Academic journal article Applied Health Economics and Health Policy

Citizens' Preferences for Brand Name Drugs for Treating Acute and Chronic Conditions: A Pilot Study

Academic journal article Applied Health Economics and Health Policy

Citizens' Preferences for Brand Name Drugs for Treating Acute and Chronic Conditions: A Pilot Study

Article excerpt


In Switzerland, as in other countries, healthcare costs have dramatically increased and are still increasing. Drugs accounted for 10% of total healthcare costs in Switzerland in 2006.[1] Generic drug (GD) use has been advocated as a means to decrease healthcare costs. However, market penetration of GDs differs markedly between European countries: in 2006 it ranged from 5% in volume in Greece and Ireland to 78% in volume and 60% in value in Poland.[2] In Switzerland, despite the introduction of a law allowing GD substitution in 2001,[3] market penetration of GDs remained low (12% in 2006), although it is rapidly increasing (15% in 2009).[4] In this country, citizens pay monthly premiums for mandatory health insurance, and the full price of over-the-counter drugs, but only part of the cost of prescription drugs. Their cost sharing for all healthcare resource consumption is limited to their annual deductible and a 10% co-payment up to an annual maximum of Swiss franc (SwF)700[3] ([euro]450, $US500; 2006 exchange rate).

Reasons may differ as to why patients are reluctant to rely on GDs, but only a few studies have addressed this issue. A sizable proportion of patients (37%) in Germany still believe that inexpensive drugs are inferior in efficiency.[5] Large cost savings seem to be required for consumers to purchase GDs with higher perceived risk.[6] However, patient education is effective in increasing the acceptance rate.[7] In Switzerland, a GD manufacturer surveyed 1000 citizens aged 15-74 years in 2006.[8] Only 80% of them had heard of GDs, 10% thought they were not safe and efficacious and 12% would refuse to use one. Another survey by pharmacists[9] showed that generic substitution sometimes creates confusion and decreased compliance in patients.

Recognized methods for measuring preferences include the standard gamble (SG), time trade-off (TTO) and rating scale (RS) techniques.[10] SG and TTO cannot be used when the benefits of the choice alternatives are similar, as with GDs and brand name drugs (BNDs). RS in such a case is too subjective and does not express real preferences, as it may be influenced by opinions. Willingness to pay (WTP) is a fourth method, and has been developed for assessing preferences in scenarios where there is no real market, such as environment protection.[11] It forces respondents to attribute a financial value to an object. In the case of GDs versus BNDs, this method is appropriate to assess the marginal value of BNDs, but is limited by the fact that it shows only declared preferences.[11]

We therefore wanted to study citizens' preferences by using WTP for BNDs in frequent acute and chronic conditions, treatable with a single drug, where GDs are available. We hypothesized that people would be more interested in BNDs for treating acute than chronic conditions because of the shorter treatment duration and lower potential for economic savings.



A questionnaire was developed for assessment of citizens' preferences via WTP for BNDs compared with GDs for the following eight scenarios: antibacterials for 10 days for acute bronchitis (scenario 1); NSAIDs for 7 days for a twisted ankle (scenario 2); proton pump inhibitors for 30 days for heartburn (scenario 3); antibacterials for 7 days for acute urinary infection (scenario 4); antihypertensives per month (scenario 5); NSAIDs per month for knee arthritis (scenario 6); proton pump inhibitors per month for heartburn because of NSAIDs taken for knee arthritis (scenario 7) and statins per month for hypercholesterolaemia (scenario 8). We selected these four acute and four chronic conditions because they are frequent and treatable with a single drug. The duration of treatment for acute conditions of 7 or 10 days, or 30 days for proton pump inhibitors, is usual in Switzerland. The duration of treatment of 1 month for the chronic conditions was selected because it is the common budget allocation framework for both working and retired people. …

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