Budget impact of adding lesinurad for second-line treatment of gout: a US health plan perspective.

Aim: To estimate budget impact of adopting lesinurad as add-on to allopurinol for urate-lowering therapy in gout. Methods: A budget impact model was developed for a US payer perspective, using a Markov model to estimate costs, survival and discontinuation in a one-million-member health plan. The population included patients failing first-line gout therapy, followed for 5 years. Results: Incremental costs of adding lesinurad versus no lesinurad were US$241,907 and US$1,098,220 in first and fifth years, respectively. Cumulative 5-year incremental cost was US$3,633,440. Estimated incremental mean cost per treated patient with gout per year was US$112. The mean per-member per-month cost increased by US$0.06. Conclusion: Initiating lesinurad would result in an incremental per-member per-month cost of US$0.06 over 5 years.

Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat.

PURPOSE: Clinical guidelines recommend febuxostat as first-line pharmacologic urate-lowering therapy for patients with gout to achieve a goal serum uric acid (sUA) <6 mg/dL; however, little is known about other contributing factors. This study identified clinical characteristics of patients treated with febuxostat to develop and validate a predictive model for achieving a goal sUA. PATIENTS AND METHODS: Patients with Humana Medicare or commercial insurance, diagnosed with gout and newly initiated on febuxostat (index date February 1, 2009 - December 31, 2013), were identified for a retrospective cohort study. Patients were followed for 365 days and the first valid sUA test result ≥120 days after index was retained. A stepwise logistic regression with backward elimination was estimated to model sUA goal attainment, and a linear model was estimated to model the impact of predictor variables on sUA level. RESULTS: The study sample (n=678) was divided into a development (training) dataset (n=453) and a validation (holdout) dataset (n=225). In the training sample, patients in the sUA <6 mg/dL group were on febuxostat for a longer time, were more adherent, and had a lower average base-line sUA level (all p<0.0001) vs patients in the sUA ≥6 mg/dL group. In the logistic model, febuxostat adherence (odds ratio [OR]=1.03, p<0.0001) and baseline sUA level (OR=0.84, p<0.0001) increased the odds of attaining sUA <6 mg/dL. In the linear regression model, increase in febuxostat adherence (p<0.0001), baseline sUA level (p<0.0001), advanced age (p=0.0021), and not having congestive heart failure (p<0.05) were associated with a reduction of sUA level. Pre-index allopurinol use was a marginally significant predictor of sUA level reduction (p=0.06). CONCLUSIONS: Among febuxostat users diagnosed with gout in a real-world setting, adherence to febuxostat and lower baseline sUA level were the strongest predictors of attaining sUA goal. These findings may help clinicians to identify appropriate patients most likely to benefit from febuxostat treatment, and underscore the importance of medication adherence in this challenging patient population.

User testing and performance evaluation of the Electronic Quality Improvement Platform for Plans and Pharmacies.

OBJECTIVE: To user-test and evaluate a performance information management platform that makes standardized, benchmarked medication use quality data available to both health plans and community pharmacy organizations. SETTING: Multiple health/drug plans and multiple chain and independent pharmacies across the United States. EVALUATION: During the first phase of the study, user experience was measured via user satisfaction surveys and interviews with key personnel (pharmacists, pharmacy leaders, and health plan leadership). Improvements were subsequently made to the platform based on these findings. During the second phase of the study, the platform was implemented in a greater number of pharmacies and by a greater number of payers. User experience was then reevaluated to gather information for further improvements. RESULTS: The surveys and interviews revealed that users found the Web-based platform easy to use and beneficial in terms of understanding and comparing performance metrics. Primary concerns included lack of access to real-time data and patient-specific data. Many users also expressed uncertainty as to how they could use the information and data provided by the platform. CONCLUSION: The study findings indicate that while information management platforms can be used effectively in both pharmacy and health plan settings, future development is needed to ensure that the provided data can be transferred to pharmacy best practices and improved quality care.

Demographic differences in the treatment and control of glucose in type 2 diabetic patients: implications for health care practice.

OBJECTIVE: Identifying modifiable covariables that reduce demographic disparities in controlling type 2 diabetes could inform efforts to improve health equity. RESEARCH DESIGN AND METHODS: This retrospective study utilized electronic health record data on 22,285 adults with type 2 diabetes seen at 110 outpatient clinics in the Southeast U.S. from 2004-2008. Demographic differences in diabetes control and modifiable covariables which reduce those disparities were quantified using descriptive and logistic regression analysis. RESULTS: Patients were 55.8 +/- 14.6 (SD) years old, 57.5% women, 61.0% white: 39.0% black and had baseline body mass index 34. +/- .3 kg/ m2 and HbA1c 7.61 +/- 1.9%. The percentage with HbAlc <7% was higher in Whites than blacks (55.6% vs. 44.7%, P < .0001) and rose with age in all patients from 45.3% at <50, to 50.0% at 50-64, and 59.6% at > or =65 years, P < .001. white vs. black race (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.51-1.68) and age/ 10 years (OR 1.20/10 years, 95% CI 1.17-1.22) were predictors of HbAlc <7% in univariable logistic regression. In multivariable analysis, three modifiable covariables (initial HbAlc, therapeutic inertia, visit frequency) accounted for 47.9% of variance in diabetes control. When accounting for these modifiable covariables, the independent impact of race/ethnicity (OR 1.21, 95% CI 1.13-1.30) and age (OR 1.13, 95% Cl 1.11-1.16) on HbA1c control declined. CONCLUSIONS: Race and age-related difference in diabetes control declined significantly when modifiable covariates were considered. Greater attention to early diagnosis and treatment, ensuring regular healthcare visits and overcoming therapeutic inertia could improve diabetes control and health equity.