title: The impact on health outcomes and healthcare utilisation of switching to generic medicines consequent to reference pricing: the case of lamotrigine in New Zealand.
abstract: BACKGROUND
  Many countries have implemented generic reference pricing and substitution as methods of containing pharmaceutical expenditure. However, resistance to switching between medicines is apparent, especially in the case of anti-epileptic medicines.
  
  
  OBJECTIVE
  This study sought to exploit a nation-wide policy intervention on generic reference pricing in New Zealand to evaluate the health outcomes of patients switching from originator to generic lamotrigine, an anti-epileptic medicine.
  
  
  METHODS
  A retrospective study using the national health collections and prescription records was conducted comparing patients who switched from originator brand to generic lamotrigine with patients who remained on the originator brand. Primary outcome measures included switch behaviour, changes in utilisation of healthcare services at emergency departments, hospitalisations and use of specialist services, and mortality.
  
  
  RESULTS
  Approximately one-quarter of all patients using the originator brand of lamotrigine switched to generic lamotrigine, half of whom made the switch within 60 days of the policy implementation. Multiple switches (three or more) between generic and brand products were evident for around 10% of switchers. Switch-back rates of 3% were apparent within 30 days post-switch. No difference in heath outcome measures was associated with switching from originator lamotrigine to a generic equivalent and hence no increased costs could be found for switchers.
  
  
  CONCLUSIONS
  Switching from brand to generic lamotrigine is largely devoid of adverse health outcomes; however, creating an incentive to ensure a greater proportion of patients switch to generic lamotrigine is required to achieve maximal financial savings from a policy of generic reference pricing.
authors.affiliation: Health Systems Section, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand, c.lessing@auckland.ac.nz.
authors.forename: Charon
authors.initials: C
authors.lastname: Lessing
authors.forename: Toni
authors.initials: T
authors.lastname: Ashton
authors.forename: Peter
authors.initials: P
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings; D003365:Costs and Cost Analysis; D016527:Drug Costs; D016568:Drugs, Generic / Q000191:economics* / Q000627:therapeutic use; D004827:Epilepsy / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D062489:Health Impact Assessment / Q000706:statistics & numerical data*; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014227:Triazines / Q000191:economics* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D016568:Drugs, Generic; D014227:Triazines; D000077213:Lamotrigine