Medical Research Institute, Alexandria University, 165, Horreya Avenue, Hadara, Alexandria, Egypt.
Health Insurance Organization, Alexandria, Egypt.
Sci Rep. 2024 Nov 4;14(1):26643. doi: 10.1038/s41598-024-77007-3.
Patient preferences for medications strongly correlate with adherence; one area of interest is the choice between branded and generic drugs. Despite extensive research about brand-versus-generic drug preferences, few studies have explored severe-illness patients like those with coronary heart disease (CHD). We could not locate studies measuring preference weights of branded drugs in different classes within guideline-recommended regimens using discrete choice experiments (DCE). We aimed to explore the preference for branded medications used for secondary prevention of CHD events among patients receiving treatment at one of the largest Egyptian health insurance clinics. Patients with CHD were interviewed to choose between various therapy regimens containing brand-name and generic versions of aspirin, beta-blockers, statins, and renin-angiotensin-aldosterone system blockers (RAAS blockers). The study employed a DCE technique and followed the recommendations of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR). Seventy-two percent (149) of the 208 patients questioned were dissatisfied with at least one of their generic medications. The majority of unsatisfied patients displayed brand preferences across the four medicine classes, primarily due to the notion that generics may be less effective. Patients preferred the RAAS blocker brand the most (adjusted odds ratio [AOR]: 3.14; 95% confidence interval [CI] 2.83 to 3.48), followed by beta-blockers (AOR: 2.06; 95% CI 1.88 to 2.27) and statins (AOR: 1.5; 95% CI 1.50 to 1.61). The relative importance of each class from the patient's perspective showed the highest importance with RAAS blockers (22.2%) and beta-blockers (14.1%), while statins and aspirin had minor importance (7.8% and 6.6%, respectively). In the present study, branded drugs for secondary CHD prevention were preferred over generic alternatives. This finding has two implications for clinical practice. Firstly, physicians and pharmacists need to assure patients about the quality of generics to insure patient satisfaction and adherence to medication. Secondly, health insurance providers need to confirm the effectiveness of generics through observational studies. Despite the well-proven protective effects of aspirin and statins, they had minor importance from the patient's perspective, highlighting the need to enhance patient knowledge. DCE was demonstrated to be a useful tool for eliciting the genuine preferences of patients treated within the setting of health insurance.
患者对药物的偏好与依从性密切相关；其中一个关注的领域是品牌药和仿制药之间的选择。尽管有大量关于品牌药和仿制药偏好的研究，但很少有研究探讨像冠心病（CHD）患者这样的重病患者。我们无法找到使用离散选择实验（DCE）衡量指南推荐方案中不同类别品牌药物偏好权重的研究。我们旨在探讨在埃及最大的一家健康保险公司诊所接受治疗的 CHD 患者对用于 CHD 二级预防的品牌药物的偏好。对 CHD 患者进行了访谈，让他们在含有阿司匹林、β受体阻滞剂、他汀类药物和肾素-血管紧张素-醛固酮系统阻滞剂（RAAS 阻滞剂）的各种治疗方案中进行选择。该研究采用了 DCE 技术，并遵循了国际药物经济学和结果研究学会（ISPOR）的建议。在接受调查的 208 名患者中，有 72%（149 名）对至少一种仿制药不满意。大多数不满意的患者在四种药物类别中都表现出对品牌的偏好，主要是因为他们认为仿制药可能效果较差。患者最偏爱 RAAS 阻滞剂品牌（调整后的优势比[OR]：3.14；95%置信区间[CI] 2.83 至 3.48），其次是β受体阻滞剂（OR：2.06；95%CI 1.88 至 2.27）和他汀类药物（OR：1.5；95%CI 1.50 至 1.61）。从患者角度来看，每个类别的相对重要性显示 RAAS 阻滞剂（22.2%）和β受体阻滞剂（14.1%）最重要，而他汀类药物和阿司匹林的重要性较小（分别为 7.8%和 6.6%）。在本研究中，二级 CHD 预防的品牌药物优于仿制药。这一发现对临床实践有两方面的意义。首先，医生和药剂师需要向患者保证仿制药的质量，以确保患者的满意度和对药物的依从性。其次，健康保险公司需要通过观察性研究来确认仿制药的有效性。尽管阿司匹林和他汀类药物具有良好的保护作用，但从患者的角度来看，它们的重要性较小，这突出了增强患者知识的必要性。DCE 被证明是一种有用的工具，可以在医疗保险环境中收集患者的真实偏好。
