OBJECTIVES: Hospitals that manage their therapeutic array without non-medical switching policies (NMSP) waste a source of savings. Economic outcomes evaluation of NMSP (i.e. therapeutic interchange [TI] and therapeutic substitution [TS]) can identify therapeutic classes or pathologies for NMSP implementation that lead to costs savings.

METHODS: A systematic literature search was conducted in Medline, Embase, and ScienceDirect. Studies published between January 1988 and June 2018 were included if: a. they assessed the economic impact of NMSP; or b. they performed an economic evaluation.

RESULTS: Seventy-three studies were identified and allocated to four categories: CI. cost-analysis (CA) of a switch after an actual NMSP implementation (n = 23, 31%); CII. retrospective CA of a switch that occurred regardless of an NMSP (n = 21, 29%); CIII. retrospective cost-effectiveness (CEA) or cost-benefit analysis (CBA) of a switch that occurred regardless of an NMSP (n = 7, 10%); CIV. economic evaluation between two drugs (n = 22, 30%).

Outcomes in NMS were: CI. one resulted in unchanged costs, eight in moderate ($6 - $97 per patient per year [PPPY]) and eleven in significant costs savings ($101 - $2 869 PPPY); CII. five increased costs (-$ 1 409 to -$ 481 PPPY), three led to unchanged costs, four to moderate ($8 - $94 PPPY) and six to significant cost savings ($126 - $1 972 PPPY); CIII. all seven NMS were deemed as “positive”; CIV. seven NMS were deemed as “neutral”, 14 as “positive” and none as “negative”. Seven outcomes were excluded. HMG-CoA reductase inhibitors (n = 10, 13%), antithrombotic agents (n = 8, 11%), diabetes mellitus (n = 16, 22%) and peptic ulcer and gastroesophageal reflux disease (n = 8, 11%) were the most studied cases.

CONCLUSIONS: This study suggests that costs savings can be achieved through NMSP but results have to be adapted to local settings.