The vilified practice of providing free drug samples to physicians to dispense to their patients may not be so pernicious after all. At least, not when the drugs are a generic statin.
Sampling fell in disfavor based on research showing that the practice influenced physician behavior, with some doctors who accepted samples being more likely to prescribe drugs whose costs exceeded guideline recommendations. Rola Kaakeh, PharmD, of Sullivan University College of Pharmacy in Louisville, Ky., and colleagues noted that there was only limited research on sampling and generics, and little was known about outcomes and costs with generic sampling.
In the March/April issue of the American Journal of Pharmacy Benefits, the researchers reported results from a study based on a hypothetical cohort of patients who were statin naïve, had experienced an MI and were 65 years old. The Markov model used a 10-year time horizon and three sampling scenarios to evaluate the cost-effectiveness of each scenario: no sampling; giving patients a free sample of a brand name statin and a prescription; or giving patients a sample of a generic statin and a prescription. The cost analysis was from the perspective of the healthcare system and third-party payers.
The model accounted for switching from a brand to a generic statin or vice versa, medication adherence and rates of adverse cardiovascular events and deaths. Kaakeh et al used Medicare reimbursement, the Nationwide Inpatient Sample and long-term care data to determine the cost of events, non-coronary heart disease deaths and incremental annual costs. Medication costs were determined from average wholesale prices and the 2010 Red Book, updated to 2012 prices.
Their analysis found that generic sampling offered the best combination of costs and discounted quality-adjusted life-years (QALYs), followed by no sampling and then brand name sampling. The generic scenario offered 5.86 discounted QALYs with total healthcare costs of $47,805. Lower costs for statins and lower healthcare costs contributed to the savings.
No sampling provided 5.82 QALYs at total healthcare costs of $49,949 and brand sampling had 5.77 QALYs and total healthcare costs of $52,868.
“Our analysis suggests that each patient who starts taking generic medications will save on average $4,960 and gain 0.09 QALY over 10 years from both a health system and a payer cost perspective,” they wrote. “The incremental cost difference between brand and generic statins is due to several factors: brand medications are more expensive, and worse adherence when patients take brand statins leads to higher other costs of stroke, MI and CHF [congestive heart failure].”
Kaakeh et al proposed that using generic sampling could save Medicare $194.2 million annually compared with brand sampling and $84 million compared with no sampling.
They cautioned that while average wholesale prices typically are used in cost analysis research, prices often are negotiated to include rebates and discounts in real-world practice.