OBJECTIVES: To explore the effects of generic substitution of the antiepileptic drug (AED) topiramate (Topamax) in Canada; to convert observed Canadian costs into the settings of France, Germany, Italy, and the United Kingdom (UK); and to forecast the economic impact of generic topiramate entry in these four European countries. DESIGN AND METHODS: Health claims from Régie de l'assurance maladie du Québec (RAMQ) plan (1/2006-9/2008) and IMS Health data (1998-2008) were used. Patients with epilepsy and > or = 2 topiramate dispensings were selected. An open-cohort design was used to classify observation into mutually-exclusive periods of branded versus generic use of topiramate. Canadian healthcare utilization and costs (2007 CAN$/person-year) were compared between periods using multivariate models. Annualized per-patient costs (2007 euro or 2007 pound sterling/person-year) were converted using Canadian utilization rates, European prices and service-use ratios. Non-parametric bootstrap served to assess statistical significance of cost differences. Topiramate market was forecasted following generic entry (09/2009-09/2010) using autoregressive models based on the European experience. The economic impact of generic topiramate entry was estimated for each country. RESULTS: A total of 1164 patients (mean age: 39.8 years, 61.7% female) were observed for 2.6 years on average. After covariates adjustment, generic-use periods were associated with increased pharmacy dispensings (other AEDs: +0.95/person-year, non-AEDs: +12.28/person-year, p < 0.001), hospitalizations ( + 0.08/person-year, p = 0.015), and lengths of hospital stays (+0.51 days/person-year, p < 0.001). Adjusted costs, excluding topiramate, were CAN$1060/person-year higher during generic use (p = 0.005). Converted per-patient costs excluding topiramate were significantly higher for generic relative to brand periods in all European countries (adjusted cost differences per person-year: 706-815 euro, p < 0.001 for all comparisons). System-wide costs would increase from 3.5 to 24.4% one year after generic entry. LIMITATIONS: Study limitations include the absence of indirect costs, possible claim inaccuracies, and IMS data limitations. CONCLUSIONS: Higher health costs were projected for G4 European countries from the Canadian experience following the generic entry of topiramate.
OBJECTIVES: To explore the effects of generic substitution of the antiepileptic drug (AED) topiramate (Topamax) in Canada; to convert observed Canadian costs into the settings of France, Germany, Italy, and the United Kingdom (UK); and to forecast the economic impact of generic topiramate entry in these four European countries. DESIGN AND METHODS: Health claims from Régie de l'assurance maladie du Québec (RAMQ) plan (1/2006-9/2008) and IMS Health data (1998-2008) were used. Patients with epilepsy and > or = 2 topiramate dispensings were selected. An open-cohort design was used to classify observation into mutually-exclusive periods of branded versus generic use of topiramate. Canadian healthcare utilization and costs (2007 CAN$/person-year) were compared between periods using multivariate models. Annualized per-patient costs (2007 euro or 2007 pound sterling/person-year) were converted using Canadian utilization rates, European prices and service-use ratios. Non-parametric bootstrap served to assess statistical significance of cost differences. Topiramate market was forecasted following generic entry (09/2009-09/2010) using autoregressive models based on the European experience. The economic impact of generic topiramate entry was estimated for each country. RESULTS: A total of 1164 patients (mean age: 39.8 years, 61.7% female) were observed for 2.6 years on average. After covariates adjustment, generic-use periods were associated with increased pharmacy dispensings (other AEDs: +0.95/person-year, non-AEDs: +12.28/person-year, p < 0.001), hospitalizations ( + 0.08/person-year, p = 0.015), and lengths of hospital stays (+0.51 days/person-year, p < 0.001). Adjusted costs, excluding topiramate, were CAN$1060/person-year higher during generic use (p = 0.005). Converted per-patient costs excluding topiramate were significantly higher for generic relative to brand periods in all European countries (adjusted cost differences per person-year: 706-815 euro, p < 0.001 for all comparisons). System-wide costs would increase from 3.5 to 24.4% one year after generic entry. LIMITATIONS: Study limitations include the absence of indirect costs, possible claim inaccuracies, and IMS data limitations. CONCLUSIONS: Higher health costs were projected for G4 European countries from the Canadian experience following the generic entry of topiramate.
Authors: William V Padula; Richard A Larson; Stacie B Dusetzina; Jane F Apperley; Rudiger Hehlmann; Michele Baccarani; Ekkehard Eigendorff; Joelle Guilhot; Francois Guilhot; Rudiger Hehlmann; Francois-Xavier Mahon; Giovanni Martinelli; Jiri Mayer; Martin C Müller; Dietger Niederwieser; Susanne Saussele; Charles A Schiffer; Richard T Silver; Bengt Simonsson; Rena M Conti Journal: J Natl Cancer Inst Date: 2016-03-04 Impact factor: 13.506