Abstract
ObjectiveGeneric substitution has contributed to economic savings but switching products may affect patient adherence, particularly among those using multiple medications. The aim was to analyse if use of multiple medications influenced the association between switching products and refill adherence to angiotensin-converting-enzyme (ACE) inhibitors in Sweden.Study Design and SettingNew users of ACE-inhibitors, starting between 1 July 2006 and 30 June 2007, were identified in the Swedish Prescribed Drug Register. Refill adherence was assessed using the continuous measure of medication acquisition (CMA) and analysed with linear regression and analysis of covariance.ResultsThe study population included 42735 individuals whereof 51.2% were exposed to switching ACE-inhibitor and 39.6% used multiple medications. Refill adherence was higher among those exposed to switching products than those not, but did not vary depending on the use of multiple medications or among those not. Refill adherence varied with age, educational level, household income, country of birth, previous hospitalisation and previous cardiovascular diagnosis.ConclusionThe results indicate a positive association between refill adherence and switching products, mainly due to generic substitution, among new users of ACE-inhibitors in Sweden. This association was independent of use of multiple medications.
Highlights
The World Health Organisation defines adherence as the extent to which a person’s behaviour—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed recommendations from a health care provider [1]
Refill adherence was higher among those exposed to switching products than those not, but did not vary depending on the use of multiple medications or among those not
The results indicate a positive association between refill adherence and switching products, mainly due to generic substitution, among new users of ACE-inhibitors in Sweden
Summary
Generic substitution has contributed to economic savings but switching products may affect patient adherence, among those using multiple medications. The aim was to analyse if use of multiple medications influenced the association between switching products and refill adherence to angiotensin-converting-enzyme (ACE) inhibitors in Sweden. Data Availability Statement: All data are available in national Swedish registers held by Statistics Sweden (http://www.scb.se/en_/) and the National Board of Health and Welfare (http://www.socialstyrelsen.se/ english). The data is not public but can be ordered after ethical approval from The Regional Ethics Board in Gothenburg (Swedish: Regionala etikprövningsnämnden i Göteborg).
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