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1.
Sr Care Pharm ; 36(2): 124, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33509336
2.
PLoS One ; 15(8): e0237790, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810185

RESUMO

This study determined the frequency and factors associated with EGFR testing rates and erlotinib treatment as well as associated survival outcomes in patients with non small cell lung cancer in Kentucky. Data from the Kentucky Cancer Registry (KCR) linked with health claims from Medicaid, Medicare and private insurance groups were evaluated. EGFR testing and erlotinib prescribing were identified using ICD-9 procedure codes and national drug codes in claims, respectively. Logistic regression analysis was performed to determine factors associated with EGFR testing and erlotinib prescribing. Cox-regression analysis was performed to determine factors associated with survival. EGFR mutation testing rates rose from 0.1% to 10.6% over the evaluated period while erlotinib use ranged from 3.4% to 5.4%. Factors associated with no EGFR testing were older age, male gender, enrollment in Medicaid or Medicare, smoking, and geographic region. Factors associated with not receiving erlotinib included older age, male gender, enrollment in Medicare or Medicaid, and living in moderate to high poverty. Survival analysis demonstrated EGFR testing or erlotinib use was associated with a higher likelihood of survival. EGFR testing and erlotinib prescribing were slow to be implemented in our predominantly rural state. While population-level factors likely contributed, patient factors, including geographic location (areas with high poverty rates and rural regions) and insurance type, were associated with lack of use, highlighting rural disparities in the implementation of cancer precision medicine.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Cloridrato de Erlotinib/uso terapêutico , Testes Genéticos/estatística & dados numéricos , Neoplasias Pulmonares/tratamento farmacológico , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Análise Mutacional de DNA/economia , Análise Mutacional de DNA/estatística & dados numéricos , Prescrições de Medicamentos/economia , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/genética , Feminino , Testes Genéticos/economia , Disparidades em Assistência à Saúde/economia , Humanos , Kentucky/epidemiologia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidade , Masculino , Medicaid/economia , Medicaid/estatística & dados numéricos , Medicare/economia , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Mutação , Pobreza/estatística & dados numéricos , Medicina de Precisão/economia , Medicina de Precisão/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Análise de Sobrevida , Estados Unidos , Adulto Jovem
3.
JAMA Netw Open ; 3(6): e208968, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32579194

RESUMO

Importance: Little is known about the current use of imported drugs and the factors associated with individual purchase of medications outside the US. Objective: To evaluate the proportion of the US adult population that purchases medications in other countries and the patient factors associated with the behavior. Design, Setting, and Participants: This retrospective cross-sectional study used data from the 2015-2017 National Health Interview Survey. The study sample included 61 238 individuals 18 years or older who reported use of prescribed medication by a physician or other practitioner. Data analysis was performed in November 2019. Main Outcomes and Measures: Self-reported experience of purchasing prescription drugs from countries outside the US in the past 12 months. Internet use behaviors for health care included searches for health information and filling of a prescription online. Medication-taking behaviors included skipping or delaying filling a prescription and using alternative therapies to save money. Survey design-adjusted analysis was used to estimate and compare characteristics between those who purchased medications outside the US and those did not. Multivariable logistic regression was fitted to examine the association of medication purchases with internet use and medication-taking behavior factors. Results: Among 61 238 US adults taking prescription medications (mean [SD] age, 50.5 [18.5] years; 56.5% female; 70.8% white), the estimated prevalence of purchasing of medication outside the US was 1.5% (95% CI, 1.4%-1.7%; 2.3 million US individuals). Those who purchased medications outside the US were more likely to be older (age >64 years; adjusted odds ratio [aOR], 1.68; 95% CI, 1.24-2.29), to be from Hispanic (aOR, 1.70; 95% CI, 1.23-2.35) or immigrant populations (aOR, 3.20; 95% CI, 2.44-4.20), and to have higher educational attainment (bachelor's degree; aOR, 1.79; 95% CI, 1.27-2.54), lower family income (low income; aOR, 1.41; 95% CI, 1.06-1.87), and lack of insurance (aOR, 3.14; 95% CI, 2.33-4.21). Data analyses indicated that online health information-seeking behavior (aOR, 1.62; 95% CI, 1.33-1.98) or use of an online pharmacy (aOR, 2.30; 95% CI, 1.83-2.90) was associated with a greater likelihood of medication purchases outside the US. Individuals who skipped medications (aOR, 3.86; 95% CI, 3.05-4.88) or delayed filling a prescription (aOR, 4.04, 95% CI, 3.23-5.06) also had higher odds of purchasing medication outside the US. Conclusions and Relevance: The findings suggest that patients are not using prescription purchases outside the US to meet their medication needs. However, monitoring to promote safe administration of medications imported into the US should be continued.


Assuntos
Prescrições de Medicamentos/economia , Prescrições de Medicamentos/estatística & dados numéricos , Internacionalidade , Medicamentos sob Prescrição/economia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto Jovem
4.
Postgrad Med ; 132(7): 629-635, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32354248

RESUMO

Objectives: Atopic dermatitis, or eczema, is an inflammatory illness that impacts individuals of all ages. The cost of treating AD and the impact on the quality of life have not been well documented in the state of Nevada. This study seeks to fill this gap by identifying factors that impact the cost of AD in the state utilizing clinical and patient demographics. Methods: ANOVA with Bonferroni adjustment was performed using a large hospital utilization database to examine the cost of AD in the state of Nevada across all hospital settings. Results: Several significant factors were associated with the overall cost of AD in Nevada, including hospital setting type (outpatient vs. inpatient), physician type, region, AD diagnosis level, and age (p < 0.05). Stratified analysis was performed by setting type. In the inpatient setting, region, diagnosis level, and records with age listed between 0 and 5 years remained significant (p < 0.05). In the outpatient setting, physician type, region, and African American race remained significant (p < 0.05). Conclusions: Data from this study indicate that the AD cost burden is dependent on both demographic and clinical factors in the state of Nevada. These differences suggest that patients with AD may encounter higher costs depending on age, race, and clinical factors.


Assuntos
Efeitos Psicossociais da Doença , Dermatite Atópica/economia , Prescrições de Medicamentos/economia , Eczema/economia , Adulto , Dermatite Atópica/dietoterapia , Eczema/dietoterapia , Feminino , Serviços de Saúde/economia , Humanos , Reembolso de Seguro de Saúde/economia , Masculino , Pessoa de Meia-Idade , Nevada
5.
BMC Public Health ; 20(1): 797, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460730

RESUMO

BACKGROUND: The speed of adoption of new drugs and frequencies of substitutions leads to changes in health care expenditures as well as patient outcomes. In this study, we aim to understand the speed of adoption of new drugs and their prescription volume in health care institutions and evaluate the impact of policy options to manage pharmaceutical expenditure. METHODS: We conducted a retrospective cohort study of health care institutions prescribing NOACs, including Apixaban, Dabigatran, and Rivaroxaban, to address the speed of adoption and their substitution from October 1, 2010, through December 31, 2015, using the National Health Insurance Service-National Sample Cohort. Two threshold time points, including the extension of reimbursement with the need for the letter of opinion and the withdrawal of the letter of opinion, were noted in this study. Then, we applied a survival analysis to elucidate factors that affected the speed of adoption of NOACs, and interrupted time series analysis to estimate the effect of amendments in reimbursement coverage in prescription volume. RESULTS: Among 934 health care institutions in a study population, 334 institutions (36%) had prescribed NOACs at least one time during the study period, indicating that health care institutions were conservative in adopting new drugs. However, the speed of adoption was related to the characteristics of health care institution. We also found that prescriptions of NOACs before the withdrawal of the need for the letter of opinion were marginal, and the prescription volume of NOACs was significantly increased after the withdrawal of a letter of opinion. CONCLUSIONS: Health care institutions were conservative in adopting new drugs, and the speed of adoption is not closely related to an increased prescription volume in the short run. Thus, policies that are centered on managing pharmaceutical expenditure should be devised with considering the impact of introducing new drugs in the long run. A letter of opinion, which was devised to manage prescriptions of NOACs, was effective in managing pharmaceutical expenditures in health care institutions, particularly for tertiary institutions. Conversely, the withdrawal of the need for the letter of opinion should be implemented with caution.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Anticoagulantes/economia , Estudos de Coortes , Dabigatrana/uso terapêutico , Prescrições de Medicamentos/economia , Gastos em Saúde/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Pessoa de Meia-Idade , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , República da Coreia , Estudos Retrospectivos , Rivaroxabana/uso terapêutico
6.
BMC Health Serv Res ; 20(1): 399, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393267

RESUMO

BACKGROUND: In 2018, the Japanese medical reimbursement system was revised to introduce a fee for the implementation of an antimicrobial stewardship (AS) fee for pediatric patients. The purpose of this study was to evaluate physicians' prescription behavior following this revision. METHODS: We conducted a retrospective observational study from January 1, 2017 to September 30, 2018 of pediatric (< 15 years) outpatients with upper respiratory tract infections (URIs). To assess the pattern of antibiotic prescription for the treatment of pediatric URIs before and after the introduction of the AS fee, we extracted data on pediatric URIs, diagnosed during the study period. Patients were divided based on whether medical facilities claimed AS fees. We defined antibiotic use as the number of antibiotics prescribed, and evaluated the proportion of each class to the total number of antibiotics prescribed. We also recorded the number of medical facilities that each patient visited during the study period. RESULTS: The frequency of antibiotic prescription decreased after AS fee implementation, regardless of whether the facility claimed the AS fee, but tended to be lower in facilities that claimed the fee. Additionally, the frequency of antibiotic prescription decreased in all age groups. Despite the reduced frequency of antibiotic prescription, consultation behavior did not change. CONCLUSIONS: The AS fee system, which compensates physicians for limiting antibiotic prescriptions, helped to reduce unnecessary antibiotic prescription and is thus a potentially effective measure against antimicrobial resistance.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Padrões de Prática Médica , Infecções Respiratórias/tratamento farmacológico , Criança , Prescrições de Medicamentos/economia , Honorários e Preços , Feminino , Humanos , Japão , Masculino , Pacientes Ambulatoriais , Estudos Retrospectivos
7.
PLoS Med ; 17(4): e1003072, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32275654

RESUMO

BACKGROUND: In 2015, there were approximately 40,000 new HIV diagnoses in the United States. Pre-exposure prophylaxis (PrEP) is an effective strategy that reduces the risk of HIV acquisition; however, uptake among those who can benefit from it has lagged. In this study, we 1) compared the characteristics of patients who were prescribed PrEP with individuals newly diagnosed with HIV infection, 2) identified the specialties of practitioners prescribing PrEP, 3) identified metropolitan statistical areas (MSAs) within the US where there is relatively low uptake of PrEP, and 4) reported median amounts paid by patients and third-party payors for PrEP. METHODS AND FINDINGS: We analyzed prescription drug claims for individuals prescribed PrEP in the Integrated Dataverse (IDV) from Symphony Health for the period of September 2015 to August 2016 to describe PrEP patients, prescribers, relative uptake, and payment methods in the US. Data were available for 75,839 individuals prescribed PrEP, and findings were extrapolated to approximately 101,000 individuals, which is less than 10% of the 1.1 million adults for whom PrEP was indicated. Compared to individuals with newly diagnosed HIV infection, PrEP patients were more likely to be non-Hispanic white (45% versus 26.2%), older (25% versus 19% at ages 35-44), male (94% versus 81%), and not reside in the South (30% versus 52% reside in the South).Using a ratio of the number of PrEP patients within an MSA to the number of newly diagnosed individuals with HIV infection, we found MSAs with relatively low uptake of PrEP were concentrated in the South. Of the approximately 24,000 providers who prescribed PrEP, two-thirds reported primary care as their specialty. Compared to the types of payment methods that people living with diagnosed HIV (PLWH) used to pay for their antiretroviral treatment in 2015 to 2016 reported in the Centers for Disease Control and Prevention (CDC) HIV Surveillance Special Report, PrEP patients were more likely to have used commercial health insurance (80% versus 35%) and less likely to have used public healthcare coverage or a publicly sponsored assistance program to pay for PrEP (12% versus 45% for Medicaid). Third-party payors covered 95% of the costs of PrEP. Overall, we estimated the median annual per patient out-of-pocket spending on PrEP was approximately US$72. Limitations of this study include missing information on prescription claims of patients not included in the database, and for those included, some patients were missing information on patient diagnosis, race/ethnicity, educational attainment, and income (34%-36%). CONCLUSIONS: Our findings indicate that in 2015-2016, many individuals in the US who could benefit from being on PrEP were not receiving this HIV prevention medication, and those prescribed PrEP had a significantly different distribution of characteristics from the broader population that is at risk for acquiring HIV. PrEP patients were more likely to pay for PrEP using commercial or private insurance, whereas PLWH were more likely to pay for their antiretroviral treatment using publicly sponsored programs. Addressing the affordability of PrEP and otherwise promoting its use among those with indications for PrEP represents an important opportunity to help end the HIV epidemic.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Prescrições de Medicamentos , Infecções por HIV/prevenção & controle , Revisão da Utilização de Seguros/tendências , Profilaxia Pré-Exposição/tendências , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/economia , Estudos Transversais , Prescrições de Medicamentos/economia , Feminino , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Humanos , Revisão da Utilização de Seguros/economia , Seguro Saúde/economia , Seguro Saúde/tendências , Masculino , Pessoa de Meia-Idade , Profilaxia Pré-Exposição/economia , Estados Unidos/epidemiologia , Adulto Jovem
10.
JAMA Netw Open ; 3(2): e1920544, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32022881

RESUMO

Importance: Reference pricing has been shown to reduce drug spending in Europe and has been adopted by some employers and labor unions in the United States. Its association with patient cost sharing depends on whether and how quickly physicians adjust their prescribing patterns to favor the least costly alternatives within each therapeutic class. Objective: To examine whether the implementation of reference pricing is associated with physicians and patients shifting to lower-cost drugs, thereby reducing consumer cost sharing and the prices paid by employers. Design, Setting, and Participants: This economic evaluation included employees of Catholic organizations who purchased health insurance through the Reta Trust and a random sample of employees of public sector organizations who purchased insurance through the California Public Employees' Retirement System (CalPERS) as a comparison group between July 1, 2010, and December 31, 2017. Data analysis was performed from January 1, 2019, to September 1, 2019. Exposures: The Reta Trust implemented reference pricing in July 2013; CalPERS did not adopt reference pricing during the study period. Main Outcomes and Measures: Probability that the drug prescribed was the least costly alternative within its therapeutic class, price paid per prescription, and patient cost sharing per prescription. Multivariable, difference-in-differences regression analysis of drug insurance claims was performed for patients before and after implementation of reference pricing, adjusted for patient characteristics, each drug's therapeutic class, and the month and year of the prescription. Results: During the study period, a total of 1.2 million prescriptions were submitted by 34 319 individuals covered by Reta Trust and 2.1 million prescriptions were submitted by 738 159 individuals covered by CalPERS. In the first 2.5 years after implementation of reference pricing, the percentage of prescriptions made for the low-priced drug within each therapeutic class increased by 5.1 percentage points (95% CI, 1.8 to 8.4 percentage points), patient cost sharing increased by 10.3% (95% CI, -1.6% to -23.6%; this difference was not statistically significant), and prices paid decreased by 19.1% (95% CI, -30.2% to -6.2%) for Reta Trust patients compared with CalPERS patients. During the subsequent 2-year postimplementation period, the percentage of prescriptions made for the low-priced drug increased an additional 6.2 percentage points (95% CI, 2.3 to 10.1 percentage points), patient cost sharing decreased by 21.3% (95% CI, -31.2% to -9.9%), and prices paid increased by 7.2% (95% CI, -12.6% to 31.4%; this difference was not statistically significant). Relative to the change experienced by the CalPERS population, during the study period, the share of prescriptions for lower-priced drugs increased by 6.3 percentage points (8.9% relative increase), the mean prescription drug price decreased by $9.5 (12.1% relative decrease), and the mean patient cost sharing decreased by $1.8 (4.3% relative decrease). Conclusions and Relevance: In this study, reference pricing was associated with a combination of lower prices paid by employers and lower cost sharing by employees but with a time lag in prescribing habits by physicians.


Assuntos
Custo Compartilhado de Seguro/métodos , Custos de Medicamentos , Prescrições de Medicamentos/economia , Padrões de Prática Médica/economia , Medicamentos sob Prescrição/economia , Análise Custo-Benefício , Feminino , Humanos , Seguro Saúde , Masculino , Análise de Regressão , Estados Unidos
11.
Health Serv Res ; 55(2): 239-248, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32030751

RESUMO

OBJECTIVE: To test whether Medicaid expansion is associated with (a) a greater number of naloxone prescriptions dispensed and (b) a higher proportion of naloxone prescriptions paid by Medicaid. DATA SOURCES/STUDY SETTING: We used the IQVIA National Prescription Audit to obtain data on per state per quarter naloxone prescription dispensing for the period 2011-16. STUDY DESIGN: In this quasi-experimental design study, the impact of Medicaid expansion on naloxone prescription dispensing was examined using difference-in-difference estimation models. State-level covariates including pharmacy-based naloxone laws (standing/protocol orders and direct authority to dispense naloxone), third-party prescribing laws, opioid analgesic prescribing rates, opioid-involved overdose death rates, and population size were controlled for in the analysis. PRINCIPAL FINDINGS: Medicaid expansion was associated with 38 additional naloxone prescriptions dispensed per state per quarter compared to nonexpansion controls, on average (P = .030). Also, Medicaid expansion resulted in an average increase of 9.86 percent in the share of naloxone prescriptions paid by Medicaid per state per quarter (P < .001). CONCLUSIONS: Our study found that Medicaid expansion increased naloxone availability. This finding suggests that it will be important to consider naloxone access when making federal- and state-level decisions affecting Medicaid coverage.


Assuntos
Analgésicos Opioides/economia , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/economia , Medicaid/legislação & jurisprudência , Naloxona/economia , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Medicaid/economia , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/economia , Patient Protection and Affordable Care Act/estatística & dados numéricos , Planos Governamentais de Saúde/legislação & jurisprudência , Planos Governamentais de Saúde/estatística & dados numéricos , Estados Unidos
12.
Cutis ; 105(1): E24-E28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32074163

RESUMO

The relationship between physicians and pharmaceutical companies has caused the medical community to question the degree to which pharmaceutical interactions and incentives can influence physicians' prescribing habits. Our study aimed to analyze whether a change in institutional policy that restricted the availability of in-office samples for patients resulted in any measurable change in the prescribing habits of faculty physicians in the Department of Dermatology and Cutaneous Surgery at the University of South Florida (USF)(Tampa, Florida). Medical records were retrospectively reviewed for common dermatology diagnoses-acne vulgaris, atopic dermatitis, onychomycosis, psoriasis, and rosacea-before and after the pharmaceutical policy changes, and the prescribed medications were recorded. These medications were then categorized as brand name, generic, and over-the-counter (OTC). Statistical analysis using a mixed effects ordinal logistic regression model accounting for baseline patient characteristics was conducted to determine if a difference in prescribing habits occurred.


Assuntos
Dermatologistas/estatística & dados numéricos , Prescrições de Medicamentos/economia , Padrões de Prática Médica/estatística & dados numéricos , Medicamentos sob Prescrição/administração & dosagem , Dermatologia/estatística & dados numéricos , Indústria Farmacêutica/organização & administração , Florida , Humanos , Visita a Consultório Médico , Medicamentos sob Prescrição/economia , Estudos Retrospectivos
13.
Nat Hum Behav ; 4(3): 255-264, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31959926

RESUMO

Health and social scientists have documented the hospital revolving-door problem, the concentration of crime, and long-term welfare dependence. Have these distinct fields identified the same citizens? Using administrative databases linked to 1.7 million New Zealanders, we quantified and monetized inequality in distributions of health and social problems and tested whether they aggregate within individuals. Marked inequality was observed: Gini coefficients equalled 0.96 for criminal convictions, 0.91 for public-hospital nights, 0.86 for welfare benefits, 0.74 for prescription-drug fills and 0.54 for injury-insurance claims. Marked aggregation was uncovered: a small population segment accounted for a disproportionate share of use-events and costs across multiple sectors. These findings were replicated in 2.3 million Danes. We then integrated the New Zealand databases with the four-decade-long Dunedin Study. The high-need/high-cost population segment experienced early-life factors that reduce workforce readiness, including low education and poor mental health. In midlife they reported low life satisfaction. Investing in young people's education and training potential could reduce health and social inequalities and enhance population wellbeing.


Assuntos
Crime/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Seguridade Social/estatística & dados numéricos , Fatores Socioeconômicos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Análise por Conglomerados , Crime/economia , Bases de Dados Factuais , Dinamarca/epidemiologia , Prescrições de Medicamentos/economia , Escolaridade , Feminino , Hospitalização/economia , Hospitais Públicos/economia , Humanos , Lactente , Seguro Saúde/economia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Satisfação Pessoal , Seguridade Social/economia , Ferimentos e Lesões/economia , Adulto Jovem
15.
An Bras Dermatol ; 95(1): 20-24, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31899062

RESUMO

BACKGROUND: Despite the economic burden of psoriasis for patients and societies, scant information exists regarding the impact and burden of the disease in Argentina. OBJECTIVE: The objective of this study was to estimate medical resource consumption and direct health care costs for patients with moderate/severe psoriasis in Buenos Aires, Argentina from the perspective of the payer. METHODS: Adults with moderate/severe psoriasis (severity was defined as receiving systemic treatment), during January 2010-January 2014, aged 18 years and older, members of the Italian Hospital Medical Care Program with at least 18 months of follow-up were included. All data on hospitalizations, drug prescription, outpatient episodes, consultations, and investigations/tests in the 12 months before inclusion in the study were considered for the estimation of medical resource consumption and direct health care costs. First-quarter 2018 costs were obtained from the IHMCP and converted into US dollars (using the January 2018 exchange rate). RESULTS: A total of 791 patients were included. The mean age at diagnosis was 34±12 years. Almost 65% of the patients had a dermatologist as their usual source of care, 43% had internists, and 14% had rheumatologists. The average yearly direct cost was US$ 5326 (95% CI: 4125-7896) per patient per year. STUDY LIMITATION: The single center design and the retrospective nature are the main limitations. CONCLUSION: This is the first Argentine study that evaluated the costs of moderate/severe psoriasis by taking into consideration the direct medical costs of the disease.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Psoríase/economia , Adulto , Argentina , Prescrições de Medicamentos/economia , Feminino , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/economia , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Fatores de Tempo , Adulto Jovem
16.
Am J Gastroenterol ; 115(1): 128-137, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31895723

RESUMO

OBJECTIVES: The prevalence of inflammatory bowel disease (IBD) is increasing. The total direct costs of IBD have not been assessed on a population-wide level in the era of biologic therapy. DESIGN: We identified all persons with IBD in Manitoba between 2005 and 2015, with each matched to 10 controls on age, sex, and area of residence. We enumerated all hospitalizations, outpatient visits and prescription medications including biologics, and their associated direct costs. Total and per capita annual IBD-attributable costs and health care utilization (HCU) were determined by taking the difference between the costs/HCU accrued by an IBD case and their controls. Generalized linear modeling was used to evaluate trends in direct costs and Poisson regression for trends in HCU. RESULTS: The number of people with IBD in Manitoba increased from 6,323 to 7,603 between 2005 and 2015. The total per capita annual costs attributable to IBD rose from $3,354 in 2005 to $7,801 in 2015, primarily driven by an increase in per capita annual anti-tumor necrosis factor costs, which rose from $181 in 2005 to $5,270 in 2015. There was a significant decline in inpatient costs for CD ($99 ± 25/yr. P < 0.0001), but not for ulcerative colitis ($8 increase ±$18/yr, P = 0.63). DISCUSSION: The direct health care costs attributable to IBD have more than doubled over the 10 years between 2005 and 2015, driven mostly by increasing expenditures on biological medications. IBD-attributable hospitalization costs have declined modestly over time for persons with CD, although no change was seen for patients with ulcerative colitis.


Assuntos
Produtos Biológicos/economia , Colite Ulcerativa/economia , Doença de Crohn/economia , Custos Diretos de Serviços/estatística & dados numéricos , Custos Diretos de Serviços/tendências , Adulto , Fatores Etários , Idoso , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Produtos Biológicos/uso terapêutico , Estudos de Casos e Controles , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/epidemiologia , Doença de Crohn/tratamento farmacológico , Doença de Crohn/epidemiologia , Prescrições de Medicamentos/economia , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Manitoba/epidemiologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Fatores Sexuais
17.
Pharmacoeconomics ; 38(1): 109-119, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31631255

RESUMO

BACKGROUND: During the period from 1999 to 2016, more than 350,000 Americans died from overdoses related to the use of prescription opioids. To the extent that supply is directly related to overprescribing, policy interventions aimed at changing prescriber behavior, such as the recent Centers for Disease Control and Prevention guideline, are clearly warranted. Although these could plausibly reduce the prevalence of opioid overuse and dependency, little is known about their economic and health-related impacts. OBJECTIVE: The aim of this study was to quantify the efficacy of a policy intervention aimed at reducing the length of initial opioid prescriptions. STUDY DESIGN AND METHODS: A Markov decision process model was fitted on a retrospective cohort of 827,265 patients, and patient cost and health trajectories were simulated over a 24-month period. The model's parameters were based on patients who received short (≤ 3 days) or long (> 7 days) initial opioid prescriptions, matched using propensity score methods. STUDY POPULATION: All active-duty US Army soldiers from 2011 to 2014; the data contained detailed medical and administrative information on over 11 million soldier-months corresponding to 827,265 individual soldiers. MAIN OUTCOME MEASURE: Overall costs of a policy change, quality-adjusted life-years (QALYs) gained, and $/QALY gained. RESULTS: Over a 2-year horizon, a reassignment of 10,000 patients to short initial duration would generate a cost saving in the vicinity of $3.1 million (excluding program costs), and would also lead to an estimated 4451 additional opioid-free months, i.e. months without any opioid prescriptions. CONCLUSION: The analysis found that efforts to change prescriber behavior can be cost effective, and further studies into the implementation of such policies are warranted.


Assuntos
Analgésicos Opioides/economia , Técnicas de Apoio para a Decisão , Prescrições de Medicamentos/economia , Modelos Econômicos , Padrões de Prática Médica/economia , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Análise Custo-Benefício , Prescrições de Medicamentos/estatística & dados numéricos , Humanos , Padrões de Prática Médica/tendências , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos
18.
J Oncol Pharm Pract ; 26(2): 279-285, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30943846

RESUMO

INTRODUCTION: Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics. METHODS: This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed. RESULTS: Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0-109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned. CONCLUSION: Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias/tratamento farmacológico , Assistência Farmacêutica/normas , Honorários por Prescrição de Medicamentos/normas , Melhoria de Qualidade/normas , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/economia , Prescrições de Medicamentos/economia , Prescrições de Medicamentos/normas , Feminino , Humanos , Masculino , Medicare/economia , Medicare/normas , Medicare/tendências , Pessoa de Meia-Idade , Neoplasias/economia , Neoplasias/epidemiologia , Assistência Farmacêutica/economia , Assistência Farmacêutica/tendências , Honorários por Prescrição de Medicamentos/tendências , Estudos Retrospectivos , Tempo para o Tratamento , Estados Unidos/epidemiologia
20.
Health Hum Rights ; 21(2): 283-293, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31885457

RESUMO

The experience of Costa Rica highlights the potential for conflicts between the right to health and fair priority setting. For example, one study found that most favorable rulings by the Costa Rican constitutional court concerning claims for medications under the right to health were either for experimental treatments or for medicines that should have low priority based on health gain per unit of expenditure and severity of disease.32 In order to better align rulings with priority setting criteria, in 2014, the court initiated a reform in its assessment of claims for medicine. This paper assesses this reform's impact on the fairness of resource allocation. It finds three apparent effects: (1) a reduction in successful claims for experimental medication, which is beneficial; (2) an increase in the success rate of medication lawsuits, which is detrimental because most claims are for extremely cost-ineffective medications; and (3) a decline in the number of claims for medicine, which is beneficial because it forestalls such low-priority spending. This paper estimates that, taking all three effects into account, the reform has had a modest net positive impact on overall resource allocation. However, it also argues that there is a need for further reforms to lower the number of claims to low-priority medicines that are granted.


Assuntos
Prescrições de Medicamentos/economia , Prioridades em Saúde , Acesso aos Serviços de Saúde/legislação & jurisprudência , Direito à Saúde/legislação & jurisprudência , Costa Rica , Humanos , Alocação de Recursos
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