Zhang Lingli, Li Dashuang, Li Xin, Yan Jianzhou
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
Medical Services Department, Qilu Hospital of Shandong University, Jinan, China.
Front Pharmacol. 2024 Jul 2;15:1400156. doi: 10.3389/fphar.2024.1400156. eCollection 2024.
Generic substitution policies have been widely implemented worldwide to enhance the accessibility of medications. Nevertheless, certain patients have voiced discontent with these policies. This study aimed to evaluate the patient preferences for generic substitution policies and explore the potential for optimization to enhance patient acceptance. A discrete choice experiment (DCE) was conducted to estimate the relative importance (RI) of five attributes, including generic consistency evaluation (GCE), reimbursement rate, medication use control, information disclosure, and post-marketing surveillance. Respondents were recruited among inpatients and outpatients in three cities and surveys were conducted face-to-face. Preference coefficients, RI of attributes, and the uptake rate of various policies were computed using a mixed logit model. The interaction effects were also included to examine preference heterogeneity. A total of 302 patients completed the survey. All five attributes significantly impacted policy acceptance. GCE held the highest RI value at 56.64%, followed by reimbursement rate (RI = 12.62%), information disclosure (RI = 12.41%), post-marketing surveillance (RI = 9.54%), and medication use control (RI = 8.80%). Patient preferences varied depending on their gender and income. The patient uptake rate of China's current policy was only 68.56%. If all generics were to pass GCE without altering the other attributes, the uptake rate of policies would rise to 82.63%. Similarly, implementing information disclosure without changing other attributes would result in a 78.67% uptake rate, which is comparable to the effect of a 10% increase in reimbursement rate for generics (78.81%). Combining these policies could mitigate the adverse effects of mandatory substitution on patient. Chinese patient preferences for generic substitution policies were mainly influenced by GCE. China's current generic substitution policy has room for further optimization to enhance patient acceptance.
通用名替换政策已在全球广泛实施，以提高药物的可及性。然而，一些患者对这些政策表示不满。本研究旨在评估患者对通用名替换政策的偏好，并探索优化的可能性以提高患者接受度。进行了一项离散选择实验（DCE），以估计五个属性的相对重要性（RI），包括通用名一致性评估（GCE）、报销率、用药控制、信息披露和上市后监测。在三个城市的住院患者和门诊患者中招募了受访者，并进行了面对面调查。使用混合逻辑模型计算偏好系数、属性的RI以及各种政策的采用率。还纳入了交互效应以检验偏好异质性。共有302名患者完成了调查。所有五个属性均对政策接受度有显著影响。GCE的RI值最高，为56.64%，其次是报销率（RI = 12.62%）、信息披露（RI = 12.41%）、上市后监测（RI = 9.54%）和用药控制（RI = 8.80%）。患者偏好因性别和收入而异。中国现行政策的患者采用率仅为68.56%。如果所有通用名药物都通过GCE而不改变其他属性，政策采用率将升至82.63%。同样，在不改变其他属性的情况下实施信息披露将导致采用率达到78.67%，这与通用名药物报销率提高10%的效果相当（78.81%）。结合这些政策可以减轻强制替换对患者的不利影响。中国患者对通用名替换政策的偏好主要受GCE影响。中国现行的通用名替换政策有进一步优化的空间以提高患者接受度。
