Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva Faculty of Science, Geneva, Switzerland
Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.
Eur J Hosp Pharm. 2021 Nov;28(Suppl 2):e2-e7. doi: 10.1136/ejhpharm-2020-002652. Epub 2021 Jan 20.
Non-medical switching (NMS) strategies have the capacity to reduce overall costs in hospitals while maintaining a high level of care. However, the most appropriate diseases and/or medicines for NMS strategies are still vague. The aim of this review was to give a state-of-the-art summary regarding the economic outcomes resulting from the use of NMS strategies and to discuss whether they would be implementable in a hospital inpatient setting.
A systematic literature search was conducted in Medline, Embase, and ScienceDirect. Studies published between 1988 and 2018 were included if they evaluated the economic impact of NMS strategies or if they performed an economic evaluation between two drugs. Studies regarding antineoplastic agents, endocrine therapies, and immunostimulants, or immunosuppressants, and biosimilars were excluded.
Fifty (69%) studies assessing an NMS strategy and 22 (31%) studies comparing two medicines were allocated to four categories: prospective studies (n=8, 11%); retrospective chart reviews (n=29, 40%); retrospective claims analysis (n=13, 18%); and retrospective data analysis (n=22, 31%). Hypercholesterolemia, peptic ulcer, and gastro-oesophageal reflux diseases, diabetes mellitus, and venous thromboembolism were the most prevalent diseases in studies evaluating an NMS strategy. Sixty-eight per cent of the included papers reported a reduction in costs with no significant changes in health outcomes and 8 per cent reported a deterioration in health outcomes and/or increased costs.
Regardless of the exclusion of studies regarding biologics or medicines used in oncology, the review highlights that NMS strategies with medicines whose management do not require a thorough clinical assessment were associated with reduced costs and no significant changes in patients' health outcomes, in the inpatient setting. NMS strategies targeting medicines that require an extensive clinical assessment should be evaluated using hospital-specific effectiveness and/or utility data prior to their implementation.
非医疗性药物转换（NMS）策略具有降低医院整体成本的潜力，同时保持较高的护理水平。然而，最适合采用 NMS 策略的疾病和/或药物仍不明确。本综述的目的是总结 NMS 策略使用所产生的经济结果，并探讨其在医院住院环境中的实施可行性。
对 Medline、Embase 和 ScienceDirect 进行系统文献检索。纳入评估 NMS 策略经济影响或对两种药物进行经济评估的研究，研究时间为 1988 年至 2018 年。排除抗肿瘤药物、内分泌治疗药物、免疫刺激剂和免疫抑制剂以及生物类似药的相关研究。
有 50 项（69%）评估 NMS 策略的研究和 22 项（31%）比较两种药物的研究被分配到四个类别：前瞻性研究（n=8，11%）；回顾性图表审查（n=29，40%）；回顾性索赔分析（n=13，18%）；以及回顾性数据分析（n=22，31%）。评估 NMS 策略的研究中最常见的疾病是高胆固醇血症、消化性溃疡和胃食管反流病、糖尿病和静脉血栓栓塞症。68%的纳入文献报告成本降低，而健康结果无显著变化，8%报告健康结果恶化和/或成本增加。
尽管排除了生物制剂或肿瘤学药物的研究，但本综述强调，针对管理不需要全面临床评估的药物的 NMS 策略与降低成本和患者健康结果无显著变化相关，在住院环境中。针对需要广泛临床评估的药物的 NMS 策略，在实施前应使用医院特定的有效性和/或实用性数据进行评估。
