The risks and costs of multiple-generic substitution of topiramate
Nitin K.Sethi, New York-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065sethinitinmd@hotmail.com
Josh Torgovnick, Prahlad K. Sethi, and Edward Arsura
Submitted August 18, 2009
We read with interest the article by Duh et al. who investigated the clinical and economic consequences following the generic substitution of one versus multiple generics of topiramate. [1] Using a database comprising pharmacy and medical claims, the authors concluded that many generic substitutions of topiramate were associated with negative outcomes including hospitalizations, fracture injuries, and overall health care costs.
We feel the thrust to use brand name drugs even for conditions which have a narrow therapeutic index such as epilepsy is predominantly industry driven. We also note that this article is industry supported. Physicians are consistently reminded by industry representatives that generics are somehow less potent than brand name drugs and that seizure control frequently deteriorates when a patient is switched to a generic. Our experience points to the contrary.
The majority of patients who are switched to a generic version either due to treating doctor or patient preferences experience no change in their seizure frequency or side-effect profile. Generic versions have to meet the same FDA standards of bioequivalence as the brand name medication. In addition, there is no scientific evidence to support that generics are inferior in quality. Under President Obama’s administration, there is a new urgency to reform health care with the goal of providing high quality health care to all Americans. Generic versions play an important role in this equation by providing essential drugs at an affordable price and thus reducing overall health care costs.
The authors used ICD diagnostic codes to determine that the use of generics led to more frequent hospitalization. They found no significant differences in the number of outpatient visits among the three studied periods. Many of these diagnostic codes for inpatient hospitalization were for reasons other than epilepsy. As the authors acknowledge, inaccuracy in coding could have confounded the results.
Seizure patients who experience deterioration in their seizure control usually do not warrant inpatient admission unless they are in status epilepticus. These patients are assessed in an outpatient setting and their anti-epileptic drugs are adjusted. We believe there is no scientific evidence to suggest that generics lead to more frequent hospitalizations.
References
1. Duh MS, Paradis PE, Latremouille-Viau D, et al. The risks and costs of multiple-generic substitution of topiramate. Neurology 2009;72:2122-2129.
We read with interest the article by Duh et al. who investigated the clinical and economic consequences following the generic substitution of one versus multiple generics of topiramate. [1] Using a database comprising pharmacy and medical claims, the authors concluded that many generic substitutions of topiramate were associated with negative outcomes including hospitalizations, fracture injuries, and overall health care costs.
We feel the thrust to use brand name drugs even for conditions which have a narrow therapeutic index such as epilepsy is predominantly industry driven. We also note that this article is industry supported. Physicians are consistently reminded by industry representatives that generics are somehow less potent than brand name drugs and that seizure control frequently deteriorates when a patient is switched to a generic. Our experience points to the contrary.
The majority of patients who are switched to a generic version either due to treating doctor or patient preferences experience no change in their seizure frequency or side-effect profile. Generic versions have to meet the same FDA standards of bioequivalence as the brand name medication. In addition, there is no scientific evidence to support that generics are inferior in quality. Under President Obama’s administration, there is a new urgency to reform health care with the goal of providing high quality health care to all Americans. Generic versions play an important role in this equation by providing essential drugs at an affordable price and thus reducing overall health care costs.
The authors used ICD diagnostic codes to determine that the use of generics led to more frequent hospitalization. They found no significant differences in the number of outpatient visits among the three studied periods. Many of these diagnostic codes for inpatient hospitalization were for reasons other than epilepsy. As the authors acknowledge, inaccuracy in coding could have confounded the results.
Seizure patients who experience deterioration in their seizure control usually do not warrant inpatient admission unless they are in status epilepticus. These patients are assessed in an outpatient setting and their anti-epileptic drugs are adjusted. We believe there is no scientific evidence to suggest that generics lead to more frequent hospitalizations.
References
1. Duh MS, Paradis PE, Latremouille-Viau D, et al. The risks and costs of multiple-generic substitution of topiramate. Neurology 2009;72:2122-2129.
Disclosure: The authors report no disclosures.