Abstract
BackgroundIn the interest of cost effectiveness, switching antiretroviral brand name medications to generics is recommended in France since 2013. The study objective was to evaluate the perception of generics per se and antiretroviral generics in HIV-infected patients and their hospital physiciansMethods and Findings556 out of 703 (79%) adult HIV+ outpatients and 116 physicians in 33 clinics were included in a multicentric cross-sectional survey performed in September 2013. Patients completed a self-questionnaire on their perception and acceptability of generics. Physicians completed a questionnaire on their acceptability of switching antiretroviral to generic. Socio-demographic data, medical history and HIV history were collected. Among the 556 patients with a median HIV duration of 13 years, 77% were France native, 59% in active employment, 100% covered by social insurance, 95% on antiretroviral therapy. Seventy-six percent of the patients accepted generics and 55% trusted them overall. Antiretroviral generics were accepted by 44% of them but only by 17% if the pill burden was going to increase. The factor significantly associated with acceptability of antiretroviral generics was acceptance of generics per se (p<0.001). Among the 116 physicians following a median of 100 HIV-patients/year, 75% would prescribe generics, dropping to 26% if the combo had to be broken. Factors significantly associated with willingness to prescribe antiretroviral generics were the absence of concern regarding the chemical entity (OR = 0.33), being aware that the patient would accept generics for other pathologies (OR = 2.04) and would accept antiretroviral generics (OR = 1.94). No factor related to sociodemographic conditions, HIV status or comorbidities was associated with the acceptability of antiretroviral generics.ConclusionsAcceptability of antiretroviral generics in this French population was mostly dictated by the patient’s and physician’s knowledge and use of generics overall. It should be improved with an efficient information of both patients and physicians.
Highlights
In France, recurrent health expenditure amounted to 243 billion Euros in 2012, i.e. 12% of the gross domestic product (GDP) [1]
It is possible to encourage the prescription of generics or switch to them (2006 agreement concerning third-party payment for prescriptions when a generic presentation is accepted)
This study that has evaluated the perception of generics in an HIV-infected population and in their specialist physicians shows that the acceptability of ARV generics is mainly driven by the knowledge and the use of generics overall. Both patients’ and HIV specialist physicians’ allegations against generics appeared to be highly inadequate, only one third of patients and one fourth of physicians are openly opposed to generics
Summary
In France, recurrent health expenditure amounted to 243 billion Euros in 2012, i.e. 12% of the gross domestic product (GDP) [1]. Treatment and health product consumption represented three-quarters of this sum, which has increased by +2.2% per year for the past two years. This expenditure on health should continue to rise all the more so as the population ages. In the Social Security Finance Bill (PLFSS) for 2014, the rate of progression of the National Objective for Health Insurance Spending (ONDAM) was set at 2.4%, whereas 2.8% was set for 2013 [2]. In the interest of cost effectiveness, switching antiretroviral brand name medications to generics is recommended in France since 2013. The study objective was to evaluate the perception of generics per se and antiretroviral generics in HIV-infected patients and their hospital physicians
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