Brand vs. Generic: Addressing Non-Adherence, Secular Trends, and Non-Overlap
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While generic drugs offer a cost-effective alternative to brand name drugs, regulators need a method to assess therapeutic equivalence in a post market setting. We develop such a method in the context of assessing the therapeutic equivalence of immediate release (IM) venlafaxine, based on a large insurance claims dataset provided by OptumLabs. To properly address this question, our methodology must deal with issues of non-adherence, secular trends in health outcomes, and lack of treatment overlap due to sharp uptake of the generic once it becomes available. We define, identify (under assumptions) and estimate (using G-computation) a causal effect for a time-to-event outcome by extending regression discontinuity to survival curves. We do not find evidence for a lack of therapeutic equivalence of brand and generic IM venlafaxine.
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