RESUMO
Chronic cough (CC), defined as a daily cough lasting longer than 8 weeks in adults, is a common condition in the United States. CC is a diagnosis of exclusion associated with a substantial economic burden related to increased healthcare and medication utilization, decreased work productivity, a greater incidence of cough-related comorbidities, and reduced quality of life. CC treatment guidelines recommend stepwise treatment with specific nonpharmacologic therapies and pharmacologic agents. However, many patients may still have incomplete or no symptom relief, encounter response attenuation over time, or experience intolerable adverse effects. New targeted therapies for refractory CC are currently under development, including the purinergic 2X3 receptor antagonists gefapixant, BLU-5937, and sivopixant (S-600918) and the neurokinin-1 receptor antagonist orvepitant. These targeted agents may have improved efficacy and safety profiles, helping fill unmet treatment needs. If approved, managed care organizations must develop formulary placement and utilization management criteria based on clinical guideline recommendations, expert opinion, and cost-effectiveness analyses to support the clinically appropriate use of these targeted therapies for best patient outcomes.
Assuntos
Tosse , Antagonistas dos Receptores de Neurocinina-1 , Adulto , Doença Crônica , Tosse/tratamento farmacológico , Humanos , Programas de Assistência Gerenciada , Antagonistas dos Receptores de Neurocinina-1/uso terapêutico , Qualidade de Vida , Estados UnidosRESUMO
Pulmonary arterial hypertension (PAH) is a rare, progressive disorder associated with a poor prognosis if not treated appropriately. Fortunately, new treatment options have significantly improved survival rates and prognosis. Despite these advances, many patients do not receive the diagnosis until years into their disease or are inappropriately diagnosed. Early referral to specialized treatment centers that allows for early diagnosis and initiation of treatment significantly improves patient outcomes including survival as well as reduction in hospital admissions, which are a main driver of economic burden of disease. It is important that evidence-based guidelines are followed and treatment is individualized based on patient-specific factors. Pharmacologic therapies carry a very high cost for PAH; however, extensive utilization of management strategies may hinder access to medication and may lead to disease progression. Cost containment strategies may help to facilitate care coordination for earlier diagnosis and initiation of treatment, adherence to PAH medications, and patient education to ensure they are using medications appropriately to optimize therapy. Managed care pharmacists can play a crucial role in the multidisciplinary team in terms of medication safety, adherence, patient education, and follow-up to improve patient engagement that leads to improved outcomes.
Assuntos
Hipertensão Pulmonar , Hipertensão Arterial Pulmonar , Efeitos Psicossociais da Doença , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/tratamento farmacológico , Prognóstico , Qualidade de VidaRESUMO
BACKGROUND: Payers often consider cost-effectiveness studies for new drugs when making decisions on coverage, formulary position, and budgets; however, cost-effectiveness studies are often calculated using estimated pricing before a drug's launch. If the drug's price changes on or after launch, or if rebate programs are initiated, cost-effectiveness studies need to be updated to prevent payers from making decisions using inaccurate value assumptions, which can lead to unexpected financial impacts and potentially delay patient access to drugs. OBJECTIVE: To evaluate how lower at-launch drug pricing versus initial estimated pricing affects cost-effectiveness ratios and potentially influences treatment decisions, using the case study of brodalumab, a biologic drug indicated for the treatment of moderate-to-severe plaque psoriasis. METHODS: We compared the estimated cost-effectiveness of brodalumab, which was published in a December 2016 Institute for Clinical and Economic Review (ICER) report based on estimated pricing, with the drug's cost-effectiveness based on its actual pricing after its approval. DISCUSSION: The 2016 ICER report on the cost-effectiveness of targeted immunomodulators indicated for the treatment of moderate-to-severe plaque psoriasis, brodalumab's price was estimated to be $4267 by averaging the cost of its likely competitors. Brodalumab's effectiveness as a treatment for moderate-to-severe plaque psoriasis is high in clinical trials, but its estimated cost placed it as the fourth most cost-effective targeted immunomodulatory drug in the ICER report. On its approval in February 2017, brodalumab's newly estimated base price was $3900, based on its prelaunch price. Calculations using this base price placed brodalumab as the most cost-effective option among targeted immunomodulators in this setting. At the time this current article was written, brodalumab's cost was $3500, making it even more cost-effective. CONCLUSION: Because payers, providers, and patients are all concerned with achieving better outcomes for the often painful and disfiguring disease of plaque psoriasis, while controlling costs, updating cost-effectiveness data when new pricing information becomes available may reveal significant cost differences to help stakeholders make better decisions about their population's healthcare outcomes and costs.
RESUMO
RSV immunoprophylaxis presents a challenge for MCOs. Despite its demonstrated ability to protect high-risk infants against serious RSV infection and to reduce morbidity, immunoprophylaxis with palivizumab incurs high costs that MCOs must grapple with every year. If MCOs, physicians, and professional organizations can agree on common guidelines for RSV management, then MCOs will be able to provide affordable treatment for those children at high risk.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Antivirais/uso terapêutico , Quimioprevenção/normas , Gerenciamento Clínico , Programas de Assistência Gerenciada , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Estações do Ano , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Antivirais/administração & dosagem , Serviços de Assistência Domiciliar , Humanos , Palivizumab , Assistência Farmacêutica/normas , Guias de Prática Clínica como Assunto , Infecções por Vírus Respiratório Sincicial/imunologia , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Chronic pain is a major public health issue that affects the quality of life and productivity. It is costly and has a significant impact on health resource utilization. Management of chronic pain requires a multidisciplinary approach that focuses on disease management and takes into account the need for ongoing support by family members and other caregivers. Managed care pharmacies can play an important role in pain management to effect positive outcomes and reduce health resource utilization.