Cost-Minimization Analysis of Dexmedetomidine Compared to Other Sedatives for Short-Term Sedation During Mechanical Ventilation in the United States.

PURPOSE: Mechanical ventilation (MV) remains a substantial cost driver in intensive care units (ICU) in the United States (US). Evaluations of standard sedation treatments used to relieve pain and discomfort in this setting have found varying impacts on ICU length of stay. This cost analysis examines both length-of=stay costs and the total cost implications among MV patients receiving common sedative treatments (dexmedetomidine, propofol, or midazolam) in short-term sedation settings (<24 hours). METHODS: A cost-minimization model was conducted from the hospital provider perspective. Clinical outcomes were obtained from published literature and included ICU length of stay, MV duration, prescription of sedatives and pain medication, and the occurrence of adverse events. Outcomes costs were obtained from previously conducted ICU cost studies and Medicare payment fee schedules. All costs were estimated in 2018 US Dollars. RESULTS: The per patient costs associated with dexmedetomidine, propofol, and midazolam were estimated to be $21,115, $27,073, and $27,603, respectively. Dexmedetomidine was associated with a savings of $5958 per patient compared to propofol and a saving of $6487 compared to midazolam. These savings were primarily driven by a reduction in ICU length of stay and the degree of monitoring and management. CONCLUSION: Dexmedetomidine was associated with reduced costs when compared to propofol or midazolam used for short-term sedation during MV in the ICU, suggesting sedative choice can have a potential impact on overall cost per episode.

Phosphodiesterase Type-5 Inhibitor Prescription Patterns in the United States Among Men With Erectile Dysfunction: An Update.

BACKGROUND: While phosphodiesterase type-5 inhibitors (PDE5Is) are highly effective for the treatment of erectile dysfunction (ED) and well tolerated, updated data on prescription patterns have been limited in real-world settings. AIM: To describe men in the United States who are prescribed PDE5Is for ED treatment and to evaluate patterns of initiation, switching, and treatment overlap. METHODS: This retrospective claims study used MarketScan Commercial and Medicare Supplement Databases from January 1, 2010, to December 31, 2015, to identify initial PDE5I claims (index date) for sildenafil, tadalafil, and/or vardenafil. Adults aged ≥18 years with ED were identified between July 1, 2010, and December 31, 2014, allowing for a 6-month preindex and 12-month follow-up period from the index date. OUTCOMES: Outcomes included patient demographics and treatment-related patterns after treatment initiation. RESULTS: A total of 106,206 identified patients met all inclusion criteria. Of these, 51,694, 40,193, and 14,319 had initial claims for sildenafil, tadalafil, and vardenafil, respectively. Mean age was 50.35 years, and comorbidities included dyslipidemia (44.17%), hypertension (43.09%), diabetes (15.32%), and depression (10.61%). More patients (48.67%) initiated on sildenafil than tadalafil (37.85%) or vardenafil (13.48%). Rate of switching was lower in the 60 days after the end of day supply of the initial prescription in the sildenafil cohort (2.71%) compared with the tadalafil (2.81%) and vardenafil (3.88%) cohorts (P < .001 for sildenafil vs tadalafil or vardenafil). Treatment overlap was lower in the sildenafil cohort (0.35%) than in the tadalafil (0.75%) and vardenafil (0.62%) groups (P < .001 for sildenafil vs tadalafil or vardenafil). CLINICAL IMPLICATIONS: These findings provide insight into updated patterns of PDE5I prescriptions in the United States and may aid in clinical decision-making. STRENGTHS & LIMITATIONS: Strengths include the large sample size, long data coverage period, and the real-world nature of the study. Limitations include the retrospective study design, use of data collected with a primary focus of claims, and lack of further details regarding reasons that drive switching. Actual rates of ED and impact on prescription patterns may be underestimated because the claims database only captured patients electing to visit a health-care provider. CONCLUSION: Among men with ED in the United States, rates of switching and treatment overlap were low for all PDE5Is but were found to be the lowest for sildenafil compared with tadalafil and vardenafil. Mulhall JP, Chopra I, Patel D, et al. Phosphodiesterase Type-5 Inhibitor Prescription Patterns in the United States Among Men With Erectile Dysfunction: An Update. J Sex Med 2020;17:941-948.

Pharmacoeconomic and associated cost savings among women who were prescribed systemic conjugated estrogens therapy compared with those without menopausal therapy.

OBJECTIVE: To explore changes in healthcare costs among postmenopausal women in a commercial population who were prescribed conjugated estrogens for menopausal symptoms. METHODS: Using the MarketScan dataset from April 1, 2008 through September 30, 2012, postmenopausal women aged ≥45 years, who were prescribed conjugated estrogen tablets (Premarin), were identified. A comparative cohort of postmenopausal women with vasomotor symptoms without any menopause therapy was also identified. Women included were required to have continuous medical and pharmacy benefits for 6 months before and 12 months after index date, with baseline characteristics compared using chi-square and t tests. The 6 and 12-month change (difference in follow-up and baseline costs) in direct healthcare costs was calculated and a difference-in-differences model was used to compare the incremental change at 6 and 12 months in healthcare costs between the cohorts, adjusting for demographic and clinical characteristics. RESULTS: The study included 1,404 women who were prescribed conjugated estrogens, and 3,096 untreated women. Women prescribed conjugated estrogens were significantly younger (52 vs 54 years; P < 0.0001) and had a lower Charlson comorbidity index score (0.29 vs 0.41; P < 0.001) compared with the untreated women. After adjusting for baseline characteristics, women treated with conjugated estrogens showed a greater difference in the change in total healthcare costs (-$1,601 vs -$503; P = 0.044), including inpatient stay costs (-$1,431 vs -$28; P < 0.0001), between the baseline and follow-up periods compared with untreated women. CONCLUSIONS: Women who were prescribed oral conjugated estrogens had a significantly greater reduction in healthcare costs after treatment initiation compared with untreated postmenopausal women.