Huo Nan, Chen Li, Ullah Mishuk Ahmed, Li Chao, Hansen Richard A, Harris Ilene, Kiptanui Zippora, Wang Zhong, Dutcher Sarah K, Qian Jingjing
Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
Department of Medicine, Indiana University School of Medicine, Indianapolis, IL, USA.
Endocrine. 2020 May;68(2):336-348. doi: 10.1007/s12020-020-02211-w. Epub 2020 Jan 28.
Generic levothyroxine has been approved and available since 2004 but its substitution remains controversial. Therefore, the objective was to examine patterns of and identify factors associated with initiation and substitution of generic levothyroxine treatment.
This was a retrospective observational study, including new users of brand and generic levothyroxine in 2013-2015 Medicare (n = 15,877) or 2011-2012 Medicaid (n = 9390) administrative claim databases. The primary outcomes included (1) generic levothyroxine initiation, and (2) among brand-new users, generic levothyroxine substitution in 12 months. The factors associated with generic levothyroxine initiation and substitution were measured.
Among all levothyroxine new users, Medicare beneficiaries had a higher proportion of generic levothyroxine initiation than Medicaid beneficiaries (66.40% vs. 44.04%, respectively). Medicare beneficiaries' demographic factors, and health service utilizations were associated with generic levothyroxine initiation. Medicaid beneficiaries who were male and residing in the northeast region and rural areas were more likely to initiate generic levothyroxine. Among brand levothyroxine new users, the generic substitution rate was higher in the Medicare than the Medicaid cohort (18.26 vs. 3.88%). Medicare brand levothyroxine new users' demographic factors and health service utilizations were associated with generic levothyroxine substitution. Medicaid brand levothyroxine new users who were residing in the northeast region, with more prior hospitalization, and initiating a lower dosage of brand levothyroxine, had higher rates of generic substitution.
Patient demographic factors and health service utilizations are associated with generic levothyroxine initiation and substitution. Educational outreach programs targeted to increase generic levothyroxine use and prescription savings should be tailored based on different patient populations.
通用型左甲状腺素自2004年起已获批准并可供使用，但其替代问题仍存在争议。因此，本研究的目的是探讨通用型左甲状腺素治疗起始和替代的模式，并确定与之相关的因素。
这是一项回顾性观察研究，纳入了2013 - 2015年医疗保险（n = 15,877）或2011 - 2012年医疗补助（n = 9390）行政索赔数据库中品牌和通用型左甲状腺素的新使用者。主要结局包括：（1）通用型左甲状腺素的起始使用，以及（2）在全新使用者中，12个月内通用型左甲状腺素的替代情况。对与通用型左甲状腺素起始和替代相关的因素进行了测量。
在所有左甲状腺素新使用者中，医疗保险受益人的通用型左甲状腺素起始使用比例高于医疗补助受益人（分别为66.40%和44.04%）。医疗保险受益人的人口统计学因素和医疗服务利用情况与通用型左甲状腺素的起始使用有关。男性、居住在东北地区和农村地区的医疗补助受益人更有可能起始使用通用型左甲状腺素。在品牌左甲状腺素新使用者中，医疗保险队列的通用型替代率高于医疗补助队列（分别为18.26%和3.88%）。医疗保险品牌左甲状腺素新使用者的人口统计学因素和医疗服务利用情况与通用型左甲状腺素替代有关。居住在东北地区、既往住院次数较多且起始使用较低剂量品牌左甲状腺素的医疗补助品牌左甲状腺素新使用者，通用型替代率较高。
患者人口统计学因素和医疗服务利用情况与通用型左甲状腺素的起始使用和替代有关。应根据不同患者群体制定针对性的教育推广计划，以增加通用型左甲状腺素的使用并节省处方费用。
