Consequences of non-medical switch among patients with type 2 diabetes

Flores, Nicholas E.; Patel, Charmi; Bookhart, Brahim; Bacchus, Shaffeeulah

doi:10.1080/03007995.2018.1465904

Cited by 4 publications

(7 citation statements)

References 16 publications

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“…[25][26][27][28] Furthermore, nonmedical switching is associated with worsening quality of life and worsening glycemic outcomes. 29 Though medication and supply safety issues were not identified in this study, it is possible that underground exchange activity could result in untoward health outcomes. Other research has examined how individuals assess safety related to sharing FDA approved medications.…”

Section: Discussionmentioning

confidence: 88%

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The Underground Exchange of Diabetes Medications and Supplies: Donating, Trading, and Borrowing, Oh My!

Litchman

Oser

Wawrzynski

et al. 2019

J Diabetes Sci Technol

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Background: The cost of diabetes medications and supplies is rising, resulting in access challenges. This study assessed the prevalence of and factors predicting underground exchange activities—donating, trading, borrowing, and purchasing diabetes medications and supplies. Research Design and Methods: A convenience sample of people affected by diabetes was recruited online to complete a survey. Mixed method analysis was undertaken, including logistic regression to examine the relationship between self-reported difficulty purchasing diabetes medications and supplies and engagement in underground exchange activity. Thematic qualitative analysis was used to examine open-text responses. Results: Participants ( N = 159) self-reported engagement in underground exchange activities, including donating (56.6%), donation receiving (34.6%), trading (23.9%), purchasing (15.1%), and borrowing (22%). Such activity took place among a variety of individuals, including friends, family, coworkers, online acquaintances and strangers. Diabetes-specific financial stress predicted engagement in trading diabetes mediations or supplies (OR 6.3, 95% CI 2.2-18.5) and receiving donated medications or supplies (OR 2.8, 95% CI 1.1-7.2). One overarching theme, unmet needs, and three subthemes emerged: (1) factors influencing underground exchange activity, (2) perceived benefits of underground exchange activity, and (3) perceived consequences of underground exchange activity. Conclusion: Over half of the participants in this study engaged in underground exchange activities out of necessity. Providers must be aware about this underground exchange and inquire about safety and possible alternative resources. There is an urgent need to improve access to medications that are essential for life. Our study points to a failure in the US healthcare system since such underground exchanges may not be necessary if medications and supplies were accessible.

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Section: Discussionmentioning

confidence: 88%

“…25-28 Furthermore, nonmedical switching is associated with worsening quality of life and worsening glycemic outcomes. 29…”

Section: Discussionmentioning

confidence: 99%

The Underground Exchange of Diabetes Medications and Supplies: Donating, Trading, and Borrowing, Oh My!

Litchman

Oser

Wawrzynski

et al. 2019

J Diabetes Sci Technol

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“…In all cases, the p-value used to conclude statistical significance was based on each study's defined p-value. Statistical significance was not reported for three usable endpoints from 2 studies; thus, we independently analyzed the data to estimate a p-value [12,23]. When studies reported overlapping endpoints (e.g., any hospitalization versus disease-specific hospitalization), the most disease-specific endpoint was included.…”

Section: Data Synthesismentioning

confidence: 99%

“…The initial search strategy yielded 3,177 citations and an additional 14 citations were manually identified (Figure 1). After screening and full-text assessment, 38 studies (11 studies added based on the updated search) with a total of 260,256 patients (median: 591; range: 31-102,076) and a median follow-up of 6 months (range: 0.5 to 18 months) were included in our review (Table 2) [8][9][10][11][12][13][14][15][16][17][18]. A total of 26 studies (68.4%) were published between 2000 and 2014, while 12 (31.6%) were published between 2015 and 2018.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Since the publication of this prior systematic review, a great deal of attention has been paid to the consequences of non-medical switching by medical and patient advocate organizations and state legislatures [4][5][6][7] and new studies/ data have been generated and published [8][9][10][11][12][13][14][15][16][17][18]. Both the Cochrane Handbook for Systematic Reviews of Interventions [19] and the methods guide for the Agency for Healthcare Research and Quality (AHRQ) Evidencebased Practice Center program [20] remark on the importance of updating of a systematic review as new evidence becomes available.…”

Section: Introductionmentioning

confidence: 99%

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The impact of non-medical switching among ambulatory patients: an updated systematic literature review

Weeda

Nguyen

Martin

et al. 2019

Journal of Market Access & Health Policy

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Background: Non-medical switching (NMS) is defined as switching to a clinically similar but chemically distinct medication for reasons apart from lack of effectiveness, tolerability or adherence.Objective: To update a prior systematic review evaluating the impact of NMS on outcomes.Data sources: An updated search through 10/1/2018 in Medline and Web of Science was performed.Study selection: We included studies evaluating ≥25 patients and measuring the impact of NMS of drugs on ≥1 endpoint.Data extraction: The direction of association between NMS and endpoints was classified as negative, positive or neutral.Data synthesis: Thirty-eight studies contributed 154 endpoints. The direction of association was negative (n = 48; 31.2%) or neutral (n = 91; 59.1%) more often than it was positive (n = 15; 9.7%). Stratified by endpoint type, NMS was associated with a negative impact on clinical, economic, health-care utilization and medication-taking behavior in 26.9%,41.7%,30.3% and 75.0% of cases; with a positive effect seen in 3.0% (resource utilization) to 14.0% (clinical) of endpoints. Of the 92 endpoints from studies performed by the entity dictating the NMS, 88.0%were neutral or positive; whereas, only 40.3%of endpoints from studies conducted separately from the interested entity were neutral or positive.Conclusions: NMS was commonly associated with negative or neutral endpoints and was seldom associated with positive ones.

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