title: The economic implications of generic substitution of antiepileptic drugs: a review of recent evidence.
abstract: BACKGROUND
  The US Food and Drug Administration (FDA) considers generic and branded drugs to be therapeutically equivalent if they are pharmaceutically equivalent and bioequivalent. The American Academy of Neurology (AAN) disagrees and opposes generic substitution of branded antiepileptic drugs (AEDs) without physician and patient approval due to the risk of loss of seizure control.
  
  
  OBJECTIVE
  To review the evidence to date surrounding the economic impact of brand-to-generic substitutions of AEDs.
  
  
  METHODS
  A systematic search of PubMed and MEDLINE was conducted; the bibliographies of key articles obtained from the search were used to identify additional sources.
  
  
  CONCLUSIONS
  Current literature suggests statistically higher overall healthcare costs during periods of generic AED use than during periods when branded AED are used, consistently demonstrated across different countries (Canada and the USA) and in both stable and unstable epilepsy patients, with more pronounced cost increases in patients receiving multiple generic versions. Brand-to-generic substitutions of AEDs do not necessarily reduce overall healthcare costs and may even increase them.
authors: Analysis Group, Inc., 111 Huntington Avenue, Tenth Floor, Boston, MA 02199, USA. mduh@analysisgroup.com
authors: Mei Sheng
authors: MS
authors: Duh
authors: Kevin E
authors: KE
authors: Cahill
authors: Pierre Emmanuel
authors: PE
authors: Paradis
authors: Pierre Y
authors: PY
authors: Cremieux
authors: Paul E
authors: PE
authors: Greenberg
mesh_terms: D000927:Anticonvulsants / Q000191:economics* / Q000493:pharmacokinetics / Q000627:therapeutic use; D002170:Canada; D003362:Cost-Benefit Analysis; D016568:Drugs, Generic / Q000191:economics* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004827:Epilepsy / Q000188:drug therapy / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D013810:Therapeutic Equivalency; D016896:Treatment Outcome; D014481:United States
chemical_list: D000927:Anticonvulsants; D016568:Drugs, Generic