2014年度から後発医薬品の使用数量割合がDPC対象病院における機能評価係数㈼に反映されたことを受け、手稲渓仁会病院でも積極的に後発医薬品への切り替えを進めている。切り替えの際は薬剤師が作成した評価表を用いて候補品目を評価し、採用の参考としている。今回、2014年4月から2017年9月までに、評価表を用いて先発医薬品および切り替え候補となる後発医薬品の評価を行い、切り替えを行った77成分（95規格）について、評価項目毎に点数を集計、比較した。大項目の平均点は先発医薬品/後発医薬品でそれぞれ [供給体制]7.8*/5.9（*：p＜0.01）、[資料]2.7*/2.3、[情報提供]5.5*/4.9、[薬物動態データ]4.7*/2.6、[リスクマネジメント]5.2/7.8*、[品質]4.1/3.9であり、[合計]29.9*/27.3であった。先発医薬品と後発医薬品の品質に差は認められなかったが、供給体制や資料、情報提供については先発医薬品の点数が有意に高く、後発医薬品導入時は安定供給の確認や薬剤部による積極的な情報の収集および医療スタッフへの周知が必要と考えられた。一方で、名称や外観、識別性等の点で、後発医薬品はリスクマネジメントへの寄与が評価され、薬剤費の削減効果も確認された。引き続き患者にとって安全で経済的な後発医薬品を提供できるよう、切り替え時は適切に評価を行いたい。
From 2014, DPC hospitals are recommended to prioritize generic medicines as part of their functional performance review, and our hospital is actively working towards this goal. Our pharmacy team discusses to evaluate original and generic medicines and determines which medicines will be stocked and included in the hospital formulary. We evaluated original and generic medicines which were due to be switched during the period of April 2014 to September 2017. A total of 77 different medicines (95 different dosages in total) were included and a scored evaluation was calculated for each. The mean results of each major category are as follows (listed as original medicine/generic medicine respectively)：Supply system 7.8/5.9 (p＜0.01), Documentation 2.7/2.3 (p＜0.01), Information provision 5.5/4.9 (p＜0.01), Pharmacokinetic data 4.7/2.6 (p＜0.01), Risk management 5.2/7.8 (p＜0.01), Quality 4.1/3.9, Overall score 29.9/27.3 (p＜0.01). Generic medicines had equivalent quality scores, but original medicines scored higher in the supply system, documentation and information provision categories. Therefore, when switching to generics it is crucial to provide adequate information to hospital staff and to ensure a steady supply of the drug. Then, we evaluated the names, appearance of these generic medicines including whether they were easy to discriminate from other medicines. Our tabulated risk score showed that generics performed better than original medicines. We were also able to show a reduction in overall cost by switching to generics, and we would like to continue to evaluate for safely providing generics to our patients.
