Edad , Medicamentos Genéricos/uso terapéutico , Industria Farmacéutica , Anciano
9.
AIDS ; 38(8): 1269-1272, 2024 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-38814716

RESUMEN

In a retrospective study conducted in three hospitals in Paris, generic antiretroviral accounted for 30.2% of all prescriptions. Tenofovir disoproxil/emtricitabine (TDF/FTC) was the most prescribed generic ART (82.3% of generic prescriptions). Generic ART (gART) was more likely to be prescribed to women, to patients less than 50 years, and with recent HIV diagnosis less than 3 years. Physicians prescribed more gART if they were men, older than 55 years or worked at a university teaching hospital.


Asunto(s)
Medicamentos Genéricos , Infecciones por VIH , Humanos , Estudios Retrospectivos , Femenino , Masculino , Medicamentos Genéricos/uso terapéutico , Persona de Mediana Edad , Paris , Infecciones por VIH/tratamiento farmacológico , Adulto , Antirretrovirales/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Anciano , Utilización de Medicamentos/estadística & datos numéricos , Fármacos Anti-VIH/uso terapéutico
10.
PLoS One ; 19(5): e0301716, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38696520

RESUMEN

BACKGROUND: Healthcare systems worldwide face escalating pharmaceutical expenditures despite interventions targeting pricing and generic substitution. Existing studies often overlook unwarranted volume increases in multisource markets due to differential physician perceptions of brand name and generics. OBJECTIVE: This study aims to explain the outpacing of generic medicine use over brand name use in multisource markets and assess the regulatory role, specifically examining the impact of reference pricing on volume and intensity increases. METHODS: Analyzing German multisource prescription medicine markets from 2011 to 2014, we evaluate regulatory mechanisms and explore whether brand name and generic medicines constitute separate market segments. Using an Oaxaca-Blinder decomposition approach, we divide the differential in brand name versus generic medicine use rates into market structure and unobserved segment effects. RESULTS: Generic use rates surpass same-market brand name substitution by 3.87 prescriptions per physician and medicine, on average. Reference pricing mitigated volume increase, treatment intensity and expenditure. Disparities in quantity and expenditure dynamics between brand name and generic segments are partially explained by market structure and segment effects. CONCLUSION: Generic medicine use effectively reduces expenditures but contributes to increased net prescription rates. Reference pricing may control medicine use, but divergent physician perceptions of brand name and generics, revealed by identified segment effects, call for nuanced policy interventions.


Asunto(s)
Medicamentos Genéricos , Medicamentos Genéricos/economía , Medicamentos Genéricos/uso terapéutico , Humanos , Alemania , Costos de los Medicamentos , Gastos en Salud , Médicos/economía
11.
BMC Cardiovasc Disord ; 24(1): 245, 2024 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-38730371

RESUMEN

BACKGROUND: The 2013 ACC/AHA Guideline was a paradigm shift in lipid management and identified the four statin-benefit groups. Many have studied the guideline's potential impact, but few have investigated its potential long-term impact on MACE. Furthermore, most studies also ignored the confounding effect from the earlier release of generic atorvastatin in Dec 2011. METHODS: To evaluate the potential (long-term) impact of the 2013 ACC/AHA Guideline release in Nov 2013 in the U.S., we investigated the association of the 2013 ACC/AHA Guideline with the trend changes in 5-Year MACE survival and three other statin-related outcomes (statin use, optimal statin use, and statin adherence) while controlling for generic atorvastatin availability using interrupted time series analysis, called the Chow's test. Specifically, we conducted a retrospective study using U.S. nationwide de-identified claims and electronic health records from Optum Labs Database Warehouse (OLDW) to follow the trends of 5-Year MACE survival and statin-related outcomes among four statin-benefit groups that were identified in the 2013 ACC/AHA Guideline. Then, Chow's test was used to discern trend changes between generic atorvastatin availability and guideline potential impact. RESULTS: 197,021 patients were included (ASCVD: 19,060; High-LDL: 33,907; Diabetes: 138,159; High-ASCVD-Risk: 5,895). After the guideline release, the long-term trend (slope) of 5-Year MACE Survival for the Diabetes group improved significantly (P = 0.002). Optimal statin use for the ASCVD group also showed immediate improvement (intercept) and long-term positive changes (slope) after the release (P < 0.001). Statin uses did not have significant trend changes and statin adherence remained unchanged in all statin-benefit groups. Although no other statistically significant trend changes were found, overall positive trend change or no changes were observed after the 2013 ACC/AHA Guideline release. CONCLUSIONS: The 2013 ACA/AHA Guideline release is associated with trend improvements in the long-term MACE Survival for Diabetes group and optimal statin use for ASCVD group. These significant associations might indicate a potential positive long-term impact of the 2013 ACA/AHA Guideline on better health outcomes for primary prevention groups and an immediate potential impact on statin prescribing behaviors in higher-at-risk groups. However, further investigation is required to confirm the causal effect of the 2013 ACA/AHA Guideline.


Asunto(s)
Adhesión a Directriz , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Análisis de Series de Tiempo Interrumpido , Guías de Práctica Clínica como Asunto , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Estados Unidos , Factores de Tiempo , Estudios Retrospectivos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Resultado del Tratamiento , Adhesión a Directriz/normas , Biomarcadores/sangre , Dislipidemias/tratamiento farmacológico , Dislipidemias/sangre , Dislipidemias/diagnóstico , Dislipidemias/mortalidad , Dislipidemias/epidemiología , Atorvastatina/uso terapéutico , Atorvastatina/efectos adversos , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/sangre , Bases de Datos Factuales , Pautas de la Práctica en Medicina/normas , Colesterol/sangre , Cumplimiento de la Medicación , Medicamentos Genéricos/uso terapéutico , Medicamentos Genéricos/efectos adversos , Medición de Riesgo
12.
Indian J Pharmacol ; 56(2): 97-104, 2024 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-38687313

RESUMEN

OBJECTIVES: India has taken several initiatives to provide health care to its population while keeping the related expenditure minimum. Since cardiovascular diseases are the most prevalent chronic conditions, in the present study, we aimed to analyze the difference in prices of medicines prescribed for three cardiovascular risk factors, based on (a) listed and not listed in the National List of Essential Medicines (NLEM) and (b) generic and branded drugs. MATERIALS AND METHODS: Outpatient prescriptions for diabetes mellitus, hypertension, and dyslipidemia were retrospectively analyzed from 12 tertiary centers. The prices of medicines prescribed were compared based on presence or absence in NLEM India-2015 and prescribing by generic versus brand name. The price was standardized and presented as average price per medicine per year for a given medicine. The results are presented in Indian rupee (INR) and as median (range). RESULTS: Of the 4,736 prescriptions collected, 843 contained oral antidiabetic, antihypertensive, and/or hypolipidemic medicines. The price per medicine per year for NLEM oral antidiabetics was INR 2849 (2593-3104) and for non-NLEM was INR 5343 (2964-14364). It was INR 806 (243-2132) for generic and INR 3809 (1968-14364) for branded antidiabetics. Antihypertensives and hypolipidemics followed the trend. The price of branded non-NLEM medicines was 5-22 times higher compared to generic NLEM which, for a population of 1.37 billion, would translate to a potential saving of 346.8 billion INR for statins. The variability was significant for sulfonylureas, angiotensin receptor blockers, beta-blockers, diuretics, and statins (P < 0.0001). CONCLUSION: The study highlights an urgent need for intervention to actualize the maximum benefit of government policies and minimize the out-of-pocket expenditure on medicines.


Asunto(s)
Hipoglucemiantes , India , Humanos , Estudios Retrospectivos , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/economía , Medicamentos Genéricos/economía , Medicamentos Genéricos/uso terapéutico , Hipolipemiantes/economía , Hipolipemiantes/uso terapéutico , Factores de Riesgo de Enfermedad Cardiaca , Costos de los Medicamentos , Hipertensión/tratamiento farmacológico , Hipertensión/economía , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/economía , Dislipidemias/tratamiento farmacológico , Dislipidemias/economía , Antihipertensivos/economía , Antihipertensivos/uso terapéutico , Costos y Análisis de Costo
13.
Malar J ; 23(1): 125, 2024 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-38685044

RESUMEN

BACKGROUND: Despite efforts made to reduce morbidity and mortality associated with malaria, especially in sub-Saharan Africa, malaria continues to be a public health concern that requires innovative efforts to reach the WHO-set zero malaria agenda. Among the innovations is the use of artemisinin-based combination therapy (ACT) that is effective against Plasmodium falciparum. Generic artemether-lumefantrine (AL) is used to treat uncomplicated malaria after appropriate diagnosis. AL is metabolized by the cytochrome P450 family of enzymes, such as CYP2B6, CYP3A4 and CYP3A5, which can be under pharmacogenetic influence. Pharmacogenetics affecting AL metabolism, significantly influence the overall anti-malarial activity leading to variable therapeutic efficacy. This study focused on generic AL drugs used in malarial treatment as prescribed at health facilities and evaluated pharmacogenomic influences on their efficacy. METHODS: Patients who have been diagnosed with malaria and confirmed through RDT and microscopy were recruited in this study. Blood samples were taken on days 1, 2, 3 and 7 for parasite count and blood levels of lumefantrine, artemisinin, desbutyl-lumefantrine (DBL), and dihydroartemisinin (DHA), the active metabolites of lumefantrine and artemether, respectively, were analysed using established methods. Pharmacogene variation analysis was undertaken using iPLEX microarray and PCR-RFLP. RESULTS: A total of 52 patients completed the study. Median parasite density from day 1 to 7 ranged from 0-2666/µL of blood, with days 3 and 7 recording 0 parasite density. Highest median plasma concentration for lumefantrine and desbutyl lumefantrine, which are the long-acting components of artemisinin-based combinations, was 4123.75 ng/mL and 35.87 ng/mL, respectively. Day 7 plasma lumefantrine concentration across all generic ACT brands was ≥ 200 ng/mL which potentially accounted for the parasitaemia profile observed. Monomorphism was observed for CYP3A4 variants, while there were observed variations in CYP2B6 and CYP3A5 alleles. Among the CYP3A5 genotypes, significant differences in genotypes and plasma concentration for DBL were seen on day 3 between 1/*1 versus *1/*6 (p = 0.002), *1/*3 versus *1/*6 (p = 0.006) and *1/*7 versus *1/*6 (p = 0.008). Day 7 plasma DBL concentrations showed a significant difference between *1/*6 and *1/*3 (p = 0.026) expressors. CONCLUSIONS: The study findings show that CYP2B6 and CYP3A5 pharmacogenetic variations may lead to higher plasma exposure of AL metabolites.


Asunto(s)
Antimaláricos , Combinación Arteméter y Lumefantrina , Artemisininas , Combinación de Medicamentos , Etanolaminas , Fluorenos , Humanos , Antimaláricos/uso terapéutico , Antimaláricos/farmacocinética , Combinación Arteméter y Lumefantrina/uso terapéutico , Femenino , Etanolaminas/uso terapéutico , Etanolaminas/farmacocinética , Adolescente , Fluorenos/uso terapéutico , Fluorenos/farmacocinética , Fluorenos/farmacología , Artemisininas/uso terapéutico , Artemisininas/farmacocinética , Masculino , Ghana , Adulto , Adulto Joven , Niño , Preescolar , Persona de Mediana Edad , Malaria Falciparum/tratamiento farmacológico , Malaria Falciparum/parasitología , Medicamentos Genéricos/uso terapéutico , Resultado del Tratamiento , Farmacogenética , Anciano , Lactante
14.
BMC Med Res Methodol ; 24(1): 82, 2024 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-38580928

RESUMEN

BACKGROUND: This retrospective analysis aimed to comprehensively review the design and regulatory aspects of bioequivalence trials submitted to the Saudi Food and Drug Authority (SFDA) since 2017. METHODS: This was a retrospective, comprehensive analysis study. The Data extracted from the SFDA bioequivalence assessment reports were analyzed for reviewing the overall design and regulatory aspects of the successful bioequivalence trials, exploring the impact of the coefficient of variation of within-subject variability (CVw) on some design aspects, and providing an in-depth assessment of bioequivalence trial submissions that were deemed insufficient in demonstrating bioequivalence. RESULTS: A total of 590 bioequivalence trials were included of which 521 demonstrated bioequivalence (440 single active pharmaceutical ingredients [APIs] and 81 fixed combinations). Most of the successful trials were for cardiovascular drugs (84 out of 521 [16.1%]), and the 2 × 2 crossover design was used in 455 (87.3%) trials. The sample size tended to increase with the increase in the CVw in trials of single APIs. Biopharmaceutics Classification System Class II and IV drugs accounted for the majority of highly variable drugs (58 out of 82 [70.7%]) in the study. Most of the 51 rejected trials were rejected due to concerns related to the study center (n = 21 [41.2%]). CONCLUSION: This comprehensive analysis provides valuable insights into the regulatory and design aspects of bioequivalence trials and can inform future research and assist in identifying opportunities for improvement in conducting bioequivalence trials in Saudi Arabia.


Asunto(s)
Medicamentos Genéricos , Humanos , Equivalencia Terapéutica , Medicamentos Genéricos/uso terapéutico , Arabia Saudita , Estudios Retrospectivos , Tamaño de la Muestra
15.
BMJ Open ; 14(3): e077545, 2024 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-38443082

RESUMEN

OBJECTIVES: Lockdowns and border closures impacted medicine availability during the COVID-19 pandemic. This study aimed to assess the availability of essential, generic medicines for chronic diseases at public pharmaceutical supply agencies in Ethiopia. DESIGN: Comparative cross-sectional study. SETTING: The availability of essential, generic medicines for chronic diseases was assessed at two public pharmaceutical supply agency hubs. PARTICIPANTS: The current study included public supply agency hub managers, warehouse managers and forecasting officers at the study setting. OUTCOMES: The assessment encompassed the availability of chronic medicines on the day of data collection, as well as records spanning 8 months before the outbreak and 1 year during the pandemic. A total of 22 medicines were selected based on their inclusion in the national essential drug list for public health facilities, including 17 medicines for cardiovascular disease and 5 for diabetes mellitus. RESULTS: The results of the study indicate that the mean availability of the selected basket medicines was 43.3% (95% CI: 37.1 to 49.5) during COVID-19, which was significantly lower than the availability of 67.4% (95% CI: 62.2 to 72.6) before the outbreak (p<0.001). Prior to COVID-19, the overall average line-item fill rate for the selected products was 78%, but it dropped to 49% during the pandemic. Furthermore, the mean number of days out of stock per month was 11.7 (95% CI: 9.9 to 13.5) before the outbreak of COVID-19, which significantly increased to 15.7 (95% CI: 13.2 to 18.2) during the pandemic, indicating a statistically significant difference (p<0.001). Although the prices for some drugs remained relatively stable, there were significant price hikes for some products. For example, the unit price of insulin increased by more than 130%. CONCLUSION: The COVID-19 pandemic worsened the availability of essential chronic medicines, including higher rates of stockouts and unit price hikes for some products in the study setting. The study's findings imply that the COVID-19 pandemic has aggravated already-existing medicine availability issues. Efforts should be made to develop contingency plans and establish mechanisms to monitor medicine availability and pricing during such crises.


Asunto(s)
COVID-19 , Medicamentos Esenciales , Humanos , COVID-19/epidemiología , Etiopía/epidemiología , Control de Enfermedades Transmisibles , Estudios Transversales , Pandemias , Medicamentos Genéricos/uso terapéutico , Enfermedad Crónica
16.
Int J Clin Pharm ; 46(3): 694-703, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38472597

RESUMEN

BACKGROUND: The global prevalence of hepatitis B virus (HBV) has presented a persistent challenge for public health prevention and treatment. However, studies that assess the public's access to anti-HBV drugs are absent. AIM: To examine the availability, pricing, and affordability of anti-HBV drugs in Jiangsu province, China and provide recommendations for improvement. METHOD: An enhanced methodology developed by the World Health Organization (WHO) and Health Action International was applied in a cross-sectional study that included 1026 healthcare facilities distributed in 13 prefectural-level cities in Jiangsu province. RESULTS: Since almost all drugs had an availability of less than 30%, the accessibility of anti-HBV drugs was notably low. Primary healthcare facilities had the lowest availability, reporting 1.4% for Original Brands (OBs) and 1.7% for lowest-priced generics (LPGs). Furthermore, the northern Jiangsu region recorded the lowest availability at 0.7%. LPGs demonstrated higher availability than OBs, with median availability probabilities of 2.6% and 1.4%, respectively. The drugs listed on the WHO Essential Medicines List exhibited higher availability than those on other lists. The median price ratios for OBs, LPGs, and volume-based purchasing drugs were 0.83, 0.50, and 0.27, respectively, less than 1.5 times the international reference price. Despite favorable pricing, affordability rate was 23% for urban residents and 0% for rural residents, which was discouraging. CONCLUSION: Low availability and affordability of anti-HBV drugs were observed. Policy recommendations should emphasize the improvement of LPG availability by incentivizing priority prescribing. Healthcare subsidies should be provided more effectively and equitably.


Asunto(s)
Antivirales , Costos de los Medicamentos , Accesibilidad a los Servicios de Salud , Hepatitis B , Estudios Transversales , Humanos , China/epidemiología , Antivirales/economía , Antivirales/uso terapéutico , Hepatitis B/tratamiento farmacológico , Hepatitis B/epidemiología , Hepatitis B/economía , Accesibilidad a los Servicios de Salud/economía , Virus de la Hepatitis B/efectos de los fármacos , Medicamentos Genéricos/economía , Medicamentos Genéricos/uso terapéutico
17.
Am Heart J ; 271: 20-27, 2024 05.
Artículo en Inglés | MEDLINE | ID: mdl-38365072

RESUMEN

BACKGROUND: US adults often overpay for generic prescription medications, which can lead to medication nonadherence that negatively impacts cardiovascular outcomes. As a result, new direct-to-consumer online medication services are growing in popularity nationwide. Amazon recently launched a $5/month direct-to-consumer medication subscription service (Amazon RxPass), but it is unclear how many US adults could save on out-of-pocket drug costs by using this new service. OBJECTIVES: To estimate out-of-pocket savings on generic prescription medications achievable through Amazon's new direct-to-consumer subscription medication service for adults with cardiovascular risk factors and/or conditions. METHODS: Cross-sectional study of adults 18-64 years in the 2019 Medical Expenditure Panel Survey. RESULTS: Of the 25,280,517 (SE ± 934,809) adults aged 18-64 years with cardiovascular risk factors or conditions who were prescribed at least 1 medication available in the Amazon RxPass formulary, only 6.4% (1,624,587 [SE ± 68,571]) would achieve savings. Among those achieving savings, the estimated average out-of-pocket savings would be $140 (SE ± $15.8) per person per year, amounting to a total savings of $228,093,570 (SE ± $26,117,241). In multivariable regression models, lack of insurance coverage (adjusted odds ratio [OR] 3.5, 95%CI 1.9-6.5) and being prescribed a greater number of RxPass-eligible medications (2-3 medications versus 1 medication: OR 5.6, 95%CI 3.0-10.3; 4+ medications: OR 21.8, 95%CI 10.7-44.3) were each associated with a higher likelihood of achieving out-of-pocket savings from RxPass. CONCLUSIONS: Changes to the pricing structure of Amazon's direct-to-consumer medication service are needed to expand out-of-pocket savings on generic medications to a larger segment of the working-age adults with cardiovascular risk factors and/or diseases.


Asunto(s)
Enfermedades Cardiovasculares , Costos de los Medicamentos , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Adulto , Persona de Mediana Edad , Masculino , Femenino , Estudios Transversales , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/tratamiento farmacológico , Adulto Joven , Costos de los Medicamentos/estadística & datos numéricos , Adolescente , Gastos en Salud/estadística & datos numéricos , Estados Unidos , Medicamentos bajo Prescripción/economía , Medicamentos Genéricos/economía , Medicamentos Genéricos/uso terapéutico , Ahorro de Costo , Servicios Farmacéuticos/economía
19.
J Natl Compr Canc Netw ; 22(1)2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-38394773

RESUMEN

Over the past several years, advances in research, treatment, and market dynamics have impacted treatment strategies in chronic myeloid leukemia in chronic phase (CML-CP). They include the broader availability of cost-effective generic imatinib, and soon other generic second-generation tyrosine kinase inhibitors (TKIs). Access to affordable generics means that all patients with CML-CP should have access to safe and highly effective lifelong therapies. When overall survival is the treatment endpoint, imatinib provides a good treatment value. Second-generation TKIs may be the best frontline strategy when treatment-free remission is the goal. Recent studies have shown maintained efficacy and reduced toxicity when TKIs are used at reduced dosing. Reduced-dose schedules of second-generation TKIs (which are less toxic and induce faster deep molecular responses) may render generic second-generation TKIs a more attractive treatment option. Adjusting the dose of TKI in the presence of mild-to-moderate, or even severe but reversible, adverse events may be preferable to switching to a different TKI. The selection of second-line and beyond therapies depends on the evolving patterns observed with frontline treatment. Dose-adjusted ponatinib schedules have demonstrated improved efficacy and safety in patients resistant to second-generation TKIs or those with T315I-mutated disease. For asciminib, longer-term follow-up is needed to better evaluate its safety and efficacy compared with ponatinib. Allogeneic stem cell transplantation represents a valid alternative to newer-generation TKIs, with a better treatment value when TKIs are priced at >$40,000/year.


Asunto(s)
Antineoplásicos , Leucemia Mielógena Crónica BCR-ABL Positiva , Leucemia Mieloide de Fase Crónica , Humanos , Mesilato de Imatinib/uso terapéutico , Antineoplásicos/efectos adversos , Inhibidores de Proteínas Quinasas , Leucemia Mieloide de Fase Crónica/tratamiento farmacológico , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Medicamentos Genéricos/uso terapéutico , Proteínas de Fusión bcr-abl/genética
20.
Sci Rep ; 14(1): 2636, 2024 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-38302589

RESUMEN

Market drugs including brand or generic with poor quality, don't meet the acceptable standard guidelines. Vildagliptin is an important antidiabetic drugs used in monotherapy or in combinations protocols for treatment of diabetes mellites. The main goal of the current study is to assess the pharmaceutical equivalence of two marketed generics of vildagliptin 50 mg tablets compared to the branded product (Galvus 50 mg). The in vitro dissolution test was used as a quality control tool to obtain the dissolution profile of vildagliptin compared to the reference drug. The results revealed that all tested samples showed dissolution behavior like standard drug. Whole samples dissolution reached after 15 min in accordance with the standard. According to the similarity factors records, tested vildagliptin samples showed a comparable dissolution to the reference drug. The current work presents an in vitro protocol for quality evaluation of recently released generic drugs.


Asunto(s)
Medicamentos Genéricos , Hipoglucemiantes , Vildagliptina , Medicamentos Genéricos/uso terapéutico , Control de Calidad , Comprimidos
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