title: [Class substitution as an instrument of efficiency in the supply of medicines: possibilities and limitations].
abstract: Class substitution is the substitution of a drug by another cheaper drug from the same pharmacological drug class to save costs. This principle is applied in drug formularies and reference-based drug-pricing systems. Class substitution should not only consider similarities in pharmacological mechanisms of action but should also assess whether the different drugs within the class are equivalent at a population level with respect to efficacy, effectiveness, applicability, and safety. The implementation of class substitution requires protocols as well as a monitoring system to evaluate compliance with the protocols and their effects on drug costs. In addition, specific studies are needed to establish whether undesirable effects occur at the patient level.
authors.affiliation: Wetenschappelijk Instituut Nederlandse Apothekers, Postbus 30.460, 2500 GL 's-Gravenhage. pdesmet@winap.nl
authors.forename: P A G M
authors.initials: PA
authors.lastname: de Smet
authors.forename: A
authors.initials: A
authors.lastname: van der Kuy
authors.forename: G J
authors.initials: GJ
authors.lastname: Bonsel
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D003361:Cost Allocation; D017046:Cost Savings; D003365:Costs and Cost Analysis; D016903:Drug Monitoring / Q000009:adverse effects; D011307:Drug Prescriptions / Q000191:economics*; D006801:Humans; D013810:Therapeutic Equivalency; D016896:Treatment Outcome
vernacular_title: Klassensubstitutie als doelmatigheidsinstrument in de geneesmiddelenvoorziening: mogelijkheden en beperkingen.