BackgroundHigh blood lipoprotein concentrations are one of the major risk factors for cardiovascular diseases. Drug therapy is the base of treatment; statins in particular. Both brand-name and generic presentations are available for statin therapy of high cholesterol levels. Factors that may influence their use in routine medical practice include, among others, patient persistence and adherence to treatment as prescribed by physicians. The aim of this retrospective analysis was to provide real-world evidence of treatment persistence and adherence and their consequences on economic and patient outcomes of generic versus brand-name statins routinely used to treat high cholesterol levels in Spain.MethodsExisting real-world electronic medical records abstracted from a database of two regions in Spain were analyzed. The analysis compared generic versus brand-name statins data from subjects’ who started treatment between July 1, 2010 and June 30, 2012. Treatment persistence, adherence expressed as medication possession ratio (MPR), healthcare resource utilization and their costs were analyzed together with patient’s at-goal rates of low-density-lipoprotein-cholesterol (LDL-c), incidence of any major cardiovascular event (CVE) and all-cause mortality during a 5-year follow-up period. Multivariate analyses were applied.ResultsA total of 13,244 records were included. Persistence was lower with generics; adjusted hazard ratio -HR- [95% confidence interval]: 0.86 [0.82–0.91], p < 0.001) and MPR was also lower: 61.5% vs. 65.1% (p < 0.001). Less patients with generics reached their LDL-c goal: 39.2% [38.3–40.2%] vs. 42.0% [40.2–43.7%]; adjusted odds ratio; 0.87 [0.80–0.95], p = 0.003. Compared to brand-name statins, the observed probability of occurrence of a CVE; HR: 1.31 [1.15–1.50], p < 0.001, and also all-cause deaths; HR: 1.36 [1.15–1.62], was significantly higher with generics; p < 0.001 in both cases. Adjusted mean total healthcare cost per patient was also higher with generic than with brand-name statins: €9118 (9059–9176) vs. €7980 (7853–8808) [adjusted difference: €1137 (997–1277), p < 0.001].ConclusionThis retrospective cost-consequences analysis found poorer treatment persistence and adherence in patients who first started therapy with generic instead of brand-name statins in routine medical practice in Spain. Also, patients receiving generics were more unlikely to reach LDL-c goals, showed increased probability of having CVE and all-cause mortality at a higher cost to payers.Electronic supplementary materialThe online version of this article (10.1186/s12944-018-0918-y) contains supplementary material, which is available to authorized users.

As a consequence of higher persistence in routine practice, patients who first started therapy with pregabalin brand-name versus generic showed better pain or anxiety outcomes at a lower cost to payers in Spain.

patients identified. The proportion of modalities were EMG 0.5%, MEP <0.1%, SEP 2.2%, Other <0.1%, and Combination 6.7%. Mean age (standard deviation (SD)) of patients who had neuromonitoring was similar across groups (range 60 (15.6) to 61.7 (12.5)). There was a similar trend in Elixhauser comorbidity score: most patients per group had 1-2 comorbidities; range of proportion: 50% to 67%. Mean total hospital costs of surgery with EMG ($32,997 OBJECTIVES: The aim of this project was to estimate the costs to society of training a physician at either a public or private university in Colombia. METHODS: Direct and indirect costs were estimated in 2016 Colombian pesos (average exchange rate 3051 COP per US dollar), as was the return on investment, expressed as net present value, return on investment, and internal rate of return. The time required to recover investing in studying medicine was also determined, and this was compared with the counterfactual of studying another academic program. A discount rate of 12% was used; a sensitivity analysis was performed with several alternative scenarios. RESULTS: In the baseline scenario, the total cost of training a physician in Colombia is US $80,972 at a private university and US $54, 972 at a public university (of which $14, 437 is contributed by the State in the latter case). The time to return of investment is 3 years 6 months for studying at a public university and 7 years 3 months for studying at a private university. In all scenarios, applying discount rates of 5%, 7.5%, and 12%, studying medicine presents a higher return than that obtained by studying other academic programs. CONCLUSIONS: The cost of training a medical doctor in Colombia is 70% higher than the cost of training other professionals, but returns are greater due to subsequent higher wages. Net returns are higher for graduates of public universities because their initial investment is smaller but their incomes are similar. OBJECTIVES:To provide real-world evidence on treatment persistence and economic and clinical consequences of generic versus brand-name pregabalin routinely used to treat peripheral neuropathic pain (pNP) or generalized anxiety disorder (GAD). METHODS: Real-world secondary data analysis of electronicmedical-records (EMR) abstracted from a database including primary healthcare centers in Spain. Brand-name (Lyrica®) and generic pregabalin data from subjects' first starting treatment for pNP or GAD between January-2015 and June-2016 were used. Main outcomes included treatment persistence (time-to-discontinuation), medication possession ratio (MPR), healthcare and non-healthcare resource utilization, and corresponding costs. Remitter and responder rates were also assessed. RESULTS: A total of 4,860 EMRs of patients >18 years-old with pNP (79.1% brandname, 20.9% generic) and 990 with GAD (68.1% brand-name, 31.9% generic) were analyzed. Discontinuation was lower with brand-name than with generic pregabalin in pNP (adjusted hazard ratio [HR]: 0.70 [95% CI: 0.58e0.85], p<0.001) and GAD patients (...