Over-the-counter pain reliever and aspirin use within a sample of long-term cyclooxygenase 2 users.
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Acetaminophen↗
Biomedical subjects
Kathleen A Fairman
Publications and source records attributed to Kathleen A Fairman.
Retrospective, long-term follow-up study of the effect of a three-tier prescription drug copayment system on pharmaceutical and other medical utilization and costs.
BACKGROUND: Previous research has suggested that 3-tier prescription drug copayment systems produce drug cost savings without affecting the use of other medical services during the first 12 months after implementation. Assessment of such systems with a longer follow-up period has been needed. OBJECTIVE: This study examined the effect of a 3-tier copayment system on pharmaceutical and medical utilization and cost for 30 months after implementation in a population of commercially insured, preferred-provider organization members. METHODS: This was a quasi-experimental, pre-post with comparison group design that gathered data retrospectively from the claims database of a preferred-provider organization in the Midwestern United States. The intervention group comprised members whose employer switched from a 2-tier (generic/brand copayment) plan to a 3-tier (generic/formulary/nonformulary) plan. The comparison group comprised members whose employer retained the 2-tier plan. Employers did not offer a choice between the 2- and 3-tier plans. Outcome measures included total drug cost; net insurer cost (drug cost minus copayment); number of prescription claims; numbers of office visits, inpatient hospitalizations, and emergency department visits; and rates of continuation with chronic medication therapy. RESULTS: Relative to the comparison group (n=4132), the intervention group (n=3577) showed reduced growth in net cost and lower utilization of third-tier (nonformulary) medications (P<0.001 and P<0.01, respectively). The intervention and comparison groups did not differ significantly with respect to numbers of office visits, emergency department visits, or inpatient hospitalizations. Medication continuation rates were lower for the intervention than the comparison group at 6 months for oral contraceptives (P<0.05), but chronic medication therapy continuation rates did not differ significantly at any other time point or for estrogens, antihypertensives, or antihyperlipidemics. CONCLUSION: In the population studied, previous research findings were confirmed over a longer time period.
Adult↗
Do decision-analytic models identify cost-effective treatments? A retrospective look at helicobacter pylori eradication.
BACKGROUND: Pharmacoeconomic models of Helicobacter (H) pylori eradication have been frequently cited but never validated. OBJECTIVE: Examine retrospectively whether H pylori pharmacoeconomic models direct decision makers to cost-effective therapeutic choices. METHODS: We first replicated and then validated 2 models, replacing model assumptions with empirical data from a multipayer claims database. Database subjects were 435 commercially insured U.S. patients treated with bismuthmetronidazole- tetracycline (BMT), proton pump inhibitor (PPI)-clarithromycin, or PPI-amoxicillin. Patients met >1 clinical requirement (ulcer disease, gastritis/duodenitis, stomach function disorder, abdominal pain, H pylori infection, endoscopy, or H pylori assay). Sensitivity analyses included only patients with ulcer diagnosis or gastrointestinal specialist care. Outcome measures were: (1) rates of eradication retreatment; (2) use of office visits, hospitalizations, endoscopies, and antisecretory medication; and (3) cost per effectively treated (nonretreated) patient. RESULTS: Model results overstated the cost-effectiveness of PPI-clarithromycin and underestimated the cost-effectiveness of BMT. Prior to empirical adjustment, costs per effectively treated patient were 1,001 US dollars, 980 US dollars, and 1,730 US dollars for BMT, PPIclarithromycin, and PPI-amoxicillin, respectively. Estimates after adjustment were US dollars for BMT, 1,118 US dollars for PPI-clarithromycin, and 1,131 US dollars for PPI-amoxicillin. Key model assumptions that proved retrospectively incorrect were largely unsupported by either empirical evidence or systematic assessment of expert opinion. CONCLUSIONS: Organizations with access to medical and pharmacy claims databases should test key assumptions of influential models to determine their validity. Journal peer-review processes should pay particular attention to the basis of model assumptions.
Anti-Infective Agents↗
Randomized controlled trial of a dose consolidation program.
OBJECTIVE: To evaluate the effectiveness and financial impact of a drug dose consolidation (optimization) program using letter intervention. METHODS: This pilot program in a large, mid-Atlantic health plan utilized a randomized controlled trial research design. A review of adjudicated pharmacy claims records was performed monthly for 3 consecutive months from November 2002 through February 2003 to identify inefficient (i.e., >once-daily) regimens for any one of 68 dosage strengths of 37 single-source maintenance drugs with once-daily dosing recommendations. Prescribers who had prescribed one or more inefficient regimens were identified and randomized to one of the 2 intervention arms or a control arm. Prescribers in both intervention arms were sent personalized letters with information on their patients. inefficient regimens and suggested dose consolidation options. Patients of prescribers in one intervention arm received a complementary, patient-oriented letter. Pharmacy claims for patients in all arms were examined at 180 days after the date of the letter mailing for conversion to an efficient (once-daily) regimen. Financial modeling analysis calculated net savings as changes in pharmacy expenditures minus administrative costs. RESULTS: A total of 2,614 inefficient regimens, representing 6.7% of claims for the targeted medications, were identified. The rate of consolidation to a suggested dosing option was lower for the Physician Letter arm (7.3%) than for the Physician/Member Letter arm (10.2%) (P = 0.046). Both intervention arms had higher consolidation rates than the Control arm (3.9%) (P = 0.018 and P = 0.000, respectively.). Approximately 30% of the regimens in each study arm were never refilled after being targeted. Financial modeling indicated that a dose consolidation intervention could save 0.03 dollars to 0.07 dollars per member per month (PMPM) in 2003 dollars with full medication compliance but only 0.02 dollars to 0.03 dollars PMPM when savings were calculated with realistic, partial compliance rates. Subanalyses performed at the drug therapy class level revealed few opportunities to justify implementing a dose consolidation program. CONCLUSIONS: After taking into consideration program administrative costs, high rates of refill discontinuation, and dose consolidation that occurs naturally without intervention, the results indicated that a letter-based dose consolidation program did not appreciably decrease pharmacy expenditures.
Cost-Benefit Analysis↗