| Generic antiepileptic drugs and associated medical resource utilization in the United States. | |
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MedLine Citation:
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PMID: 20393142 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To evaluate whether generic substitution was associated with any difference in medical resource utilization for 5 widely used antiepileptic drugs (AEDs) in the United States. METHODS: Health insurance claims from PharMetrics Database, representing over 90 health plans between January 2000 and October 2007, were analyzed. Adult patients with epilepsy, continuously treated with carbamazepine, gabapentin, phenytoin, primidone, or zonisamide, were selected. An open-cohort design was used to classify patients into mutually exclusive periods of brand vs generic use of AEDs. Pharmacy and medical utilization were compared between the 2 periods with multivariate regression analyses. Results were stratified into epilepsy-related medical services, and stable (< or = 2 outpatient visits per year and no emergency room visit) vs unstable epilepsy. Time-to-event analyses were also performed for all services and epilepsy-related endpoints. RESULTS: A total of 18,125 patients were observed in the stable group and 15,500 patients in the unstable group. After adjustment of covariates, periods of generic AED treatment were associated with increased use of all prescription drugs (incidence rate ratio [IRR] [95% confidence interval (CI)] = 1.13 [1.13-1.14]) and higher epilepsy-related medical utilization rates (hospitalizations: IRR [95% CI] = 1.24 [1.19-1.30]; outpatient visits: IRR [95% CI] = 1.14 [1.13-1.16]; lengths of hospital stays: IRR [95% CI] = 1.29 [1.27-1.32]). Generic-use periods were associated with increased utilization rates in stable and unstable patients and with 20% increased risk of injury, compared to periods with brand use of AEDs. CONCLUSIONS: Generic antiepileptic drug use was associated with significantly greater medical utilization and risk of epilepsy-related medical events, compared to brand use. This relationship was observed even in patients characterized as stable. AED = antiepileptic drug; CI = confidence interval; ER = emergency room; HR = hazard ratio; ICD = International Classification of Diseases; IRR = incidence rate ratio. |
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Authors:
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D M Labiner; P E Paradis; R Manjunath; M S Duh; M-H Lafeuille; D Latrémouille-Viau; P Lefebvre; S L Helmers |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-04-14 |
Journal Detail:
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Title: Neurology Volume: 74 ISSN: 1526-632X ISO Abbreviation: Neurology Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-18 Completed Date: 2010-06-02 Revised Date: 2011-03-09 |
Medline Journal Info:
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Nlm Unique ID: 0401060 Medline TA: Neurology Country: United States |
Other Details:
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Languages: eng Pagination: 1566-74 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurology, The University of Arizona, 1501 N Campbell Ave., Tucson, AZ 85724, USA. labinerd@u.arizona.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Anticonvulsants / adverse effects*, economics Chi-Square Distribution Drug Utilization / economics* Drugs, Generic / adverse effects*, economics Epilepsy / drug therapy*, economics Female Health Care Costs Health Services / economics, utilization* Humans Male Middle Aged Patient Selection Retrospective Studies United States |
| Chemical | |
Reg. No./Substance:
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0/Anticonvulsants; 0/Drugs, Generic |
| Comments/Corrections | |
Comment In:
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Neurology. 2010 May 18;74(20):1562-3
[PMID:
20427747
]
Neurology. 2011 Feb 8;76(6):583; author reply 583-4 [PMID: 21300975 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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